The Neuroses: types, diagnosis and treatment

A neurotic disorder is not a disease in the biological or neurological sense of the term. It is a psychiatric concept that refers to a specific problem of the human being, an existential dilemma that is linked to the fact of how we relate to ourselves and how we face life being aware of our limitations and our own death.

As a species endowed with symbolic thought, we are traversed by characteristics that are unique to us humans: desire, the ability to choose, the perception of transcendence, the search for something always beyond, and these same characteristics can sometimes be accompanied by a certain desperation and an expression of suffering in the form of anxiety or emotional discomfort. When these symptomatic manifestations produce difficulties in adapting to the environment, maintaining healthy relationships or an inability to lead a satisfactory life, we speak of a neurotic disorder.

Neurosis: Unfocused Interpretation

These neurotic disorders are linked to the fact of living one’s existence based on an unfocused interpretation of oneself and this same interpretation, often persistent, generates anguish and discomfort.
These are people who are easily frustrated and blame themselves, who worry excessively, who never feel ready, who postpone their decisions and see themselves through the most harmful side.

The popular idea we have of it are the characters in Woody Allen’s movies, those eccentric and hypochondriacs, excessively obsessed with things and situations that we could all identify with: sex, illness, death and the anguish to find meaning in life.

Neurosis refers to a repetitive pattern of behavior that usually produces maladaptive relationships with others, with their environment and with themselves.
A certain desperation for not wanting to be oneself (and having to be), or a certain desperation for wanting to be oneself (and not being able to be). All this can enhance the appearance of symptoms of the spectrum of anxiety or depression.

Types of neurosis: Obsession, hysteria, phobia

The classic classification describes three types of neurosis: obsessive, hysterical and phobic. Each of them represents different ways of facing the existential void that can often produce anguish. They also represent different ways of dealing with desire, decision making, uncertainty and the always complex relationship with others.

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Obsessive neurosis is structured around a desire that is prevented and impossible to realize, it never quite reaches its goal, doubt and procastination are its insignia and everything must be under control.

Hysterical neurosis is based on an unsatisfied desire, no matter what he chooses, the feeling of loss will always persist, the best will always be what he does not have and his decisions always lead him to choose what he does not want, or what makes him suffer. Somatic symptoms are frequent.

Phobic neurosis will avoid contact with what he wants or likes, fear will direct his life and anguish will encourage avoidant and evasive behavior.

These personality structures, whether in their phobic, hysterical or obsessive modality, respond to a very wide range, from their most banal and everyday forms to their most morbid modalities, and can present acute symptomatic manifestations, from severe anxiety crises to different forms of depression and somatization.

Diagnosis and treatment of neurosis

For the diagnosis of this type of condition it is essential to take into account the life history of the subject in order to locate the causes of origin of his unfocused reading pattern and thus be able to establish a treatment that takes into account its uniqueness and history.
The basic treatment of neurosis is psychological but, depending on its level of severity, a combined treatment of psychotherapy and pharmacological treatment may be necessary.

Psychotherapy is aimed at changing the erroneous cognitions and the unfocused interpretation that the subject has constructed about himself/herself.

Pharmacological treatment has a role as a pacifier of acute symptoms, when they exceed the threshold of personal suffering, and as a fire breaker, since acute symptoms act as enhancers of neurotic interpretations.

Neurosis helps us to remember that the treatment of emotional distress should not be directed only to the suppression of acute symptoms, but should take into account the personality structure that is the cause of these symptoms.