neurosis

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animas said:
what is neurosis and is there a new term to replace this?
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I figure that's the Freudian term for nonpsychotic mental illness, the ones he was willing to treat, and the ones who were amenable to his particular brand of psychoanalytic treatment.

I don't know of another more contemporary term that can be used interchangeably.
 
I am speculating here but I think it would have to have a component of anxiety although the underlying cause could be an anxiety disorder, adjustment, depression or personality.
 
According to contemporary psychodynamic theory, neurotic refers to a level of personality functioning that is associated with symptoms such as anxiety and depression that may limit the capacity for work and relationships to an extent, but do not in themselves meet criteria for an Axis I or Axis II disorder. Think Woody Allen, or your cousin who always gets involved with men who drink and cheat on her, or your "ditzy" friend who falls in love so easily, but can never seem to sustain a relationship. Many neurotics have concurrent Axis I diagnoses of depression or anxiety, but the same patients can also feel depressed or anxious without having a major depressive episode or panic attacks. The thought is that the personality style predisposes the neurotic patient to certain symptoms (e.g. depression or anxiety), which are then magnified or perpetuated by their biological substrate; i.e., personality is the "psycho" in the biopsychosocial framework.

Neurotic is different from personality disorder, which reflects a more severe personality pathology. According to Kernberg, neurotics have relatively intact reality testing, consolidated identity, and use relatively higher level defenses (e.g. repression). Borderline level organization (which includes Borderline PD, along with Narcissistic PD and a few others), involves primitive defenses (e.g. splitting), diffusion of identity (i.e. "I don't know who I am"), but intact (with some exceptions) reality testing. Psychotic has disruptions in all of these. Neurotics include masochists, obsessionals, hysterics and "shy" narcissists, none of whom reach borderline level functioning. Neurotics are the ones who are thought to benefit from more exploratory psychodynamic psychotherapies (i.e. psychoanalysis), whereas borderlines and psychotics are thought to require more ego supportive techniques (i.e. less interpretation, which is thought to be destabilizing). This is why this distinction is made in the first place, as a way to assign treatment.

In terms of more contemporary language, modern psychiatry has, unfortunately, really stopped concerning itself with neurotics, since they do not meet DSM criteria for any Axis I or II disorder (and therefore their insurance will not pay for treatment). I suspect that many of these patients present to their PMD with minor anxiety and depression symptoms and are put on SSRIs, with little effect. These patients probably need a long-term, insight-oriented psychotherapy.

This relates the question of "does psychodynamic psychotherapy work?" Given that most of the indications for insight-oriented psychodynamic psychotherapy are related to treating neurotic level functioning, and most clinical trials are focused on Axis I or Axis II (i.e. non-neurotic) disorders, it makes sense that many people would get the impression that there is no evidence for psychodynamic psychotherapy having any purpose; the primary indication for this type of therapy has never really been studied in the modern era.

The DSM-V may be better than the DSM-IV at addressing neurotic level character pathology, as it appears to now include designations for level of personality functioning, which does not use the term neurotic, but does use a somewhat Kernbergian system for classification. Perhaps this will lead to insurers paying for psychotherapy for neurotics, and to some clinical trials addressing the effects of insight-oriented psychodynamic psychotherapy on neuroses.
 
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strangeglove said:
According to contemporary psychodynamic theory, neurotic refers to a level of personality functioning that is associated with symptoms such as anxiety and depression that may limit the capacity for work and relationships to an extent, but do not in themselves meet criteria for an Axis I or Axis II disorder. Think Woody Allen, or your cousin who always gets involved with men who drink and cheat on her, or your "ditzy" friend who falls in love so easily, but can never seem to sustain a relationship. Many neurotics have concurrent Axis I diagnoses of depression or anxiety, but the same patients can also feel depressed or anxious without having a major depressive episode or panic attacks. The thought is that the personality style predisposes the neurotic patient to certain symptoms (e.g. depression or anxiety), which are then magnified or perpetuated by their biological substrate; i.e., personality is the "psycho" in the biopsychosocial framework.

Neurotic is different from personality disorder, which reflects a more severe personality pathology. According to Kernberg, neurotics have relatively intact reality testing, consolidated identity, and use relatively higher level defenses (e.g. repression). Borderline level organization (which includes Borderline PD, along with Narcissistic PD and a few others), involves primitive defenses (e.g. splitting), diffusion of identity (i.e. "I don't know who I am"), but intact (with some exceptions) reality testing. Psychotic has disruptions in all of these. Neurotics include masochists, obsessionals, hysterics and "shy" narcissists, none of whom reach borderline level functioning. Neurotics are the ones who are thought to benefit from more exploratory psychodynamic psychotherapies (i.e. psychoanalysis), whereas borderlines and psychotics are thought to require more ego supportive techniques (i.e. less interpretation, which is thought to be destabilizing). This is why this distinction is made in the first place, as a way to assign treatment.

In terms of more contemporary language, modern psychiatry has, unfortunately, really stopped concerning itself with neurotics, since they do not meet DSM criteria for any Axis I or II disorder (and therefore their insurance will not pay for treatment). I suspect that many of these patients present to their PMD with minor anxiety and depression symptoms and are put on SSRIs, with little effect. These patients probably need a long-term, insight-oriented psychotherapy.

This relates the question of "does psychodynamic psychotherapy work?" Given that most of the indications for insight-oriented psychodynamic psychotherapy are related to treating neurotic level functioning, and most clinical trials are focused on Axis I or Axis II (i.e. non-neurotic) disorders, it makes sense that many people would get the impression that there is no evidence for psychodynamic psychotherapy having any purpose; the primary indication for this type of therapy has never really been studied in the modern era.

The DSM-V may be better than the DSM-IV at addressing neurotic level character pathology, as it appears to now include designations for level of personality functioning, which does not use the term neurotic, but does use a somewhat Kernbergian system for classification. Perhaps this will lead to insurers paying for psychotherapy for neurotics, and to some clinical trials addressing the effects of insight-oriented psychodynamic psychotherapy on neuroses.
Click to expand...


Wow, I just learned so much from this post. Thank you.
 
Nicely done, strangeglove. Thank you...
 
strangeglove said:
According to contemporary psychodynamic theory, neurotic refers to a level of personality functioning that is associated with symptoms such as anxiety and depression that may limit the capacity for work and relationships to an extent, but do not in themselves meet criteria for an Axis I or Axis II disorder. Think Woody Allen, or your cousin who always gets involved with men who drink and cheat on her, or your "ditzy" friend who falls in love so easily, but can never seem to sustain a relationship. Many neurotics have concurrent Axis I diagnoses of depression or anxiety, but the same patients can also feel depressed or anxious without having a major depressive episode or panic attacks. The thought is that the personality style predisposes the neurotic patient to certain symptoms (e.g. depression or anxiety), which are then magnified or perpetuated by their biological substrate; i.e., personality is the "psycho" in the biopsychosocial framework.

Neurotic is different from personality disorder, which reflects a more severe personality pathology. According to Kernberg, neurotics have relatively intact reality testing, consolidated identity, and use relatively higher level defenses (e.g. repression). Borderline level organization (which includes Borderline PD, along with Narcissistic PD and a few others), involves primitive defenses (e.g. splitting), diffusion of identity (i.e. "I don't know who I am"), but intact (with some exceptions) reality testing. Psychotic has disruptions in all of these. Neurotics include masochists, obsessionals, hysterics and "shy" narcissists, none of whom reach borderline level functioning. Neurotics are the ones who are thought to benefit from more exploratory psychodynamic psychotherapies (i.e. psychoanalysis), whereas borderlines and psychotics are thought to require more ego supportive techniques (i.e. less interpretation, which is thought to be destabilizing). This is why this distinction is made in the first place, as a way to assign treatment.

In terms of more contemporary language, modern psychiatry has, unfortunately, really stopped concerning itself with neurotics, since they do not meet DSM criteria for any Axis I or II disorder (and therefore their insurance will not pay for treatment). I suspect that many of these patients present to their PMD with minor anxiety and depression symptoms and are put on SSRIs, with little effect. These patients probably need a long-term, insight-oriented psychotherapy.

This relates the question of "does psychodynamic psychotherapy work?" Given that most of the indications for insight-oriented psychodynamic psychotherapy are related to treating neurotic level functioning, and most clinical trials are focused on Axis I or Axis II (i.e. non-neurotic) disorders, it makes sense that many people would get the impression that there is no evidence for psychodynamic psychotherapy having any purpose; the primary indication for this type of therapy has never really been studied in the modern era.

The DSM-V may be better than the DSM-IV at addressing neurotic level character pathology, as it appears to now include designations for level of personality functioning, which does not use the term neurotic, but does use a somewhat Kernbergian system for classification. Perhaps this will lead to insurers paying for psychotherapy for neurotics, and to some clinical trials addressing the effects of insight-oriented psychodynamic psychotherapy on neuroses.
Click to expand...

Great reply.

p.s. Your post seems to conflate neurosis (Freud, originally) with neurotic personality organization (Kernberg).
 
ClinPsycMasters said:
Great reply.

p.s. Your post seems to conflate neurosis (Freud, originally) with neurotic personality organization (Kernberg).
Click to expand...

True. We all have neuroses (in the Freudian sense) but only some of us have neurotic level personality organization (in the Kernbergian sense). Thanks for clarifying.
 
ClinPsycMasters said:
Great reply.

p.s. Your post seems to conflate neurosis (Freud, originally) with neurotic personality organization (Kernberg).
Click to expand...

True. We all have neuroses (in the Freudian sense) but only some of us have neurotic level personality organization (in the Kernbergian sense). Thanks for clarifying.
 
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