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Differences between Psychosis and Neurosis

The increase in mental disorders among the population worldwide is on the rise , so it is important to be informed and to know some characteristics and differences between some of them.

As the so-called neurosis and psychosis , which usually cause confusion among many. So that, through the recognition of some characteristics and symptoms, a timely intervention can be made and referrals with health professionals, thus avoiding major complications that can diminish the quality of life of the sufferer and those who cohabit or live with them .

What is Psychosis?

“Now when I remember it, it seems very ridiculous to me and I think I should laugh. But it was not. It was a place of indescribable pain . That’s what people who have never been crazy can not understand. How much it hurts delirium. How far reality can be from one’s reach. It is a world of despair and frustration. “John Katzenbach

It is a generic term that refers to some mental disorders, encompass several conditions, which cause changes in personality, have loss of contact with reality in the form of hallucinations or delusions , which is something very characteristic within psychoses, since the person can not distinguish them, there are alterations of the judgment and behavior.

“Sometimes I’m not sure that some incidents that I remember clearly really happened. A memory that seems solid like a stone, immediately afterwards it is as vaporous as a mist. That is one of the main problems … You are never sure of things. “John Katzenbach.

Regardless of the special etiology, they have common psychopathological syndromes; they are considered serious mental disorders, they are characterized by alterations at the global level, which presuppose problems in different cognitive processes such as language, memory, attention, thought and sensoperception. It causes a split or loss of contact with reality, which often produces delusions , hallucinations and disorganized behavior, many of them tend to have persecutory and paranoid ideas. The symptoms of psychosis can disable a person to work and develop in several aspects.

There are psychoses that have an organic etiology , are produced by diseases, tumors, traumatisms; others induced by external agents such as   alcohol and stimulant drugs such as methamphetamines and cocaine , as well as hallucinogens, for example: LSD , to name a few causes. In these cases the disconnection with reality is induced by other agents.

There are brief reactive psychoses , those that end in remission. As the name implies, they last for a short time , they can be hours or weeks, although they could be periodic, without proper treatment. They are derived because of a detonating factor as a highly stressful or traumatic event , such as the death of a loved one or being victims of an act of violence.

What is Neurosis?

” The neurotic man closes himself the way to his genuine possibilities, he stands before himself on the way to his being power. ”  Viktor E. Frankl

The concept of neurosis is linked to a more psychodynamic and psychoanalytic interpretation , remains and is still widely used today; It can cover a range of conditions, which is why its concept has been blurred. Although the term is still used, the WHO (World Health Organization), the APA (American Psychologycal Association), and the DSM-V (Diagnostic and Statistical Manual of Mental Disorders), have integrated it into a wide range of disorders. , thus trying to focus on more clinical and descriptive aspects.

Trying to eradicate in this way its etiology as unique in nervous system affections, because they have found adjacent frames that have nothing to do with this, while trying to eliminate pejorative connotations that can stigmatize the person. When it does not underlie another disorder, the neurosis, is caused by psychological factors, because they come into conflict: the impulses or desires, the unconscious defenses of the individual and what is allowed both socially and culturally.

They may present somatic symptomatology, not adapt in all cases to certain situations, or respond adequately to stressful events, as their coping strategies are usually not optimal .

Characteristics of the neurotic personality

There are circumstantial characteristics in this type of subjects, which allows us to pose the traits that define the neurotic personality, this type of character is an expression of intense internal conflicts , as it is subjected to a constant drive struggle, usually not able to harmonize their desires (often repressed), with what he thinks he should do or the society and culture in which he lives he demands to do. The great drama lies in not being able to identify with the ideal character of his own Self , he does not usually have a good self-image, or acceptance of himself, which generates anguish, anxiety , anger and frustration, He feels that it can not be carried out in several aspects that he desires, resorting to certain defense mechanisms, which are not so convenient.

Everyday situations can be overwhelming. So their social interactions are usually not the best, neither for themselves nor for others, they can often have poor impulse control, they tend to accumulate guilt and high disagreements. They suffer from excessive stress and worry and almost constantly, many refer to having catastrophic thoughts even when there are no real reasons that sustain these beliefs, so they may be prey to superstitious beliefs and repetitive behaviors or rituals to release a little anxiety and anxiety, but complicating their lives more, as they may result even maladaptive, such as having to wash their hands every time they touch something they perceive is not hygienic or when they shake a person’s hand.

From the psychological point of view, the somatic plane can be reached and vice versa, thus affecting the integral well-being of the person.

These topics are fascinating and very broad, so I will delimit some distinctions below.

Comparative table of the main differences between Psychosis and Neurosis

Excision of reality.Disturbance between the I the external nexus. Contact with reality, although they may present shared attention between what happens and their internal conflicts that overwhelm them, but they do not lose the reality judgment.
There is no awareness of the condition. There is awareness that “something is wrong”.
They present hallucinations (they can be auditory, tactile, visual and sensory) and delusions, their constructions can take fragments of reality and in the escape of reality an active phase of reconstruction continues, replacing many elements of reality with others created. Primitive and fragmented superego. They do not usually manifest hallucinations or delusions. You can use avoidance as an escape to overwhelming situations. They may have attempts to substitute reality for some more according to their desire, but they are aware that many of these constructions are fantasies, for example.
Imbalance of thought, judgment, behavior, will and emotions.What generates social mismatch. It can stay within socially accepted limits, although sometimes its coping strategies may be unsatisfactory and not very suitable for the context.
It usually presents loss of interest for what surrounds him and for self-care, may manifest obsessions. They manifest anguish, anxiety, stress, disproportionately and constantly.They can be somewhat perfectionists and prey to obsessions.
They can present catatonic symptoms, and poor coordination of body movements. When the states of anxiety, panic or anguish are exacerbated, they may present nervous tics.Repeat patterns of behavior to try to release anxiety, anguish and stress.
In its etiology, organic, biochemical and environmental factors influence. Its genesis is rather psychological and can be learned or conditioned behaviors.
The inheritance, neurological factors, traumatisms, cerebrovascular accidents, certain type of infections and even toxicological factors could be decisive. Hereditary factors can be important but not determinative.
Cognitive processes such as language, attention and thinking can be disorganized and incoherent, sensory perception and memory are also affected. So theanalysis of speech can predict the risk of psychosis . They can be coherent and use logical thinking. They tend to have tendencies that situations are under their control and order, as they can not generate more anxiety. Your attention may be divided between the present and your worries about the future, or your anguish and guilt of the past.
They require psychological and psychiatric support because they need psychotropic drugs, hospitalization or equivalent home care, because they are incapable of taking care of themselves. With work and proper psychological treatment they can learn to manage their emotions and react in more adaptive ways.They respond well to different types of psychotherapy.
Generally they carry a high risk of self-harm and threatening their own lives. Few cases end in suicide, although there may be an idea about it.
They may be related to disorders such as those included in the spectrum of schizophrenia, neurocognitive disorders, eating disorders, body dysmorphic,  chronic delusional disorder, psychotic depression, bipolar disorder, dementia, anxiety and panic disorders, mood disorders, dissociative , impulse control, disruptive and behavioral personality disorders, paraphilic, adaptive, risk of suffering from other addictive and substance use disorders, disorders related to trauma and stress.Schizophreniform disorder is another type of psychosis , among others. They can include anxiety disorders, panic disorder, mood disorder, obsessive-compulsive disorder , phobic, somatomorphic, impulse control, disruptive and behavioral disorders, such as intermittent explosive disorder, food disorders, paraphiliacs. , disorders related to trauma and stress, risk of suffering other addictive disorders and substance use. It includes mood and anxiety disorders. You can see: anxiety disorder (anxiety neurosis) .
Serious deterioration in the functioning of the person and their social interactions. The deterioration can be slight in the functioning of the person and their social relations, although this condition could be aggravated if it does not receive adequate psychological treatment.
They have sleep disturbances. They can present alterations in sleep.
Projective identification, split, negation, idealization, among others. Some predominant defense mechanisms are:repression , intellectualization,projection , displacement,reactive formation, rationalization.Partial dissatisfaction of the drive by means of substitute formations (symptoms as symbolic expression) conflict it and me.
Disorder and severe mental disorder, with alteration of reality, cognitive processes and detriment in social functionality. Emotional and behavioral alterations mainly caused by anxiety.
People with behaviors that may seem extravagant, dramatic, emotional or erratic. People with dramatic, emotional and sometimes erratic behavior.
Brief reactive psychosis , happens during periods of great stress such as a traumatic event or the death of a relative, to name a few examples. They usually experience a remission in a few days or weeks, depending on the source of the stress.

It is important to sensitize the population in general about these issues so that there is more understanding and empathy. And in turn, people who need professional psychological and psychiatric help can be referred to in a timely manner, for their own good and that of others.


Bibliographic references

  • American Psychiatric Association (2013). DSM-5. Diagnostic and statistical manual of mental disorders (5th Edition) . Washington, DC: Masson.
  • Goldman, Howard, H. (1987). General Psychiatry . Mexico: Modern Manual.
  • Katzenbach, J. (2004). The story of the madman . 

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