What is Neurotics Anonymous?

Introduction

Neurotics Anonymous (N/A), founded in 1964, is a twelve-step programme for recovery from mental and emotional illness.

To avoid confusion with Narcotics Anonymous (NA), Neurotics Anonymous is abbreviated N/A or NAIL.

Refer to Neuroticism and Neurosis.

Brief History

The conception of Neurotics Anonymous began with Alcoholics Anonymous (AA) co-founder Bill W. After achieving sobriety Bill continued to suffer from neurosis, specifically depression. In letters to other AA members he wrote about his personal experience with neurosis, its prevalence in AA, and how he and others learned to cope with it. Bill expressed that as he learned to let go of his dependence on people and situations for emotional security and replaced that dependence with “showing outgoing love as best as he could,” his depression began to subside. In correspondence with another AA member about neurosis and psychoanalyst Karen Horney Bill suggested how a Neurotics Anonymous fellowship might operate.

You interest me very much when you talk of Karen Horney. I have the highest admiration of her. That gal’s insights have been most helpful to me. Also for the benefit of screwballs like ourselves, it may be that someday we shall devise some common denominator of psychiatry — of course, throwing away their much abused terminology — common denominators which neurotics could use on each other. The idea would be to extend the moral inventory of AA to a deeper level, making it an inventory of psychic damages, reliving in conversation episodes, etc. I suppose someday a Neurotics Anonymous will be formed and will actually do all this. Bill W., Letter to Ollie in California, 04 January 1956.

In a subsequent letter to Ollie in June 1956, Bill suggested the inventory of psychic damages include inferiority, shame, guilt and anger. He added that the effectiveness of the inventory would come from reliving the experiences and sharing them with other people.

Neurotics Anonymous was created eight years later, 03 February 1964 in Washington, D.C. by Grover Boydston (16 August 1924 to 17 December 1996). Grover was an AA member, recovering alcoholic, psychologist, and Ed.M. Grover had attempted suicide five times before the age of 21 and, like Bill W., was neurotic. Grover believed members of twelve-step programmes shared the same underlying neuroses caused by self-centeredness, a view expressed in other twelve-step programmes. Grover went as far as to say, “All of us are, indeed, brothers, and the variations in detail are no more than if one of us likes chocolate ice cream, and the other likes vanilla.”

While in AA, Grover discovered working the Twelve Steps helped remove the neuroses underlying his alcoholism. As an experiment Grover instructed a woman who suffered from neurosis, but not alcoholism, to work the Twelve Steps. He discovered that they aided her recovery from neurosis as well. He wrote Alcoholics Anonymous World Services for permission to use their Twelve Steps with the word “alcohol” in the First Step replaced with “our emotions.” Permission was granted. Grover placed an ad in a Washington, D.C. newspaper for Neurotics Anonymous, and organised the first meeting from those who responded to it. N/A grew modestly until an article was published on it in Parade magazine. The Associated Press and United Press International republished the story, and N/A groups began forming internationally.

By 1974 the Diagnostic and Statistical Manual of Mental Disorders, at the time in second edition (DSM-II), was undergoing revision. The framework developed for the third edition (DSM-III) was no longer based on psychoanalytic principles such as neurosis. The connotation of neurosis in common language also began to change. “Neurosis” was being used, increasingly, in a facetious or pejorative sense, rather than a diagnostic sense. These combined factors could make it difficult to take an organization known as Neurotics Anonymous seriously. In current Neurotics Anonymous literature, there is not a scientific definition ascribed to neurosis. As used in N/A, a neurotic is defined as any person who accepts that he or she has emotional problems.

Demographics

Grover Boydston conducted the first demographic study of Neurotics Anonymous in 1974. Such studies are rare and samples sizes are usually small as any group following the Twelve Traditions is required to protect the anonymity of their members. While researching such groups is still ethically possible, it is more difficult given this constraint.

  • Age: Boydston’s study found the average age of N/A members surveyed to be 43.02 years. A study six years later of self-help groups for people with serious mental illness, found the average age to be 35.3 years.
  • Attendance and Tenure: Of the N/A members surveyed Boydston found they attended, on average, six meetings per month and had spent an average of 2.37 years in N/A. N/A had existed for approximately ten years at the time of the survey.
  • Employment and socioeconomic status: Boydston categorised the occupations of N/A members into four categories.
    • Professionals: Includes people who practice a profession that is so considered by scientific, academic, business, and other people. It includes physicians, lawyers, engineers, nurses, college and university instructors. These represented 38% of the members surveyed.
    • Clerical persons: Includes people who perform office work or sales work according to the classification of “clerical.” These represented 32% of the members surveyed.
    • Homemakers: A person who takes care of a home as his or her main work. These represented 16% of the members surveyed.
    • Other: Includes students and people who do not fit into the three previous categories. These represented 32% of the members surveyed.
  • According to Boydston’s results at least 70% of N/A members were employed. This is similar to a specific study of Emotions Anonymous that found most of the members were middle class. Other studies of self-help groups for people with serious mental illness found most of the members tend to be unemployed, while others found members to be predominantly working class.
  • Ethnicity: Boydston’s study, and all similar studies in the literature have found that the majority of members in N/A and other self-help groups for people with serious mental illness in the United States are white.
  • Hospitalisation: Boydston’s study of N/A members found that 42% percent had been hospitalised for psychiatric reasons. More recent studies have shown that in self-help groups for serious mental illness approximately 60% (55-75%) of members had been hospitalised for psychiatric reasons.
  • Marital Status: In Boydston’s study of N/A members he found 25% were single, 48% were currently married, 22% were divorced and 5% were widowed. This finding has not been replicated in studies of similar groups where it was found most members had never been married.
  • Religion: Boydston’s survey included not only religious affiliation, but also included a measure of religiosity. Of the N/A members surveyed he found 24% identified as Catholic, 47% identified as Protestant, 9% identified as Jewish, and 19% did not consider themselves religious. Additionally, only 19% of members identified themselves as “very religious”, 42% identified themselves as moderately religious, and 39% identified themselves as “not very religious”.
  • Specific disorders (neuroses): Boydston’s survey contained an open-ended question asking about the “main complaints” N/A members came to the programme with. He summarized them in a list of twelve. Listed below are his results, in order from the highest to lowest percentage of members reporting them. Members often presented with more than one complaint.
    • Depression (58%).
    • Anxiety (32%).
    • Fears (23%).
    • Problems in relationships (18%).
    • Psychosomatic pains (14%).
    • Confusion (13%).
    • No desire to live (11%).
    • Inability to cope (9%).
    • Nervousness (7%).
    • Loneliness (6%).
    • Feelings of hopelessness (5%).
    • Hate (3%).
  • Sex: Boydston’s study of N/A members found approximately 36% were male, and 64% were female. This ratio, of two (or more) females for every male, has been reproduced in all other studies of self-help groups for persons with serious mental illness, as well as specific studies of Emotions Anonymous groups.

Criticism

N/A members in Comalapa (a municipality in Nicaragua) believe X-ray images (radiografías) can serve as a moral diagnostic revealing information about the intent and mores of those being examined. There is, however, no evidence that they are deliberately attempting to mislead other members. Americans had similar misunderstandings of X-ray technology when it was first introduced in the United States.

Increasing Deviant Stigma

Sociologist Edward Sagarin noted that alcoholics and addicts are considered deviants because their behaviour is socially labelled as deviant. Meaning chronic substance abuse is seen as deviant, while being sober or “clean” is normal. For an alcoholic or addict, joining groups such as AA or NA immediately reduces their deviant stigma, regardless of whether or not the alcoholic or addict believes it does. There is no similar clear cut language to label the deviance of those in N/A, in the act of joining members label themselves as deviant and take on stigma by identifying as one of those in the group afflicted with the problems of the other members. Initially joining the group may prove to be more ego damaging than ego reinforcing, regardless of whether or not the group helps them overcome their problems. Therefore, social stigma would attract alcoholics and addicts to groups like AA and NA. It would, however, become a barrier preventing people from joining groups such as N/A.

In contrast, those with severe mental illness may have acquired stigma through professional labels and diagnoses as well as through other behaviours associated with their mental illness defined as deviant. This stigma may not be as easily understood as alcoholism or addiction because the behaviour is more varied and can not be explained by substance use.

The objective of NA and AA is not just to help their members stop abusing drugs and alcohol. It is acknowledged in these programs that addiction is more systemic than a “bad habit” and is fundamentally caused by self-centeredness. Long term membership in Alcoholics Anonymous has been found to reform pathological narcissism, and those who are sober but retain characteristics of personality disorders associated with addiction are known in AA as “dry drunks.”

Effectiveness

Neurotics Anonymous developed the Test of Mental and Emotional Health as a tool to help members evaluate their progress. It is a fifty question test, with each answer rated on a three level Likert scale. Possible scores range from zero to one hundred. Higher scores are thought to indicate better mental and emotional health.

In Boydston’s survey of N/A members, when asked if they had received help through the program, 100% of those surveyed said “yes.” Boydston claimed N/A had similar results to AA in terms of recovery – 50% with a desire to stop drinking do so, 25% recover after one or more relapses, but most of the other 25% never successfully recover.

Literature

From 1965 to 1980 Neurotics Anonymous published a mimeographed quarterly periodical, the Journal of Mental Health. This should not be confused with the newer journal of the same name that began publishing in 1992. Early in the development of N/A they used Alcoholics Anonymous (the so-called Big Book) and the Twelve Steps and Twelve Traditions, the two fundamental books of the Alcoholics Anonymous programme. While reading out loud at meetings, members changed instances of the word “alcoholic” to “neurotic.” Passages in the book referring specifically to drinking were ignored. Eventually, N/A began creating books from articles published in the Journal of Mental Health. There were three such books published in English.

  • Neurotics Anonymous (1968). Neurotics Anonymous. Washington, D.C.: Neurotics Anonymous International Liaison, Inc.
  • Neurotics Anonymous (1970). The Laws of Mental and Emotional Illness. Washington, D.C.: Neurotics Anonymous International Liaison, Inc. ASIN B000FTOFYS. LCCN 76102220. OCLC 104842.
  • Neurotics Anonymous (1978). The Etiology of Mental and Emotional Illness and Health. Washington, D.C.: Neurotics Anonymous International Liaison, Inc. ASIN B000FTON22. LCCN 76040759. OCLC 4500175.

The N/A organisations in Brazil and Mexico use translations of the English literature as well as literature written by groups in their area.

Parallel Organisation

A registered charity, known as Neurotics Anonymous and located in London, was created in the late 1960s by John Oliver Yates. Yates was prompted to create the groups after trauma he had suffered from a car accident that left him completely blind. Group membership was open to anyone, although it was recommended for people who had a nervous illness severe enough to require hospitalization. This charity differed from conventional twelve-step programmes in several ways. There was a nominal fee charged for membership. Meetings opened with a discussion of outside issues, such debate on social, political or cultural topics. The debate was followed by a personal problem forum where members brought their problems to Yates for initial comment followed by a presentation for group discussion.

What is Neurosis?

Introduction

Neurosis is a class of functional mental disorders involving chronic distress, but neither delusions nor hallucinations.

The term is no longer used by the professional psychiatric community in the United States, having been eliminated from the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980 with the publication of DSM III. However, it is still used in the ICD-10 Chapter V F40-48.

Neurosis should not be mistaken for psychosis, which refers to a loss of touch with reality. Nor should it be mistaken for neuroticism, a fundamental personality trait proposed in the Big Five personality traits theory.

Etymology

The term is derived from the Greek word neuron (νεῦρον, ‘nerve’) and the suffix -osis (-ωσις, ‘diseased’ or ‘abnormal condition’).

The term neurosis was coined by Scottish doctor William Cullen in 1769 to refer to “disorders of sense and motion” caused by a “general affection of the nervous system.” Cullen used the term to describe various nervous disorders and symptoms that could not be explained physiologically. Physical features, however, were almost inevitably present, and physical diagnostic tests, such as exaggerated knee-jerks, loss of the gag reflex and dermatographia, were used into the 20th century. The meaning of the term was redefined by Carl Jung and Sigmund Freud over the early and middle 20th century, and has continued to be used in psychology and philosophy.

The DSM eliminated the neurosis category in 1980, because of a decision by its editors to provide descriptions of behaviour rather than descriptions of hidden psychological mechanisms. This change has been controversial. Likewise, according to the American Heritage Medical Dictionary, neurosis is “no longer used in psychiatric diagnosis.”

Symptoms and Causes

Neurosis may be defined simply as a “poor ability to adapt to one’s environment, an inability to change one’s life patterns, and the inability to develop a richer, more complex, more satisfying personality.” There are many different neuroses, including:

According to C. George Boeree, professor emeritus at Shippensburg University, the symptoms of neurosis may 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.

Jungian Theory

Carl Jung found his approach particularly effective for patients who are well adjusted by social standards but are troubled by existential questions. Jung claims to have “frequently seen people become neurotic when they content themselves with inadequate or wrong answers to the questions of life”.[8]: 140  Accordingly, the majority of his patients “consisted not of believers but of those who had lost their faith”.  A contemporary person, according to Jung,

…is blind to the fact that, with all his rationality and efficiency, he is possessed by ‘powers’ that are beyond his control. His gods and demons have not disappeared at all; they have merely got new names. They keep him on the run with restlessness, vague apprehensions, psychological complications, an insatiable need for pills, alcohol, tobacco, food — and, above all, a large array of neuroses.

Jung found that the unconscious finds expression primarily through an individual’s inferior psychological function, whether it is thinking, feeling, sensation, or intuition. The characteristic effects of a neurosis on the dominant and inferior functions are discussed in his Psychological Types. Jung also found collective neuroses in politics: “Our world is, so to speak, dissociated like a neurotic.”

Psychoanalytic Theory

According to psychoanalytic theory, neuroses may be rooted in ego defence mechanisms, though the two concepts are not synonymous. Defence mechanisms are a normal way of developing and maintaining a consistent sense of self (i.e. an ego). However, only those thoughts and behaviours that produce difficulties in one’s life should be called neuroses.

A neurotic person experiences emotional distress and unconscious conflict, which are manifested in various physical or mental illnesses; the definitive symptom being anxiety. Neurotic tendencies are common and may manifest themselves as acute or chronic anxiety, depression, an obsessive-compulsive disorder, a phobia, or a personality disorder.

Horney’s Theory

In her final book, Neurosis and Human Growth, Karen Horney lays out a complete theory of the origin and dynamics of neurosis. In her theory, neurosis is a distorted way of looking at the world and at oneself, which is determined by compulsive needs rather than by a genuine interest in the world as it is. Horney proposes that neurosis is transmitted to a child from their early environment and that there are many ways in which this can occur:

When summarized, they all boil down to the fact that the people in the environment are too wrapped up in their own neuroses to be able to love the child, or even to conceive of him as the particular individual he is; their attitudes toward him are determined by their own neurotic needs and responses.

The child’s initial reality is then distorted by their parents’ needs and pretences. Growing up with neurotic caretakers, the child quickly becomes insecure and develops basic anxiety. To deal with this anxiety, the child’s imagination creates an idealized self-image:

Each person builds up his personal idealized image from the materials of his own special experiences, his earlier fantasies, his particular needs, and also his given faculties. If it were not for the personal character of the image, he would not attain a feeling of identity and unity. He idealizes, to begin with, his particular “solution” of his basic conflict: compliance becomes goodness, love, saintliness; aggressiveness becomes strength, leadership, heroism, omnipotence; aloofness becomes wisdom, self-sufficiency, independence. What—according to his particular solution—appear as shortcomings or flaws are always dimmed out or retouched.

Once they identify themselves with their idealised image, a number of effects follow. They will make claims on others and on life based on the prestige they feel entitled to because of their idealized self-image. They will impose a rigorous set of standards upon themselves in order to try to measure up to that image. They will cultivate pride, and with that will come the vulnerabilities associated with pride that lacks any foundation. Finally, they will despise themselves for all their limitations. Vicious circles will operate to strengthen all of these effects.

Eventually, as they grow to adulthood, a particular “solution” to all the inner conflicts and vulnerabilities will solidify. They will be either:

  • Expansive, displaying symptoms of narcissism, perfectionism, or vindictiveness.
  • Self-effacing and compulsively compliant, displaying symptoms of neediness or co-dependence.
  • Resigned, displaying schizoid tendencies.

In Horney’s view, mild anxiety disorders and full-blown personality disorders all fall under her basic scheme of neurosis as variations in the degree of severity and in the individual dynamics. The opposite of neurosis is a condition Horney calls self-realisation, a state of being in which the person responds to the world with the full depth of their spontaneous feelings, rather than with anxiety-driven compulsion. Thus the person grows to actualise their inborn potentialities. Horney compares this process to an acorn that grows and becomes a tree: the acorn has had the potential for a tree inside it all along.

What is the Neurotic Personality Questionnaire KON-2006?

Introduction

The Neurotic Personality Questionnaire KON-2006 is a psychometric tool used for diagnosing personality dysfunctions that contribute to the development of neurotic disorders.

The use of the questionnaire may facilitate the diagnosis of neurotic disorder, as well as make it easier to differentiate between neurotic and pseudoneurotic syndroms, e.g. reaction to stress. Moreover, the questionnaire enables evaluation of changes occurring in the course of treatment.

The questionnaire has been created by Jerzy W. Aleksandrowicz, Katarzyna Klasa, Jerzy A. Sobański and Dorota Stolarska in the Department of Psychotherapy of the Jagiellonian University Medical College in Kraków, Poland.

Refer to Neuroticism and Neurosis.

The Content of the Questionnaire

The questionnaire consists of 243 items that require positive or negative answer. They determine the values of 24 scales that describe areas related to the development of neurotic disorders, as well as the value of X-KON index that describes the global intensity of neurotic personality. Currently, only the Polish and Ukrainian versions of KON-2006 are available, however a number of studies based on the tool has been published in English.

Scales

The following working (approximate) names were given to KON-2006 scales:

  • Feeling of being dependent on the environment.
  • Asthenia.
  • Negative self-esteem.
  • Impulsiveness.
  • Difficulties with decision making.
  • Sense of alienation.
  • Demobilisation.
  • Tendency to take risks.
  • Difficulties in emotional relations.
  • Lack of vitality.
  • Conviction of own resourcelessness in life.
  • Sense of lack of control.
  • Deficit in internal locus of control.
  • Imagination. indulging in fiction.
  • Sense of guilt.
  • Difficulties in interpersonal relations.
  • Envy.
  • Narcissistic attitude.
  • Sense of being in danger.
  • Exaltation.
  • Irrationality.
  • Meticulousness.
  • Ponderings.
  • Sense of being overloaded.

Methodology of the Questionnaire Creation

Search for and selection of items that were used for the creation of the KON-2006 questionnaire were based on empirical methods. Analysis of usefulness of 779 items was conducted (including items drawn from scales belonging to various personality and temperament inventories e.g. 16PF, MMPI, PTS, TTS, IPIP, TCI). Clarity, explicitness and comprehensiveness of each item was evaluated and appropriate improvements were implemented. Next, a comparison of answers was made between healthy individuals and the patients that were beginning treatment due to neurotic disorders. This allowed to select 243 items most useful in differentiation of the patients with neurotic disorders from the healthy individuals. These items were used for the creation of Neurotic Personality Questionnaire. The construction of 24 scales was based on cluster analysis conducted on the population of patients at the beginning of treatment and control groups.

What is Neuroticism?

Introduction

In the study of psychology, neuroticism has been considered a fundamental personality trait.

For example, in the Big Five approach to personality trait theory, individuals with high scores for neuroticism are more likely than average to be moody and to experience such feelings as anxiety, worry, fear, anger, frustration, envy, jealousy, guilt, depressed mood, and loneliness. Such people are thought to respond worse to stressors and are more likely to interpret ordinary situations, such as minor frustrations, as appearing hopelessly difficult. They are described as often being self-conscious and shy, and tending to have trouble controlling urges and delaying gratification.

People with high scores on the neuroticism index are thought to be at risk of developing common mental disorders (mood disorders, anxiety disorders, and substance use disorders have been studied), and the sorts of symptoms traditionally referred to as “neuroses”.

Refer to Neurosis and Neurotic Personality Questionnaire KON-2006.

Definition

Neuroticism is a trait in many models within personality theory, but there is significant disagreement on its definition. It is sometimes defined as a tendency for quick arousal when stimulated and slow relaxation from arousal, especially with regard to negative emotional arousal. Another definition focuses on emotional instability and negativity or maladjustment, in contrast to emotional stability and positivity, or good adjustment. It has also been defined in terms of lack of self-control, poor ability to manage psychological stress, and a tendency to complain.

Various personality tests produce numerical scores, and these scores are mapped onto the concept of “neuroticism” in various ways, which has created some confusion in the scientific literature, especially with regard to sub-traits or “facets”.

Individuals who score low in neuroticism tend to be more emotionally stable and less reactive to stress. They tend to be calm, even-tempered, and less likely to feel tense or rattled. Although they are low in negative emotion, they are not necessarily high in positive emotion. Being high in scores of positive emotion is generally an element of the independent trait of extraversion. Neurotic extraverts, for example, would experience high levels of both positive and negative emotional states, a kind of “emotional roller coaster”.

Measurement

Like other personality traits, neuroticism is typically viewed as a continuous dimension rather than a discrete state.

The extent of neuroticism is generally assessed using self-report measures, although peer-reports and third-party observation can also be used. Self-report measures are either lexical or based on statements. Deciding which measure of either type to use in research is determined by an assessment of psychometric properties and the time and space constraints of the study being undertaken.

Lexical measures use individual adjectives that reflect neurotic traits, such as anxiety, envy, jealousy, and moodiness, and are very space and time efficient for research purposes. Lewis Goldberg (1992) developed a 20-word measure as part of his 100-word Big Five markers. Saucier (1994) developed a briefer 8-word measure as part of his 40-word mini-markers. Thompson (2008) systematically revised these measures to develop the International English Mini-Markers which has superior validity and reliability in populations both within and outside North America. Internal consistency reliability of the International English Mini-Markers for the Neuroticism (emotional stability) measure for native English-speakers is reported as 0.84, and that for non-native English-speakers is 0.77.

Statement measures tend to comprise more words, and hence consume more research instrument space, than lexical measures. Respondents are asked the extent to which they, for example, “Remain calm under pressure”, or “Have frequent mood swings”. While some statement-based measures of neuroticism have similarly acceptable psychometric properties in North American populations to lexical measures, their generally emic development makes them less suited to use in other populations. For instance, statements in colloquial North American English like “Seldom feel blue” and “Am often down in the dumps” are sometimes hard for non-native English-speakers to understand.

Neuroticism has also been studied from the perspective of Gray’s biopsychological theory of personality, using a scale that measures personality along two dimensions: the behavioural inhibition system (BIS) and the behavioural activation system (BAS). The BIS is thought to be related to sensitivity to punishment as well as avoidance motivation, while the BAS is thought to be related to sensitivity to reward as well as approach motivation. Neuroticism has been found to be positively correlated with the BIS scale, and negatively correlated with the BAS scale.

Neuroticism has been included as one of the four dimensions that comprise core self-evaluations, one’s fundamental appraisal of oneself, along with locus of control, self-efficacy, and self-esteem. The concept of core self-evaluations was first examined by Judge, Locke, and Durham (1997), and since then evidence has been found to suggest these have the ability to predict several work outcomes, specifically, job satisfaction and job performance.

There is a risk of selection bias in surveys of neuroticism; a 2012 review of N-scores said that “many studies used samples drawn from privileged and educated populations”.

Neuroticism is highly correlated with the startle reflex in response to fearful conditions and inversely correlated with it in response to disgusting or repulsive stimuli. This suggests that Neuroticism may increase vigilance where evasive action is possible but promote emotional blunting when escape is not an option. A measure of the startle reflex can be used to predict the trait neuroticism with good accuracy; a fact that is thought by some to underlie the neurological basis of the trait. The startle reflex is a reflex in response to a loud noise that one typically has no control over, though anticipation can reduce the effect. The strength of the reflex as well as the time until the reflex ceases can be used to predict neuroticism.

Mental Disorder Correlations

Questions used in many neuroticism scales overlap with instruments used to assess mental disorders like anxiety disorders (especially social anxiety disorder) and mood disorders (especially major depressive disorder), which can sometimes confound efforts to interpret N scores and makes it difficult to determine whether each of neuroticism and the overlapping mental disorders might cause the other, or if both might stem from other cause. Correlations can be identified.

A 2013 meta-analysis found that a wide range of clinical mental disorders are associated with elevated levels of neuroticism compared to levels in the general population. It found that high neuroticism is predictive for the development of anxiety disorders, major depressive disorder, psychosis, and schizophrenia, and is predictive but less so for substance use and non-specific mental distress. These associations are smaller after adjustment for elevated baseline symptoms of the mental illnesses and psychiatric history.

Neuroticism has also been found to be associated with older age. In 2007, Mroczek & Spiro found that among older men, upward trends in neuroticism over life as well as increased neuroticism overall both contributed to higher mortality rates.

Mood Disorders

Disorders associated with elevated neuroticism include mood disorders, such as depression and bipolar disorder, anxiety disorders, eating disorders, schizophrenia and schizoaffective disorder, dissociative identity disorder, and hypochondriasis. Mood disorders tend to have a much larger association with neuroticism than most other disorders. The five big studies have described children and adolescents with high neuroticism as “anxious, vulnerable, tense, easily frightened, ‘falling apart’ under stress, guilt-prone, moody, low in frustration tolerance, and insecure in relationships with others,” which includes both traits concerning the prevalence of negative emotions as well as the response to these negative emotions. Neuroticism in adults similarly was found to be associated with the frequency of self-reported problems.

These associations can vary with culture: for example, Adams found that among upper-middle-class American teenaged girls, neuroticism was associated with eating disorders and self-harm, but among Ghanaian teenaged girls, higher neuroticism was associated with magical thinking and extreme fear of enemies.

Personality Disorders

A 2004 meta-analysis attempted to analyse personality disorders in light of the five-factor personality theory and failed to find meaningful discriminations; it did find that elevated neuroticism is correlated with many personality disorders.

Theories of Causation

Mental-Noise Hypothesis

Studies have found that the mean reaction times will not differ between individuals high in neuroticism and those low in neuroticism, but that, with individuals high in neuroticism, there is considerably more trial-to-trial variability in performance reflected in reaction time standard deviations. In other words, on some trials neurotic individuals are faster than average, and on others they are slower than average. It has been suggested that this variability reflects noise in the individual’s information processing systems or instability of basic cognitive operations (such as regulation processes), and further that this noise originates from two sources: mental preoccupations and reactivity processes.

Flehmig et al. (2007) studied mental noise in terms of everyday behaviours using the Cognitive Failures Questionnaire, which is a self-report measure of the frequency of slips and lapses of attention. A “slip” is an error by commission, and a “lapse” is an error by omission. This scale was correlated with two well-known measures of neuroticism, the BIS/BAS scale and the Eysenck Personality Questionnaire. Results indicated that the CFQ-UA (Cognitive Failures Questionnaire- Unintended Activation) subscale was most strongly correlated with neuroticism (r = .40) and explained the most variance (16%) compared to overall CFQ scores, which only explained 7%. The authors interpret these findings as suggesting that mental noise is “highly specific in nature” as it is related most strongly to attention slips triggered endogenously by associative memory. In other words, this may suggest that mental noise is mostly task-irrelevant cognitions such as worries and preoccupations.

Evolutionary Psychology

The theory of evolution may also explain differences in personality. For example, one of the evolutionary approaches to depression focuses on neuroticism and finds that heightened reactivity to negative outcomes may have had a survival benefit, and that furthermore a positive relationship has been found between neuroticism level and success in university with the precondition that the negative effects of neuroticism are also successfully coped with. Likewise, a heightened reactivity to positive events may have had reproductive advantages, selecting for heightened reactivity generally. Nettle contends that evolution selected for higher levels of neuroticism until the negative effects of neuroticism outweighed its benefits, resulting in selection for a certain optimal level of neuroticism. This type of selection will result in a normal distribution of neuroticism, so the extremities of the distribution will be individuals with excessive neuroticism or too low neuroticism for what is optimal, and the ones with excessive neuroticism would therefore be more vulnerable to the negative effects of depression, and Nettle gives this as the explanation for the existence of depression rather than hypothesizing, as others have, that depression itself has any evolutionary benefit.

Some research has found that neuroticism, in modern societies, is positively correlated with reproductive success in females but not in males. A possible explanation may be that neuroticism in females comes at the expense of formal education (which is correlated with lower fertility) and correlates with unplanned and adolescent pregnancies.

Terror Management Theory

According to terror management theory (TMT) neuroticism is primarily caused by insufficient anxiety buffers against unconscious death anxiety. These buffers consist of:

  • Cultural worldviews that impart life with a sense of enduring meaning, such as social continuity beyond one’s death, future legacy and afterlife beliefs, and
  • A sense of personal value, or the self-esteem in the cultural worldview context, an enduring sense of meaning.

While TMT agrees with standard evolutionary psychology accounts that the roots of neuroticism in Homo sapiens or its ancestors are likely in adaptive sensitivities to negative outcomes, it posits that once Homo sapiens achieved a higher level of self-awareness, neuroticism increased enormously, becoming largely a spandrel, a non-adaptive by-product of our adaptive intelligence, which resulted in a crippling awareness of death that threatened to undermine other adaptive functions. This overblown anxiety thus needed to be buffered via intelligently creative, but largely fictitious and arbitrary notions of cultural meaning and personal value. Since highly religious or supernatural conceptions of the world provide “cosmic” personal significance and literal immortality, they are deemed to offer the most efficient buffers against death anxiety and neuroticism. Thus, historically, the shift to more materialistic and secular cultures – starting in the Neolithic, and culminating in the industrial revolution, is deemed to have increased neuroticism.

Genetic and Environmental Factors

A 2013 review found that “Neuroticism is the product of the interplay between genetic and environmental influences. Heritability estimates typically range from 40% to 60%.” The effect size of these genetic differences remain largely the same throughout development, but the hunt for any specific genes that control neuroticism levels has “turned out to be difficult and hardly successful so far.” On the other hand, with regards to environmental influences, adversities during development such as “emotional neglect and sexual abuse” were found to be positively associated with neuroticism. However, “sustained change in neuroticism and mental health are rather rare or have only small effects.”

In the July 1951 article: “The Inheritance of Neuroticism” by Hans J. Eysenck and Donald Prell it was reported that some 80 per cent of individual differences in neuroticism are due to heredity and only 20 percent are due to environment….the factor of neuroticism is not a statistical artifact, but constitutes a biological unit which is inherited as a whole….neurotic predisposition is to a large extent hereditarily determined.

In children and adolescents, psychologists speak of temperamental negative affectivity that, during adolescence, develops into the neuroticism personality domain. Mean neuroticism levels change throughout the lifespan as a function of personality maturation and social roles, but also the expression of new genes. Neuroticism in particular was found to decrease as a result of maturity by decreasing through age 40 and then levelling off. Generally speaking, the influence of environments on neuroticism increases over the lifespan, although people probably select and evoke experiences based on their neuroticism levels.

The emergent field of “imaging genetics,” which investigates the role of genetic variation in the structure and function of the brain, has studied certain genes suggested to be related to neuroticism, and the one studied so far concerning this topic has been the serotonin transporter-linked promoter region gene known as 5-HTTLPR, which is transcribed into a serotonin transporter that removes serotonin. It has been found that compared to the long (l) variant of 5-HTTLPR, the short (s) variant has reduced promoter activity, and the first study on this subject has shown that the presence of the s-variant 5-HTTLPR has been found to result in higher amygdala activity from seeing angry or fearful faces while doing a non-emotional task, with further studies confirming that the s-variant 5-HTTLPR result greater amygdala activity in response to negative stimuli, but there have also been null findings. A meta-analysis of 14 studies has shown that this gene has a moderate effect size and accounts for 10% of the phenotypic difference. However, the relationship between brain activity and genetics may not be completely straightforward due to other factors, with suggestions made that cognitive control and stress may moderate the effect of the gene. There are two models that have been proposed to explain the type of association between the 5-HTTLPR gene and amygdala activity: the “phasic activation” model proposes that the gene controls amygdala activity levels in response to stress, whereas the “tonic activation” model, on the other hand, proposes that the gene controls baseline amygdala activity. Another gene that has been suggested for further study to be related to neuroticism is the catechol-O-methyltransferase (COMT) gene.

The anxiety and maladaptive stress responses that are aspects of neuroticism have been the subject of intensive study. Dysregulation of hypothalamic-pituitary-adrenal axis and glucocorticoid system, and influence of different versions of the serotonin transporter and 5-HT1A receptor genes may influence the development of neuroticism in combination with environmental effects like the quality of upbringing.

Neuroimaging studies with fMRI have had mixed results, with some finding that increased activity in the amygdala and anterior cingulate cortex, brain regions associated with arousal, is correlated with high neuroticism scores, as is activation of the associations have also been found with the medial prefrontal cortex, insular cortex, and hippocampus, while other studies have found no correlations. Further studies have been conducted trying to tighten experimental design by using genetics to add additional differentiation among participants, as well as twin study models.

A related trait, behavioural inhibition, or “inhibition to the unfamiliar,” has received attention as the trait concerning withdrawal or fear from unfamiliar situations, which is generally measured through observation of child behaviour in response to, for example, encountering unfamiliar individuals. This trait in particular has been hypothesized to be related to amygdala function, but the evidence so far has been mixed.

Age, Gender, and Geographic Patterns

A 2013 review found that groups associated with higher levels of neuroticism are young adults who are at high risk for mood disorders. Research in large samples has shown that levels of neuroticism are higher in women than men. Neuroticism is found to decrease slightly with age. The same study noted that no functional MRI studies have yet been performed to investigate these differences, calling for more research. A 2010 review found personality differences between genders to be between “small and moderate,” the largest of those differences being in the traits of agreeableness and neuroticism. Many personality traits were found to have had larger personality differences between men and women in developed countries compared to less developed countries, and differences in three traits – extraversion, neuroticism, and people-versus-thing orientation – showed differences that remained consistent across different levels of economic development, which is also consistent with the “possible influence of biologic factors.” Three cross-cultural studies have revealed higher levels of female neuroticism across almost all nations.

Geographically, a 2016 review said that in the US, neuroticism is highest in the mid-Atlantic states and southwards and declines westward, while openness to experience is highest in ethnically diverse regions of the mid-Atlantic, New England, the West Coast, and cities. Likewise, in the UK neuroticism is lowest in urban areas. Generally, geographical studies find correlations between low neuroticism and entrepreneurship and economic vitality and correlations between high neuroticism and poor health outcomes. The review found that the causal relationship between regional cultural and economic conditions and psychological health is unclear.

What is Neurosis?

Introduction

Neurosis is a class of functional mental disorders involving chronic distress, but neither delusions nor hallucinations. The term is no longer used by the professional psychiatric community in the United States, having been eliminated from the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980 with the publication of DSM III. However, it is still used in the ICD-10 Chapter V F40-48.

Neurosis should not be mistaken for psychosis, which refers to a loss of touch with reality. Nor should it be mistaken for neuroticism, a fundamental personality trait proposed in the Big Five personality traits theory.

Etymology

The term is derived from the Greek word neuron (νεῦρον, ‘nerve’) and the suffix -osis (-ωσις, ‘diseased’ or ‘abnormal condition’).

The term neurosis was coined by Scottish doctor William Cullen in 1769 to refer to “disorders of sense and motion” caused by a “general affection of the nervous system.” Cullen used the term to describe various nervous disorders and symptoms that could not be explained physiologically. Physical features, however, were almost inevitably present, and physical diagnostic tests, such as exaggerated knee-jerks, loss of the gag reflex and dermatographia, were used into the 20th century. The meaning of the term was redefined by Carl Jung and Sigmund Freud over the early and middle 20th century, and has continued to be used in psychology and philosophy.

The DSM eliminated the neurosis category in 1980, because of a decision by its editors to provide descriptions of behaviour rather than descriptions of hidden psychological mechanisms. This change has been controversial. Likewise, according to the American Heritage Medical Dictionary, neurosis is “no longer used in psychiatric diagnosis.”

Symptoms and Causes

Neurosis may be defined simply as a “poor ability to adapt to one’s environment, an inability to change one’s life patterns, and the inability to develop a richer, more complex, more satisfying personality.” There are many different neuroses, including:

According to C. George Boeree, professor emeritus at Shippensburg University, the symptoms of neurosis may 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.

Jungian Theory

Carl Jung found his approach particularly effective for patients who are well adjusted by social standards but are troubled by existential questions. Jung claims to have “frequently seen people become neurotic when they content themselves with inadequate or wrong answers to the questions of life”. Accordingly, the majority of his patients “consisted not of believers but of those who had lost their faith”. Contemporary man, according to Jung,

…is blind to the fact that, with all his rationality and efficiency, he is possessed by ‘powers’ that are beyond his control. His gods and demons have not disappeared at all; they have merely got new names. They keep him on the run with restlessness, vague apprehensions, psychological complications, an insatiable need for pills, alcohol, tobacco, food — and, above all, a large array of neuroses.

Jung found that the unconscious finds expression primarily through an individual’s inferior psychological function, whether it is thinking, feeling, sensation, or intuition. The characteristic effects of a neurosis on the dominant and inferior functions are discussed in his Psychological Types. Jung also found collective neuroses in politics: “Our world is, so to speak, dissociated like a neurotic.”

Psychoanalytic Theory

According to psychoanalytic theory, neuroses may be rooted in ego defence mechanisms, though the two concepts are not synonymous. Defence mechanisms are a normal way of developing and maintaining a consistent sense of self (i.e. an ego). However, only those thoughts and behaviours that produce difficulties in one’s life should be called neuroses.

A neurotic person experiences emotional distress and unconscious conflict, which are manifested in various physical or mental illnesses; the definitive symptom being anxiety. Neurotic tendencies are common and may manifest themselves as acute or chronic anxiety, depression, an obsessive compulsive disorder, a phobia, or a personality disorder.

Horney’s Theory

In her final book, Neurosis and Human Growth, Karen Horney lays out a complete theory of the origin and dynamics of neurosis. In her theory, neurosis is a distorted way of looking at the world and at oneself, which is determined by compulsive needs rather than by a genuine interest in the world as it is. Horney proposes that neurosis is transmitted to a child from his or her early environment and that there are many ways in which this can occur:

When summarized, they all boil down to the fact that the people in the environment are too wrapped up in their own neuroses to be able to love the child, or even to conceive of him as the particular individual he is; their attitudes toward him are determined by their own neurotic needs and responses.

The child’s initial reality is then distorted by his or her parents’ needs and pretences. Growing up with neurotic caretakers, the child quickly becomes insecure and develops basic anxiety. To deal with this anxiety, the child’s imagination creates an idealised self-image:

Each person builds up his personal idealized image from the materials of his own special experiences, his earlier fantasies, his particular needs, and also his given faculties. If it were not for the personal character of the image, he would not attain a feeling of identity and unity. He idealizes, to begin with, his particular “solution” of his basic conflict: compliance becomes goodness, love, saintliness; aggressiveness becomes strength, leadership, heroism, omnipotence; aloofness becomes wisdom, self-sufficiency, independence. What—according to his particular solution—appear as shortcomings or flaws are always dimmed out or retouched.

Once he identifies himself with his idealised image, a number of effects follow. He will make claims on others and on life based on the prestige he feels entitled to because of his idealised self-image. He will impose a rigorous set of standards upon himself in order to try to measure up to that image. He will cultivate pride, and with that will come the vulnerabilities associated with pride that lacks any foundation. Finally, he will despise himself for all his limitations. Vicious circles will operate to strengthen all of these effects.

Eventually, as he grows to adulthood, a particular “solution” to all the inner conflicts and vulnerabilities will solidify. He will be either:

  • Expansive, displaying symptoms of narcissism, perfectionism, or vindictiveness;
  • Self-effacing and compulsively compliant, displaying symptoms of neediness or codependence; or
  • Resigned, displaying schizoid tendencies.

In Horney’s view, mild anxiety disorders and full-blown personality disorders all fall under her basic scheme of neurosis as variations in the degree of severity and in the individual dynamics. The opposite of neurosis is a condition Horney calls self-realisation, a state of being in which the person responds to the world with the full depth of his or her spontaneous feelings, rather than with anxiety-driven compulsion. Thus the person grows to actualize his or her inborn potentialities. Horney compares this process to an acorn that grows and becomes a tree: the acorn has had the potential for a tree inside it all along.