All neurosis includes anxiety.” Develop.

“All neurosis includes anxiety.” Develop. Abstract Neurotic disorders which involve exaggerated use of avoidance behaviors or defense mechanisms hold a very important place among mental disorders because of their close relationship with anxiety. In the world, considerable amount of people have been diagnosed with neurotic disorders and these disorders have various sub-types too. In DSM IV, ICD-10 and other books related to categorization of mental disorders, neurotic disorders have been given a very important place because psychiatrists, psychologists, scientists and researchers have understood that all neurotic disorders have a very common characteristic; the anxiety. By doing this assignment I have taken an effort to find out whether all neurosis includes anxiety or not and if it includes, how anxiety relates to neurosis. Introduction There are two main categories of psychological disorders namely psychotic disorders and neurotic disorders. A psychotic disorder simply means a major organic or psychological impairment that causes a person to feel, think or act in seriously deviant ways (DSM IV R, 1994). Psychotic patients are out of touch with reality, that his or her thoughts and actions are so disturbed that he or she can't cope with the demands of daily life (Barlow & Durand, 2005). Psychoses require intensive treatment and sometimes hospitalization too. Neurosis Neurosis which is also called as psychoneurosis is an umbrella term for non-psychotic personality disorders that has fallen out of favor with diagnosticians. Disorders once called neuroses are usually now labeled under more specific categories such as phobias, anxiety and panic disorders, obsessive-compulsive disorder and hypochondriasis (Carson, Butcher and Mineka, 2000). People with neurosis generally continue to function in society, although not always at full capacity. The word “Neurosis” was coined by the Scottish doctor William Cullen in 1769 to refer to "disorders of sense and motion" caused by a "general affection of the nervous system" (John, 2003). According to him, neurosis described various nervous disorders and symptoms that could not be explained physiologically. It derives from the Greek word "νεῦρον" (neuron, "nerve") with the suffix -osis (diseased or abnormal condition) (John, 2003). The term was however most influentially defined by Carl Jung and Sigmund Freud over a century later. It has continued to be used in contemporary theoretical writings in psychology and philosophy. Neurotic disorders mainly include seven primary types of anxiety disorder. Anxiety disorders include phobic disorders of the “specific” or of the “social” type, panic disorder with or without agoraphobia, generalized anxiety disorder, obsessive compulsive disorder and post traumatic disorder. In the same way, neurotic disorders include reaction to severe stress and adjustment disorders, dissociative disorders and somatoform disorders, eating disorders, sexual disorders, mood disorders and now it has been revealed that even autism also has some relationship with anxiety (www.psychiatrictimes.com.) According to Professor C. George Boeree, effects of neurosis can involve: ...anxiety, sadness or depression, anger, irritability, mental confusion, low sense of self-worth, etc., behavioral symptoms such as phobic avoidance, vigilance, impulsive and compulsive acts, lethargy etc., cognitive problems such as unpleasant or disturbing thoughts, repetition of thoughts and obsession, habitual fantasizing, negativity and cynicism, etc. Interpersonally, neurosis involves dependency, aggressiveness, perfectionism, schizoid isolation, socio-culturally inappropriate behaviors, etc. (A Bio-Social Theory of Neurosis, 2002). To Freud, neurosis is a psychological disorder that resulted when there was anxiety that was a sign of intrapsychic conflict (Carson, Butcher and Mineka, 2000). Anxiety Anxiety is a negative mood state characterized by bodily symptoms of physical tension and apprehension about the future (American Psychiatric Association, 1994, Barlow, 2002). Anxiety is also closely related to depression (Barlow, 2000, 2002, Barlow, Chorpita & Turovsky, 1996, Minekja, Watson & Clark, 1998). In the same way, anxiety is a general term for several disorders that cause nervousness, fear, apprehension, and worrying. These disorders affect how human feel and behave and they can manifest real physical symptoms. Mild anxiety is vague and unsettling while severe anxiety can be extremely debilitating, having a serious impact on daily life. People who have anxiety disorders experience overwhelming feelings of panic and fear, uncontrollable obsessive thoughts, painful, intrusive memories, recurring nightmares, physical symptoms such as feeling sick to his or her stomach, “butterflies” in the stomach, heart pounding, startling easily, muscle tension and neurological problems. Humans often experience a general state of worry or fear before confronting something challenging such as a test, examination, recital or interview. These feelings are easily justified and considered as normal. Psychologists have known for nearly a century that we perform better when we are little anxious (Yerks & Dodson, 1908). According to Howard Liddell (helpful) anxiety is the “shadow of intelligence” (Barlow & Durand, 2005). But, anxiety becomes a problem when it passes the normal level. Generally speaking, anxiety occurs when a reaction is out of proportion with what might be normally expected in a situation. People with anxiety disorders are likely to suffer from depression and they also may abuse alcohol and other drugs in an effort to gain relief from their anxious symptoms. Because of that a person’s whole life can be changed. Anxiety disorders have an unrealistic, irrational fear or anxiety of disabling intensity as its core and also as its principle and most obvious manifestation. It is also very common for a person diagnosed with one anxiety disorder to be diagnosed with one or additional anxiety disorders as well as with a mood disorder. Though anxiety is an emotion different from fear, there is no complete agreement whether fear and anxiety are distinct from other. But, most of the emotion theorists agree there is much evidence that fear and anxiety reactions differ psychologically and physiologically (Barlow, 2002.). However, according to psychologists, when the source of danger is obvious, the experienced emotion is called fear and if we can’t specify clearly what the danger is, then, experienced emotion is called anxiety (Carson, Butcher and Mineka, 2000). As Carson, Butcher and Mineka explain in the book Abnormal Psychology and Modern Life, intuitively, anxiety seems to be experienced as an unpleasant inner state in which we are anticipating some dreadful thing happening that is not entirely predictable from our actual circumstances and the term anxious apprehension is often used to describe this state (p. 160). According to David Barlow, in contrast to fear, anxiety is best thought of as a complex blend of emotions and cognitions that is much more diffuse than fear (Carson, Butcher and Mineka, 2000). As with fear, anxiety involves not only cognitive or subjective components but also physiological and behavioral levels. At the cognitive or subjective level, anxiety involves negative mood, worry about possible future threat or danger, self-preoccupation and a sense of being unable to predict the future threat or to control it if it occurs (Barlow, 1998; Barlow et al., 1996). At physiological level, anxiety involves a state of chronic over arousal which may reflect the state of readiness for dealing with danger should it occur. This is the preparation for, or priming of, the fight or flight response. At the behavioral level, the anxiety involves a strong tendency to avoid situations where the danger or threat might be encountered, but, there is no immediate urge to flee associated with anxiety as there is with fear (Barlow, 1998; Barlow et al.1996). In the book, Introductory Lectures to Psychoanalysis, Sigmund Freud says, “One thing is certain, that the problem of anxiety is a nodal point, linking up all kinds of the most important questions; a riddle of which the solution must cast a flood of height upon our whole mental; life” (p. 121, Barlow & Durand, 2005). As he says anxiety is a sign of an inner battle or conflict between some primitive desire (from the id) and prohibitions against its expression (from the ego and superego). The Relationship between Neurotic Disorders and Anxiety According to psychiatrists, psychologists, scientists and researchers etc. there is a one main common characteristic of neurotic disorders. It is anxiety. The severity of anxiety can be seen that there is a separate categorization of anxiety disorders in DSM IV. These disorders include phobic disorders, generalized anxiety disorder, obsessive compulsive disorder and post traumatic disorder. In DSM IV, there are three main categories of phobias. Specific phobias involve fears of other species (snake and spider etc.) or fears of various aspects of the environment such as water, heights, tunnels or bridges. Social phobias involve fears of various social situations in which a person exposed to the scrutiny of others and is afraid of acting in a humiliating or embarrassing way. Agoraphobia includes a fear of both open and enclosed spaces. If we clearly examine theses disorders, we can see that all these disorders include anxiety. It is a major characteristic. If we examine specific phobias, the people who have specific phobias are extremely afraid of animals such as snakes or spiders, heights, water, blood, airplanes, elevators, darkness, fire etc. It is true that we are somewhat afraid of some of above mentioned things like snakes, darkness, fire etc. But, that fear or anxiety does not affect our daily routine. We can manage it and face it. But, people who have anxiety towards above mentioned objects are unable to carry their daily routines because of their anxiety. They thoroughly refuse and avoid those objects. When anxiety arises, it affects both their physical (increasing heart rate, blood pressure etc.) and psychological life. People who have been diagnosed with generalized anxiety disorder, has chronic excessive worry about number of events or activities. In the same way, the subjective experience of excessive worry contains with restlessness or feelings of being keyed up or on edge, a sense of being easily fatigued, difficulty concentrating or mind going blank, irritability, muscle tension and sleep disturbance. The anxious people live in a relatively constant state of tension, worry and diffuse uneasiness (Carson, Butcher and Mineka, 2000). He or she is always ready to deal with upcoming negative events. People with generalized anxiety disorder have difficulty in concentrating and making decisions, dreading to make a mistake. They always have a doubt and seek the help of others. All these symptoms are due to the severe anxiety. Posttraumatic stress disorder (PTSD) occurs in individuals who have survived a severe or terrifying physical or emotional event. People with PTSD may have recurrent nightmares, intrusive memories or even have flashbacks, where the event seems to be happening all over again. They feel extreme distress when in circumstances that remind them of the trauma and go to extremes to avoid these situations. This is because situations that recall the traumatic experience provoke anxiety in them. So, they are always in alert. With anxiety, other psychological and physiological symptoms also arise. The only reason person experience these symptoms is because he or she has elements of anxiety-general feelings of fear and apprehension in his or her minds. Panic disorder which is another anxiety disorder is defined and characterized by the occurrence of “unexpected” panic attacks that often seem to come “out of the blue” (Barlow & Durand, 2005). According to DSM IV, a person who has a panic disorder experience recurrent unexpected attacks and also persistently concerns about having another attack which means fear or anxiety with doubt. In the same way, the symptoms like shortness of breath, heart palpitations, sweating, dizziness, depression or derealization, fear of dying, of going crazy, of loosing control etc. are experienced. Most of these symptoms are because of acute anxiety. Obsessive compulsive disorder is defined by the occurrence of unwanted and intrusive obsessive thoughts or distressing images which are usually accompanied by compulsive behaviors designed to neutralize the obsessive thoughts or images or to prevent dreaded event or situation. According to DSM IV, obsessions involve persistent and recurrent intrusive thoughts, images or impulses that are experienced as disturbing and inappropriate (Carson, Butcher and Mineka, 2000). These thoughts, images or impulses always have a doubt and therefore it relates to anxiety. Compulsions includes repetitive behaviors such as hand washing, checking or ordering or more covert mental acts counting, praying or saying certain words silently. They are afraid of mistakes, germs etc. All these are the symptoms of anxiety. The compulsive behaviors are performed with the goal of preventing or reducing distress or preventing some dreaded event or situation, even though they are not very realistically connected with what they are designed to neutralize or prevent or are dearly excessive. (American Psychiatric Association, 1994). People with OCD are always in a constant fear or anxiety. The somatoform disorders are a group of conditions involving physical complaints or disabilities that occur without any evidence of physical pathology to account for them (Comer, 1995). Other common symptoms include anxiety and depression. The somatoform disorders include four somatoform patterns namely somatization disorder, hypochondriasis, pain disorder and conversion disorder. Somatization disorder include four pain symptoms like from four different sites or functions, two gastrointestinal symptoms, one sexual symptoms, one pseudo neurological symptom etc. These symptoms have a close relationship with anxiety especially for neurological symptoms. Hypochondriasis or hypochondria refers to excessive preoccupation or worry about having a serious illness. It is sometimes referred to as health phobia or health anxiety because anxiety is high in hypochoandriac patients. This debilitating condition is the result of an inaccurate perception of the body’s condition despite the absence of an actual medical condition. Conversion disorder causes patients to suffer apparently neurological symptoms, such as numbness, blindness, paralysis, or fits, but without a neurological cause. It is thought that these problems arise in response to difficulties in the patient's life and conversion is considered a psychiatric disorder in the DSM IV. So, it is clear that here also, the main cause is anxiety. The term "conversion" has its origins in Freud's doctrine that anxiety is "converted" into physical symptoms (Carson, Butcher and Mineka, 2000). Dissociative disorders can be defined as conditions that involve disruptions or breakdowns of memory, awareness, identity or perception. People with dissociative disorders use dissociation, a defense mechanism, pathologically and involuntarily. These people use defense mechanisms because they are anxious with the doubt and fear. The five dissociative disorders listed in the DSM IV are depersonalization disorder, dissociative amnesia, dissociative fugue, dissociative identity disorder: (formerly Multiple Personality Disorder), dissociative disorder not otherwise specified. The major symptom of all these disorders is the anxiety. Eating Disorders with Anxiety Eating disorders refer to a group of conditions defined by abnormal eating habits that may involve either insufficient or excessive food intake to the detriment of an individual's physical and mental health. When we observe carefully, it is clear that eating disorders also have a close relationship with anxiety. People with Anorexia or Bulimia have obsessions with weight and complaining of weight problems (even if "average" weight or thin), obsession with calories and fat content of foods and obsessions with continuous exercise. And they like isolation because of fear of eating around and with others. People who have Compulsive Overeating or Binge Eating Disorder, develop fear of not being able to control eating and while eating, not being able to stop. And they also prefer isolation because ear of eating around and with others. They also experience excessive sweating and shortness of breath. Insomnia and they have poor sleeping habits and vague or secretive eating patterns. The root of all these symptoms is anxiety. Other Neurotic Disorders with Anxiety An adjustment disorder occurs when an individual is unable to adjust to or cope with a particular stressor like a major life event. Though the condition is different from anxiety disorder, anxiety symptoms like nervousness can be seen in patients with adjustment disorders. Sexual dysfunctions or sexual malfunctions refers to a difficulty experienced by an individual or a couple during any stage of a normal sexual activity, including desire, arousal or orgasm. It has been found that sexual dysfunctions include anxiety. For examples, hypoactive sexual desire disorder, anorgasmia erectile dysfunction, premature ejaculation etc. include anxiety. Specially, premature ejaculation has an underlying neurobiological cause. Dyspareunia arises because of fear and anxiety about sex. According to Coretti and Baldi (2007), sexual dysfunction is especially common among people who have anxiety disorders (www.psychiatrictimes.com/anxiety/article). Ordinary anxiousness can obviously cause erectile dysfunction in men without psychiatric problems, but clinically diagnosable disorders such as panic disorder commonly cause avoidance of intercourse and premature ejaculation. Pain during intercourse is often a comorbidity of anxiety disorders among women. According to Ward and Ogden's (1994), qualitative study on the experience of vaginismus for women is fear of painful sex (www.psychiatrictimes.com/anxiety/article). New research suggests Americans living with depression or bipolar disorders are also likely to have significant problems with anxiety. Often the conditions, both diagnosed and undiagnosed, receive inadequate care compromising quality of life. (www.psychiatrictimes.com/anxiety/article). Children with autism also have anxiety. (www.psychiatrictimes.com/anxiety/article). People with depersonalization disorder have severe and frightening feelings of detachment dominate the person’s life. People with dyssomnias also have anxiety. When considering above mentioned facts it is clear that anxiety and neurotic disorders have a close relationship. Some kind of neurotic disorders have high level of anxiety while others have low level of anxiety. Though the severity changes according to the disorder, in each and every neurotic disorder has some kind of relationship with anxiety. Conclusion A large number of mental disorders are belonged to neurotic category of mental disorders. Though the symptoms and syndromes of all those disorders are different, all those disorders have one common symptom; anxiety. The above mentioned neurotic disorders clearly explain it. According to the disorder, the severity of anxiety differs and anxiety can totally change one’s life. It affects both physically and mentally. Though normal anxiety is a very helpful thing for our well being, the severe anxiety is very dangerous. It can pave the way le to even various psychotic disorders which are very difficult to cure. So, it is very important to balance anxiety for our physiological and psychological well being. References Barlow, D. H., & Durand,V. M, (2005). Abnormal psychology (4th ed). USA: Thomson Wadsworth. Carson, R. C., Butcher, J. N., Mineka, S., (2000), Abnormal psychology and modern life (11th ed.) Delhi: Pearson Education. Comer, R. J., (1995). Abnormal psychology (2nd ed.). USA: W. H. Freeman and Company. 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