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Types of neuroses. Stages of development of neurosis

Neurosis– a psychogenic, functional, personality disorder, which is manifested mainly by emotional disorders, behavioral disorders and disorders of the neurovegetative regulation of internal organs.

Neurosis– this is a consequence of an insoluble intrapersonal motivational conflict with insufficient effectiveness of mechanisms psychological protection.

Neurosis– acquired functional disease nervous system, in which a “disruption” of brain activity occurs without any signs of its anatomical damage. Neurosis is a consequence of failures, frustrations and interpersonal clashes and at the same time often serves as their cause. So a vicious circle results: conflicts lead to neuroticism, and this, in turn, provokes new conflicts. Short-term neurotic states that go away on their own over time, without treatment, are observed at one time or another in almost any person’s life.

The causes of neuroses lie in a wide variety of traumatic situations, acute or chronic emotional stress. And depending on the predisposing background, the disease can manifest itself with various symptoms. The main manifestations of neurosis:

High sensitivity to stress - people react to a minor stressful event with despair or aggression
tearfulness
touchiness, vulnerability
anxiety
fixation on a traumatic situation
when trying to work, they quickly get tired - memory, attention, and thinking abilities decrease
sensitivity to loud sounds, bright lights, temperature changes
sleep disorders: it is often difficult for a person to fall asleep due to overexcitation; superficial, disturbing sleep that does not bring relief; I often feel drowsy in the morning
autonomic disorders: sweating, palpitations, fluctuations in blood pressure (usually downward), disruption of the stomach
sometimes – decreased libido and potency

Neuroses are often caused by:

Long-term psycho-emotional and physical activity moderate intensity without the opportunity to relax and recuperate, that is, chronic stress - this can be a job that takes all the strength, difficulties in personal life, a conflict about which a person is very worried, and most often a combination of these factors

Sometimes exhaustion of the nervous system occurs due to the inability to complete a task or get out of a deadlock situation.

Often, the origin of neurosis is based on the same genes as those that cause depression.

The emergence of neurosis is facilitated by the inability to relax and workaholism

Some people naturally do not tolerate prolonged stress well and are therefore prone to overwork


An additional factor in the development of neuroses are diseases that debilitate the body (for example, influenza)

Types of neuroses:

1. Neurasthenia(Lat. – “nervous weakness”). Reason: prolonged emotional stress, leading to exhaustion of the nervous system. Conflicts at work, family troubles, instability personal life. Psychological defense mechanisms such as “denial”, “rationalization”, “repression”. A patient with neurasthenia is bothered by irritability for the most significant reasons. It is difficult for them to concentrate their attention, they quickly get tired, they develop headaches, heart pain, stomach functions are disrupted, insomnia appears, sexual function is upset, and the acuity decreases. sexual relations. Sleep disturbance.

2.Hysteria– observed more often in women. They sometimes imagine themselves as seriously ill, unhappy, “misunderstood people” and become deeply accustomed to the image they have created. Sometimes an occasional unpleasant minor family quarrel or minor work conflict is enough for the Patient to begin to sob bitterly, curse everything and everyone, and threaten to commit suicide. A hysterical reaction usually begins when the Patient needs to achieve something from others, or, conversely, to get rid of their allegedly unfair or simply unwanted demands. These reactions can manifest themselves as uncontrollable tears, fainting, complaints of dizziness and nausea, vomiting, convulsive curling of the fingers, and in general - symptoms of almost any disease known to a given person; imaginary paralysis, deafness, and loss of voice may occur. But with all this, a hysterical attack cannot be considered a simulation; it most often occurs against a person’s desire and causes him to suffer greatly physically and mentally.

3.Neurosis obsessive states (psychasthenia) – persistent anxious thoughts and fears appear, for example, “of contracting a disease”, of losing loved one, blush during a conversation, be left alone in a room, etc. At the same time, the person understands well the illogicality of his fears, but cannot get rid of them.

Each of them occurs in people with a certain type of GNI, with specific mistakes in their upbringing and typical unfavorable life situations.

Problems and approaches to study

IN Pavlov's teachings the essence of neurosis comes down to a chronic deviation of the GNI from the norm, which occurred as a result of overexertion nervous processes and changes in their mobility. According to Pavlov and his students, neuroses depend on the initial type of nervous system. Thus, people of the “artistic type”, who perceive reality very emotionally, are more prone to hysteria; “mental type” - to obsessive-compulsive neurosis, and the mean between them - to neurasthenia.

The first definition of the concept “neurosis” belongs to Gullen. Neuroses are “disorders of sensations and movements that are not accompanied by fever and do not depend on local damage to any organ, but are caused by general suffering, on which movements and thought specifically depend.” In the second half of the twentieth century. have emerged 2 main directions in the doctrine of the origin of neuroses: anatomical and psychological.

It should be noted that the search for the pathoanatomical substrate of neuroses has not yet brought significant results, although supporters anatomical direction It is believed that advances in the field of molecular biology and genetics make it possible to confidently deny the existence of functional diseases and find morphological substrates that are adequate to any dysfunction.

Supporters of the psychological direction are the most numerous. Already in the second half of the 19th century. The basis for the emergence of neuroses in humans, in particular hysteria, was considered to be increased suggestibility and self-hypnosis. Therefore, hypnosis was proposed as the main method of treating neurotic conditions.

According to Z. Freud, who headed the psychoanalytic school, neuroses are explained by the action of “infringed” affects, repressed into the unconscious of various drives. Freud divided all psychogenic disorders that have somatic correlates into 2 main groups: conversion neuroses (hysteria) and actual neuroses. The latter included anxiety neurosis, hypochondria and neurasthenia. From the perspective of various psychological trends associated with Freudianism, the essence of the conflict in neuroses is the contradiction between instincts in the sphere of the unconscious and social norms.

All representatives of the psychological movement recognize that psychological factors are leading in the etiopathogenesis of neuroses.

Obsessive thoughts - one of the types of obsessive states (obsessions). The term "obsessions" is sometimes misused to refer only to intrusive thoughts, but its meaning is much broader.

Obsessive states are conventionally divided into obsessions in the intellectual-affective (phobia) and motor (compulsions) spheres. The conventionality of this division is evidenced by the fact that most often several types of obsessions are combined in the structure of obsessions.

Obsessive thoughts are characterized by the same basic properties that, according to the definition of V.P. Osipov (1923), are inherent in all obsessive phenomena in general. The main distinctive features of obsessive thoughts were highlighted by S. A. Sukhanov (1912) and V. P. Osipov (1923).

1. Obsessive thoughts arise involuntarily and even against the will in a person’s mind. At the same time, consciousness remains unclouded and clear.

2. Obsessive thoughts are not in visible connection with the content of thinking; they have the character of something alien, extraneous to the patient’s thinking.

3. Obsessive thoughts cannot be eliminated by the patient’s willpower. The patient is unable to get rid of them.

4. Obsessive thoughts arise in close connection with emotional sphere, accompanied by depressive emotions and anxiety.

6. The painful nature of obsessive thoughts is recognized by the patient, and there is a critical attitude towards them.

V.P. Osipov admitted that with a sharp expression of obsessive thoughts, a loss of reasonable attitude towards them is possible and then intrusive thoughts and ideas can develop into delusion. D. S. Ozeretskovsky (1961) writes that the development of obsessions into delirium is observed in isolated cases, so it cannot be considered a typical phenomenon.

The main difference between an obsession and a delusional idea is the patient’s critical attitude towards obsessive thoughts that remain alien to his thinking and his personal position. Obsessive thoughts involuntarily invade the patient’s psyche, he experiences them hard, understands their absurdity, but

Painful ideas, impulses and actions bring significant suffering to a person, but he cannot do anything with himself except to replace, use another instead of one stupid idea, move from one prohibition to another. A person suffering from neurotic obsessive actions has all kinds of doubts, indecision increases, and there is a restriction of freedom. Psychoanalysis takes into account the symptoms of the disease, perceives a hidden meaning in them, based on the identification of this meaning, gives a historical (rooted in childhood) interpretation of them and thereby provides the opportunity to translate the unconscious into consciousness with the aim of subsequently eliminating neurotic symptoms.

All main types of neuroses in the modern edition of the ICD are coded using codes F 40-48. In the Medical Subject Headings (MeSH) dictionary they are assigned the index D009497. This collective name means psychogenic disorders, which with properly selected therapy are reversible. Regardless of the form of manifestation, all neuroses are considered as functional disorders GNI.

All types of neuroses tend to be protracted. The basis of disturbances in these pathologies is overstrain of the processes of excitation, inhibition or their mobility. The cause of all types of neuroses is stress, prolonged mental tension, conflicts, and emotional turmoil.

There are three main types of neuroses: neurasthenia (asthenic neurosis), hysteria (hysterical neurosis) and obsessive-compulsive neurosis.

This article presents a classification of the main types of neuroses and their brief description with treatment recommendations.

Causes of neuroses and their general symptoms

The following factors play a role in the etiology of neuroses: biological (heredity and constitution, long-term somatic diseases); socio-psychological (unfavorable family circumstances, improper upbringing). Also, the cause of neuroses are factors of a psychological nature (premorbid personality characteristics, mental trauma, etc.).

Common signs of neuroses include instability of mood, irritability, low resistance to stress, manifested in despair or aggression. Tearfulness, fixation on a traumatic situation, vulnerability, touchiness, anxiety, fatigue, decreased attention, memory, and thinking abilities are observed, but a critical attitude towards the disease remains. Also symptoms of neuroses are increased sensitivity to loud sounds, temperature changes, and bright light. This pathology accompanied by sleep disturbances, headaches, as well as heart pain and abdominal pain. There is vegetative-vascular dystonia, dizziness, as well as darkening in the eyes from pressure changes, impaired body coordination, sweating, cough, frequent urination, decreased libido, loose stools, decreased potency. Eating disorders (bulimia - overeating or anorexia - undereating). Hypochondria - taking care of your health, psychological feeling and the experience of physical pain (psychalgia).

Below you can familiarize yourself with the characteristics of neuroses of the three main types.

Asthenic neurosis: causes, symptoms, diagnosis and treatment of neurasthenia

Asthenic neurosis(neurasthenia) is a pathology characterized increased excitability and irritability combined with rapid fatigue and exhaustion of mental activity.

Neurasthenia occurs most often in people 20-40 years old, less often in women than in men. Asthenic syndrome in case of neurosis, it develops during prolonged physical overstrain (hard work, insufficient sleep, lack of rest), frequent stressful situations, personal tragedies, long-term conflicts. Also, the cause of neurasthenia can be somatic diseases and chronic intoxication.

Symptoms of asthenic neurosis are emotional instability, mental and physical hyperesthesia. The disease is very often accompanied by anxiety, fear, neurotic depression, hypochondriacal symptoms, and reversible somatovegetative disorders.

Violent reactions of irritation and outbursts of anger can occur at the slightest provocation. They are frequent but short-lived. Patients with neurasthenia are unable to to the fullest control the external manifestations of your emotions. There may be tearfulness, previously not characteristic of this person, impatience, fussiness, and increased sensitivity. Patients themselves regret that they are not able to fully restrain their emotions. All the patient’s experiences are permeated with a feeling of self-pity, as well as a tendency to exaggerate the severity of the subjective manifestations of the disease.

Another symptom of neurasthenia is anxiety in varying degrees severity: vague painful premonitions, unaccountable internal agitation, impaired attention.

The clinical course of neurasthenia is divided into three periods: hypersthenic, transitional and hyposthenic. At the initial stage of the disease, irritability prevails - patients do not tolerate sharp noise, bright light, loud speech, emotional and physical stress.

Various vegetative reactions easily occur: pressing headache(“neurasthenic helmet”) or constant feeling heaviness in the head, memory loss, feeling of discomfort in various areas body, palpitations, sweating, cold extremities. Sleep is disturbed. Gradually, irritability reactions are replaced by rapid exhaustion, severe weakness, fatigue, impaired attention. This is a signal about the onset of the second period of the disease. The patient is also easily excited and screams, but this first reaction is replaced by a feeling of powerlessness and resentment and often turns into crying. Mental reactions with opposite emotional states arise for any, even the most trifling, reason. It takes a lot of effort for the patient to force himself to do any task or work; he is unable to concentrate. Trying to concentrate on something, he quickly gets tired, his headache gets worse, and he can’t clearly think about what he’s doing. Increasing general and nervous weakness forces you to quit the job you started with a feeling of complete powerlessness. After some time, attempts to get down to work resume, but due to nervous exhaustion the patient abandons her again.

Such repeated attempts to work can bring a patient with asthenic neurosis (neurasthenia) to a state of complete exhaustion, since the patient does not mentally rest between attempts to work.

Symptoms of the hyposthenic period of neurasthenia: characterized by constant lethargy, physical and mental weakness, passivity, decreased mood, lack of interests. Patients experience a feeling of sadness and some vague anxiety, but pronounced attacks of anxiety or melancholy are not typical for them. Depressed mood is combined with severe asthenia and is often manifested by emotional instability and tearfulness. Because of the feeling constant fatigue and general weakness, patients generally cannot get ready to begin any physical or mental work. They are focused on their internal sensations, and thoughts about their condition suppress them even more. Hypochondriacal complaints about various sensations emanating from the internal organs are characteristic.

The diagnosis of neurasthenia is made by a neurologist based on characteristic complaints the patient, the history of the disease and examination, excluding the presence of chronic infections, intoxications or somatic diseases. To exclude organic damage to the brain (tumor, inflammatory diseases, neuroinfections), when diagnosing neurasthenia, the causes of this type of neurosis are studied and a CT or MRI of the brain is performed. For evaluation cerebral circulation REG is performed.

During the treatment of neurasthenia, it is necessary to resolve the situation causing emotional stress, provide the patient good rest, and the condition quickly returns to normal. In other cases, it requires quite long-term treatment. With long-term exposure to stimuli, the formation of neurotic personality development is likely. Patients with neurasthenia benefit from walking before bedtime, fresh air, fortified food, change of environment. Rational psychotherapy and autogenic training are recommended.

For general restorative treatment of asthenic neurosis, pantocalcin and calcium glycerophosphate are prescribed, sometimes in combination with iron supplements. Bromine and caffeine are effective in individually selected dosages. Therapy for cardiovascular disorders is carried out with hawthorn tincture, valerian and motherwort preparations.

For the hypersthenic form of neurasthenia, tranquilizers are indicated: elenium, radedorm, eunoctin; for sleep disorders - sleeping pills: zopiclone (imovan), zolpidem.

For confirmed symptoms of neurasthenia in the hyposthenic form, small doses of sibazon (diazepam), encephabol, eleutherococcus, and phenotropil are used to treat the pathology. They recommend coffee, strong tea, drugs with a tonic effect: ginseng, Chinese lemongrass, saparal, pantocrine.

The administration of Sonapax in hyposthenic form in small doses acts as an antidepressant and has a stimulating effect on the nervous system. In large doses it manifests itself sedative effect, which makes it possible to use it in the desire for the hypersthenic form.

Also, electrosleep, massage, reflexology, aromatherapy and other procedures can be used to treat this type of neurosis and its symptoms.

Prevention of the development of neurasthenia includes compliance with correct mode work and rest, the use of relaxation techniques after nervous overstrain, avoiding physical overload and stressful situations. A change in activity, complete disconnection from work, and active rest are of great importance.

Hysterical neurosis: causes, symptoms and treatment of hysteria

Hysterical neurosis (hysteria)- manifestation of mental discomfort, directly related to the pathological transfer of internal conflict to somatic grounds.

People with an unstable psyche are prone to hysterical reactions - characterized by increased suggestibility, lack of independence of judgment, impressionability, easy excitability, emotional swings, and egocentrism. Such people have a desire to attract attention to their own person by any means, which further results in manipulation of others.

The causes of hysteria are suddenly developed stressful situations: a family quarrel, a conflict at work, a breakup with a loved one, or a sudden threat to life. A person finds an outlet for his emotions in hysterics, while extracting his own benefit from others (attention, sympathy, participation). The mechanism of development of hysterical neurosis includes “flight into illness”, “conditional pleasantness or desirability” of a painful symptom.

Symptoms of hysterical neurosis manifest themselves most clearly with the participation of other people. Motor disturbances are observed: finger tremor, poor coordination, loss of voice (aphonia). Muscle tics (hyperkinesis) and cramps are often demonstrated. Moreover, all symptoms intensify during a medical examination by a pediatrician, therapist, neurologist and other specialists. This is explained by the fact that very often symptoms arise as self-hypnosis and usually correspond to a person’s ideas about the most striking painful manifestations.

A hysterical attack begins with a feeling of a lump in the throat, a sudden increase in heart rate and a feeling of lack of air. There may be unpleasant sensations in the heart area, which greatly frighten the patient. The condition continues to rapidly deteriorate, the person falls to the floor “successfully” without receiving any injuries. The next symptom of hysteria is convulsions, during which the patient stands on the back of his head and heels (“hysterical arc”). A seizure may be preceded by crying or hysterical laughter.

Unlike epileptic seizures, during hysterical fits there is never involuntary urination, tongue biting, severe injuries, persists pupillary reaction to the light. A seizure in the manifestation of hysterical neurosis is accompanied by redness or paleness of the face. Often patients begin to tear their clothes, shout out some words and bang their heads on the floor.

Sometimes hysterical attacks are less pronounced: the patient sits down or lies down, begins to cry or laugh, making a series of random movements with his limbs (mainly with his hands), his gestures can be theatrical, with an attempt to tear out his hair, scratch his body, throw objects that fall under his hand.

After an attack of hysteria, the patient may exhibit amnesia, even to the point of ignorance proper names and last names. However, this manifestation is short-term, memory recovery occurs quite quickly, as it is inconvenient for the patient himself.

Hysterical neurosis is often accompanied by sensitivity disorders - anesthesia, hypoesthesia, hyperesthesia, hysterical pain. Most often, pain is observed in a limited area of ​​the head (a feeling of a “driven nail”).

Loss of sensory function such as deafness or blindness may also occur. Quite often, with hysteria, a narrowing of the field of vision and distortion of color perception occur. However, even a pronounced narrowing of vision does not prevent such patients from orienting themselves in space. Speech disturbances are observed, consisting of loss of sonority of the voice, stuttering, pronunciation by syllables and silence. At the same time, the cough remains loud.

Vegetative manifestations are limited by the patient’s imagination. He may complain of pain in any internal organ, most often the gastrointestinal tract and heart. Sometimes patients refuse to eat due to a false spasm of the esophagus. Nausea, abdominal pain, the urge to vomit, pain in the heart, difficulty breathing, palpitations or a sinking heart have no basis - in most cases there are no pathological changes in these organs that can cause such symptoms. The patient may complain of skin sensations (burning, itching, numbness) and exhibit scratching from itching.

The patient, vividly talking about his complaints and excessively demonstrating their confirmation, remains emotionally indifferent. It seems that the patient enjoys many of his “sores”, while considering himself a complex nature that requires close and comprehensive attention. If the patient learns about any manifestations of the disease that were previously absent from him, high probability these symptoms will appear.

The absence of organic changes against the background of serious complaints is the main sign in the diagnosis of hysterical neurosis. During the examination, increased tendon and periosteal reflexes and tremor of the fingers of outstretched arms may be noted. Patients often react to examination with groans and tears; there is a demonstrative increase in motor reflexes and deliberate shuddering of the whole body.

During diagnosis, instrumental studies are carried out to confirm the absence of any organic changes in the internal organs. The doctor will prescribe a CT scan of the spine and an MRI spinal cord for movement disorders. CT and MRI of the brain will confirm the absence of organic pathology. To exclude vascular pathology, they resort to angiography of cerebral vessels, rheoencephalography, Doppler ultrasound of blood vessels head and neck. EEG (electroencephalography) and EMG (electromyography) can confirm the diagnosis of hysteria.

Treatment of hysteria is aimed at eliminating the cause of the disease. The psychotherapist's main assistants (trainings, hypnosis and all kinds of suggestions) will positively influence the elimination of mental disorder, explaining to the patient that this disease is caused by “flight into illness” and only a full awareness of the depth of the problem can change it.

Drug treatment of hysterical neurosis is carried out with tranquilizers (diazepam, phenazepam), prescribed in small doses and short courses.

When the symptoms of hysteria are protracted, tranquilizers are used to treat the pathology in combination with antipsychotics that have a corrective effect on human behavior (neuleptil, eglonyl, chlorprothixene).

The prognosis for the life of such patients is quite favorable. Patients with signs of anorexia, somnambulism and suicide attempts require longer observation. Longer treatment is required for patients of the artistic type and with symptoms of hysteria that began in childhood. A more unfavorable outcome is observed when hysterical neurosis is combined with organic lesions nervous system or severe somatic diseases.

In the prevention of hysterical neurosis, the main thing is to create and maintain conditions that reduce mental trauma at work and at home. There should also be no excessive care and sympathy from the patient’s relatives, since their reverent attitude may be misinterpreted: patients may well feign illness not only in order to deserve a large portion of attention to their person, but also to obtain some benefit. Ignoring the seriousness of the problem may well lead to the fact that the hysteria will disappear if the very need for its spectacular demonstration disappears. It is important to drink teas and infusions of medicinal herbs.

Obsessive-compulsive neurosis: causes, symptoms, diagnosis and treatment of the disease

Obsessive-compulsive neurosis is less common than hysterical neurosis and neurasthenia.

The causes of obsessive-compulsive neuroses may be a disturbance in the metabolism of hormones (serotonin and norepinephrine), which leads to two interrelated consequences: an increase in the level of anxiety and a change in the normal course of thought processes. Disturbances in hormone metabolism can be either hereditary or acquired. Hereditary disorder- a consequence of gene mutations.

Acquired disorder occurs due to various psychological factors: mental trauma, long-term experiences, stress, etc.

The main risk group for the development of obsessive-compulsive neurosis are people of the thinking type with fearful, anxious-suspicious and highly conscientious character traits.

Various infectious diseases and injuries are sometimes provoking factors for the development of the disease. By destabilizing the nervous system and influencing the mobility of nervous processes, they can contribute to the development of the disease.

Symptoms obsessive neuroses are obsessions, thoughts, pictures, states. Obsessive states are a source of decompensation. In obsessive-compulsive neurosis, obsessive phenomena are presented very clearly.

Phobias in the disease obsessive-compulsive disorder are expressed in the following clinical manifestations:

  • Ereithophobia - obsessive fear of blushing;
  • oxyphobia - obsessive fear of sharp objects;
  • lissophobia - obsessive fear of madness;
  • agoraphobia - obsessive fear of open spaces (squares, wide streets, etc.);
  • gypsophobia - obsessive fear of heights;
  • claustrophobia - obsessive fear of closed spaces;
  • mysophobia - obsessive fear of pollution;
  • Cardiophobia is an obsessive fear for the condition of your heart.

If some of the phobias in obsessive-compulsive neurosis occur predominantly in isolated form (such as mysophobia, ereitophobia), then others appear in various combinations, and the primary phobia leads to the development in dynamics neurotic state secondary, tertiary, etc. obsessive fears. For example, cardiophobia causes the appearance of claustrophobia, agoraphobia, or an obsessive fear of sharp objects is added to the primary lissophobia.

A symptom of obsessive action neuroses is a passion for rituals. Rituals are obsessive actions and movements that are accompanied by obsessive fears, concerns and doubts. There is often a combination of phobias and obsessions, i.e. we're talking about O various options obsessive-phobic or phobic obsessive syndrome; in the form of a neurotic reaction - phobias (usually cardiophobia, insectophobia - fear of insects, algophobia - fear of pain, etc.), the basis is usually the experience of fear of death. In the case of the gradual development of neurosis (a form of neurotic development), the obsessive symptom complex is more complex; often, along with phobias, there are obsessive thoughts and actions. Along with phobias, general neurotic (or, as they are often called, neurasthenic) symptoms are also noted, which include difficulty concentrating, fatigue, sleep disturbances, increased irritability etc.

Rare symptoms of obsessive neurosis are: obsessive thoughts (obsessive neurosis), memories, doubts, obsessive movements (obsessive neurosis) and actions (obsessive neurosis), which, in addition to the obsessive component, are characterized by an awareness of their painfulness and a critical attitude towards them.

At acute forms The situational factor acquires relatively greater importance; in forms of neurotic development, its role appears less clearly; at the same time, the characteristics of the patient’s personality and the conditions of their formation are of greater importance.

This type of neurosis is quite variable in terms of symptoms. It can manifest itself in the form of intrusive thoughts, uncontrollable fears or compulsive actions. Symptoms can appear either separately or in combination with each other.

Obsessive thoughts (obsessions) are images or feelings that involuntarily arise in the mind against the will and reason. Obsessions may not have emotional coloring(mental repetition of words or recalculation of numbers) or, conversely, have a vivid emotional connotation inherent in sensations, and be expressed in the form of obsessive fears, doubts, memories, etc.

With intrusive memories, as a rule, there is a painful uncertainty about fidelity decision taken or the completion of an action. In some cases, there may be a feeling of unreality of the surrounding world and depersonalization (violation of self-awareness).

A distinctive feature of fears in obsessive-compulsive neurosis is the fact that they arise only in certain situations and the patient is aware of the illogicality of his fears or thoughts. The severity of symptoms may vary.

To diagnose obsessive-compulsive disorder, the patient's medical history is collected, electrocardiography and biochemical studies are performed.

There are two ways to treat this pathology: medication and behavioral. At drug treatment For obsessive-compulsive disorder, a course of antidepressants is prescribed, which increase serotonin levels and improve overall well-being.

For confirmed symptoms of obsessive-compulsive neurosis, behavioral treatment uses various cognitive-behavioral methods aimed at eliminating obsessive manifestations.

These types of treatment are used both individually and in combination. At severe course diseases more weight The treatment regimen includes medications and, to a lesser extent, psychotherapy.

Forecast: Complete recovery with therapy is possible, but it is temporary, since in stressful situations or depression the disease can recur.

– the most common type of psychogenicity, characterized by shallow depth mental disorders.

The development of neuroses occurs in various ways. Along with short neurotic reactions, a protracted course occurs, which may not be accompanied by behavioral disorders. Neurotic reactions, as a rule, manifest themselves weakly, but in the case of prolonged irritation, constant emotional tension or internal conflict occurs.

There are three types of neuroses:

Hysterical neurosis.

Obsessive-compulsive neurosis.

Neurasthenia.

Neurasthenia.

The first place is occupied by asthenic manifestations. They are characterized by physical and mental fatigue, confusion, absent-mindedness, the need for long rest, which, as a rule, does not restore strength, and decreased performance. The most common complaints are lack of vigor, loss of strength, low mood, weakness, fatigue, intolerance to the most ordinary stress, and decreased energy. Severe mental exhaustion is accompanied by excessive excitability and hypertension. Patients behave extremely unrestrained, are very hot-tempered, and complain of a regular feeling of internal overstrain.

Patients with neurasthenia experience a strong emotional reaction, often ending in tears, with small misunderstandings, telephone conversations. Also, manifestations of asthenia can be expressed in headaches, various somato-vegetative disorders (disruption of the genitourinary system, disturbance gastrointestinal tract, respiratory disorders, cardiovascular system, sweating).

Obsessive-compulsive neurosis.

This disease is manifested by various obsessions, despite the fact that isolated case relatively monotonous. Obsessions (obsessions) are manifested by an insane involuntary desire and the appearance of thoughts, doubts, ideas, fears, motor acts and drives.

The manifestation of obsessions is usually unpleasant and occurs with a preserved understanding of the painfulness of disorders and always a negative attitude towards them.

Obsessive neurosis is divided into several types:

Obsessive states - ideas, obsessive thoughts, ideas.

Obsessive actions and attractions.

Obsessive phobias(fears).

Also, obsessive states are divided into 2 types:

With a painful affect.
With affectively neutral content.

Affective-neutral obsessions - obsessive counting, reproduction of long-forgotten names and past events.

Obsessions with a painful affect are colorful figurative representations. At the same time, patients need the desire to shout out cynical phrases and words, to present the events of death in small details.

Obsessive-phobic disorders are based on claustrophobia (fear of enclosed spaces), agorophobia (fear of open space), fear of public speaking, fear of moving certain types transport, fear of performing usual functions (chewing, swallowing, sexual intercourse, urination). Also, with obsessive-phobic disorders, the presence of a group of nosophobias (fear of diseases) is noted: cardiophobia (fear of myocardial infarction), cancerophobia (fear of getting cancer), schizophobia (fear of going crazy), AIDS phobia (fear of contracting HIV).

Obsessive actions can occur against the will of the patient and resemble natural gestures and movements. In this case, patients can make movements with their hands, straightening their hair, shaking their heads, straightening their hats, and straightening the folds of their clothes.

Unlike other neuroses, obsessive-compulsive neurosis has the property long-term treatment, in this case, there is no expansion of symptoms, and patients slowly get used to fears and fears. As a rule, they try not to find themselves in situations where they are overcome by fear, so as not to lead themselves to violations of their usual way of life.

Hysterical neurosis.

Basically, hysterical neuroses manifest themselves in the form of disturbances of autonomic functions, motor and sensory disorders, simulating neurological and somatic diseases (conversion syndrome).

Movement disorders include hysterical paralysis and cutting, and rhythmic tremor, tics, hyperkinesis, trembling, which can increase with fixation of attention. There is also a risk of hysterical seizures.

Sensory disorders include hypoanesthesia (decreased sensitivity), anesthesia (complete loss of sensitivity), and hysterical pain. Neuroses may include several types of stuttering, anorexia, and enuresis.

In the case of neuroses, the feeling of alienness of pain and the desire to resist it remain. Neurosis-like conditions are characterized by a pattern of increasing symptoms, a large polymorphism of symptoms, a bizarre, abstract content of obsessions and fears, and an unmotivated feeling of anxiety.

Treatment of neuroses.

Treatment of neuroses should only be carried out by a psychiatrist. Treatment is carried out comprehensively, including therapy with pharmacological medications and a course of psychotherapy.

The purpose of psychotherapeutic influence is to resolve the conflict, or change the patient’s attitude towards conflict situation. For neuroses, there are several methods of psychotherapeutic influence: individual conversations, hypnotic sessions, collective, group, family psychotherapy.

Treatment of neuroses is carried out with the help drug therapy. Effective treatment is achieved by taking drugs from the tranquilizer group of benzodiazepines, chlordiazepoxide (Napothon, Librium, Elenium), diazepam (Valium, Relanium, Duxen, Seduxen), alprozolam (Alzolam, Neurol, Cassada), nitrozepam (Nitrosan, Eunoctin, Radedorm), carbamine esters (Sedanil, meprobomate), sibazon.

For advanced neuroses, neuroleptics are prescribed, for example, fluspirilene, eglonil, neuleptil, thioridazine, chlorprothixene, etapnrazine. Patients suffering from neurosis with asthenic manifestations should use nootropics together with tranquilizers: aminalon, nootropil.

It would not be superfluous to take psychoactivating drugs, for example, tincture of Eleutherococcus or Chinese lemongrass.

It is worth remembering that neurotic diseases curable with integrated approach, which is why vitamin-mineral complexes, restoratives, therapeutic exercises, and physiotherapeutic procedures should be included in therapy.

Perhaps you have encountered a situation where a strong shock disrupts your mental balance, causes unpleasant emotions and takes you out of your usual rhythm of life for a long time. At such times, any work becomes difficult and tiring, and thoughts return again and again to the traumatic event. Thus, under the influence of psychological trauma or prolonged nervous tension, neurosis or a neurotic disorder can occur.

Neurosis and its manifestations

Neurosis is understood as a group of borderline nervous - mental illness, which are reversible and occur with pronounced emotional and somatovegetative manifestations. In a neurotic disorder, a person has no organic disorders and contact with reality is maintained, but mental and physical performance is significantly reduced.

Main mental symptoms Neurosis is emotional distress and instability of mood, feelings of guilt, irritability, fears, frequent flinching from surprise, vulnerability, tearfulness, low resistance to stress, fatigue, possible photophobia and sensitivity to sharp sounds.

Among somatic symptoms– sleep and appetite disturbances, headaches and dizziness, palpitations and fluctuations in blood pressure, increased sweating, frequent urination, decreased libido.

And although the clinical picture of the disease is varied, emotional disorders still come to the fore.

Causes

The main causes of neurosis are psychogenic factors. This can be either a very strong impact (for example, the loss of a loved one) or a weak, but effective long time(for example, constant overload when performing activities), as well as conflicts, both external and internal.

Contribute to the occurrence of neurosis:

– heredity and biological factors – poor resistance to stress, congenital fatigue, current and past diseases that cause exhaustion of the nervous system

– personal characteristics– emotional instability, vulnerability, indecisiveness, inadequate self-esteem, lack of self-confidence

– defects in upbringing – infantilism, lack of independence in decision-making, persistence in overcoming difficulties

– social conditions– unfavorable family situation, unsatisfactory living conditions, features of professional activities performed under conditions of constant stress

– incorrect lifestyle – lack of sleep, overwork, excessive mental and physical stress

Basic forms of neuroses

The following main forms of neurotic disorders are distinguished:

1. Neurasthenia.

This neurosis is characterized by exhaustion of the nervous system, its clinical manifestations are weakness, increased fatigue, depressed mood, irritability, headaches, and sleep disturbances. Some authors give this form of neurosis a name.

2. Neuroses of fear.

This neurosis is spoken of when fear is the leading syndrome. Moreover, fear can manifest itself both as a general fear and as a fear that is tied to a specific situation, for example, when suffering severe mental trauma.

The main symptoms of this type of neurosis are obsessive thoughts, memories, actions or movements. Such neurosis most often occurs in suspicious, anxious, insecure people.

4. Hysterical neurosis.

This form of neurosis is clearly manifested in motor sphere in the form of convulsive seizures, speech disorders(for example, mutism), sensory and vegetative-visceral disorders. Characterized by pronounced demonstrative behavior and is almost always tied to a certain life situation.

At the same time, there are many other forms of neurosis. Some of them arise in certain conditions and during age periods, others can arise only under the influence of a traumatic situation. So they distinguish school neurosis, postpartum, traumatic, social (with changes social status), informational, fear neurosis and expectation neurosis (possible failures), hypochondriacal and cardiophobic, motor neuroses (tics, stuttering) and organ neuroses (if nervous regulation without organic pathology), as well as others.

Treatment of neuroses

Thus, neurotic disorder is the general name of the group neurological diseases with pronounced emotional manifestations that impair the individual’s performance. Unlike mental disorders in neuroses, the leading role in the occurrence and development of the disease belongs to psychogenic factors, while the patient does not have irreversible changes in personality and maintains a critical attitude towards his condition.

Irritability, intolerance and other negative emotional manifestations not only reduce a person’s quality of life, but can also lead to disruption of adaptation in society, the emergence of conflicts and difficulties in establishing contacts with others. Therefore, it is very important to recognize neurosis in time and seek qualified help. Neurotic disorders are successfully treated with the help of restorative therapy, normalization of the daily routine, drug treatment and application of psychotherapy methods.

The prognosis for treatment is favorable, but it is necessary to eliminate the source of the neurosis, or change the attitude towards a certain life situation or traumatic experience. To achieve these goals, methods are an excellent choice.

Classification of neuroses, i.e. their distribution depending on common features, has not yet been developed, and various attempts to systematize them are not generally accepted. In the last International classification diseases (ICD-10) there is not even a section “Neuroses”, and this term is practically not used. They are registered under different names in different blocks of class V “Mental and behavioral disorders”. For example, the well-known hysteria is labeled "dissociated (conversion) disorder." This will give little to a person without medical education as well as doctors general practice. When describing these diseases, we use the classification of past years, which was generally accepted in former USSR, and is now cited not only in popular, but also in scientific and educational medical literature (X. Remschmidt, 2000, R. Telle, 2000, L. A. Bulakhova, 2001).

In our opinion, replacing the name of a disease with new terminology will not give the patient anything, but will only complicate and confuse the perception of medical knowledge.

Below is a description of two groups of neuroses - general and systemic.
General neuroses:
1. Neurosis of fear.
2. Hysterical neurosis (hysteria).
3. Obsessive-compulsive neurosis:
- obsessive movements and actions (obsessive);
- obsessive fears (phobic).
4. Depressive neurosis.
5. Asthenic neurosis (neurasthenia).
6. Hypochondriacal neurosis.
7. Nervous (mental) anorexia of puberty.
8. Neuroses not differentiated by psychopathological syndrome.

General neuroses are psychogenic diseases in which the clinically leading emotional and behavioral disorders are: general irritability, anxiety, fears, emotional instability, heightened perception of the activity of internal organs, increased suggestibility, etc. Varieties general neuroses determined by the nature of these violations.

However, in preschool (3-6 years old) and early school age (6-11 years old), clinically defined forms of most common neuroses, with the exception of fears, hysterical and obsessive states, are extremely rare, and therefore they are usually diagnosed after 10-12 years. Children are characterized by blurred and variable clinical manifestations of general neuroses, absence or minimal severity of experience of the defect and, as a consequence, lack of desire to overcome them. According to the figurative expression of G.K. Ushakov (1981), neuroses in children are characterized by “the absence of distinct complaints from the child and their abundance from others.”

Systemic neuroses are a large group of psychogenically caused disorders, i.e. arising under the influence of acute or chronic psychotrauma, usually characterized by one clinical manifestation in the form of motor, speech or autonomic disorders. This is described in more detail in the section “Systemic neuroses and neurosis-like conditions”, and now a description will be given separate forms general neuroses.