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Chapter: 11th 12th std standard Class Nursing Health Care Hospital Hygiene Higher secondary school College Notes

Mental Disorders - Neurosis

Neurosis can be classified as follows: psycho athnic states, psycho somatic disorders.


Various mental disorders have enabled psychiatrists and psychologists to discover some general symptoms of mental disorders. These symptoms pertain to various distinguishable aspects of the mind. They have been produced by certain needs and meaningful situations in the life of the individual. Many of these symptoms have been produced by the operation of our mental mechanism. Neurosis and psychosis are the two major kinds of disorders.


Mental Disorders -  Neurosis:


Neurosis can be classified as follows:


psycho athnic states


psycho somatic disorders


A The psychoneuroses:


This group of mental illness includes psychassthemia, hysteria , neurasthemia, anxiety state and hypochondria. The psychoneuroses as is evident from nomenclature, implies disorders of mind and nervous systems.


Characteristics of psychoneuroses:


Psychoneuroses is the term used to denote mental disease of an ordinary kind, since in them fatality does not result.


It also does not cause much physical pain.


In such patients the power of speech and thoughts also remain intact and order.


Patients also do not suffer from delusion and hallucination.


The patient behaves in a normal manner, does not revolt against social custom.


The patient also does not evince an absence of self-control and self-dependence.


They are mostly caused by frustration, conflicts and mental tensions. They have their origin in psychological, cause (hereditary elements) than chemical and psychosomatic causes. These diseases can be cured by suggestion, hypnoses, psychoanalysis and re-education.


Neurotic disorders are considered to be of five kinds.

1.     Neurasthenia


2.     Anxiety neurosis


3.     Anxiety hysteria


4.     Obsessive - compulsive neurosis


5.     Hysteria



This term Neurasthenia was first used by the Americans Scientist Beard in 1880 in the sense of nervous exertion. Nowadays

it is employed to denote complaints of physical and mental exhaustion.


Symptoms of Neurasthenia:


1.     Fatigue is a factor that every individual experiences at sometime or the other. The following differences between normal fatigue and Neurasthenia fatigue should be noticed.


2.     Normal fatigue and exhaustion can be easily got rid of by rest but the fatigue of the disease does not leave the person after rest. Even when getting up in the morning the patient gets exhausted.


3.     Common fatigue is a temporary state of the body but in this disease it is more permanent.


4.     Normal exhaustion is normally the outcome of mental or physical effort but in this disease, fatigue remains even when no exertion has been done.


5.     Normal fatigue is concerned with muscles but in this disease no connection between fatigue and muscular exertion is noticeable.


Kinds of neurasthenia:


Psychiatrists treating neurasthenia divide it into two classes, acute or secondary neurasthenia and chronic or primary neurasthenia.


Acute neurasthenia:


This can be caused by any disease of the body that undermines contribution or otherwise leaves some kind of poison or toxin in the body. It is also caused in nurses if they work for longer period without adequate rest and relaxation. This is also true of other occupations (soldier) in which work is done over long periods continuously without intermittent rest. The symptom observed is fatigue.


The patient constantly complains of insomnia and lack of appetite. He tends to irritability and finds difficult to concentrate on any ward. Even the slightest efforts leave him fixed and exhausted, debilitated and shun down.

Emotional control is often lost with the result that he tends to be conscious. His head tends to heaviness, his memory becomes weak and he does not enjoy doing anything. Besides these psychological symptoms the patient also exhibits certain physical signs of the disease.


Fatigue often accompanied by a wide fluctuation with rate of pulse from very high to very low. He tends to perspire much and heart beats at a rapid rate.


Chronic or primary neurasthenia:


In this the patient often appears disgruntled and discouraged, depressed and fatigued. Beside fatigue he complains headache, backache, irritability and anxiety commonly prevails. He shows signs of indigestion and easily becomes excited over the smallest incidents.


Causes of neurasthenia:


Weakness of central nervous system, haziness and inactivity, auto intoxication over work and anxiety, mental disintegration caused by abnormal fatigue and emotional experience, level of excitement and frequency of discharge of seminal fluid, emotional conflict and tension and withdrawal are some of the causes. People of introvert are prone to become neurasthenic.

Cure of neurasthenia:


Rest, nutritive food, hypnosis re-education, psychoanalysis may help benefit the patient than medication.


Anxiety neurosis:


Nature: Anxiety neurosis is a neurotic disturbance in which the patient is constantly anxious, the anxiety being different from a normal worry, because the patient is not aware of the reason for his anxiety. It can even be said to be objectless.


Characteristics of anxiety neurosis:


Physical symptoms:


The main ones are changes in heart beat, respiration, blood pressure, in the process of digestion and glandular secretion, tension in stripped muscles lack of vitality, insomnia fatigue etc.

Mental symptoms:


Irrational fear and suspicion do always prevail. Doubts related to some future or imagined accident or death in the family, but both anxiety and fear rob the patient of his sleep. With the result that he appears exhausted and restless. He tends to become introvert, selfish, irritable, unhappy and depressed and he has no enthusiasm, inherent attachment for any object or work.


Kinds of anxiety neurosis:


Acute anxiety:


The above symptoms appear in the most intense form and condition.


Chronic anxiety:


In this the symptoms are natural and to the condition neither momentary nor intense but more permanent and continuing. It takes the following two forms:


Free floating anxiety: In this the patient is completely unaware of the causes of anxiety but he continues to be worried and restless.


Bound anxiety: In this the patient attaches his anxiety to some specific condition or circumstances.


Causes of anxiety neurosis:


Suppression of sexual desire: According to Freud, whenever the libido of a person becomes excited, but finds no satisfaction and is instead suppressed, it takes the form of anxiety but the cause is not known to the patient.


Further he says that when a man or woman is sexually excited but finds no creative outlet for the libido he becomes a prey to anxiety and in this way he traces anxiety for suppression of libido. But not all psychiatrists see eye to eye with Freud in this connection.


Emotional conflict: According to McDougall and Gordan, the anxiety neurosis can arise as a result of conflict between any two emotions.

Repression of self-assertive tendency: according to Adler, man' s most important and most intense impulse is to assert himself. If the person' s ego does not develop properly and he instead develops a sense of inferiority then his self-assertive tendency is repressed and this leads to development of anxiety neurosis.


Frustration and mental conflict: According to O. Kelly, the root causes of anxiety neurosis are mental conflict and frustration whatever the cause of them or whatever the form they take. Not one of the above mentioned causes of anxiety neurosis could be said to explain it fully in the case of any patient.


The truth is that in particular circumstances one or more or even all of these causes may be present at the root of the anxiety neurosis.


Cure of anxiety neurosis:


Suggestion, psychoanalysis and re-education can help the disease.


Anxiety hysteria:


Anxiety hysteria unlike anxiety neurosis is not merely phobia because there is more of anxiety in it. In anxiety hysteria the sufferer is afraid of circumstances, which do not frighten the normal person, such as dark places, height etc. A young woman always asked mother and father to accompany her wherever she went.




Physical symptoms:


The main ones are shivering, high rate of heartbeat and occasionally fainting. Patient is often frightened very much. He perspires, his heartbeat increases and he even faints.


Psychological symptoms:


The most prominent psychological characteristics of anxiety hysteria are anxiety, restlessness, insomnia, projection, introjections, regression aggression, compulsion etc. In anxiety hysteria often the patient displaces the object inspiring his anxiety.

For example some people are afraid of broad or very narrow streets. Displacing the fear to the lane is an example of projection in anxiety hysteria. Otto Ferickel has mentioned the case of young man who was abnormally afraid of hens because he had projected his internal conflict on hens.


Kinds of anxiety hysteria:


Anxiety hysteria takes various forms of fear and anxiety in different individuals such as agro phobia, acrophobia, clustophobia, ochlophobia, locomotion phobia, path phobia, ero-phobia or tox-phobia, etc.


Simple concrete anxiety phobia:


In this the patient is afraid of some concrete object such as water. Fischer has mentioned the case of a young lady who was so profoundly affected by the sound of running water that she once fainted on hearing a fountain.


Symbolic concrete anxiety hysteria:


In this the case, fear and anxiety is certainly concrete but the patients fear is not for its physical shape but because it symbolises some other object of experience. In one case the young woman is afraid of knifes that she could not even touch it and she could not even sleep, fear that her mother would stab her with a knife if she slept. In this an abstract object that functions as a symbol for example, closed or wide open spaces, height and depths etc.

Causes of anxiety hysteria:


Conditioning, emotional shock, disorganization of mind or power of volition, strong feelings of incest, repression not only of the sexual drive but of any very strong desire are the causes leading to anxiety hysteria.


Cure of anxiety hysteria:


Suggestion, psychoanalysis, hypnosis are some of the methods for curing the disease.


Obsessive-compulsive neurosis:


As is evident from its name in an obsessive-compulsive neurosis the patient is compelled to repeat an illegal thought of

undesirable activity and despite his best efforts he cannot put it out of his mind.


Physical characteristics:


Bodily signs of this kind of neurosis are lack of appetite and sleep, the need to repeat some action etc.


Psychological characteristics:


In this, psychological symptoms are obsession, emotional tension, lack of attention, anxiety, irritability, the presence of conflicting emotions, feelings and thoughts, basic reaction etc.




1.     Frustration and transformation of sexual energy: Freud has believed sexual causes to be at the root of compulsive neurosis and are the base of all other mental disorders.


2.     According to him, whom some sexual desire is denied, fulfillment on account of the intervention of superego, then it becomes repressed, but gives rise to internal conflict.


3.     In this conflict the sexual energy of the individual is transformed so that he becomes a prey to various kinds of compulsion.


4.     Introverted personality: The fundamental cause of compulsive neurosis is an introverted personality. Since such an individual, even though intelligent is sensitive and has a sense of insecurity.


5.     It is due to this feeling of insecurity that an individual is compelled to do many things over and over again. For example he imagines he might lose money that he may be carrying and hence feels compelled to count it many times.


6.     Substitution: Some psychological sign compulsive neurosis as a kind of protective reaction in which the individual develops this disorders in order to keep out painful thoughts or actions.


7.     Mental conflict and emotional tension influence of heredity and environment habit formations are some of the factors contributing to the disease.


Cure of Obsessive-compulsive neurosis:


Psychoanalytic method, hypnotic, suggestion and shock treatment are some of the methods of curing in addition to medication.




One form of hysteria is known as hysteric fugue, in which the individual is compelled by a concealed impulse to run away from home and wander about for many days.


When he recovers to normal state he returns home but forgets all occurred during his fugue condition. A stage of fugue may last for any time period from a few hours to a few months and during this period; he has no recollection of his past life.




As in the case of other mental diseases, fugue also has its root in excessive repression. If a person suffers from some serious psychological or emotional shock, then his repressed desires finds expression in the form of fugue.




An example, a boy who has lost identity, who had run away from home for many months secured a job in a shop. He was given alcoholic drink on the occasion of some festival. When he heard the date he suddenly shouted it' s my mother' s birthday. Immediately he recollected his thoughts on home and simultaneously forget all that had happened to him after he had run away from home. From this it is evident that shock can end a condition of fugue.




This Latin term denotes walking in ones sleep. This is often found in hysteric person. Besides the hysteric person, somnambulism is a condition that can be seen in individuals who are otherwise normal. In this condition the individual comes under the influence of some feelings, memories or concepts and act upon them, while actually asleep in the manner of purpose.




It is a condition of mental disorganization, a condition in which the individual' s complexions or sentiments are not organized and synthesized and do not find expressions in normal life. Hence they are expressed through abnormal behaviour. In this abnormal condition the distorted thoughts gain control over the individual' s normal personality and guide him into mechanical behaviour.


In such a condition the person' s ' normal life does not remain undisturbed and the primary mental organization becomes subordinated to the somnambulistic secondary mental organization. When the stroke of sleepwalking is over the individual returns to normalcy and forgets all that is confined to this condition.




Hypnosis, psychoanalytic method, behaviour therapy are some of the methods of cure.



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