Neuroses causes and types of neuroses. Types of neurotic disorders. Obsessive-compulsive disorder: causes, symptoms, diagnosis and treatment of the disease

A separate niche among psychogenic diseases is occupied by neuroses, also called neurotic disorders. Neurosis- a collective term denoting certain types of neurotic disorders that are reversible and are distinguished by a persistent, protracted course of the disease.

Neurosis can occur in men and women of different ages, regardless of their social status, level of education, material security, marital status. In a special risk group for the development of neurotic disorders are people who are at the natural biological stages of life - during puberty and in the phase of withering body functions.

Often, neurosis is recorded in children during puberty, when abrupt changes in the hormonal background make the teenager particularly susceptible to various life phenomena. However, in children, neurosis most often resolves on its own and does not entail the development of dangerous and protracted mental disorders. At the same time, a neurosis that arose in adults in the period of approaching old age is fraught with the development mental disorders and often causes disease internal organs.

Neurosis implies the manifestation in the patient of a variety of painful phenomena that have arisen as a result of prolonged exposure to negative ones or have developed as a result of acute ones. The leading factor initiating the formation of a neurosis is the presence of unresolved internal conflicts or external pressure of negative circumstances.

At the same time, the above aspects do not necessarily have to have a high intensity of action: neurosis can be the result of significant mental overstrain or prolonged unrest. The clinical symptoms of certain types of neuroses are numerous and varied, however, the dominant position among the signs of neurotic disorders is occupied by the asthenic status of the patient, the presence of either irrational fears, or the demonstration by the subject of reactions of hysterical content.

What can neurosis lead to? Neurosis in the vast majority of cases is the cause of the decrease mental activity a person, a decrease in physical endurance and work productivity, a deterioration in the quality of work. In addition, the progression of neurosis leads to the fact that a person has clearly expressed negative character traits - conflict, irritability, aggressiveness, which ultimately causes the restriction of contacts in society and the deterioration of relationships in social groups. With untimely or incorrectly performed treatment, neurosis can be transformed into psychotic disorders, which are characterized by a change in the structure of the patient's personality.

Causes of neurosis

From the point of view of physiological teachings, neurosis is pathological condition organism, caused by prolonged failures in the higher nervous activity of a person. This phenomenon is a consequence excessive activity psyche at excess simultaneously ongoing nervous processes occurring in the cerebral cortex. As part of physiological theory neurosis is the result of an overstrain of the nervous system due to long-term or short-term exposure to stimuli that are excessive for the capabilities of the subject's psyche.

Scientists put forward other hypotheses, according to which the cause of neurosis is a combination of two factors: the presence of an excessively strong stimulus and specific features personal portrait of a person. At the same time, the significance of the acting stimulus depends to a greater extent not on its intensity, spontaneity, and the existing threat. The cause of neurosis is precisely how a person perceives and interprets this stressor. Studies show that the attitude to the experienced situation and, accordingly, the emergence of affective emotions depends on the individual characteristics of the individual, namely: the person's way of responding to any danger signal and the speed of response to the presented stimulus.

A significant role among the causes contributing to the emergence of neurosis, and has a real functional state organism. In a high risk group for the occurrence of neurotic disorders are people who lead wrong image life, do not observe the regime of work and rest, experience enormous mental overload and mentally overwork. The development of neurosis also depends on the type of activity that the subject conducts and his attitude to the duties performed. Among the causes of neurosis are the realities of our turbulent modernity with an abundance negative information and excessive demands on a "successful" person.

It should be emphasized that neurosis is not a hereditary, genetically determined disorder. Its appearance is almost always associated with the conditions in which the subject grew up and was brought up. The main cause of neurosis in children is growing up in a dysfunctional family. Living with drinking relatives, frequent scandals between parents, overly expressive expression of feelings by ancestors lays the ground for the formation of neurotic reactions in a child.

Neurosis can arise not only because of the prolonged experience of negative feelings. Very bright and intense positive emotions can also cause neurosis. Therefore, upbringing according to the "carrot-and-stick" type often leads to neurotic disorders.

Also, children very often imitate the behavior of their parents. If it is customary in a family to achieve what they want with the help of tantrums or to prove their case by completely ignoring their household members, then a baby with a fragile psyche will most likely develop an asthenic state, depressive moods or hysterical habits over time. In the future, such a person will become a real despot in the family or will be a talented "hysteric" in order to commit illegal acts and not be punished. Since a habit is formed in a person very quickly, and a neurotic simply does not have enough inner core to refuse a harmful behavior model, most children who grew up in a dysfunctional environment have various types of neuroses.

From the point of view of psychoanalytic theories, neurosis is a product that has arisen due to the existence of an unresolved conflict in the depths of the human psyche. Such a psychological conflict often arises due to the lack of satisfaction of the existing basic needs of the individual. The foundation for neurosis is the existence of a real or imagined threat to the future, which the person interprets as an unsolvable problem.

Among other causes of neurosis:

• social isolation of a person;
• contradictions between instinctive drives and moral norms;
• total control by others;
• excessive need for recognition and protection;
• unsatisfied thirst for power and glory;
• unfulfilled need for personal freedom;
• the desire to perform all actions perfectly;
• and inability to have a good rest;
• lack of skills to competently respond to.

The biological cause of neurosis is insufficient production of certain neurotransmitters and a malfunction in the functioning of neurotransmitter systems. Such defects make a person overly susceptible to the action of various stimuli, reward him with emotional lability and deprive him of the possibility of functional resolution of difficult situations.

Among the reasons predisposing to the onset of neurosis, scientists call acute viral and infectious diseases that worsen the overall resistance of the body to negative factors. Special meaning in the development of neurotic disorders assigned to pernicious habits of man. Chronic alcoholism, the use of psychoactive substances primarily "hit" the nervous system, rewarding the person with painful neurotic reactions.

Symptoms of neurosis

Before proceeding with the treatment of neurosis, it is necessary to make a clear differentiation of the human condition from disorders of the psychotic level. The criteria for the selection of neuroses are the following aspects:

• The leading role in the formation of neuroses is assigned to the action of psychogenic factors.
• A person is aware of the abnormality of his condition and makes efforts to compensate for the painful symptoms.
• Neurotic disorders are always reversible.
• An objective examination of the patient does not show any symptoms of personality change.
• The patient retained criticism of his condition.
• All the symptoms that arise give the person the difficulties he feels.
• The subject is willing to cooperate with the doctor, he tries to make efforts to achieve success in treatment.

Among the symptoms of neuroses, two large groups can be distinguished: psychological signs and physical phenomena. Let's describe them in more detail.

Psychological signs of neurosis

The psychological (mental) symptoms include factors:

• Lack of emotional stability in the subject.
• Frequent mood swings for no apparent reason.
• The appearance of indecision and lack of initiative of a person.
• Lack of adequate self-esteem: excessive underestimation of one's abilities or overestimation of one's own abilities.
• The appearance of obsessive uncontrollable fear.
• Experiencing feelings, anticipation of any trouble.
• Excessive nervousness, irritability.
• Restlessness and fussiness of action.
• Conflict and aggressiveness towards others.
• Critical and cynical attitude to what is happening.
• Uncertainty in one's own aspirations, inconsistency of desires.
• Excessive reaction to the slightest changes in the habitual way of life.
• Tearfulness without any objective reasons.
• Suspiciousness, vulnerability, impressionability.
• Resentment, pickiness to the words of other people.

A common symptom of neurosis is the fixation of attention on a traumatic event. A person obsessively reflects on the drama that has happened, analyzes the past, looking for confirmation of his guilt. He is unable to focus on positive thoughts because all thoughts are fixated on the negative moments of life.

Symptom of neurosis significant reduction human performance. The person is unable to perform the usual amount of work. The subject's quality indicators of labor are deteriorating. He quickly gets tired of standard loads.

Common symptom of neurosis deterioration of cognitive and mnestic functions. The person has trouble concentrating. It is difficult for him to extract the required information from the depths of memory. He cannot answer the question quickly as his thinking is slow.

Common symptoms of neurosis - increased sensitivity to external stimuli. A person reacts intensely to loud sounds and notices barely audible noises. He cannot stand bright light and is uncomfortable with sunlight. A symptom of neurosis is meteosensitivity: the subject painfully endures changes in weather conditions. A change in climatic zones for a person with a neurosis provides a significant increase in painful symptoms.

Common symptoms of neurosis include: various sleep problems. It is very difficult for a person to fall asleep at the usual time due to a significant overexcitation of the nervous system. Having fallen into a dream, a person is forced to "watch" nightmares. He often wakes up in the middle of the night in a cold sweat from the frightening pictures he saw in his dream. In the morning, the subject feels overwhelmed, as his sleep does not provide a burst of energy. In the first half of the day, a person feels overwhelmed and sleepy, but after lunch his condition improves.

Physical signs of neurosis

The physical symptoms of neurotic disorders include a variety of autonomic disorders, neurological defects, and somatic problems. The most common symptoms of neurosis are the following phenomena:

• chronic headache of a pressing or compressive nature, which is called the "helmet of a neurasthenic";
• discomfort or pain in the region of the heart, perceived by a person as heart defects;
• pain syndrome in the epigastric zone, heaviness in the stomach;
• dizziness, difficulty keeping balance, unsteady gait;
• jumps in blood pressure;
• the appearance of "flying flies" before the eyes, deterioration of visual acuity;
• weakness and trembling in the limbs;
• sensation of a “lump” in the throat, difficulty making deep breath feeling short of breath;
• change in eating habits - compulsive overeating, refusal of food, loss of appetite;
• various dyspeptic disorders;
• vegetative defects - excessive sweating;
• violation of the heart rhythm;
• frequent need to urinate;
• the appearance of problems in the intimate sphere - a decrease in sexual desire, inability to have sexual intercourse, a change menstrual cycle among women.

Often, neurosis is the cause of impotence in men and makes it impossible for women to conceive and bear a child. Quite often, neurosis leads to a variety of somatic problems, including gastritis, pancreatitis, cholecystitis. Consequence neurotic state human - hypertonic disease and cardiac problems. Therefore, timely treatment of neurotic disorders is a guarantee of good health and well-being of a person.

Types of neurotic disorders

Doctors distinguish several independent types of neuroses, which are characterized by the dominance of certain clinical signs. The most common types of neurotic disorders are:

• hysterical neurosis;
• anxiety disorder.

Neurasthenia

Neurasthenia has another name: astheno-neurotic syndrome. Among ordinary people, this type of neurosis is often called chronic fatigue syndrome. Neurasthenia is characterized by the following symptoms:

• increased irritability;
• high excitability;
• fast fatigue;
• loss of the ability to self-control and self-control;
• tearfulness and resentment;
• distraction, inability to concentrate;
• decreased ability to prolonged mental stress;
• loss of habitual physical endurance;
• severe sleep disturbances;
• loss of appetite;
• apathy and indifference to what is happening.

A patient with this type of neurosis develops heartburn and a feeling of heaviness in the epigastric region. The subject complains of intense headache, sensations of sinking heart, worsening of opportunities in the intimate aspect. With this type of neurotic disorder, depressive moods of the cyclothymic level predominate in a person.

obsessive-compulsive disorder

Obsessive-compulsive disorder is a borderline status, fraught with rapid transformation into mental kind- obsessive-compulsive disorder. Patients with this type of neurosis are vulnerable, suspicious, sensitive persons. The main symptom of obsessive-compulsive disorder neurosis is the presence of uncontrollable painful thoughts, obsessive thoughts, meaningless images that arise.

A common symptom of this type of neurosis is experiencing feelings of anxiety and anticipation of imminent troubles. Stereotypical reflections, characteristic of this type of neurosis, overcome a person constantly and force him to resort to peculiar ritual actions. The person regularly makes absurd, from an objective point of view, decisions, trying to protect himself from the coming catastrophic events that he invented.

Hysterical neurosis

Hysterical neurosis, also called hysteria, is a common pathology, more often recorded in women than in men. This type neurotic disorder It is manifested by the acted demonstrative behavior of a person in order to attract the attention of others. The person rolls up theatrical performances: violently sobs, screams loudly, convulses, so that they pay attention to her and satisfy desires.

Hysteria - a kind of flight into the disease, when a person can mimic the symptoms various diseases and sacredly believe in their incurable morbidity. It has been established that a hysteric can inspire himself with absolutely any disease and successfully imitate the symptoms characteristic of the disease.

The main symptom of hysterical neurosis is frequent seizures with convulsions of a tonic nature. During such a crisis, the patient's face takes on a reddish or pale tint. A person's eyes are closed during an attack, but the pupils retain a reaction to light. A fit of hysteria is preceded or accompanied by wild laughter or inappropriate sobs.

Another important symptom hysterical neurosis - the patient's lack of sensitivity. If the hysteric has set himself a certain goal, then in order to achieve it, he can, in the literal sense, walk on coals and not feel pain. May develop hysterical deafness or blindness, a variety of speech disorders, such as stuttering.

The treatment of this form of neurosis is a long and painstaking process that requires a competent selection of medications. With inadequate treatment of hysterical neurosis, the patient may develop significant mental defects that completely change the characterological portrait of the individual.

anxiety neurosis

This type of neurosis is a precursor to anxiety-phobic or generalized anxiety disorders. This disease is characterized the presence of obsessive irrational fears and persistent anxiety in a person. At the same time, the patient's fear of anxiety neurosis has no real grounds. The subject worries excessively about his own future, anticipates failures and problems, constantly feels excitement and anxiety.

With this type of neurosis, excessive motor tension is observed, manifested in the fussiness and randomness of the patient's actions. The person feels that his nerves are taut, like a string, and he cannot relax. Symptoms of autonomic activity are observed: dry mouth, irresistible thirst, increased heart rate, increased sweating.

Treatment of neurosis

How to get rid of neurotic disorders? Today, many methods of treating neuroses have been developed and successfully applied. However, you cannot give general recommendations, since the treatment regimen should be chosen exclusively on an individual basis after a thorough examination of the patient and the determination of the correct diagnosis. The main task of the doctor is to determine the origin of neurosis by establishing true reason disorders.

Drug treatment of neurotic disorders, as a rule, includes antidepressants, benzodiazepine tranquilizers, anxiolytics, sedatives vegetable origin, B vitamins and minerals. In cases where neurosis is caused by some disturbances in the blood supply to the brain, it is advisable to use nootropic drugs and agents that improve the functioning of the nervous system.

It must be remembered that pharmacological treatment helps only eliminate the symptoms of the disorder and improves the patient's well-being. However, medications are unable to act on the cause of the disease, so it is impossible to completely get rid of neurosis with their help.

Currently, the main methods of treating all types of neuroses are psychotherapeutic techniques and hypnotherapy. To completely get rid of neurotic disorders, it is advisable to conduct treatment with the help of psychodynamic, interpersonal, cognitive-behavioral and gestalt therapy. Psychoanalysis is often used in the treatment of neuroses. During psychotherapy sessions, a person gets the opportunity to build a complete picture of his personality, to establish cause-and-effect relationships that gave impetus to the emergence of neurotic reactions.

In the treatment of neurosis, an important place is given to the normalization of the regime of work and rest and the construction of the correct nutrition schedule with a properly composed menu. Of great importance in the treatment of neurotic disorders is also teaching the patient relaxation techniques and performing autogenic training.

Neurosis, regardless of its type and severity of symptoms, is subject to complete cure. However, in order to achieve a stable and lasting result, a person needs to reconsider the existing way of thinking and “cleanse” his life program from destructive links that prevent freedom from fears and anxieties.

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Psychological stress

Neurosis is reversible neuropsychiatric disorder arising from the violation of significant life relationships manifested by specific clinical phenomena in the absence of psychotic phenomena. Neurosis occupies a borderline position between neurological and psychiatric diseases.

The prevalence of neuroses

Neurosis is one of the most common diseases, according to statistics from developed countries, detected in 10-20% of the population. The prevalence of neurosis is constantly increasing. According to WHO, the number of patients with neurosis over the past 65 years of the twentieth century. increased 24 times, while the number of patients with mental illness increased only 1.6 times over the same period. Women get sick 2 times more often than men.

Classification of neuroses

In ICD-10, neuroses are included in the section on neurotic and somatoform disorders (F-4). This section presents data on neuroses from a phenomenological point of view. According to the prevailing phenomenological manifestations, six main types of neuroses are distinguished:

1. anxiety-phobic;
2. depressive;
3. obsessive-compulsive;
4. asthenic;
5. hysterical;
6. somatoform.

In our country, where nosological diagnosis has long been preferred, it is customary to distinguish three forms of neuroses:

• obsessive-phobic neurosis;
• hysterical neurosis.

The form of neurosis depends mainly not on the nature and severity of the psychogenic impact, but on the personal characteristics of a particular person.

Taking into account the duration and characteristics of the course, the following variants of neuroses are distinguished:

• neurotic reaction that usually occurs in acute emotional stress(for example, the death of a loved one) and lasts up to 2 months;
• neurotic state (neurosis proper), the duration of which varies from 2 months to a year;
• neurotic personality development, which usually manifests itself with the chronic impact of a psychotraumatic factor on a person who is not able to adapt to it.

Causes of neuroses and pathogenesis

The main reason for the development of neurosis is considered to be an acute or chronic psychogenic effect, which has a high degree of personal significance, disrupts the possibility of realizing important needs for the patient and causes strong negative emotions, resulting in vegetative and somatic manifestations.

Risk factors for neurosis:

• congenital emotional instability, anxiety, vulnerability, suspiciousness, suspicion;
• tendency to develop depression and the appearance of hysterical reactions;
• difficulty social adaptation;
• constitutional features;
• chronic fatigue;
• starvation;
• long;
• somatic diseases;
• previous injuries;
• hypoxic conditions;
• states;
• endocrine disorders, including physiological hormonal changes (puberty, pregnancy,);
• exogenous intoxications.

The primary pathophysiological basis of neurosis is functional changes in the deep structures of the brain, usually arising under the influence of pronounced stressful influences. Neurosis develops as a result of a dysfunction of the predominantly limbic-reticular complex (LRC), which ensures the integration of the emotional, vegetative, endocrine spheres and secondarily affects the tone of the hemispheric cortex, which in neuroses can affect the productivity of cortical processes, in particular, cognitive activity.

In the development of neurosis, the premorbid state of PRC (inherited features and manifestations of congenital pathology, as well as past traumatic, toxic, infectious and other brain lesions) has a certain significance. With a congenital or acquired mismatch of the functions of the PRC structures, a metabolic imbalance occurs in it, leading to an increased response of the brain to emotional influences, a decrease in its adaptive capabilities and an increasing predisposition to neurosis.

According to the results of experimental studies, in neurosis, changes in PRK occur primarily at the subcellular level and include:

• decrease in the number of ribosomes in nerve cells;
• destruction of cell membranes;
• violation of lipid peroxidation;
• expansion of cisterns of the endoplasmic reticulum;
• an increase in the concentration of vesicles containing mediators in synaptic nerve endings.

In addition, in patients with neuroses in the LRC, the following are possible:

• degeneration of nerve endings;
• a decrease in the number of nerve cells in the hippocampus;
• formation of additional synaptic connections (hypersynapsia). It has also been established that a decrease in the number of nerve cells in the PRC is accompanied by the accumulation in the remaining neurons of a larger than normal amount of nucleic acids and enzymes. Such cells are called highly charged.

All these changes are accompanied by disintegration of the functions of the emotional sphere, vegetative, endocrine systems, secondary intellectual disorders and memory impairment. Such a memory impairment is not related to dementia, since it is dynamic in nature, but it negatively affects the ability to work during the period of illness.

Symptoms of neurosis

Along with emotional disorders, the main manifestations of neurosis are various signs of autonomic and endocrine imbalance. At the same time, there are no psychotic disorders (for example, hallucinations, delusions), and the critical attitude of the patient to his condition remains.

The picture of neurosis is determined not so much by the nature and severity of emotional stress as by its significance for the patient who has been exposed to stress. The peculiarities of his personality are essential. Since the personality of each person is formed under the influence of inherited characteristics, as well as upbringing, training, influence environment and the somatic state of a person, it is practically unique. As a result, many clinical variants of neurosis arise, i.e. each patient suffers from neurosis in his own way. However, from a practical point of view, it is advisable to single out the main clinical forms of neurosis, or neurotic syndromes.

Neurasthenia

Neurasthenia develops against the background of nervous exhaustion, more often in people with suspicious character traits. The condition is manifested by a neurasthenic syndrome, the signs of which are usually observed in neurosis-like states. The basis of this syndrome is "irritable weakness" - increased emotional excitability and the rapid onset of exhaustion. Characteristic features this state:

• increased sensitivity, emotionality, irascibility;
• fixation on a stressful situation and, as a result, a decrease in attention, difficulty in concentrating and assimilating current information, complaints of memory impairment;
• decreased mood, sleep disturbance, appetite;
• tendency to senestopathies;
• neurocirculatory dystonia, the consequence of which may be, in particular, persistent;
• hormonal disorders, which are manifested primarily by a decrease in libido, sexual potency, frigidity, and sometimes menstrual irregularities.

The clinical picture of neurasthenia is quite diverse. It is customary to distinguish hypersthenic and hyposthenic forms of neurasthenia.

The hypersthenic form is characterized by:

• incontinence, impatience, irritability, inattention;
• muscle tension and the impossibility of arbitrary muscle relaxation;
• a persistent feeling of decreased productivity shortly after the start of mental work.

The hyposthenic form of neurasthenia is characterized by apathy, persistent fatigue and general weakness after a little mental and especially physical exertion, fatigue, exhaustion after minimal effort. Often, the manifestations of these forms of neurasthenia are combined or transformed into each other in the course of the disease. With variants of neurasthenia, dizziness and headache are possible. Neurasthenic disorders are usually included in the picture of other forms of neuroses, as well as neurosis-like conditions, but with neurasthenia they are the leading signs of the disease.

For all forms of neurosis, in particular, for neurasthenia, constant vegetative-vascular lability is characteristic, but sometimes autonomic paroxysms develop against this background, with a predominance of sympathetic-adrenal or parasympathetic manifestations. In the ICD-10, they are known as panic disorder - attacks of intense anxiety, sometimes intense fear, that suddenly appear without a clear connection with specific situations, reaching a maximum in minutes. During an attack, pronounced autonomic reactions are typical: tachycardia, hyperhidrosis, tremor, dry mouth, shortness of breath, a feeling of suffocation, discomfort, sometimes chest pain, nausea, a feeling of gastrointestinal discomfort, dizziness, in rare cases, derealization and depersonalization. Attacks are repeated with different frequency. The duration of the attack usually does not exceed 20-40 minutes. As a rule, between attacks, patients are worried about the unpredictable possibility of their resumption.

obsessive-compulsive disorder

Since the patient tends to repeat certain actions, associating them with the prevention of misfortune or good luck, then over time these actions become obsessive. The patient gradually forms more and more complicated rituals. At the initial stage of formation, rituals are in the nature of the so-called direct protection. It is expressed in the desire to avoid traumatic situations, diverting attention from them and leads to a gradual complication of protective actions, which sometimes acquire an illogical, absurd form of ritual action, qualified as a manifestation of "indirect protection".

In addition to rituals, the main obsessive neuroses include:

• obsessive fears (phobias), characterized by irrational fear;
• obsessive thoughts (including "mental chewing gum"), ideas, doubts;
• intrusive memories;
• obsessive images (including representations);
• obsessive drives (obsession, mania);
• compulsions (compulsions).

Obsessive phenomena can be abstract (obsessive counting, recalling names, definitions, dates and other “mental chewing gum”) and sensual (figurative) with an affective, often extremely painful, feeling of discomfort.

Manifestations of obsession make the patient indecisive, reduce the productivity of his thinking, worsen the results of physical and mental work. They arise against the will of the patient, as if forcibly. A patient with an obsessive neurosis usually treats them quite critically, but is not able to overcome them. Only during the climax of fear, the patient sometimes completely loses his critical attitude towards him. If a patient with cardiophobia embraces a corresponding sense of fear, he may experience sensations that, in his opinion, are characteristic of cardiac pathology. Fear is accompanied by pronounced general vegetative, sometimes violent emotional reactions (for example, the horror of impending death), accompanied by calls for help.

For obsessive neurosis typically a gradual expansion of the range of situations that cause anxiety, which can become generalized, sometimes unmotivated, and usually lead to hyperventilation and other autonomic disorders. The number of variants of obsessive manias, phobias and other similar phenomena is calculated in many dozens. Manias and phobias, as a rule, are combined with a feeling of anxiety, independent of the will, and may be accompanied by elements of depression.

Contrasting obsessive states are possible: a pronounced desire to commit some particular tactless or dangerous act and the realization of its uselessness and fear of being prompted to do something that should not be done. Refraining from such an act is usually accompanied by expressed feeling discomfort, but the act leads to a feeling of comfort.

Obsessive neurotic phobias include:

1. agoraphobia - fear of spaces;
2. algophobia - fear of pain;
3. acryophobia - fear of misunderstanding what is heard or read;
4. acrophobia - fear of heights;
5. acousticophobia - fear of harsh sounds;
6. anthropophobia - fear of people;
7. autophobia, isolophobia, monophobia - fear of loneliness;
8. automysophobia - fear of smelling;
9. aerophobia - fear of drafts;
10. hamartophobia - fear of committing a sin;
11. haptophobia - fear of touch;
12. iophobia - fear of poisoning;
13. claustrophobia - fear of enclosed spaces;
14. copophobia - fear of overwork;
15. mesophobia - fear of pollution;
16. oxyphobia - fear of sharp things;
17. Peiraphobia - fear of speaking
18. peniaphobia - fear of poverty;
19. scopophobia - fear of being funny;
20. thanatophobia - fear of death;
21. erythrophobia - fear of blushing, fear of red.

There are also the following forms of phobias in neuroses.

social phobias usually occur in adolescents, centered around fear heightened attention surrounding. At the same time, manifestations of anxiety, shame and confusion are possible, as well as the fear that its manifestations will be recognized by others and become objects of ridicule. Such phobias, as a rule, are combined with low self-esteem, fear of criticism. In severe cases, patients often seek social isolation.

Specific phobias- fears caused by a specific isolated starting situation (fear of heights, darkness, thunderstorms, eating certain foods, sharp objects and HIV infection, cancerophobia). They usually appear from childhood or young years and do not show a tendency to arbitrary fluctuations in intensity.

generalized anxiety state- pronounced constant anxiety persistent, usually unmotivated character. Dominated by complaints of constant nervousness, excessive sweating, trembling, palpitations, dizziness, abdominal discomfort. Often there is a fear that he or his relatives will fall ill, and other forebodings of an approaching disaster are possible. These fears are usually combined with restlessness, signs of depression and autonomic dysfunction, in particular, with cardiorespiratory disorders. Generalized anxiety is typical for women and is associated with chronic emotional stress, which is detected by careful history taking.

Mixed anxiety-depressive disorder- a combination of chronic manifestations of anxiety and depression without a specific motivation. Their severity is often moderate. In the neurological status, patients usually show signs of autonomic lability.

A reaction to stress in neurosis, adaptation disorders develop with acute intense emotional or chronic psychosocial stress, i.e. major upheavals or major life changes leading to long-term negative manifestations, in particular, fear, accompanied by a disorder of general and social adaptation. It is characterized by:

• dulling of feelings (emotional "anesthesia");
• a feeling of remoteness, detachment from other people;
• loss of interest in previous activities, dulling of adequate emotional reactions;
• behavioral changes, up to stupor;
• feelings of humiliation, guilt, shame, anger;
• bouts of anxiety, fear;
• transient decrease in attention, memory;
• possible amnesia of the experienced stressful situation, rudimentary illusions and hallucinations, impaired control of one's own impulses;
• often a tendency to abuse alcohol, take drugs, suicide.

The described neurotic syndrome develops in 50% of people who have experienced severe stress. At the same time, the severity of pathological manifestations is often disproportionate to the intensity of this stress, and they are often regarded as manifestations of reactive psychosis.

In addition, ICD-10 distinguishes between organ neuroses (somatoform disorders) and hypochondriacal neurosis.

Somatoform disorders- repeated, often changing symptoms of somatic diseases of a functional origin, which are usually present for several years. Most patients have previously been treated in non-psychiatric specialties, in particular, have come a long way and many different examinations, and sometimes have undergone useless surgical interventions. Most often, the patient's attention is focused on the possibility of the disease. digestive tract and skin; complaints of menstrual disorders, impotence, which are often accompanied by anxiety and depression, are possible. Somatic complaints of the patient are usually combined with emotional instability.

Hypochondriacal disorders are characterized by the fact that patients are burdened by somatic discomfort, experience fear, being sure that they have an unidentified disfiguring or life-threatening disease. As a rule, they suggest a cardiovascular or gastroenterological disease. Patients tend to:

• limited empathic potential (inability to understand and empathize with the state of mind of another person);
• self-centeredness;
• verbosity at the doctor's appointment, a tendency to detailed descriptions, the presentation of numerous materials from previous consultations and examinations;
• frequent affective reactions of protest when trying to dissuade them in the presence of dangerous somatic diseases;
• a feeling of resentment at insufficient attention to them and the sympathy of others. Sometimes the increased concern of patients with their health becomes for them a protection against low self-esteem. Sometimes an imaginary somatic illness turns into a symbolic means of atonement for a felt sense of guilt and is regarded as a punishment for previously committed unseemly acts.

Hysterical neurosis

People with hysterical traits are prone to hysteria (demonstrativeness, a thirst for recognition by others, a tendency to pseudological judgments). The diverse manifestations of hysterical neurosis include:

• emotional "storms";
• disorders various kinds sensitivity by functional type (such as hysterical blindness and deafness);
• movement disorders (functional paresis or paralysis, hyperkinesis, seizures);
• quick change of mood;
• demonstrative behavior;
• increased suggestibility;
• the often absurdity of complaints and behavioral responses;

the development of painful manifestations according to the mechanism of "escape to the disease". The disturbances of movements and sensitivity shown to patients correspond to their idea of ​​a really possible organic pathology. Others may perceive them as patients with focal neurological symptoms, however, movement and sensitivity disorders are contrary to anatomical and physiological principles, and when examining patients, objective signs of organic neurological pathology are not detected.

The manifestations of motor and sensory disorders depend on their emotional state, which is usually influenced by the presence of people, their composition and number. As with other manifestations of hysteria, psychogenic conditioning, the obligatory visibility of emerging symptoms, and demonstrativeness are characteristic. Paralysis, convulsions, disturbances of sensitivity can be accompanied by a pronounced emotional accompaniment, or they can be transferred with "beautiful indifference." These disorders are more common in young women.

Since neurosis is always associated with a psycho-traumatic effect and its development is determined by personal attitude to this irritant, then in the process of examining the patient, it is necessary, carefully analyzing the complaints and anamnesis, to obtain maximum information about the characteristics of his personality and social status, the conditions of his life and work. At the same time, one should strive to identify and understand the nature of the acute and chronic psycho-traumatic influences affecting the patient, adequately assessing the significance of these influences for him personally. As for the initial personality traits of the patient, the same personal characteristics predispose to the development of a neurosis, a neurosis-like state. In the process of diagnosing neurosis, a complete somatic and neurological examination is indicated.

Differential diagnosis of neurosis

Dysfunction of the LRC can cause the development of neurosis, a neurosis-like syndrome, a condition similar to neurosis in clinical manifestations. Like neurosis, a neurosis-like syndrome is characterized by signs of disintegration of the emotional, autonomic, and endocrine systems. It can be caused by intoxication, TBI, infection, damage to tissues and organs. In somatic and infectious diseases, a neurosis-like syndrome can manifest itself not only in the acute period of the disease, but also during the period of convalescence, and in cases, for example, of chronic liver or kidney failure, it usually acquires a protracted, often progressive course.

The main difference between a neurosis and a neurosis-like state lies in etiological factor, cause of illness. In neurosis, this cause is acute or chronic emotional stress, while the development of a neurosis-like state is usually provoked by other exogenous or endogenous factors. Therefore, a carefully collected anamnesis is important in differential diagnosis. In addition, the diagnosis of somatogenic neurosis-like conditions is aided by the results of a detailed and careful physical examination, including laboratory data and the results of imaging studies (for example, ultrasound, radiological, computed tomography, magnetic resonance imaging).

Having established the diagnosis of "neurosis", one should analyze the nature of the dominant clinical manifestations, which usually directly depend on the characteristics of the patient. As a result of such an analysis, it is possible to determine the form of the neurosis of the examined patient.

Treatment of neurosis

When starting treatment, it is necessary to consider the possibility of removing a patient with neurosis from a psychotraumatic situation. Unfortunately, this is rarely possible. Much more often, the doctor has the opportunity to assist the patient in revising his attitude to the traumatic factor.

Psychotherapy can be useful, in particular rational psychotherapy, which every doctor should own: based on evidence, in particular, on the results of a medical examination, as well as on the patient's ability to think logically, the doctor can often reduce the relevance of the patient's anxiety and fear of existing or imaginary circumstances.

If the patient does not accept logical evidence, then it is possible to use suggestion both in the normal waking state of the patient, and after the administration of psychotropic drugs (narcopsychotherapy) or against the background of hypnosis (hypnotherapy). Self-hypnosis, in particular, autogenic training, has a certain value in the treatment and prevention of neuroses; this method of self-treatment should be taught (if indicated).

Effective physical methods treatment, especially hydroprocedures and balneotherapy. It is noted that drug therapy and physiotherapy are more effective if accompanied by therapeutic suggestion, i.e. suggestion to the patient of the idea of ​​the expediency and effectiveness of drugs and medical procedures. The condition of patients with neuroses is favorably influenced by reflexotherapy, herbal medicine and acupuncture; all these methods of treatment must be accompanied by a suggestion aimed at improving the patient's condition. People close to him can also contribute to the treatment of a patient with neurosis, creating a favorable psychological climate for him in the family.

Evaluation of the effectiveness of treatment

For neurotic disorders long-term treatment; its effectiveness can be assessed no earlier than a few weeks. Signs of the effectiveness of treatment are the disappearance neurotic symptoms, improving the mental, physical condition of the patient, reducing the severity of experiences associated with the transferred or current psycho-traumatic impact.

Complications and side effects of treatment

Excessively long-term use of benzodiazepines and hypnotic drugs is inappropriate, as it can lead to the development of tolerance and drug dependence. Side effects of highly potent benzodiazepines (alprazolam, clonazepam) in panic attacks include their lack of effectiveness at high frequency of attacks, the possibility of excessive sedation and ideation retardation, especially on early stages drug therapy for neurosis.

Treatment with tri- and tetracyclic antidepressants may be accompanied by the development of severe side effects, including tachycardia, extrasystoles, changes in blood pressure and dry mucous membranes.

Taking SSRIs occasionally (and in case of overdose) leads to the development of serotonin syndrome (tremor, akathisia, myoclonic manifestations, dysarthria, in severe cases confusion and cardiovascular disorders).

Mistakes and unreasonable appointments

In chronic somatoform disorders accompanied by pain, the use of benzodiazepines is ineffective; an attempt to relieve pain with the help of analgesics and novocaine blockades is also ineffective.

In hysterical neurosis, drug therapy is not always effective; psychotherapy (psychoanalysis, hypnosuggestion) is needed.

MAO inhibitors cannot be combined with antidepressants of other groups, because, by suppressing the metabolism of the latter, they can provoke psychomotor agitation, delirium, convulsions, tachycardia, fever, tremor and coma.

Prognosis for neurosis

When right tactics treatment and resolution of a traumatic situation, the prognosis for neuroses is usually favorable. As a rule, a good prognosis in the development of a reaction to stress is noted with a rapid deployment of the clinical picture, an initially good ability to adapt, expressed social support, as well as in the absence of concomitant mental and other serious illnesses in the patient.

With chronic exposure to a psycho-traumatic factor, which is of great personal importance for the patient, and in the absence of adaptation to it, “neurotic personality development” is possible, i.e. the acquisition of persistent pathological characterological properties, such as hysterical, hypochondriacal, litigious or affective.

If we draw parallels with the forms of neurosis, then in simple words they can be designated as a spoiled mood. All people are familiar with the various signs and symptoms of a bad mood. Someone screams, someone becomes depressed, someone is aggressive, etc. Neurosis can be called the totality of all manifestations of a bad mood, but which lasts a very long time. for a long time. That is why specialized treatment of all its causes is required here.

Of course, talking about neurosis as a bad mood is a simplified form of conveying the essence of a mental disorder. In fact, a person in a state of neurosis is simply not in balance with his psyche, emotions and self-perception.

What is a neurosis?

What is, in the psychological sense of the word, neurosis? These are functional and psychogenic reversible disorders that last for a long time. Neurosis manifests itself in the form of asthenic, hysterical and obsessive states. Mental and physical performance is also noted. In other words, neurosis is referred to as a neurotic disorder or psychoneurosis.

The causes of this disorder are classified as psychological:

• Long term stress.
• Emotional overstrain.
• Psychotraumatic situations.
• External or internal.
• Circumstances that cause emotional imbalance.
• Tension in the intellectual sphere.

IP Pavlov defined neurosis as a chronic, prolonged tension of the nervous system, provoked by inadequate and strong external stimuli that overstrain the nervous processes.

Psychoanalysis considers neurosis as a psychological latent conflict in a person.

There is still debate about what neurosis is and how it is provoked. However, one thing remains obvious: most people suffer from various forms of neurosis, which today are considered the norm, until they cause real harm person and those around them.

Forms of neurosis

What are the most common forms of neurosis today?

1. Neurasthenia, manifested in headaches, increased fatigue and vulnerability, lack of concentration. There are 3 stages of this form:

• The first is accompanied by irritability with the preservation of mental and physical abilities and the absence of somatic symptoms.
• The second stage is marked by a decrease in working capacity, which is realized by a person.
• The third stage is expressed in lethargy, apathy, weakness, asthenic syndrome.

1. Hysterical neurosis, which manifests itself in inappropriate behavior, unpredictability, nervousness and irritability. Symptoms such as hypotension, obsessive acts, seizures, paralysis, hysterical arthralgia, paresis, body pain, vomiting, hyperkinesis, a "lump" in the throat, etc. develop. At the time of a hysterical attack, the patient screams, rolls on the floor, physically affects people trying to hurt himself.
2. Depressive neurosis, which manifests itself in sleep disturbance, bad mood, painful sensations, loss of the ability to rejoice, palpitations, dizziness, hypersensitivity, tearfulness, gastrointestinal dysfunction, lethargy, sexual dysfunction, hypotension. A person complains of despondency, there is sadness, a feeling of abandonment and uselessness, an inferiority complex.
3. Obsessional neurosis, when a person does not control his actions and thoughts, which seem alien to him.
4. Hypochondriacal neurosis - fear of a situation from which a person cannot get out, or get sick with a serious illness. The disorder may take the form of obsessive-compulsive disorder or hysteria with associated symptoms.

Causes of neurosis

The causes of neurosis include psychological and physiological factors:

• Prolonged mental overload or emotional experiences: dissatisfaction with life, dismissal, study stress, divorce, etc.
• Inability to solve personal problem situations, for example, if it is impossible to repay a loan to a bank.
• The confusion that led to Negative consequences. For example, leaving a kettle on the stove to boil and leaving the house, which led to a fire. Often this leads to the development of obsessive states.
• Diseases and intoxication, which depletes the body. People who use tobacco or alcohol are also prone to neuroses.
• Pathology of the development of the central nervous system (congenital asthenia), when a person is not able to endure prolonged physical and mental stress.
• Self-hypnosis and pain inner world which leads to neuroses. It occurs in individuals with a hysterical personality type.

Symptoms of neurosis

All forms of neurotic disorder exhibit somatic and psychopathic symptoms. They differ in each case, by which it is possible to determine the form of neurosis.

Psychopathic symptoms of neurosis include:

• Chronic anxiety, fatigue, self-doubt, indecision. A person does not strive for anything, because he is sure in advance that nothing will work out. Here an inferiority complex is formed due to their own appearance and lack of communication with others.
• A constant feeling of fatigue, which leads to a decrease in academic performance or performance, and sleep is also disturbed (insomnia or drowsiness occurs).
• Inadequate self-esteem - low or high.

The somatic symptoms of neurosis include:

1. Episodic heart pain that occurs during exercise or at rest.
2. Severe anxiety, sweating, symptoms of vegetative-vascular dystonia, tremor of the extremities, hypotension.
3. It is possible to lower blood pressure, which will lead to loss of consciousness or fainting.
4. Psychalgia is pain in the body for no apparent reason.

Signs of neurosis

To determine the presence of neurosis, the following signs should be identified:

• Problems in communication.
• Irritability.
• Tearfulness.
• Unreasonable emotional distress.
• phobias, panic attacks and disorders.
• Constant experience of anxiety, fear, anxious expectation.
• Inadequate self-esteem, which can be both overestimated and underestimated.
• High sensitivity to stressful situations in the form of aggression or despair.
• Indecision.
• Attempts to work quickly end with fatigue, a decrease in mental ability and attention.
• An unstable mood that changes abruptly and often.
• Resentment, vulnerability, anxiety.
• Contradictory values, desires, positions, cynicism.
• Fixation on a situation that hurts.
• Pain in the head, stomach, heart.
• Hypersensitivity to bright light, loud sounds, temperature changes.
• Fear of physical pain over-concern about your health.
• : superficial, does not allow to rest, anxious, drowsiness in the morning, nightmares, early awakening, inability to sleep, nocturnal awakenings.
• Constant fatigue, decreased performance.
• Dizziness, darkening in the eyes due to pressure drops.
• Loss of balance, disorders of the vestibular apparatus.
• Decreased libido and potency.
• Appetite disorders: overeating, malnutrition, fast satiety, hunger.
• Vegetative disorders: disruption of the stomach, frequent urge to urinate, increased heart rate and sweating, jumps in blood pressure, loose stools, cough.

Treatment of neurosis

The treatment of neurosis has two main directions: psychotherapeutic and pharmacological. Medication is prescribed in severe cases. Usually the emphasis is on psychotherapeutic work.

Psychotherapy is aimed at changing a person's view of the world around him, solving his psychological problems, expanding the range of interests, as well as eliminating the causes that caused emotional imbalance. When a person learns to cope with his own problems, then neuroses disappear.

A person can be drawn into a situation where his neurosis manifests itself. Then there is a discussion of his actions, finding other ways of behavior. Also, the client is invited to indulge in a new hobby or to relax more, to be distracted from problems.

If psychotherapy does not help, then medications are prescribed:

• Antidepressants.
• Antipsychotics.
• Tranquilizers.
• Psychostimulants.
• Nootropics.

The first 3 groups of drugs are aimed at a sedative effect. Only the last 2 groups have an exciting effect. Which drugs and in what dosage to take, should be prescribed by a doctor who takes into account the patient's condition, as well as his individual body reactions to certain drugs.

How to treat neurosis?

A person can resort to, as well as such techniques as treating neurosis - music therapy and auto-training.

If hypnosis requires the help of a specialist who will direct all his efforts to change attitudes and beliefs that provoke neuroses, then a person can do music therapy and auto-training himself. The desire to recover personally in a person is a huge step towards the goal.

Music therapy suggests listening to melodies that have positive impact. These include compositions that cheer up a person or soothe. It should be noted that this may be your favorite music and pop compositions. The most important thing is that they do not oppress emotionally.

Auto-trainings involve self-tuning of a person in a positive way. When a person sets himself up to be active, cheerful, etc., this has a greater effect than medicines.

Prevention of neuroses

It is much more difficult and financially costly to treat neurosis than to carry out its prevention. It is recommended to take care in advance not to fall into a neurotic disorder. This will help:

1. Normalization of work and rest.
2. Having hobbies that interest and fascinate.
3. Hiking and moderate exercise.
4. Communication with nice people.
5. Keeping a diary, which notes the state of the person.
6. Sun walks and light therapy to prevent seasonal depression.
7. Resolution of family conflicts.
8. Eliminate stress at work and at home.
9. Good nutrition, avoiding alcohol and coffee.
10. Changing your attitude towards a situation that hurts.
11. Adding brightness to a room.
12. Exclusion of alcoholism, drug addiction, substance abuse.
13. Prevention of relapses.
14. Taking vitamins.
15. Complete sleep.

Outcome

Neurosis is a common condition in modern society. It appears in various forms, which depends on the structural features of the nervous system and the human psyche. The result in any case depends only on whether a person takes actions to heal himself or not.

Forecasts are only favorable if a person accepts and seeks the help of specialists, if he himself cannot cope with his own condition. Things turn out quite differently if a person ignores all attempts to get rid of a neurosis. In the latter case, there is only a deepening negative state which often leads to isolation, loneliness, mental disorders and even suicide.

They represent an extensive group of mental illnesses, for which a common feature is the absence of organic brain damage. Neuroses, for which there are no age or gender boundaries, are primarily manifested by asthenic syndrome, which includes such signs as increased fatigue, exhaustion of the nervous system. mental processes, the occurrence of autonomic disorders (sweating, palpitations) and sleep disorders.

Neuroses should not be confused with psychosis, in which the patient loses contact with the outside world, with the surrounding reality. In addition, neurosis is characterized by the presence of a pronounced moment of onset of the disease.

Today, about 400 million people worldwide suffer from one or another type of mental disorder, while 80% of such patients are diagnosed with borderline (that is, on the border of health and illness) neuropsychiatric disorders. Among them, the leading position is occupied by neuroses that develop in cases where a person, due to various circumstances, cannot find the most optimal way out of the situation that has developed. The patient cannot correctly resolve a psychologically significant situation, as well as endure a tragedy.

Etiology and pathogenesis

• biological ( we are talking about heredity, constitution, course of pregnancy and childbirth),
• psychological (taking into account premorbid personality traits, various mental traumas received in childhood, traumatic situations, as well as their relevance and duration),
• social (the relationship of parents to each other, education, profession, upbringing).

A long-term study of neurosis has shown that neurotic disorders are mainly diagnosed in young people (both men and women) whose age exceeds 30 years. In addition, neurotic disorders are more severe in women, ending in disability much more often than in men.

One cannot fail to say that neuroses are formed more easily in cases where the nervous system is significantly weakened. infectious diseases, intoxication of the body (especially alcoholism), the presence of a traumatic brain injury, overwork. Both antecedent and concomitant somatic hazards play a significant role, which is especially characteristic of modern neuroses, which are formed under conditions of ever-increasing psycho-emotional stress. In the so-called crisis periods of life (for example, puberty and menopause), a person is most vulnerable to neuroses.

The development of neurosis is due to both external and internal factors, because any neurotic disorder is primarily psychogenic, which is the result of neuropsychic overstrain and all kinds of conflicts (we are talking about injustice, material losses, death of relatives and friends, non-recognition of merit, betrayal loved one, etc.). Moreover, the social and individual significance of the experience is also of great importance. Simply put, a neurotic reaction appears only when a person is exposed to the main stimulus that is suitable for him. The second most important factor is the phenotypic personality traits that are formed under the influence of heredity and upbringing.

So, the hypersthenic form of neurasthenia is formed more often in children who are left to their own devices, while the hyposthenic form develops under conditions of oppression, but hysteria is inherent in children who are overprotected (such family idols). In people deprived of neurotic character traits, under the influence of excessive nervous and mental overload, neurasthenic disorders or vegetative neurosis may appear, but still, without certain constitutional features of a person, hysteria or obsessive neurosis usually does not form.

The main factors provoking the formation and development of neurosis:

• physical stress,
• somatic diseases,
• injury,
• unfavorable situation in the family,
• professional dissatisfaction,
• alcohol and drug abuse,
• uncontrolled use of sleeping pills.

Kinds

With neurasthenia, patients experience frequent headaches, they are constantly tormented by the feeling that their head is “bursting”, that they put on a tight hoop or helmet (this symptom was called the “Charcot neurotic helmet”). In addition, there are symptoms indicating dysfunction of the nervous autonomic system.

So, for neurasthenics, the following manifestations are characteristic:

• sweating,
• tachycardia,
• lack of appetite,
• bloating,
• frequent constipation,
• frequent urge to urinate
• sleep disorders.

Hysteria
The basis of hysterical neurosis are behavioral features that depend on increased emotionality, as well as the suggestibility of the individual. Most often, hysteria affects women between the ages of 20 and up to 40 years.

One of the main features of the behavior of patients is the desire to be in the center of attention of others, to evoke in them such feelings as surprise, admiration, envy. Such self-centeredness is achieved through a noisy manner of dressing, fictional stories about an amazing past, about tragic events or illnesses. The mood of people suffering from hysteria changes many times during the day: for example, a depressed mood can be abruptly replaced by an enthusiastic mood. It must be said that increased emotionality strongly affects all, without exception, the patient's judgments and assessments, which, like mood, are characterized by inconstancy and extreme instability (such a change of opinion is called "affective logic").

Frequent symptoms of hysteria are pseudo-organic sensorimotor disorders, including:

• distribution of sensitivity that does not correspond to anatomical laws,
• paralysis and paresis, not accompanied by symptoms of central or flaccid paralysis,
• astasia-abasia, characterized by the inability to stand and walk (while there are no paresis and impaired coordination),
• blindness and narrowing of the visual fields, and without any changes directly in the fundus.

obsessive states
It is characterized, firstly, by obsessive-phobic manifestations, and secondly, by general neurotic symptoms.

In most cases, the following types of phobias are diagnosed:

• cardiophobia - an obsessive fear of heart disease,
• carcinophobia - fear of getting cancer
• claustrophobia is the fear of enclosed space,
• Agoraphobia is the fear of open spaces.

Obsessive thoughts or memories, certain movements and actions are considered to be the rarest manifestations of this type of neurosis. For example, rituals can be accompanied by obsessive doubts, fears and fears.

Persons suffering from obsessive-compulsive disorder are usually extremely critical of the state of their health in general and the psyche in particular. They are collected and trying to cope with their illness on their own.

General neurotic symptoms include:

• decreased mood (this is especially noticeable at times of exacerbation of the disease),
• irritability,
• bad dream,
• anxiety,
• suspiciousness.

Fear
The main symptom of fear neurosis (or anxiety) is a feeling of anxiety or fear, which often occurs sharply, suddenly, while its intensity gradually increases. Having arisen, this sensation does not leave the patient throughout the day, sometimes a week or even several months. Its intensity can fluctuate between a slight feeling of anxiety and pronounced fear, which is replaced by bouts of real horror.

Fear does not depend on this or that situation, it is unmotivated, empty and devoid of plot. Often, under the influence of fear, disturbing fears appear that are psychologically associated with fear. Such fears are unstable, while the degree of their intensity primarily depends on the strength of the fear itself. Sometimes patients take certain protective measures (everything depends on the content of the existing disturbing fears), which are more or less adequate to the content of the fear. So, patients are asked to stay with them and not leave them alone, because "something terrible" can happen to them, and therefore they may need someone's help. Sometimes patients avoid physical activity, fear for the condition of their heart, so they regularly undergo medical examinations. In particular serious cases the patient may ask to hide sharp objects, with which he can hurt himself if he has a clouding of his mind.

Due to the predominance of feelings of anxiety or fear, patients cannot concentrate on any type of activity, they have increased excitability and affective instability. They are extremely agitated and seek help. Often they have painful and uncomfortable sensations in the region of the heart or in the upper abdomen, which gives a certain vital connotation to the feeling of fear.

If we talk about arterial pressure, then during the period of illness it does not exceed the norm or is at the lower limit, but nevertheless, at the height of affect, blood pressure rises slightly, while such manifestations as increased heart rate and respiration are noted, severe dryness in the mouth, increased urge to urinate.

During the course of the disease, appetite is reduced, so patients often lose weight, but not very rapidly. sex drive most often lowered. Many have difficulty falling asleep and sleep itself, which is accompanied by nightmares.

A special variant of fear neurosis is affective-shock neurosis (it is also called fright neurosis), which is divided into the following forms.

1. Simple. It is characterized by a slow course of absolutely all mental processes and certain somatovegetative disorders. Thus, the disease comes on acutely, while the cause is mainly the transferred shock, trauma, signaling a great danger. The patient develops pallor, tachycardia, fluctuations in blood pressure, rapid or shallow breathing, frequent acts of urination and defecation, constant dryness in the mouth, complete loss of appetite, sleep disturbance, weight loss, tremor of the hands and knees, a feeling of weakness in the legs, severe inhibition of not only thought processes, but also verbal and speech reactions. Over time, there is a restoration of all impaired functions, but sleep disorders are cured for the longest time.
2. Ansitized. It is characterized primarily by the development of anxiety, as well as motor restlessness, accompanied by a slowdown in verbal and speech reactions, not to mention the thought processes and vegetative disorders inherent in a simple form.
3. Stuporous. in this form, numbness and numbness of the extremities are observed. The duration of such conditions can range from several hours to several months.
4. Twilight. This is a form in which the patient has a sudden disorder of consciousness, and without any apparent reason. Altered consciousness is manifested by sudden hallucinations and delusions, phenomena of a frightening nature. The particular danger of this form is that patients are capable of severe aggressive actions (and this despite outwardly normal behavior). Aggression and cruelty are the hallmarks of the twilight state.

During a fright, a short-term stuporous state is observed, manifested by numbness and numbness, and further fear can be fixed. Young children who have suffered a strong fright may lose previously acquired skills and abilities. In some cases, the disorder is manifested by loss of speech, the ability to walk, while children begin to urinate or bite their nails when they see the source of fright.

The course of the disease in most cases is extremely favorable, implying the restoration of impaired functions. However, in children over five to seven years old who have suffered a fright, the formation of phobias may begin.

Such neuroses are mainly formed in persons with a rather weak type of nervous system or with insufficient mobility of the directly nervous processes.

Expectation neurosis
It is expressed by difficulty in performing daily functions due to an obsessive fear of failure. As a result, the patient can not perform a particular task. Thus, a so-called "vicious circle" is formed, from which it is extremely difficult for the patient to get out. This type of neurosis can be observed not only within the framework of psychasthenia, but also within the framework of neurasthenia.

The starting point for the development of the disease is a dysfunction that is provoked by a specific cause, for example, trauma, infection or intoxication. Further, the idea of ​​the upcoming execution of this function causes fear of the impossibility of its implementation, causing a feeling of anxious expectation of a pre-programmed failure. In turn, the mechanism of self-hypnosis provokes inhibition of the function, while an unsuccessful attempt leads to the consolidation of the violation that appeared earlier.

This disorder can occur at any age, but is especially common in children. Both men and women who are overly anxious, suspicious, fearful and emotionally unstable are sick. Contribute to the formation of this neurosis of injury, infection, intoxication, various vascular diseases of the brain, disorders associated with nutrition, prolonged lack of sleep.

The clinical picture of the disease is expressed in violations of the functions of speech, walking, as well as writing, reading, sleep. So, a speech disorder can provoke an unsuccessful public speaking, during which a person experienced great excitement. In the future, the patient has a feeling of anxious expectation of failure before each public performance, but if the generalization of the disorder occurs, then speech will be disturbed during performances in any non-standard conditions that cause an emotional reaction. For this reason, certain forms of stuttering are referred specifically to expectancy neurosis.

Similarly, falling when trying to walk after severe injuries lower extremities or due to dizziness in patients with vascular diseases of the brain, they can further provoke a violation of the act of walking.

Children and adolescents often have a fear of verbal answers directly in the classroom, accompanied by the inability to coherently present the learned material at the blackboard, despite the fact that the material is well studied.

The inability to sleep, which is caused by the emergence of emotions of fear or, conversely, joy, anxiety or sadness, can lead to the development of anxious anticipation of sleep disorders, not to mention difficulty falling asleep.

It is also undeniable that impotence in the stronger sex, manifested by the disappearance of an erection, is caused in most cases precisely by the anxious expectation of failure. It is interesting that such a reaction can be selective: for example, with one sexual partner, a man will not have an erection, while with another, all sexual functions will be preserved.

It is necessary to differentiate expectancy neurosis, first of all, from hysteria and phobia in obsessive-compulsive disorder (we are talking about hysterical seizures and severe paralysis in hysteria). The main difference between phobias is the ability of the patient to perform a particular function (although he is afraid to do this, expecting failure). In the course of expectancy neurosis, it is precisely the performance of the function that is disturbed.

hypochondriacal
Hypochondria is a morbid focus on one's state of health, as well as a tendency to attribute illnesses to oneself for insignificant reasons. With hypochondria, different painful sensations easily arise in different parts of the body (the so-called senestopathies). Even ancient doctors associated this condition with the hypochondria zone (or hypochondria), hence the name.

It must be said that in clinical picture This neurosis is dominated by reactively arisen anxious fears and worries about one’s health in total absence sufficient grounds. Such fears are often formed in people who are anxious, suspicious or asthenic, characterized by increased concern for their health. In addition, upbringing can provoke hypochondria, during which the child is instilled with excessive concern for his health from early childhood.

The reason for the formation of hypochondriacal ideas is a story about someone's illness or death, any somatic illness suffered by the patient, autonomic disorders (for example, tachycardia, sweating, a feeling of weakness).

If we talk about the manifestations of hypochondriacal neurosis, then the following symptoms are inherent in patients:

• cardiopalmus,
• feeling of tightness in the chest area,
• dry mouth,
• nausea,
• dysfunction of the gastrointestinal tract.

One of the main causes of hypochondriacal neurosis among women is sexual disharmony between spouses, which causes sexual dissatisfaction and is extremely difficult for a woman to experience.

A special subgroup of hypochondriacal neurosis is hypochondriacal depression, in which patients complain of pain and painful sensations in the area of ​​the stomach, head, chest as well as limbs. In addition, patients experience a feeling of weakness and fatigue, lethargy, and sometimes anxiety, not to mention a growing sense of hopelessness, which can provoke thoughts of suicide.

A bad mood is interpreted as a psychologically understandable reaction to an allegedly present serious illness or on the onset of a drop in the degree of performance. In fact, low mood gives rise to hypochondriacal ideas in patients, which are its consequences. The duration of such depressions in patients ranges from six months to three years.

Motor neuroses
They are local movement disorders, among which the most common are tics, severe stuttering and occupational seizures. Such disorders are most often formed against the background of other neurasthenic disorders, for example, increased irritability, excessive fatigue, constant headache, or poor sleep.

Vegetative neuroses
Selective dysfunction of many internal organs. In many cases, violations of the following systems are observed:

• cardiovascular (we are talking about tachycardia, increased blood pressure, pallor and excessive sweating),
• digestive (complete or partial lack of appetite, feeling of stomach fullness, nausea, spasm),
• respiratory (shortness of breath, a feeling of squeezing and tightness in the chest).

Many people believe that neurosis is not a very serious mental illness, because most of our population suffers from different types of neuroses. But this is a delusion, and neurosis could be the beginning of the worst. mental illness such as psychosis or schizophrenia.

Types of neuroses

The classification of neuroses is in a chaotic state. Many patients showed a mixture of several neurotic syndromes. Pure syndromes, however, can also be found, and this helps to clearly form the core of the diagnostic categories into which they are divided. The second edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-II) lists nine neurotic syndromes. We will consider only six main ones.

Anxiety

Anxiety in neurosis is characterized by signs of anxiety.

Anxiety is a painful internal state of nervousness and tension. This is a premonition of fear that is accompanied by a variety of unpleasant bodily sensations such as palpitations, sweating, trembling, shortness of breath and chest pain.

Anxiety occurs in both acute and chronic form. AT acute form, with sudden attacks, violent symptoms capture the patient, causing a panic state.

Chronic anxiety is characterized by lingering symptoms of lesser intensity.

Both forms can be painful and debilitating and often cause the patient to seek medical attention.

Conversion type hysteria

Hysterical neurosis is more common in women than in men, and is accompanied by a wide range of somatic symptoms. Patients become paralyzed, have abnormal movements, feelings, blindness or deafness; or vegetative functions, loss of appetite and vomiting.

The bodily symptoms of hysteria are different from those associated with organic causes; thus, in hysteria, the dysfunction is not related to neural pathways, but rather to the overall concept of a particular body part.

Hysterical patients are characteristically unconcerned and unconcerned about having very serious and painful impairments, a phenomenon often referred to as "indifference".

Hysteria of the dissociative type

The difficulty of this type of hysterical neurosis lies in altered states of consciousness of varying severity. The simplest and most common is amnesia, in which the patient loses memory of events in his life, which ranges from a few hours to a lifetime.

Recurring periods of amnesia may alternate with periods of normal memory.

in double or multiple personality two separate entities and more exist in one body. Two (or more) people alternately appear and exhibit personality and behavioral traits that are often completely opposite to each other.

Phobia

The basis of phobic neurosis is irrational anxiety in the face of some object (subway, elevator, crowd) or situation (loneliness, open space), in which there is not enough real danger to justify the manifestations of fear. The patient has the ability to control his anxiety by avoiding the phobia of the object or situation. If the phobias are sufficiently extensive, they affect life, can limit the life of the individual, cause serious disability.

Obsessive Compulsive Neurosis

This type of neurosis is characterized by obsession or intrusive thoughts. Possession is usually the thought that some harm or damage is about to happen. Thoughts are not controlled, they go against the will of a person. The patient feels obligated, as a rule, unsuccessfully struggles against the obsessive thought. Although he knows that the thought is irrational and most likely will not be realized, nevertheless, he reacts emotionally with considerable anxiety.

Depression

In depressive neurosis, there is painful feeling sadness and depressed mood. It may be accompanied by fatigue, difficulty concentrating, loss of appetite, and disturbed, restless sleep. In addition, the patient may experience an unpleasant loss of self-esteem and self-confidence.

Unlike patients with psychotic depression, patients with nervous depressions rarely commit suicide.