Like several other words that represent nuanced psychological conditions or phenomena, “neurotic” has been co-opted to mean something it doesn’t. You’ve probably heard someone say, “That person is so neurotic,” but do they really know what they’re saying?
Historically, when I hear the word “neurotic,” fear bubbles up in me. I’ve heard it used interchangeably with “crazy”—another word that’s been co-opted and turned into a somewhat general, insulting jab. Before knowing its true definition, I, too, have wondered if I’m neurotic, thinking it was a clinical diagnosis. Dr. Nicholas Farrell, clinical psychologist and a Regional Clinical Director at NOCD, helped me clear up what it actually means to be “neurotic.”
Let’s define neuroticism
First of all, neuroticism is not a clinical diagnosis. Neuroticism is one of five dimensions of personality, identified by psychologists, that exist on a spectrum for all people. Known as “Big Five” personality traits, the others include extroversion, agreeableness, openness, and conscientiousness. Again, these traits represent a spectrum: someone can be highly neurotic, not neurotic at all, or anywhere in between, and one’s neuroticism can change at any time based on what’s going on in their life.
The trait of neuroticism indicates moodiness, emotional instability, anger, and sadness. Put simply, it measures one’s capacity to experience negative emotions. Those who have a high level of neuroticism are more prone to anxiety, depression, mood swings, irritability, certain personality disorders, substance abuse, and eating disorders. They have a difficult time dealing with stress and can find minor challenges to be overwhelming.
The personality trait of neuroticism is not to be confused with the antiquated term of “neurosis.” Dr. Farrell says it used to “refer to more present day understandings of anxiety and fear-based disorders. What folks a century ago called neurosis,” he says, “we now call anxiety.” Similar to how “hysteria” used to be used as a blanket term for women experiencing any sort of emotional or mental distress, our understanding of mental health has evolved and, fortunately, so has the language we use to describe it.
What conditions are associated with “neurotic” symptoms?
There is interesting research on the exact relationship between neuroticism and common mental disorders (CMDs)—but it’s not entirely clear how they influence one another. However, the research is clear on the presence of a correlation between high levels of neuroticism and CMDs, including the aforementioned anxiety disorders, as well as depression, obsessive-compulsive disorder, substance abuse, personality disorders, and eating disorders. In fact, those with high neuroticism are even at greater risk for having more than one mental health condition. Those whose personality profile features a high level of neuroticism tend to be more attuned to their internal experiences and feel negative emotions more deeply, so it’s hypothesized that neuroticism can pave the way for CMDs. That being said, it’s also been argued that the CMDs are what shape neuroticism.
It’s also widely reported that neuroticism can lead to more physical health problems. The focus on one’s inner world extends to physical sensations and, psychologists say, those with neuroticism are also more likely to focus on, and sometimes exacerbate, their symptoms, physical or mental. Of course, that’s not to say that their experiences should not be taken seriously; rather, it’s a way in which people and their care team can better understand their experiences. Because of the correlations with mental and physical health, researchers are interested in continuing to study neuroticism and its implications for public health.
Because the words “neurotic” and “neurosis” are used in conversation to convey someone who is erratic, irrational, unstable, a worrier, uptight, or particular, they also tend to be used interchangeably with those mental health conditions that they share a correlation with. It is important to know the differences between these phenomena. Having accurate language to describe an experience means that people will be better equipped to recognize it themselves—and to find adequate support and treatment. Continue reading for a breakdown of the disorders that are most often mischaracterized and overgeneralized as “neurotic.”
Anxiety disorders include generalized anxiety disorder, panic disorder, phobias, social anxiety, and agoraphobia. Specific symptoms will vary between conditions, but in general, anxiety disorders share symptoms of excessive worry, a sense of impending doom, physical sensations such as a racing heart, sweaty palms, or trembling, racing thoughts, and trouble concentrating. People with certain anxiety disorders may have a difficult time dealing with change, due to the unknown nature of new circumstances, and a difficult time dealing with stress. They typically live with a high level of fear, which can cause them to behave in a way that may seem, from an outsider’s perspective, “erratic” or “irrational” and therefore, neurotic.
Personality disorders, such as borderline personality disorder, antisocial personality disorder, and narcissistic personality disorder, are characterized by ways of behaving that differ from what is expected and cause distress to the individual. They affect the way one thinks about themselves and others, the way they respond emotionally, and the way they control their behavior. For example, those with borderline personality disorder can have intense mood swings, another concept that may be referred to in conversation with the word “neurotic.”
Those with eating disorders, such as anorexia, bulimia, binge eating, or orthorexia, might be viewed as “neurotic,” too. Out of a desire to keep their eating disorder a secret, those suffering can behave in a way that appears strange and secretive. With orthorexia, for example, the sufferer becomes hyperfocused on clean, healthy eating, and there are generally very few foods they will eat. Because “neurotic” has the colloquial connotation of meaning “particular” or “fussy,” sufferers and their loved ones could easily dismiss this behavior as neurotic.
Obsessive-Compulsive Disorder (OCD)
People with OCD can appear erratic and irrational, too. This disorder is categorized by 1) repetitive, intrusive thoughts, images, feelings, sensations, or urges followed by 2) compulsive behavior, performed either internally or externally, done to relieve oneself of the anxiety caused by the intrusive thoughts and/or prevent a bad thing from happening. You might observe someone with OCD having compulsive, rigid routines, for example, or compulsively avoiding certain places or activities. To sum this up as “neurotic” is both inaccurate and beside the point. In all of these conditions, it’s quite possible that the individuals suffering from them possess a high level of neuroticism, but the presence of neuroticism is not itself the sign of a clinical condition that needs treating.
As with most things, neuroticism is not all bad news. Neuroticism is also associated with high levels of creativity. The area of the brain responsible for self-generated thought, the medial prefrontal cortex, is highly active. A plethora of successful artists and innovators are thought of as rating high in neuroticism. Plus, though neuroticism is generally associated with poor health outcomes, some studies show that those with high neuroticism are more likely to catch health problems sooner rather than later, due to being so closely in tune with their internal experiences.
Anecdotally, I can surmise that I have an above-average level of neuroticism. Despite the fact that it may be related to my struggles with OCD, and my proclivity to melancholy, it also has paved the way for my big imagination, which I love. I can’t imagine not being a creative, artistic person—I simply wouldn’t be me. I also value being self-aware, having a strong inner world, and thinking deeply, traits I might not have if not for neuroticism.
Neuroticism might have sounded bleak so far, and for many, it does have less-than-desirable implications. However, that doesn’t mean you’re doomed, or can’t thrive, or can’t manage the feelings and experiences that a more neurotic personality makes you more prone to.
Should you seek help to manage a personality with high neuroticism?
Whether or not it’s time to seek help managing the effects of a neurotic personality depends, of course, on how it’s impacting your life. If any of the above conditions resonate with you, reach out to a licensed psychologist, psychiatrist, or therapist to help you determine a diagnosis and course of treatment. Anxiety disorders as well as eating disorders are most commonly treated with cognitive-behavioral therapy (CBT). OCD is best treated with exposure and response prevention therapy (ERP), which is also a highly effective treatment option for phobias. And some personality disorders may be treated and managed through dialectical behavioral therapy (DBT).
Here are some general questions to ask yourself if you’re not sure whether or not to seek help:
- Do you have persistent thoughts of worry and/or restlessness?
- Do you have trouble controlling your emotions or behaviors?
- Are your relationships, school, or work being affected by your behavior?
- Do you find objectively small stressors to be enormously difficult to deal with?
- Do your feelings or behaviors stop you from doing the things you want to do?
- Do you have trouble understanding yourself, your emotions, and/or your behaviors?
In summary, if your functioning and/or quality of life is being impacted negatively in any way, therapeutic treatment can help. If the symptoms of OCD, or phobias, sounded familiar, you can schedule a free call with NOCD to be matched with a licensed, ERP-trained therapist. For other forms of treatment, check out Psychology Today’s therapist directory.