Neurotic Disorders 

Neuropsychiatry is a field in psychology that studies the relationships between behavior and the brain’s function. This specialty focuses on behavioral and cognitive conditions that can be traced to brain malfunction. The commonality among neuropsychiatric disorder diagnoses is a combination of problems with brain function, and include a range of minor psychiatric conditions called neurotic disorders. These mental disorders might include anger, anxiety, self-consciousness, irritability, emotional instability and depression.

Antisocial personality disorder (APD), posttraumatic stress disorder (PTSD), phobias and obsessive-compulsive disorder (OCD) are examples of neuroses, and the accompanying mental health challenges result in involuntary thoughts, actions, emotions and reactions that are beyond the individual’s ability to self-regulate. 

Personality disorders represent “an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture” per the Diagnostic and Statistical Manual on Mental Disorders, Fifth Edition (DSM-5). These mental health conditions affect how one thinks, feels, perceives or relates to others. An antisocial personality disorder diagnosis displays as reckless, deceitful and manipulative behavior, with little care for another’s feelings. This disorder ranges in severity, and is more common in men than women. 

Post-traumatic stress disorder (PTSD) is a disorder that develops in some people who have experienced a shocking, scary or dangerous event. It is natural to feel afraid during and after a traumatic situation. Fear is a part of the body’s “fight-or-flight” response, which helps us avoid or respond to potential danger. People may experience a range of reactions after trauma, and most people recover from initial symptoms over time. Those who continue to experience problems may be diagnosed with PTSD.

Obsessive-compulsive disorder (OCD) is a common, chronic and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts ("obsessions") and/or behaviors ("compulsions") that he or she feels the urge to repeat over and over.

This group of diseases result from a disruption in the hormones, vitamins, metabolism of neurotransmitters, and biologically active chemicals required for the central nervous system to function properly. This is often a result of insufficient rest and overwork.

The cause of antisocial personality disorder (APD) is not known, though links to genetic and environmental factors may play a role. Those who have been victims of child abuse are often at higher risk of developing this condition, including children of antisocial or alcoholic parents. 

Anyone can develop post-traumatic stress disorder (PTSD) at any age. This includes combat veterans and people who have experienced or witnessed a physical or sexual assault, abuse, an accident, a disaster or other serious events. People who have PTSD may feel stressed or frightened, even when they are not in danger.

Not everyone with PTSD has been through a dangerous event. Sometimes, learning that a friend or family member experienced trauma can cause PTSD. Women are more likely to develop PTSD than men. Certain aspects of the traumatic event and some biological factors (such as genes) may make some people more likely to develop PTSD.

Obsessive-compulsive disorder (OCD) is a common disorder that affects adults, adolescents and children all over the world. Most people are diagnosed by about age 19, typically with an earlier age of onset in boys than in girls, but onset after age 35 does happen. The causes of OCD are unknown, but risk factors include genetics, brain structure and functioning, and environment.

Patients suffering from neuroses are frequently exposed to high-stress factors in childhood and adolescence. Risk factors are similar to risks of developing anxiety, including:

• Genetic history of neuroses
• Environmental factors
• Shyness or feeling distressed or nervous in new situations in childhood
• Exposure to stressful and negative life or environmental events
• A history of anxiety or other mental disorders in biological relatives

Those at higher risk for developing antisocial personality disorder (APD) are those with genetic predisposition and/or traumatic childhood events, including abuse and neglect, alcoholic parents, parental conflict, and overly harsh and inconsistent parenting. 

Not everyone who lives through a dangerous event develops post-traumatic stress disorder (PTSD)—many factors play a part. Some of these factors are present before the trauma, while others become important during and after a traumatic event.

Risk factors that may increase the likelihood of developing PTSD include:

• Being exposed to previous traumatic experiences, particularly during childhood
• Getting hurt or seeing people hurt or killed
• Feeling horror, helplessness or extreme fear
• Having little or no social support after the event
• Dealing with extra stress after the event, such as loss of a loved one, pain and injury, or loss of a job or home
• Having a personal or family history of mental illness or substance use

Resilience factors that may reduce the likelihood of developing PTSD include:

• Seeking out support from friends, family or support groups
• Learning to feel okay with one’s actions in response to a traumatic event
• Having a coping strategy for getting through and learning from the traumatic event
• Being prepared and able to respond to upsetting events as they occur, despite feeling fear

Obsessive-compulsive disorder (OCD) is a common disorder that affects adults, adolescents and children all over the world. Most people are diagnosed by about age 19, typically with an earlier age of onset in boys than in girls, but onset after age 35 does happen. The causes of OCD are unknown, but risk factors include genetics, brain structure and functioning, and environment. 

Twin and family studies have shown that people with first-degree relatives (such as a parent, sibling or child) who have OCD are at a higher risk for developing OCD themselves. The risk is higher if the first-degree relative developed OCD as a child or teen. Ongoing research continues to explore the connection between genetics and OCD and may help improve OCD diagnosis and treatment.

Imaging studies have shown differences in the frontal cortex and subcortical structures of the brain in patients with OCD. There appears to be a connection between the OCD symptoms and abnormalities in certain areas of the brain, but that connection is not clear. Research is still underway. Understanding the causes will help determine specific, personalized treatments to treat OCD.

An association between childhood trauma and obsessive-compulsive symptoms has been reported in some studies. More research is needed to understand this relationship better. In some cases, children may develop OCD or OCD symptoms following a streptococcal infection—this is called pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). 

Medical professionals can conduct personality tests that can reveal low, medium or high scores for neuroses. Those with lower scores can manage stress more effectively than those with high scores. Prevention measures include identifying personal triggers and learning coping tools and healthy ways to manage daily stress.

Individuals with an antisocial personality disorder (APD) typically have a history of conduct, and diagnosis involves a rigorous psychological assessment for those 18 and older. Criteria for behavior red flags include the following, which may become more extreme over time: 

• Lack of remorse for bad behavior
• Consistently irresponsible
• Reckless, with little to no regard for their safety or the safety of others
• Impulsive and aggressive behavior
• Multiple incidents of breaking the law
• Being deceitful

People with obsessive-compulsive disorder (OCD) may try to help themselves by avoiding situations that trigger their obsessions. Although most adults with OCD recognize that what they are doing doesn’t make sense, some adults and most children may not realize that their behavior is out of the ordinary. Parents or teachers typically recognize OCD symptoms in children.

Most people are diagnosed by about age 19, typically with an earlier age of onset in boys than in girls, but onset after age 35 does happen. If you think you have OCD, talk to your healthcare provider about your symptoms. If left untreated, OCD can interfere in all aspects of life.

It is important for anyone with post-traumatic stress disorder (PTSD) symptoms to work with a mental health professional who has experience treating PTSD. If you think you may have symptoms of PTSD and you are not sure where to get help, a healthcare provider can refer you to a licensed mental health professional, such as a psychiatrist or psychologist with experience treating PTSD.

Symptoms of neurotic disorders are similar to those of anxiety. Behavior of those with neurotic disorder are extreme to the extent that one’s personal, professional and romantic lives are affected negatively. Those with neuroses fixate fears and negativity, and behave obsessively in an attempt to control the outcome of situations beyond your control. Neurotic personalities struggle with their response to stressors, and everyday situations make them feel overly irritated, angry, sad, guilty, worried, hostile, self-conscious or frightened. 

Other symptoms include: 

• Negative reactions and emotions
• Anger, irritability and depression
• Anxiety and over-worrying
• Excessive feelings of guilt and worry
• Self-conscious behavior and low self-esteem
• Inability to handle stressful situations
• Feeling threatened in normal situations

Those with antisocial personality disorder (APD) typically have a history of behavioral issues in childhood, such as aggression, substance misuse, criminal behavior and truancy. Symptoms of APD include:

• Breaking the law repeatedly
• Showing no remorse for hurting or putting others safety at risk
• Often angry or arrogant, lacking guilt or remorse
• Ability to act witty and charming, often seen as “charismatic”
• Good at manipulating others’ emotions, particularly through flattery
• Problems with substance abuse
• Frequent lying, stealing and fighting 
• Blaming others for problems in their lives

People with obsessive-compulsive disorders (OCD) may have symptoms of obsessions, compulsions or both. These symptoms can interfere with all aspects of life, such as work, school and personal relationships.

Obsessions are repeated thoughts, urges or mental images that cause anxiety. Common symptoms include:

• Fear of germs or contamination
• Unwanted forbidden or taboo thoughts involving sex, religion or harm
• Aggressive thoughts toward others or self
• Having things symmetrical or in a perfect order

Compulsions are repetitive behaviors that a person with OCD feels the urge to do in response to an obsessive thought. Common compulsions include:

• Excessive cleaning and/or handwashing
• Ordering and arranging things in a particular, precise way
• Repeatedly checking on things, such as repeatedly checking to see if the door is locked or that the oven is off
• Compulsive counting

Not all rituals or habits are compulsions. Everyone double checks things sometimes. But a person with OCD generally:

• Can’t control his or her thoughts or behaviors, even when those thoughts or behaviors are recognized as excessive
• Spends at least one hour a day on these thoughts or behaviors
• Doesn’t get pleasure when performing the behaviors or rituals, but may feel brief relief from the anxiety the thoughts cause
• Experiences significant problems in their daily life due to these thoughts or behaviors

Some individuals with OCD also have a tic disorder. Motor tics are sudden, brief, repetitive movements, such as eye blinking and other eye movements, facial grimacing, shoulder shrugging, and head or shoulder jerking. Common vocal tics include repetitive throat-clearing, sniffing or grunting sounds.

Symptoms may come and go, ease over time, or worsen. People with OCD may try to help themselves by avoiding situations that trigger their obsessions, or they may use alcohol or drugs to calm themselves. Although most adults with OCD recognize that what they are doing doesn’t make sense, some adults and most children may not realize that their behavior is out of the ordinary. Parents or teachers typically recognize OCD symptoms in children.

If you think you have OCD, talk to your health care provider about your symptoms. If left untreated, OCD can interfere in all aspects of life.

Symptoms of post-traumatic stress disorder (PTSD) usually begin within three months of the traumatic event, but they sometimes emerge later. To meet the criteria for PTSD, a person must have symptoms for longer than one month, and the symptoms must be severe enough to interfere with aspects of daily life, such as relationships or work. The symptoms also must be unrelated to medication, substance use or other illness.

The course of the disorder varies. Some people recover within six months, while others have symptoms that last for one year or longer. People with PTSD often have co-occurring conditions, such as depression, substance use, or one or more anxiety disorders.

After a dangerous event, it is natural to have some symptoms. For example, some people may feel detached from the experience, as though they are observing things rather than experiencing them. A mental health professional who has experience helping people with PTSD, such as a psychiatrist, psychologist or clinical social worker, can determine whether symptoms meet the criteria for PTSD.

To be diagnosed with PTSD, an adult must have all of the following for at least one month:

• At least one re-experiencing symptom
• At least one avoidance symptom
• At least two arousal and reactivity symptoms
• At least two cognition and mood symptoms

Re-experiencing symptoms include:

• Experiencing flashbacks—reliving the traumatic event, including physical symptoms such as a racing heart or sweating
• Having recurring memories or dreams related to the event
• Having distressing thoughts
• Experiencing physical signs of stress

Thoughts and feelings can trigger these symptoms, as can words, objects or situations that are reminders of the event. Avoidance symptoms include:

• Staying away from places, events or objects that are reminders of the traumatic experience
• Avoiding thoughts or feelings related to the traumatic event

Avoidance symptoms may cause people to change their routines. For example, some people may avoid driving or riding in a car after a serious car accident. Arousal and reactivity symptoms include:

• Being easily startled
• Feeling tense, on guard or on edge
• Having difficulty concentrating
• Having difficulty falling asleep or staying asleep
• Feeling irritable and having angry or aggressive outbursts
• Engaging in risky, reckless or destructive behavior

Arousal symptoms are often constant. They can lead to feelings of stress and anger and may interfere with parts of daily life, such as sleeping, eating or concentrating.

Cognition and mood symptoms include:

• Having trouble remembering key features of the traumatic event
• Having negative thoughts about oneself or the world
• Having exaggerated feelings of blame directed toward oneself or others
• Having ongoing negative emotions, such as fear, anger, guilt or shame
• Losing interest in enjoyable activities
• Having feelings of social isolation
• Having difficulty feeling positive emotions, such as happiness or satisfaction

Cognition and mood symptoms can begin or worsen after the traumatic event. They can lead a person to feel detached from friends or family members.

Children and teens can have extreme reactions to trauma, but some of their symptoms may not be the same as those seen in adults. In children younger than age six, these symptoms can include:

• Wetting the bed after having learned to use the toilet
• Forgetting how to talk or being unable to talk
• Acting out the scary event during playtime
• Being unusually clingy with a parent or other adult

Older children and teens usually show symptoms more like those seen in adults. They also may develop disruptive, disrespectful or destructive behaviors. Older children and teens may feel guilty for not preventing injury or deaths. They may also have thoughts of revenge.

Doctors and medical professionals conduct a physical exam and request lab work to determine symptoms and their causes. You may be diagnosed with a mental health disorder if the behaviors are causing extreme life challenges and relationship issues.

Additionally, personality tests may be conducted. Scores may result in low, medium or high probability for neuroticism. Low scores indicate more emotional security allowing an individual to handle stress more successfully than those with high scores.

Work with your team of medical professionals to manage your anxiety and stress levels to help control the symptoms and behaviors associated with neuroses. Experts also suggest a healthy lifestyle, with a healthy diet, a good night’s sleep and plenty of exercise.

Treatment for neuroses like antisocial personality disorder (APD) can be difficult to plan, as most individuals with symptoms for this condition don’t readily seek help. Some studies show that talk therapy, like cognitive behavioral therapy (CBT) or democratic therapeutic communities (DTC) can be effective, as can treating co-occurring disorders like depression, ADHD and PTSD. Children with early signs of APD may respond to behavior correction using a reward system for appropriate behavior and negative consequences for troublesome behavior. 

OCD is typically treated with medication, psychotherapy or a combination of the two. Although most patients with OCD respond to treatment, some patients continue to experience symptoms.

Sometimes people with OCD also have other mental disorders, such as anxiety, depression and body dysmorphic disorder, a disorder in which someone mistakenly believes that a part of their body is abnormal. It is important to consider these other disorders when making decisions about treatment.

Serotonin reuptake inhibitors (SRIs), which include selective serotonin reuptake inhibitors (SSRIs), are used to help reduce OCD symptoms. SRIs often require higher daily doses in the treatment of OCD than of depression and may take eight to 12 weeks to start working, but some patients experience more rapid improvement.

If symptoms do not improve with these types of medications, research shows that some patients may respond well to an antipsychotic medication. Although research shows that an antipsychotic medication may help manage symptoms for people who have both OCD and a tic disorder, research on the effectiveness of antipsychotics to treat OCD is mixed.

If you are prescribed a medication, be sure you:

• Talk with your healthcare provider or a pharmacist to make sure you understand the risks and benefits of the medications you’re taking.
• Do not stop taking medication without talking to your healthcare provider first. Suddenly stopping a medication may lead to "rebound" or worsening of OCD symptoms. Other uncomfortable or potentially dangerous withdrawal effects are also possible.
• Report any concerns about side effects to your healthcare provider right away. You may need a change in the dose or a different medication.
• Report serious side effects to the U.S. Food and Drug Administration (FDA) MedWatch Adverse Event Reporting program online or by phone at 1-800-332-1088. You or your healthcare provider may send a report.

Other medications have been used to treat OCD, but more research is needed to show the benefit of these options. For basic information about these medications, you can visit the NIMH Mental Health Medications webpage. For the most up-to-date information on medications, side effects, and warnings, visit the FDA website.

Psychotherapy can be an effective treatment for adults and children with OCD. Research shows that certain types of psychotherapy, including cognitive behavior therapy (CBT) and other related therapies (e.g., habit reversal training) can be as effective as medication for many individuals. Research also shows that a type of CBT called exposure and response prevention (EX/RP)—spending time in the very situation that triggers compulsions (e.g., touching dirty objects) but then being prevented from undertaking the usual resulting compulsion (e.g., handwashing)—is effective in reducing compulsive behaviors in OCD, even in people who did not respond well to SRI medication.

As with most mental disorders, treatment is usually personalized and might begin with either medication or psychotherapy, or with a combination of both. For many patients, EX/RP is the add-on treatment of choice when SRIs or SSRIs do not effectively treat OCD symptoms or vice versa for individuals who begin treatment with psychotherapy.

In 2018, the FDA approved transcranial magnetic stimulation (TMS) as an adjunct in the treatment of OCD in adults.

It is important for anyone with post-traumatic stress disorder (PTSD) symptoms to work with a mental health professional who has experience treating PTSD. The main treatments are psychotherapy, medications or a combination of psychotherapy and medications. A mental health professional can help people find the best treatment plan for their symptoms and needs.

Some people with PTSD, such as those in abusive relationships, may be living through ongoing trauma. In these cases, treatment is usually most effective when it addresses both the traumatic situation and the symptoms of PTSD. People who experience traumatic events or who have PTSD also may experience panic disorder, depression, substance use or suicidal thoughts. Treatment for these conditions can help with recovery after trauma. Research shows that support from family and friends also can be an important part of recovery.

Psychotherapy (sometimes called talk therapy) includes a variety of treatment techniques that mental health professionals use to help people identify and change troubling emotions, thoughts and behaviors. Psychotherapy can provide support, education and guidance to people with PTSD and their families. Treatment can take place one-on-one or in a group and usually lasts six to 12 weeks but can last longer.

Some types of psychotherapy target PTSD symptoms, while others focus on social, family or job-related problems. Effective psychotherapies often emphasize a few key components, including learning skills to help identify triggers and manage symptoms.

One common type of psychotherapy, called cognitive behavioral therapy (CBT), can include exposure therapy and cognitive restructuring:

• Exposure therapy helps people learn to manage their fear by gradually exposing them, in a safe way, to the trauma they experienced. As part of exposure therapy, people may think or write about the trauma or visit the place where it happened. This therapy can help people with PTSD reduce symptoms that cause them distress.
• Cognitive restructuring helps people make sense of the traumatic event. Sometimes people remember the event differently from how it happened. They may feel guilt or shame about something that is not their fault. Cognitive restructuring can help people with PTSD think about what happened in a realistic way.

The U.S. Food and Drug Administration (FDA) has approved two selective serotonin reuptake inhibitors (SSRIs), a type of antidepressant medication, for the treatment of PTSD. SSRIs may help manage PTSD symptoms such as sadness, worry, anger and feeling emotionally numb. Healthcare providers may prescribe SSRIs and other medications along with psychotherapy. Some medications may help treat specific PTSD symptoms, such as sleep problems and nightmares. People should work with their healthcare providers to find the best medication or combination of medications and the right dose. Here are some things you can do to help yourself while in treatment:

• Talk with your healthcare provider about treatment options and follow your treatment plan.
• Engage in exercise, mindfulness or other activities that help reduce stress.
• Try to maintain routines for meals, exercise and sleep.
• Set realistic goals and focus on what you can manage.
• Spend time with trusted friends or relatives and tell them about things that may trigger symptoms.
• Expect your symptoms to improve gradually, not immediately.
• Avoid the use of alcohol or drugs.

If you know someone who may be experiencing PTSD, the most important thing you can do is to help that person get the right diagnosis and treatment. Some people may need help making an appointment with their healthcare provider; others may benefit from having someone accompany them to their healthcare visits.

If a close friend or relative is diagnosed with PTSD, you can encourage them to follow their treatment plan. If their symptoms do not get better after six to eight weeks, you can encourage them to talk to their healthcare provider. You also can:

• Offer emotional support, understanding, patience and encouragement.
• Learn about PTSD so you can understand what your friend is experiencing.
• Listen carefully. Pay attention to the person’s feelings and the situations that may trigger PTSD symptoms.
• Share positive distractions, such as walks, outings and other activities.

The National Institute of Mental Health (NIMH) is supporting research into other new treatment approaches for people whose OCD does not respond well to the usual therapies. These new approaches include combination and add-on (augmentation) treatments, as well as novel techniques such as deep brain stimulation. You can learn more about brain stimulation therapies on the NIMH website.

For general information on mental health and to locate treatment services in your area, call the Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment Referral Helpline at 1-800-662-HELP (4357). SAMHSA also has a Behavioral Health Treatment Locator on its website that can be searched by location. You can also visit the NIMH’s Help for Mental Illnesses page for more information and resources.

Work with your team of medical professionals to manage your anxiety and stress levels to help control the symptoms and behaviors associated with neuroses. Experts also suggest a healthy lifestyle, with a healthy diet, a good night’s sleep and plenty of exercise.

Consider participating in a clinical trial so clinicians and scientists can learn more about your diagnosis and related disorders. Clinical research uses human volunteers to help researchers learn more about a disorder and perhaps find better ways to safely detect, treat or prevent disease.

All types of volunteers are needed—those who are healthy or may have an illness or disease—of all different ages, sexes, races and ethnicities to ensure that study results apply to as many people as possible, and that treatments will be safe and effective for everyone who will use them.

Work with your team of medical professionals to manage your anxiety and stress levels to help control the symptoms and behaviors associated with neuroses. Experts also suggest a healthy lifestyle, with a healthy diet, a good night’s sleep and plenty of exercise.

Consider participating in a clinical trial so clinicians and scientists can learn more about your diagnosis and related disorders. Clinical research uses human volunteers to help researchers learn more about a disorder and perhaps find better ways to safely detect, treat or prevent disease.

All types of volunteers are needed—those who are healthy or may have an illness or disease—of all different ages, sexes, races and ethnicities to ensure that study results apply to as many people as possible, and that treatments will be safe and effective for everyone who will use them.