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In every society, it has been realized that there are many troubled individuals who are neither insane nor mentally retarded. They differ from other people in being plagued by feelings of inferiority or self-doubt, suspicion about the motives of others, low energy, inexplicable fatigue, shyness, irritability, moodiness, sense of guilt, and unreasonable worries and fears. They suffer as a result of these feelings or they behave in ways that are upsetting to those around them and to society at large. Yet none of these conditions precludes partaking in the everyday affairs of life, such as attending school, working, marrying, and rearing a family. As these conditions were more carefully documented in the early part of the last century, they came to be called psychoneuroses, and later, neuroses, and those that created societal difficulties were called psychopathies, and more recently, personality disorders and sociopathies.

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The question of the purity and homogeneity of these mental states excites a polemic in psychiatry. The neuroses as a group appeared to be so diverse as to require subdivision in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) into no less than seven different types. Originally, Freud referred to the neuroses as psychoneuroses and the subject became enmeshed in psychoanalytic theory. The assumption was that an undercurrent of anxiety arising from unconscious conflict explained all the different types of neuroses as well as the psychopathies. Later, psychiatrists uncommitted to psychoanalytic theory attributed these states to social forces leading to maladaptive behavior from childhood. These notions were not acceptable to biologically oriented physicians, with the result that the term psychoneurosis was expunged from later editions of the DSM, and even neurosis was replaced by anxiety disorders, phobic states, and obsessive-compulsive disorder. These terms are at present applied to mental disorders with the following characteristics: (1) symptoms that are distressing to the affected individual and regarded by the person as unacceptable or alien; (2) intactness of reality testing (the patient’s evaluation of the relationship between himself and the outside world); (3) symptomatic behavior that does not seriously violate social norms, although personal functioning may be considerably impaired; (4) a disturbance that has its onset early in life and is enduring—not a transitory reaction to stress; and (5) the absence of a discernible medical cause or structural disease of the brain. The foregoing definition of the anxiety and its allied disorders has the virtue of being descriptive without committing one to any theory of causation.

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The genesis of the neuroses remains elusive. It is generally conceded that such disorders do not arise de novo. The antecedents are thought in some quarters to be abnormalities in personality development, strongly influenced by genetic factors and possibly molded by stressful events in the life of the individual (Noyes et al). Traits of this nature undoubtedly arise in several individuals from the same family. Thus any discussion requires a brief digression into ...

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