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

More recently, the definition of neurotic anxiety has been expanded to describe people who are more prone to stress and anxiety, and who also have controlling, rigid, “type A” personalities.

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. Understanding the ways that a person’s mood, thoughts, and behaviors can change when they are experiencing neurotic anxiety is essential can help a person identify whether they are experiencing it and if so, how it shows up for them.

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

A person with obsessive compulsive disorder (OCD) copes with their anxiety by using repetitive mental or behavioral acts (compulsions) in order to feel less anxious and more in control. Their anxiety tends to show up in the form of specific worried thoughts or fears (obsessions) that they become fixated on.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

Most people begin their search online when they’re interested in finding a therapist, and many use an online therapist directory to find therapists who have specific training or specialties.

Final Thoughts

Neurotic anxiety describes a type of anxiety that stems from inner insecurities, urges, or fears of losing control. People who suffer from neurotic anxiety often have another mental health condition, with anxiety, mood, eating, or obsessive compulsive disorders being most common. This kind of anxiety often leads people to become defensive, impulsive, overreactive, and to engage in behaviors aimed at restoring a sense of control.^2,3,6

Unfortunately, many of the neurotic behaviors and defenses a person will use can backfire, making their anxiety worse and causing additional problems for them. Therapy can help people with neurotic anxiety learn better, more effective methods of coping and responding to anxiety, which can greatly improve their quality of life and ability to function.