Historically, the term "neuroses" was used to describe a broad spectrum of mental disorders characterized by persistent emotional distress, anxiety, and a range of physical symptoms without an identifiable organic cause. However, modern diagnostic manuals like the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) and ICD-11 (International Classification of Diseases, 11th Revision) have largely replaced "neurosis" with more specific categories. This article uses the term "neurosis" for clarity and historical context, while primarily focusing on the contemporary understanding and classification of these conditions. These conditions are now understood and categorized differently, mainly within categories like anxiety disorders, obsessive-compulsive and related disorders, trauma- and stressor-related disorders, and somatic symptom and related disorders. These conditions are often characterized by maladaptive patterns of thinking and behavior that interfere with daily functioning. Neurotic symptoms can be classified based on their duration and intensity as primarily acute or chronic presentations.

Acute and Chronic Presentations: The Difference in Duration and Impact

Acute presentations are typically triggered by a sudden stressor or a traumatic event. Symptoms appear rapidly, manifesting as intense anxiety, panic attacks, sleep disturbances, and fluctuating moods. These symptoms, although distressing, are often temporary and may subside as the individual processes the stressor or after the situation has passed. Acute episodes are generally situational and can be managed with supportive care, brief psychotherapy, or stress-reduction strategies. While the body and mind may naturally recover from these short-lived episodes, it is important to address acute distress to prevent it from escalating.

In contrast, chronic presentations develop under the weight of long-term stressors such as ongoing interpersonal conflicts, persistent work pressure, or continuous exposure to adverse life conditions. Over time, the prolonged state of heightened anxiety can lead to significant maladaptation in social, occupational, and personal spheres. Chronic conditions are characterized by enduring symptoms that may include persistent anxiety, depression, fatigue, problems with concentration, and a general sense of helplessness. Unlike acute episodes, chronic presentations often require a more comprehensive therapeutic approach, incorporating long-term psychotherapy, lifestyle modifications, and sometimes pharmacological treatment to alleviate symptoms and restore quality of life.

Exploring the Varied Forms of Presentations

Within the broad spectrum of what was historically termed "neuroses," several distinct presentations are recognized, each with a unique set of symptoms and underlying mechanisms.

Historically Referred to as Neurasthenia: This term, less commonly used today in Western medicine, describes a condition marked by profound mental and physical exhaustion, irritability, and reduced emotional resilience. Individuals may experience headaches, a racing heart, gastrointestinal discomfort, and sleep disturbances. The symptoms often align with those seen in chronic fatigue syndrome, major depressive disorder, or generalized anxiety disorder.

Conversion Disorder (Functional Neurological Symptom Disorder): This condition involves the appearance of neurological symptoms—such as sudden loss of motor function, speech difficulties, or sensory impairments—without any identifiable medical cause. It is crucial to understand that the symptoms are real and involuntary, not feigned or malingered. The symptoms emerge as psychological distress is unconsciously converted into physical manifestations. Conversion disorder highlights the complex interplay between emotional turmoil and bodily functions.

Obsessive-Compulsive Disorder (OCD): OCD involves relentless anxiety accompanied by intrusive thoughts, images, or urges (obsessions) and repetitive behaviors or mental acts (compulsions) performed to reduce the anxiety caused by the obsessions. The persistent need to perform these actions or mental routines can severely disrupt daily activities.

Somatic Symptom and Related Disorders: This group of conditions includes "Illness Anxiety Disorder" (preoccupation with having or acquiring a serious illness) and "Somatic Symptom Disorder" (disproportionate thoughts, feelings, and behaviors related to somatic symptoms). Individuals experience genuine physical symptoms—such as pain, fatigue, or gastrointestinal distress—without any underlying organic pathology. The absence of an identifiable medical cause does not diminish the distress; rather, it underscores the influence of psychological factors on physical health.

Autonomic Dysfunction in Anxiety and Somatic Symptom Disorders: The symptoms previously described as "Vegetative Neurotic Disorder" or "Vegeto-Vascular Dystonia" are now understood as manifestations of anxiety disorders, panic disorder, or somatic symptom disorders. Dysregulation of the autonomic nervous system can present with two distinct symptom patterns. One pattern involves an overactive sympathetic nervous system, resulting in symptoms such as increased heart rate, elevated blood pressure, and rapid breathing. In contrast, a predominance of the parasympathetic nervous system can result in a slower heart rate, lower blood pressure, and increased gastrointestinal activity.

Adjustment Disorder with Anxious Mood: Noogenic neurosis, related to existential concerns. In this type, the individual grapples with profound questions about the meaning of life, personal values, and inner conflicts.The existential angst experienced often results in a pervasive sense of emptiness and demotivation.

Social Anxiety Disorder: Previously some symptoms were classified as "Neurogenic bladder syndrome", and centeres on an intense fear related to bodily functions—in this case, the act of urination in public spaces. This anxiety can lead to avoidance of social situations and contribute to a feeling of isolation.

Irritable Bowel Syndrome (IBS): IBS is a functional gastrointestinal disorder. Stress and anxiety are *contributing factors*, exacerbating symptoms, but it's not solely or primarily caused by psychological factors alone. It's a complex condition with biological, psychological, and social influences.

Cardiac Anxiety: This Condition would meet some criteria for a few diagnoses. The symptom presentation would be categorized under Panic Disorder, Somatic Symptom Disorder, or Illness Anxiety Disorder. Those affected may experience chest pain, palpitations, and a sensation that their heart is "freezing" during moments of stress. Although these symptoms are not indicative of an actual heart condition, the fear can be overwhelming.

Sexual Dysfunction: While not categorized under one specific neurosis, it is vital to recognize that disruptions in sexual function can be related to psychological issues. Sexual dysfunctions can occur in individuals, but should be assessed and treated on an individual level.

Alcohol-Induced or Alcohol-Related Conditions: The symptoms previously attributed to "alcoholic neurosis" are better understood as consequences of alcohol use disorder (AUD) and co-occurring mental health conditions (like anxiety or depression). Individuals may experience insomnia, chronic fatigue, irritability, and depressive moods. Addressing these issues requires a multifaceted approach targeting both the substance use and the underlying psychological factors.

The Importance of Diagnosis and Tailored Treatment

Identifying the specific disorder and/or combination of symptoms is essential for determining the most effective treatment plan. Mental health professionals—such as psychologists, psychiatrists, and licensed therapists—use a combination of clinical interviews, symptom assessments, and sometimes standardized diagnostic tools (e.g., SCID-5, MINI, Beck Anxiety Inventory) to identify the precise nature of the condition. This careful assessment helps in formulating a treatment strategy that may include cognitive-behavioral therapy (CBT), exposure and response prevention (ERP) for OCD, acceptance and commitment therapy (ACT), mindfulness-based therapies, and, where necessary, pharmacotherapy (e.g., SSRIs, SNRIs, benzodiazepines for short-term use). It is crucial for individuals experiencing persistent symptoms to seek professional guidance.

Practical Recommendations for Managing Symptoms

In addition to professional treatment, self-help strategies can support recovery. Regular practice of relaxation techniques, such as deep breathing, meditation, or yoga, can help reduce physiological symptoms. Maintaining a healthy lifestyle—including a balanced diet, adequate sleep, and regular physical exercise—plays a significant role in stabilizing mood. Social support is equally important; nurturing relationships can provide emotional validation and a sense of belonging. Learning to manage stress through these proactive measures can complement formal therapeutic interventions and promote long-term well-being.

Conclusion

What was historically termed "neuroses" represents a complex interplay between our minds and bodies. These conditions, now understood through more specific diagnostic categories, can significantly disrupt daily life and emotional well-being. Understanding the various presentations—from the fatigue and exhaustion often associated with what was called neurasthenia, the intrusive thoughts and compulsions of OCD, to the unsettling physical sensations of cardiac anxiety—provides valuable insights. Each presentation has its own set of causes, symptoms, and treatment challenges, underscoring the importance of individualized diagnosis and tailored therapeutic approaches. Combining evidence-based treatments with healthy lifestyle changes and self-care practices can pave the way for a more balanced and fulfilling life. Addressing these conditions is about reclaiming control over your mental health, understanding the root causes of distress, and taking proactive steps toward recovery.

References

• American Psychiatric Association. (2013). *Diagnostic and statistical manual of mental disorders* (5th ed.).
  This manual provides the current diagnostic criteria for mental disorders, including anxiety disorders, obsessive-compulsive and related disorders, trauma- and stressor-related disorders, somatic symptom and related disorders, and dissociative disorders, which have replaced the older concept of "neurosis." (Relevant sections throughout the manual, particularly the sections on the disorders mentioned above).
• Andrews, G., Crino, R., Hunt, C., Lampe, L., & Page, A. (2003). *The Treatment of Anxiety Disorders: Clinician Guides and Patient Manuals*. Cambridge University Press.
  This book provides detailed, evidence-based information on the treatment of various anxiety disorders, which represent a significant portion of what was previously classified as neuroses. It covers cognitive-behavioral therapy (CBT) approaches, exposure therapy, and other relevant interventions.(Pages related to specific disorders, e.g., Panic Disorder, Generalized Anxiety Disorder, Social Anxiety Disorder, approximately pages 50-200).
• Starcevic, V., & Berle, D. (2013). *Towards Reconceptualising the Somatoform Disorders*. Current opinion in psychiatry, 26(1), 57–62.
  This article provides comprehensive and practical guidance on the assessment and cognitive behavioral treatment of the five main anxiety disorders (panic disorder with or without agoraphobia, social phobia, generalized anxiety disorder, obsessive compulsive disorder, and post-traumatic stress disorder). The book outlines a step-by-step treatment approach based on the latest evidence. (Pages related to conceptualizing disorders, approximately pages 57-62).
• Kring, A. M., Johnson, S. L., Davison, G. C., & Neale, J. M. (2015). Abnormal psychology (13th ed). Wiley.
  This textbook offers a broad overview of abnormal psychology, including detailed discussions of anxiety disorders, mood disorders, somatic symptom disorders, and other conditions that were previously encompassed by the term "neurosis." It integrates current research, diagnostic criteria, and treatment approaches. (Chapters on anxiety disorders, mood disorders, and somatic symptom disorders, approximately pages 150-300).