‘Neurotic’ is a term colloquially used to describe someone who is uptight, anxious about the tiniest of slights, emotionally unstable, quick to anger, and frequently obsessive about small things. If you regularly sweat the small stuff, and stay awake at night worrying and overthinking, then you may even think of yourself as neurotic. But what does being neurotic actually mean?

In the dictionary, neurosis is defined as: “A mental illness, resulting in high levels of anxiety, unreasonable fears and behaviour and, often, a need to repeat actions for no reason.” In the early days of psychoanalytic diagnosis, neurotic meant ‘nerve disorder’ and was the opposite end of the spectrum to ‘psychotic’. People with neurosis still have a grip on reality. People with psychosis don’t.

Fast forward to today and neurosis is technically no longer classified as a mental illness in the DSM-5, the manual that psychiatrists use to diagnose patients. The World Health Organisation’s International Classification of Diseases combines ‘neurotic, stress-related and somatoform disorders’. This category includes phobias, stress-related disorders, anxiety and panic disorders, obsessive and compulsive disorders, dissociative disorders, hypochondria and psycho-somatic disorders, and dissociative disorders. Neurotic disorder per se is ‘unspecified’. However, neuroticism is classified as one of the Big Five personality traits (alongside extroversion, openness to experience, agreeableness and conscientiousness).

Roots of neurosis

There will be a reason in childhood why someone develops neurosis. That reason will relate to the child’s needs not being completely met in the way he or she needs them to be. Perhaps because the parents are absorbed in their own world, or because they are too critical, inconsistent, overindulgent – or just aren’t attuned to the child’s needs and thoughts and fears. The child doesn’t feel heard, and doesn’t feel able to express his or her true feelings. The child grows up without an internalised sense of safety and belonging. Instead, a growing sense of anxiety and insecurity develops. The child can’t relate spontaneously to others, and so creates his or her own coping strategies to soothe that anxiety. These strategies, or defences, can become quite rigid over time. The world can seem a scary place to someone who’s neurotic, and those strategies help the person survive in the world.

Some signs of being neurotic

• You have persistent, low-level anxiety, accompanied by excessive worrying and constant fretting. Your brain never lets you free to enjoy a moment because you’re worrying about what you’re saying, how people are taking it, and what impact it will have in the future.
• Your self-esteem is low: you doubt yourself and your own abilities. You may even feel depressed because of your inability to express and be your true self.
• Your focus is on validation from others – valuing external successes and achievements highly – rather than tuning into your internal truth and acting from an intuitive place.
• You’re known for your ‘Jekyll and Hyde’ mood swings.
• You are over-sensitive, take slights easily, and aren’t able to regulate your emotions once triggered.
• Your most-used word is ‘should’: the things that you should be doing, and the expectations you have on others.
• Perfectionism is what you’d love to achieve, but often it turns into self-criticism as you fail to reach that perfect outcome.
• You can be needy and clingy in your relationships, whether with friends, family or romantic partners. You can spend hours reading and re-reading text messages to interpret what the sender really meant, and is everything OK between you.
• You worry about your health to the point of hypochondria – and you often have headaches or stomach issues with vague causes that the doctors can’t quite pin down.
• You describe yourself as OCD about certain aspects of your life, and feel guilty and anxious if you’re not keeping up your extremely high standards.

How therapy can support neurotics

The psychoanalyst Nancy McWilliams (author of Psychoanalytic Diagnosis) says that neurotics “tend to seek therapy because of problems not in essential security or sense of agency, but because they keep running into conflicts between what they want and obstacles to attaining it that they suspect are of their own making”. In other words, neurotics keep making problems for themselves and don’t quite have the tools to untangle themselves from those problems. They’re functioning well, but life isn’t as smooth or as joyful as they’d like it to be.

For a neurotic coming into therapy – which is usually long-term and open-ended – the work may be to look at the defences that have kept them going all these years, and starting to unpick the defences that aren’t working quite so well for them. They may also work on the aspects of self that keep holding them back, becoming less buttoned up, getting in touch with their playful, creative side, and gradually connecting with their true self.

If you’d like to seek support for your anxiety, depression, phobias or obsessions then do get in touch. We have a team of counsellors, psychotherapists and psychologists offering sessions seven days a week at our centres in Clapham and Tooting. Call 020 8673 4545 or email info@theawarenesscentre.com for an initial chat and to book an appointment.