(When) Are You Neurotic?
Identifying neurotic patterns
Posted Nov 23, 2012
Although the term “neurotic” has more recently fallen out of favor, it was used by psychiatrists for most of the 20th Century to describe a broad category of conditions that were associated with poor functioning, anxiety and depression, but were clearly differentiated from “psychotic” in that in constrast to individuals in the latter category, neurotics maintained contact with reality and were rarely engaged in highly deviant, socially unacceptable behavior. (A factoid worth noting is that the term “borderline”, of borderline personality disorder fame, originated from the conceptual space between neurotic and psychotic. Originally, borderline individuals were those who generally maintained contact with reality, but under duress exhibited extreme volatility and primitive defenses and were not good candidates for psychoanalysis).
For a host of reasons, I hope the term makes a comeback, and I describe here the various ways the term is still used and how it can be helpful in framing human problems and suffering. The most important thing to distinguish when using the term "neutoric" is to know whether it is referring to personality traits or character adaptations. Personality traits are longstanding patterns of thoughts, feelings, and actions which tend to stabilize in adulthood and remain relatively fixed. There are five broad trait domains, one of which is labeled Neuroticism, and it generally corresponds to the sensitivity of the negative affect system, where a person high in Neuroticism is someone who is a worrier, easily upset, often down or irritable, and demonstrates high emotional reactivity to stress.
Whereas traits are broad descriptions of tendencies, character adaptations are the more situation- specific ways people adjust to the environment. Here the term neurotic refers to maladaptive coping strategies driven by fear or anxiety (which can be conscious or subconscious) elicited by a certain kind of situation. By maladaptive, I mean the response ultimately moves the individual away from their long-term goals and needs.
Consider a case I was supervising. Susan had just started dating Brian and she reported that on their third date, Brian was supposed to show up at seven. At 7:10 pm Susan called Brian on his cell, upset, asking him in a somewhat panicked voice, “Where are you? Are you coming or not?” Here Susan’s anxious-dependency needs drove her to reach out for contact and assurance. However, the response was “neurotic” because the likely consequence was that her actions probably worked against her long- term goals. While Brian’s response, “I will be there in a minute” alleviated Susan’s short term anxiety, it is also likely that at some level Brian will register Susan as dependent and needy, which will increase the likely that he will actually avoid her in the future—which, of course, is exactly Susan’s fear.
The importance of understanding the meaning of “neurotic” in terms of character adaptations is that we are all neurotic some of the time, even if we might be low on trait Neuroticism. Indeed, much of the work I do in psychotherapy is helping people become aware of, accept, and change their neurotic strategies. Consistent with my previous blog on self-knowledge, it is crucial that all of us understand our neurotic insecurities and strategies we use to cope with them. I typically look for such neurotic patterns in five different domains of adaptation: 1) habits; 2) emotions; 3) relations; 4) defenses; and 5) beliefs (verbal cognitions).
Neurotic habits are automatic or ritualized patterns of overt behavior that people engage in to alleviate anxiety and provide a sense of familiar security. The problem is that, carried out over the long term, the habitual patterns are maladaptive. A classic example is the anxious drinker. Stressed all day, riddled with achievement and relational anxieties, alcohol becomes a short term, medicating balm. Unfortunately over time, it comes with significant costs (hangovers, weight gain, health problems, etc). Binging and purging, ritualistic ordering or cleaning, nail biting or trichotillomania (hair pulling) are all common examples of neurotic, maladaptive habits.
Neurotic emotional patterns come in two basic flavors, over-regulated (meaning suppressed and not expressed) and under-regulated (meaning hyper-sensitized and over-expressed). Feeling states per se are almost never bad. However, feeling states can become hyperactive (or chronically accessible) such that they can be triggered at the slightest stimuli and can then dominate the individual’s mind set. Individuals with depressive or anxious disorders are generally under-regulated in those feeling states and need help containing them. Often, however, the problem isn’t that an individual is feeling too much, but that he or she is walled off from some or all of their emotions. Some common examples are the “always nice” person who “never” feels angry, the competitor who attacks others instead of feeling shame, the unemotional distancing person who can’t feel anything at all. These individuals usually have a form of “affect phobia,” which is maladaptive because it blocks them from key aspects of their human experience.
The human relationship system is guided fundamentally by needs for relational value, navigated on the dimensions of power, love, and freedom. Neurotic relationship patterns emerge when people adopt rigid styles or express extreme interpersonal reactions in response to fears that their relational value needs won’t be met. Susan’s needs for relational value drove her to respond in a maladaptive way. Individuals who hide in their apartments out of social anxiety, individuals who hunt for any signs of betrayal, and individuals who vacillate between being needy and fearing control all engage in neurotic relational patterns in that they each are attempting to manage their needs for relational value, but are doing so in a way that ultimately produces intense conflict or pushes others away leaving such needs fundamentally unmet.
Our defenses are the way we manage tension between conflicting goals and filter stuff out of our full consciousness. The defensive system tries to bring harmony to the various other systems of adaptation, but sometimes does so at significant costs. Two very common defenses are repression and rationalization. Repression is when material is blocked out of self-conscious recognition (see here for an example). Rationalization is when we make up reasons that hide our true needs or feelings. Research on cognitive dissonance offers some compelling examples, and I highly recommend the book, Mistakes were Made but Not by Me, for an excellent analysis of ego defensive processes via rationalization and how such processes lead to maladaptive patterns.
Finally, our verbal beliefs are networked into systems of justification that provide us with theories about ourselves in the world. Cognitive psychotherapy became widespread because it helped individuals realize that at the roots of much suffering were maladaptive interpretations or beliefs about how the world ought to be. For example, many people have core beliefs that they are ineffective or unlovable, and in vulnerable periods interpret setbacks as confirming such beliefs. Others have rigid or extreme beliefs about how the world must be if they are to function (e.g., the belief that everyone must like them or that they must be perfect all the time). Others make catastrophic interpretations of minor events. The problem is that these beliefs legitimize actions, feeling states, or perceptions of self or others that lead to a host of maladaptive patterns. Cognitive psychotherapy is effective because it teaches folks to catch, check, and change maladaptive beliefs into more adaptive narratives.
Regardless of whether we are high or low on trait neuroticism, it is inevitable through the course of our development that we will develop at least some neurotic reactions to cope with our insecurities. For example, I bite my nails when stressed, sometimes turn a cold shoulder when I am in need of connection or intimacy, or rationalize my failures to protect my sense of pride. Consider what situations make you feel insecure and then look across your patterns of habits, feelings, relationship processes, defenses, and justifications and reflect on where neurotic patterns might reside in you. And, if you are feeling open and secure enough, ask someone you trust when and how they think you are neurotic. After all, the very nature of neurotic processes is such that we will very likely be blind to them.