Neurosis

Neurosis is no longer considered a stand-alone medical condition but comes under an anxiety diagnosis.

Symptoms generally include excessive worry or intense behavior that interferes with a person’s professional, romantic and social life, no matter how minor the problem is.

Examples of neurotic behavior include:

• You arrive at the airport 4 hours before departure even though 2 hours would be sufficient, then ask the gate agent every 10 minutes if the departure is on time
• You constantly ask a new romantic partner if they are cheating on you then blame yourself for driving them away
• Complaining about random aches and pains or illnesses, although to an outsider there appears to be no medical cause
• Constantly telling people off for obscure reasons, such as laughing too loudly, walking on your sidewalk, or the way they hang up their washing
• Being obsessed about your child’s safety to the point you won’t let them play at the playground or play with friends
• Spending more time than necessary to complete a task because you don’t want to make a mistake
• Making a controversy about minor incidents
• A sense of dread about the future.

Having a neurotic personality can make people more prone to other conditions, called internalizing disorders, such as:

• Generalized anxiety disorder
• Depression
• Obsessive-compulsive disorder
• Social phobia
• Post-traumatic Stress Disorder
• Panic disorder
• Antisocial personality disorder.

How is Neurosis Treated?

Neurosis may be treated using behavior modification therapies, or pharmacological treatments or both. Treatments may include:

• Helping the person with neurosis to become aware of the repressed impulses, feelings, and traumatic memories that underlie their symptoms
• Reconditioning learned responses, through a process known as desensitization
• Modeling more effective behavior, so the person learns by example
• Discussing thoughts and perceptions that contribute to a patient’s neurotic symptoms, and then replacing them with more realistic interpretations
• Mindfulness – thinking more intensely about one's experiences and then changing the way you view the experience
• Antidepressants, anti-anxiety, and antipsychotic drugs
• Electroconvulsive (shock) therapy.

Neurosis vs. Anxiety

Of all the diagnoses you can find in the American Psychiatric Association’s Diagnostic and Statistical Manual, 5^th Edition (DSM-5), neurosis isn’t one of them. “Neurosis” became a footnote in the 1970s in the DSM-3 version, and was then removed entirely in the next revisions.

Being neurotic is associated more with being a worrier or an overthinker rather than a mental disorder. Still, without some help, neuroticisms that are surrounded by unhealthy coping mechanisms and high-stress environments may lead to anxiety disorders.

Anxiety disorders may include: 

• Separation anxiety disorder 
• Generalized anxiety disorder
• Specific phobia
• Social anxiety disorder
• Panic disorder or panic attack disorder
• Substance- or medication-induced anxiety disorder 

Symptoms

If you’re wondering if you have neurosis, ask yourself if you’ve ever experienced any of the following symptoms or traits:³

• Anxiety and apprehension 
• Excessive worry and guilt
• Tendency toward more negative emotions and reactions
• Irritability and anger
• Low self-esteem and self-consciousness
• Poor response to stressors
• An interpretation of everyday situations as threatening
• Depression
• Emotional instability

If you’re concerned that a friend or family member may have neurosis, here’s what to watch for:

• Constantly needing reassurance (even on small matters and things you’ve previously validated)
• Being overly dependent on others or codependent in relationships 
• Making their dissatisfaction or stress well known to you 
• Conflicts with others due to a lack of emotional resilience or ability to bounce back 
• Perfectionist tendencies or obsessing about getting things right
• Flying off the handle whenever you try to have a serious conversation 

Of course, these symptoms don’t necessarily mean your loved one is neurotic. But if it’s a pattern of behavior over time and it's causing them distress, you should encourage them to seek help from a mental health professional. 

Complications

Left untreated, neurosis can grow into bigger health concerns for you and your relationships. This is because being neurotic takes a toll on your mental health and ability to function in everyday life.

Physical complications over time may include:

• Exhaustion 
• Heart problems
• Immune system dysfunction
• Asthma
• Eczema
• Irritable bowel syndrome

Neurosis can also lead to other health complications, including:

• Perceived and actual marital issues (marital dissatisfaction)⁴
• Decreased work performance and occupational failure
• Increased vulnerability to conditions like eating disorders, mood disorders, and use disorders to try to cope with the emotional instabilities of neuroticism⁵

Causes 

Researchers have identified an association between neuroticism and mental disorders and lower quality of life, but have not pinpointed its exact cause.⁵ Several factors are believed to be at play in the development of neuroticism.

Genetics

People who have a family history of neuroticism may be more likely to have it. The evidence that shows this includes:

• Twins studies suggesting overlap of genetic factors between different traits in neuroticism, along with other anxiety disorders.⁶
• The G72 gene, which plays a role in glutamate functioning (the neurotransmitter responsible for proper brain functioning), has also been associated with neuroticism, but these findings are not consistent.⁷
• Genetic studies on neuroticism have found a small but noteworthy difference in one of the serotonin transporter genes associated with emotion processing.⁸⁹

Environment

Both shared environments (common to family members) and nonshared environments like a child’s individual classroom are associated with the likelihood of developing neurotic traits.

One large-scale twins study of over 3,330 Dutch twins found that shared environments were insignificant compared with nonshared environments in predicting future neurotic behavior, meaning things that happen outside your home may have a bigger impact. However, this has been explained more so by the gene-environment interactions than the conclusion that shared environments have no impact.¹⁰

Mental health conditions associated with neurotic behavior include:

• Anxiety 
• Depression
• Substance use
• Psychological distress
• Personality disorders
• Obsessive disorders
• Phobia

Diagnosis

If neurotic behavior is becoming a problem, you can talk to your family doctor or a mental health professional. Your doctor will likely conduct a physical exam and request lab work to determine the cause of your symptoms. 

While you will not get a diagnosis of neuroticism, you may be diagnosed with a mental health disorder if the behaviors are causing severe distress and relationship issues.

Treatment

If the neurosis is stemming from an underlying mental disorder, you and your healthcare team will discuss the best treatments for that diagnosis.

Medications 

Your family doctor or psychiatrist can prescribe the appropriate medications to help reduce symptoms associated with disorders like anxiety, depression, and others. Medications work to help change the brain chemistry behind neurotic behavior.

Common medications prescribed for mental disorders associated with neuroticism include:

• Anti-anxiety medications work to reduce anxiety and associated symptoms like nervousness or restlessness. One commonly prescribed example is benzodiazepine, which is fast-acting, but people can build up a tolerance to it. 
• Antidepressants like selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors can be used for managing the symptoms of depression.

Psychotherapy

Various forms of talk therapy, including cognitive behavioral therapy, can help address negative thought patterns and help a person work to change unhealthy ways of coping. It can also be useful for helping a person identify their neurotic behaviors and how those behaviors are contributing to other problems they’re facing.

Lifestyle Changes

Coping with your own neurotic behavior can be tiring. Practicing self-awareness and recognizing what can trigger these behaviors are critical and ongoing steps in managing neurosis. Once you know what makes your neuroticism worse, you can make some or all of the following positive lifestyle changes to support your mental health:

• Create a “no” list: Lists can help you set boundaries throughout the day when things come up that are stressful. If you’re unsure how to proceed and are obsessing about what to do, check the list.
• Be proactive about triggers: For example, if you know staying up later than usual too many times a week is almost always followed by an increase in symptoms or neurotic behaviors, make routine sleep times a top priority.
• Practice breathing exercises: They help counter anxiety-related shallow breathing that deprives your body and brain of oxygen, which can then progress to full-blown anxiety or panic attacks.
• Download a meditation or sleep story app: These can help guide you through stressful times and promote better sleep. Use apps that let you track mindfulness, write notes, or document mood so you can see your progress over time.¹¹

Summary

Neuroticism is not a mental disorder but a personality trait. It's characterized by obsessive thinking and anxiety. Sometimes it can contribute to the development of a mental disorder like an anxiety disorder, though. It's not something you can cure, but you can reduce neurotic behaviors by learning and managing your triggers and developing healthy ways to cope with daily stress.