Neurotic Anxiety: Signs, Symptoms, & Treatment

What Is Neurotic Anxiety?

Neurotic anxiety is a term coined by Sigmund Freud to describe the emotional distress caused by inner conflicts between their ego (self-concept) and id (primal urges and desires). Unlike “objective” anxiety, which he defined as a normal fear response to an actual threat, neurotic anxiety is a form of anxiety that’s excessive, irrational, and stems from internal insecurities, rather than external threats.^{1, 3}

According to Freud’s psychoanalytic theory, a person experiences neurotic anxiety because of feeling like they are losing control over themselves, their lives, or when their ego is threatened. This anxiety causes them to become “neurotic,” which is a word used to describe dysfunctional and rigid responses to stress or anxiety in a desperate attempt to restore a sense of control.¹

Recently, the definition of neurotic anxiety has broadened to include individuals who naturally experience higher stress levels and anxiety, often exhibiting controlling, rigid, or “Type A” personality traits.

What Is Neuroticism?

In modern psychology, neuroticism is a word used to describe a personality trait that makes some people more likely to experience negative emotions, and also less equipped to cope in healthy ways with these emotions. ^{2, 3, 4, 5, 6} People who score high on neuroticism in personality tests like the Big Five are known to be more at risk for developing a range of chronic health and mental health conditions, including anxiety, depression, addiction, impulse control disorders, eating disorders, and obsessive compulsive disorder.^{4, 5, 6}

Neuroticism is a personality trait that can attach itself to a variety of different issues or conditions.² For example, neurotic depression describes a depressed person who is also more likely to self-harm, attempt suicide, or be impulsive when experiencing symptoms of depression. Compared to non-neurotic depressed people, they are less emotionally stable and more impulsive, and may have more trouble thinking clearly and making good decisions, especially when depressed.⁵

Neurotic Anxiety Vs. “Regular” Anxiety

The signs and symptoms of anxiety can be different for each person, and even neurotic anxiety can show up differently for people. Understanding the differences between “neurotic” and “non-neurotic” anxiety can be a useful way to differentiate between the two, as well as helping people identify which kind they struggle with.

Here is a summary of some of the main differences between neurotic and non-neurotic anxiety:^{3, 4}

Neurotic Anxiety Symptoms

In addition to making people more vulnerable to these conditions, neurotic anxiety is often a symptom of other mental health disorders and will show up alongside other symptoms.² Usually, neurotic anxiety increases and becomes more apparent during times of stress or hardship, which are also times when other mental health symptoms tend to increase as well.

Like all mental health conditions, anxiety causes distinct changes in the way a person thinks, feels, and behaves. Recognizing how neurotic anxiety influences mood, thoughts, and behaviors is crucial. It helps individuals identify whether they are experiencing neurotic anxiety and understand its specific manifestations.

Below is a summary of some of the common ways that neurotic anxiety shows up as changes in thoughts, emotions, and behaviors:^{2, 3}

Neurotic Anxiety Examples

Sometimes, it’s easier to identify signs and symptoms of neurotic anxiety when given clear examples of how it can show up for a specific person. With a better understanding of how it presents, once can also work to reduce neurotic anxiety symptoms with a professional.  Below are some examples of the different ways neurotic anxiety can present itself for people with different kinds of issues and disorders.

Neurotic Anxiety in People With OCD

Individuals with obsessive-compulsive disorder (OCD) manage anxiety through repetitive behaviors or mental rituals known as compulsions, aiming to regain control and alleviate anxiety. Their anxiety typically manifests as persistent, distressing thoughts or fears known as obsessions, on which they fixate.⁷ Depending on the specific ‘subtype’ of OCD the person has (the theme of their obsessions), their compulsions can also present differently.⁸

Here are some common examples of obsessions and compulsions in different subtypes of OCD:^{7, 8}

• Contamination OCD
  • Common obsessions: Worried about germs, bacterial or viral exposure, or getting dirty and being unable to get clean
  • Common compulsions: Hand washing, sanitizing surfaces, wearing gloves or masks, or frequent testing for exposure to viruses or bacteria
• Harm OCD
  • Common obsessions: Thoughts, fears, or detailed imagined scenarios of harming or killing themselves or others or committing graphic or violent acts
  • Common compulsions: Avoiding triggers, including people, places, or situations, excessive online research about murders, sociopaths, or suicide, or dedicating a lot of time to doing ‘good’ or ‘pure’ deeds like praying, volunteering, etc
• “Just Right” OCD
  • Common obsessions: Needing things or objects to be arranged in a certain way or needing to perform an action or task in a specific way, or with specific steps
  • Common compulsions: Arranging and rearranging things, organizing, revising, editing or checking something that was already done, or needing to re-do something a specific way or number of times

Neurotic Anxiety in a Perfectionist

People who describe themselves as perfectionists often struggle with anxiety, which shows up as rigid and unrealistically high standards they set for themselves, and possibly also for others. A perfectionist’s neurotic anxiety tends to show up as never being satisfied, always finding something they ‘should’ or ‘could’ have done better, and constantly feeling the need to overachieve.⁹

Some of the ways neurotic anxiety presents in someone who struggles with perfectionism include:⁹

• High levels of self-doubt and lack of trust in their own abilities and capabilities
• Restless dissatisfaction with themselves and their achievements
• High internal pressure placed on themselves to do things ‘perfectly’
• Low tolerance for mistakes and becoming highly self-critical when making one
• Trouble prioritizing tasks or managing time effectively because of the need to be perfect
• Interpreting any negative feedback as a sign of failure or rejection
• Trouble being flexible, adaptable, and open to uncertainty or change

Neurotic Anxiety & Social Anxiety Disorder

Neurotic people may be more prone to shame, self-consciousness, and negative beliefs about themselves that make them more socially anxious.(Paulus) People with social anxiety disorder have fears about being negatively judged by other people, which can show up only in certain kinds of interactions (i.e. dates, speeches, or job interviews) or in almost all interactions.⁷

People with social anxiety cope by either avoiding these kinds of feared interactions or by putting a lot of effort into trying to control how they are perceived in them.

Here are some examples of neurotic anxiety in people who struggle with social anxiety disorder:⁷

• Excessive worry or dread before social interactions
• Extreme self-consciousness and discomfort during social interactions
• Overthinking everything they say or do during an interaction and self-censoring
• Trying too hard to seem interesting, smart, cool, or to get people to like them
• Adopting a false persona to be more likable or make a positive impression on others
• Replaying awkward or embarrassing interactions over and over afterwards
• Mentally rehearsing or practicing conversations ahead of time to feel more prepared
• Avoiding social situations that are unfamiliar, uncertain, or uncomfortable for them

When & How a Therapist Can Help

Anxiety is highly treatable, and many people experience an improvement in their symptoms with just therapy, although some people benefit from a combination of therapy and medication.⁷ Most people with neurotic anxiety are struggling with another underlying mental health condition, and most of these can be effectively treated or at least improved with therapy.

In group or individual therapy, a client can learn healthier and more effective ways to cope with anxiety, and can also learn how to avoid making impulsive decisions that cause more problems for them. The goal of therapy is normally to reduce anxiety, improve functioning, and learn more effective methods of coping with symptoms.

Different therapists use different types of therapy, and it’s important to find a therapist you like who uses a style or approach that works for you. Some examples of therapies that can help reduce symptoms of neurotic anxiety include CBT for anxiety, acceptance and commitment therapy (ACT), and exposure therapy.

Finding a Therapist

Many people begin their search for an anxiety therapist online using therapist directories or reputable online therapy platforms for anxiety, which help match individuals with qualified professionals based on specific needs or therapeutic preferences.These platforms allow users to find therapists who specialize in anxiety treatment, schedule virtual sessions, and access professional support from the comfort of home.