Lesson 9: Neurotic Mental Disorders

Nuerosis

• A mild mental disorder without hallucinations or delusions.

• Includes chronic depression and emotional distress.

• Covers a range of problems such as anxiety, phobias, and obsessive-compulsive disorder (OCD).

• Involves inner conflicts, mental and physical disturbances.

Difference Between Neurosis and Psychosis

• Neurosis:

  • Mild and functional disorder.

  • No loss of contact with reality.

  • Characterized by anxiety, tension, and emotional struggles.

• Psychosis:

  • Severe mental disorder with loss of contact with reality.

  • Involves hallucinations, delusions, and social maladaptation.

  • Affects emotional and mental stability.

Stress

• A response to external pressure or demands.

• Triggered by a specific situation (e.g., exams, deadlines, financial problems).

• Usually temporary and goes away once the situation is resolved.

• Can be positive (eustress) or negative (distress).

• Physical symptoms: headache, muscle tension, fatigue.

• Emotional symptoms: irritability, frustration, difficulty concentrating.

• Managed through rest, relaxation, time management, and coping strategies.

Anxiety

• A persistent feeling of worry or fear even without a clear cause.

• Internal reaction — comes from within, not necessarily tied to a specific event.

• Lingers even after the stressor is gone.

• Can become an anxiety disorder if excessive and long-term.

• Physical symptoms: rapid heartbeat, sweating, trembling, dizziness.

• Mental symptoms: excessive worrying, fear of the worst, inability to relax.

• Managed through therapy, breathing exercises, or medication.

Anxiety Disorders

• Defined as vague, unpleasant feelings of fear and apprehension.

• Symptoms include:

  • Rapid heartbeat, shortness of breath, dizziness, sweating

  • Sleeplessness, trembling, headaches

  • Restlessness, irritability, nausea, muscle tension

• Can interfere with daily functioning.

• Normal: appropriate to a situation.

• Neurotic: excessive and disproportionate to actual danger.

Separation Anxiety Disorder

• Common in young children but can persist into teens or adulthood.

• Symptoms:

  • Intense distress when away from loved ones

  • Fear of losing loved ones or being kidnapped

  • Refusal to leave home or sleep away

  • Physical complaints (headache, stomachache) when anticipating separation

• Causes:

  • Life stresses, trauma, loss, or overprotective parenting

  • Genetic and environmental factors

• Treatment:

  • Psychotherapy (especially CBT)

  • Parent guidance and emotional support

  • Medication (SSRIs) if severe

Selective Mutism

• Anxiety disorder where a child cannot speak in certain settings despite speaking normally in others.

• Often mistaken for stubbornness or shyness.

• Appears around age 3–4, often diagnosed at school age.

• Causes:

  • Social anxiety, genetic predisposition, overprotective parenting

• Treatment:

  • Behavioral therapy using controlled exposure

  • Gradual confidence-building in speaking situations

  • Positive reinforcement, never forced speech

Fear

• A common feeling experienced by everyone.

• Can be felt by anyone when faced with an unknown or dangerous situation.

• Characterized by nervousness, anxiety, discomfort, and distress.

• May cause tachycardia, shortness of breath, dizziness, nausea, vomiting, diarrhea, or even panic attacks.

• Does not need medical intervention.

• Cannot be overcome by medical treatment, as it is a natural emotional response to real or perceived danger.

Specific Phobia

• Irrational fear of a specific object or situation.

• Causes avoidance and can lead to panic attacks.

• form of anxiety disorder characterized by excessive and persistent fear of objects or situations that may not carry real threats.

• Will cause irrational fear that can consume most of your time, energy, and focus.

• Produces similar physical symptoms to fear, such as racing heart, dizziness, or panic attacks, but in a more intense and uncontrollable way.

• Needs medical help due to its severity and impact on daily functioning.

• Diagnostic features:

  • Immediate anxiety on exposure

  • Avoidance behavior

  • Fear lasting 6 months or more

  • Interferes with daily life

• Types:

  1. Animal type – fear of dogs, snakes, etc.

  2. Natural environment type – fear of water, heights, storms.

  3. Situational type – fear of confined spaces, dark.

  4. Blood/injection/injury type – fear of needles, blood.

  5. Other – fear of loud sounds, costumed characters.

• Treatment:

  • Cognitive Behavioral Therapy (CBT)

  • Exposure therapy (gradual confrontation of fear)

  • Medication (e.g., benzodiazepines) may help temporarily

Shyness

• A normal personality trait, not a disorder.

• Involves mild nervousness or discomfort in social situations.

• Person still interacts, though may feel awkward or self-conscious.

• Usually temporary and fades with familiarity.

• Does not interfere greatly with daily life.

• Common in new or unfamiliar environments.

• Managed by exposure and confidence building.

Social Anxiety Disorder

• Intense fear of embarrassment in social situations.

• Goes beyond normal nervousness — affects relationships, school, and work.

• marked by intense fear of being judged or embarrassed.

• Causes avoidance of social situations.

• Fear is persistent and excessive, not just temporary.

• Interferes with daily functioning (school, work, relationships).

• Physical symptoms: trembling, sweating, blushing, nausea.

• Requires psychotherapy (CBT) or medication to manage.

• Symptoms:

  • Avoiding attention or social interactions

  • Fear of criticism, humiliation, or authority figures

  • Panic attacks in social settings

  • Blank mind during social pressure

• Treatment:

  • Psychotherapy (CBT, interpersonal, or family therapy)

  • Medications: SNRIs (e.g., Venlafaxine) or SSRIs

  • Exposure and social skills training

Nervous Breakdown

• Not a medical diagnosis; a state of extreme mental or emotional stress.

• Occurs when a person can no longer cope with life’s pressures.

• Develops gradually due to accumulated stress or burnout.

• Symptoms may include withdrawal, exhaustion, insomnia, crying spells, and loss of motivation.

• May lead to temporary inability to function in daily tasks.

• Recovery often involves rest, therapy, and lifestyle changes.

Panic Disorder

• happens when you have recurring, unexpected panic attacks.

• Panic attacks are sudden surges of intense fear or discomfort that peak within minutes.

• People with panic disorder live in fear of another attack, even when there’s no clear cause.

• Common Physical Symptoms:

  • Racing heartbeat or palpitations

  • Shortness of breath or choking feeling

  • Dizziness or lightheadedness

  • Nausea or stomach upset

  • Sweating or chills

  • Trembling or shaking

  • Chest pain or tightness

  • Numbness or tingling (hands/feet)

  • Feeling unreal (derealization) or detached (depersonalization)

  • Fear of dying or losing control

• Duration:

  • Attacks last 10–20 minutes, but severe cases may last over an hour.

• Causes:

  • Genetic factors (runs in families)

  • Stressful life transitions (e.g., going to college, getting married, having a baby)

• Treatment:

  • Cognitive Behavioral Therapy (CBT): teaches how to manage fear and understand attacks.

  • Medications:

    • SSRIs such as fluoxetine, paroxetine, or sertraline.

Agoraphobia

• An anxiety disorder where a person fears and avoids places that may cause panic, helplessness, or embarrassment.

• Often develops after a panic attack, leading to fear of having another in public places.

• Common Fears:

  • Leaving home alone

  • Crowds or waiting in line

  • Enclosed spaces (elevators, small stores, theaters)

  • Open spaces (parking lots, bridges, malls)

  • Public transportation (bus, train, plane)

• Behavioral Signs:

  • Avoids feared places or needs a companion to go out.

  • Fear/anxiety is out of proportion to actual danger.

  • Avoidance lasts 6 months or more and affects daily life.

• Causes:

  • Biological: health, genetics, and brain chemistry (low GABA activity).

  • Environmental and learning experiences (trauma, stress).

  • GABA’s role: helps calm the brain; low GABA = more anxiety.

  • Anti-anxiety meds like Xanax, Ativan, and Klonopin work by targeting GABA receptors.

• Treatment:

  • Psychotherapy (especially CBT):

    • Learn what triggers panic.

    • Challenge fears and face them gradually (exposure therapy).

    • Build coping skills and confidence.

  • Medications:

    • SSRIs (e.g., fluoxetine, sertraline (Zoloft)

    • Benzodiazepines (e.g., Xanax, Ativan, Klonopin) for short-term relief only, as they can be habit-forming

Agoraphobia vs Social Phobia

• Agoraphobia = fear of being trapped or unable to escape

• Social Phobia = fear of being judged by others

Generalized Anxiety Disorder

• involves excessive, uncontrollable, and irrational worry about everyday life situations.

• constantly anticipate disaster and worry about:

  • Health, money, death, family, friends, relationships, and work

• This worry is diffuse, not linked to a specific thing, and can interfere with daily life.

• You worry so much that it interferes with your everyday life.

• Worrying is constant or continual, and it affects your ability to function normally.

• Your worries control you or feel uncontrollable.

• Common physical symptoms include:

  • Fatigue, fidgeting, and muscle tension

  • Headaches and nausea

  • Trembling, sweating, restlessness, and insomnia

  • Difficulty concentrating and shortness of breath

• Common emotional and behavioral symptoms include:

  • Constant or uncontrollable worry

  • Difficulty relaxing or being alone

  • Avoiding anxiety-provoking situations

  • Needing frequent reassurance

• Symptoms must persist for at least six months for diagnosis.

• In children, this may center on school performance, social acceptance, or fear of mistakes.

• Cognitive Theories view this as maladaptive information processing focused on threat.

  • Individuals interpret harmless events as dangerous or threatening.

• Biological Theories suggest that this may involve low GABA levels or GABA receptor issues, causing excessive brain activity and chronic anxiety.

• Treatment: combines medication and cognitive-behavioral therapy (CBT)

Normal Worry

• everyone experiences.

• Your worrying doesn’t get in the way of your everyday life.

• You can control your worries.

• Your worries are few and about relevant things; while they may be disagreeable, they are not very upsetting.

• Periods of worrying last only a short time.

Anxiety vs Anxiety disorder

• Anxiety = normal and temporary

• Anxiety Disorder = chronic and interferes with functioning

Technique for coping with anxiety

• A – Accept the anxiety instead of fighting it.

• W – Watch it without judgment; observe how it rises and falls.

• A – Act with the anxiety; continue functioning calmly.

• R – Repeat the steps until anxiety lowers.

• E – Expect the best; remember that fear is often worse than reality.

Obsessive-Compulsive Disorder

• Involves obsessions (unwanted thoughts, images, or urges) and compulsions (repetitive actions to relieve anxiety).

• Common compulsions include handwashing, checking, and cleaning.

• Severe OCD may require hospitalization or even neurosurgery in extreme cases.

• Common types:

  • Checking: locks, appliances, health concerns

  • Contamination: fear of germs, constant cleaning

  • Symmetry/Ordering: need for things to be perfectly aligned

  • Intrusive thoughts: violent, disturbing, or repetitive thoughts

• Treatment:

  • Medication: SSRIs (antidepressants) help reduce symptoms; may take 8–12 weeks.

  • Psychotherapy: Cognitive Behavioral Therapy (CBT), especially Exposure and Response Prevention (EX/RP)— involves facing fears and avoiding compulsions

Body Dysmorphic Disorder

• Strong obsession with imagined or slight flaws in appearance.

• Common concerns: skin, hair, or nose.

• Can cause shame, anxiety, and social withdrawal.

• Specifier types:

  • Muscle Dysmorphia: belief of being too small or weak

  • Insight levels: good, poor, or delusional belief about the flaw

• Treatment:

  • CBT: challenges negative body image and habits like mirror-checking.

  • Medications: antidepressants (SSRIs) may help.

Hoarding Disorder

• Strong urge to save items, regardless of value.

• Commonly hoarded: papers, clothes, household goods, even animals.

• Leads to unsafe, cluttered living spaces.

• Symptoms:

  • Can’t throw things away

  • Anxiety about losing items

  • Cluttered or unusable spaces

  • Social withdrawal

• Causes/Risks: family history, brain injury, trauma, depression, compulsive buying.

• Treatment:

  • CBT: helps reduce anxiety about discarding items.

  • Medication: antidepressants (e.g., Paxil, Effexor).

  • Combo of both is often effective

Trichotillomania

• Repetitive pulling of hair from scalp, eyebrows, or other areas.

• Brings relief or satisfaction after pulling.

• Can cause bald spots, distress, and low self-esteem.

• Possible causes: genetics, stress, childhood trauma, boredom.

• Treatment:

  • Habit Reversal Therapy (HRT):

    1. Awareness training (identify triggers)

    2. Competing response (replace with other actions)

    3. Motivation building

    4. Relaxation techniques

    5. Practice in real situations

Excoriation Disorder

• Repetitive skin picking causing wounds or scarring.

• Patients often try to cover marks with makeup or clothing.

• May also have other habits like nail-biting or hair-pulling.

• Treatment:

  • Medication: SSRIs for anxiety or depression.

  • Behavioral therapy: habit reversal, awareness training, and finding safe replacement behaviors.

Trauma and Stressor-Related Disorders

• Develop after stressful or traumatic events.

• Includes:

  • Post-Traumatic Stress Disorder (PTSD)

  • Acute Stress Disorder (ASD)

  • Adjustment Disorder (AD)

  • Reactive Attachment Disorder (RAD)

  • Disinhibited Social Engagement Disorder (DSED)

• These disorders were separated from anxiety disorders because not all show anxiety — some involve anger, sadness, or emotional numbness.

Post-Traumatic Stress Disorder

• Caused by trauma (abuse, war, accident, disaster, etc.).

• Main symptoms:

  1. Reliving the event: flashbacks, nightmares, intrusive thoughts

  2. Avoidance: avoiding reminders or people connected to the trauma

  3. Hyperarousal: easily startled, trouble sleeping, always “on edge”

  4. Negative changes: guilt, sadness, hopelessness, loss of interest

• Brain effects:

  • Low cortisol, high stress hormones

  • Changes in brain areas that control emotions (hippocampus, amygdala).

• Treatment:

  • Eye Movement Desensitization and Reprocessing (EMDR): uses guided eye movement to process painful memories.

  • CBT and exposure therapy also help.

Acute Stress Disorder

• PTSD-like symptoms lasting 3 days to 1 month after trauma.

• Symptoms: intrusive memories, flashbacks, avoidance, sleep problems, anxiety.

• In children: may appear in play, nightmares, clinginess, or tantrums.

• Goal of treatment: prevent it from turning into PTSD.

• Therapy: crisis counseling, debriefing, and group or individual support.

Adjustment Disorder

• Strong emotional or behavioral reaction to a stressful event (e.g., breakup, loss, illness).

• Symptoms: sadness, worry, crying, irritability, trouble concentrating, withdrawal, or even suicidal thoughts.

• Starts within 3 months of the stressor and usually resolves within 6 months.

• Treatment:

  • Psychotherapy: main treatment to teach coping skills and emotional regulation.

  • Medication: short-term use of antidepressants or anti-anxiety drugs.

Disinhibited Social Engagement Disorder

• Children are overly friendly with strangers and lack boundaries.

• Common in kids with trauma or neglect history.

• Symptoms:

  • Too talkative or physically affectionate with strangers

  • Willing to leave with unfamiliar adults

  • Doesn’t check back with caregiver for safety

• Treatment:

  • Family therapy, play therapy, art therapy, parenting guidance, and special education support.

  • Focuses on building trust and safe emotional connections.

ASD vs PTSD

• ASD = short-term (within 1 month of trauma)

• PTSD = long-term (symptoms last beyond 1 month)