June 17th, 2019
You may often hear the term, “neurotic,” thrown around in casual conversations, perhaps labeling a friend or foe. But what does the declaration really mean? What was once considered a broad category of conditions associated with poor functioning, anxiety, and depression, is now a generalization of high strung, tense, or moody individuals. So wherein lies the truth?
The textbook definition of “neurotic” states, “suffering from, caused by, or relating to neurosis.” According to the Merriam-Webster dictionary, neurosis is “a mental and emotional disorder that affects only part of the personality, is accompanied by a less distorted perception of reality than psychosis, does not result in disturbance of the use of language, and is accompanied by various physical, physiological, and mental disturbances.”
Aside from the dictionary descriptions outlined above, there is no single “neurotic definition.” Some psychologists and psychiatrists use the term to describe a spectrum of mental illnesses outside of psychotic disorders. Other doctors use the term to refer to anxious symptoms and behaviors. Dr. William Cullen coined the term in the 18th century as a concept that encompasses nervous disorders and symptoms that do not have a clear cause. Following Cullen, Sigmund Freud used the term, “anxiety neurosis” to describe mental illness or distress with extreme anxiety as a defining feature.
In general, “neurosis” is no longer used as a diagnostic category by American psychologists and psychiatrists, and was removed from the American Psychiatric Association’s Diagnostic and Statistic Manual of Mental Disorders’ third edition in 1980 (last appearing as a diagnostic category in DSM-II).
Some physicians hope the term “makes a comeback” and carries less negative connotation. The term “neurotic” can present in various ways and we will outline how the term is still used and how it can be helpful in framing human difficulties and suffering.
The most important thing to distinguish when using the term "neurotic" is to know whether it’s referring to personality traits or character adaptations.
Personality traits are longstanding patterns of thoughts, feelings, and actions which tend to stabilize in adulthood and remain relatively fixed.
There are five broad trait domains, one of which is labeled “neuroticism,” and it generally corresponds to the sensitivity of the negative affect system, where a person high in neuroticism is someone who worries, easily upsets, is often down or irritable, and demonstrates high emotional reactivity to stress.
In contrast, traits are broad descriptions of tendencies, and character adaptations are the situation- specific ways people adjust to the environment. Here the term neurotic refers to maladaptive coping strategies driven by fear or anxiety (which can be conscious or subconscious) elicited by a certain kind of situation. Maladaptive, meaning the response ultimately moves the individual away from their long-term goals and needs.
A good example of this would be a person who gets upset if their date is even 10 minutes late, and riddled with anxious-dependency, they reach out for assurance in a panicked manner, demanding when the date will be arriving, asking if they are cancelling. The date may respond that they will be right there, easing the short-term anxiety, but the behavior of the anxious party provokes an opposite long-term effect – and the date has likely labeled the person as needy and dependent. The date would probably avoid that person in the future, which was the fear of the frantic person from the beginning.
The importance of understanding the definition of neurotic in terms of character adaptations is that we are all neurotic some of the time, even if our neuroticism trait is low (the other four being extraversion, agreeability, conscientiousness, and openness). It is crucial to understand that we all experience neurotic insecurities that we are equipped with strategies to cope with them.
Neurotic patterns can be observed in five different domains of adaptation: Habits, Emotions, Relations, Defenses, and Beliefs (verbal cognitions).
Neurotic habits are automatic or routine patterns of behavior that people engage in to alleviate anxiety and provide a sense of security. The problem is that, carried out over the long term, the habitual patterns are maladaptive. A classic example is one of the anxious drinker. Stressed all day, riddled with achievement and interpersonal anxieties, alcohol becomes a short-term, medicating “fix.” Unfortunately, it comes with significant costs and health issues over time. Binging and purging, obsessive compulsive behaviors, nail biting and/or trichotillomania are all common examples of neurotic, maladaptive habits.
Neurotic emotional patterns come in two forms, over-regulated (suppressed and not expressed) and under-regulated (hyper-sensitized and over-expressed). Feeling states are rarely bad, however, they can become hyperactive and triggered at the slightest stimuli, overpowering the mind. Individuals with depressive or anxious disorders are generally under-regulated in those feeling states and need help managing them. The problem is that the individual is usually walled off from some or all their emotions. Some common examples are the “nice guy” who is “never angry,” the competitor who bullies others instead of feeling shame, and/or the distanced and unemotional person who can’t feel anything. These individuals usually have a form of “affect phobia,” which is maladaptive because it blocks them from key aspects of the human experience.
The human relationship system is fundamentally guided by desires for relational value, driven by the dimensions of power, love, and freedom. Neurotic relationship patterns emerge when people adopt rigid styles or express extreme interpersonal reactions in response to fears that their relational value needs won’t be met. Individuals who withdraw because of social anxiety, who hunt for signs of betrayal, and/or who waver between dependency and control, all engage in neurotic relational patterns. In doing so, they attempt to manage their needs for relational value, but are navigating it in a way that ultimately produces conflict or pushes others away, leaving needs unmet.
We manage tension between conflicting goals and filter things out of our full consciousness through our defenses. The defensive system tries to bring harmony to the various other systems of adaptation, but sometimes does so at significant costs. Two very common defenses are repression and rationalization. Repression is when material is blocked out of self-conscious recognition. For example, someone who makes up reasons that hide their true feelings or an “ego-defensive” person who processes through rationalization. Research on cognitive dissonance offers some compelling examples of how these processes lead to maladaptive patterns.
Finally, our verbal beliefs are networked into systems of justification that provide us with theories about ourselves in the world. Cognitive psychotherapy became widespread because it helped individuals realize that maladaptive interpretations or beliefs about how the world should be were the root of their suffering.
For example, many people have core beliefs that they are unlovable, and in vulnerable periods, they interpret setbacks as confirmation of such beliefs. Others have rigid beliefs about how the world must be if they are to function (e.g., the belief that everyone must like them). Others make catastrophic interpretations of minor events. The problem is that these beliefs legitimize actions, feeling states, or perceptions of self or others that lead to a crowd of maladaptive patterns. Cognitive psychotherapy is effective because it teaches folks to catch, check, and change maladaptive beliefs into more adaptive narratives.
As we have outlined above, the definition of neurotic is not fixed, and the neurotic person definition is not easily identifiable. If you’d like to explore the topic further, or have any questions, please reach out to one of our clinicians at 312-754-9404.
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