Neurotic Disorders: Anxiety, Phobic, Obsessive-Compulsive and Stress-Related Disorders
Neurotic disorders is a historical umbrella term for anxiety, phobic, obsessive-compulsive, dissociative, somatic-symptom and stress-related disorders in which distress is prominent but reality testing is usually preserved. Modern practice names the specific disorder and assesses physical causes, suicide risk and functional impairment.
Classification
| Group | Core pattern | Examples |
|---|
| Anxiety | Excessive fear/worry and autonomic arousal | Generalized anxiety, panic disorder |
| Phobic | Marked fear and avoidance of particular situations | Agoraphobia, social anxiety, specific phobia |
| Obsessive-compulsive | Intrusive thoughts/urges and repetitive rituals | OCD |
| Trauma/stressor-related | Re-experiencing, avoidance, threat and negative mood after trauma | Acute stress reaction, PTSD, adjustment disorder |
| Dissociative/somatic | Disruption of memory/identity or distressing bodily symptoms | Dissociative disorder, somatic symptom disorder |
Aetiology and pathophysiology
Symptoms arise through interaction of genetic vulnerability, temperament, autonomic arousal, fear conditioning, cognitive misinterpretation, avoidance learning, trauma, chronic adversity and social factors. Avoidance gives short-term relief but prevents corrective learning, maintaining fear. Medical illness, caffeine/stimulants, alcohol withdrawal, asthma, arrhythmia, anaemia, thyroid disease, hypoglycaemia and medicines can mimic anxiety.
Clinical assessment
- Describe symptoms: onset, trigger, duration, frequency, avoidance, rituals, trauma exposure, sleep, substances and functional effect.
- Exclude emergencies: chest pain, syncope, hypoxia, severe headache, pregnancy complications, intoxication/withdrawal and delirium require medical assessment.
- Mental-state and risk: depression, suicide/self-harm, psychosis, safeguarding, substance use and ability to care for dependants.
- Physical assessment: vitals, glucose when indicated, cardiovascular/respiratory/neurological examination and targeted tests—not indiscriminate investigations.
Disorder-specific features
- Panic attack: sudden intense fear with palpitations, breathlessness, trembling, dizziness, chest discomfort and fear of dying; peaks rapidly, but first/atypical attacks need medical exclusion.
- GAD: difficult-to-control worry across many areas with tension, poor sleep, fatigue and concentration problems.
- OCD: obsessions are unwanted intrusive thoughts/images/urges; compulsions are rituals intended to reduce distress, not pleasurable habits.
- PTSD: trauma re-experiencing, avoidance, negative thoughts/mood and persistent threat/arousal with impairment.
Management
Immediate support
- Move to a calm place, introduce yourself, assess safety and speak slowly in short sentences.
- Coach gentle breathing without forcing deep rapid breaths; orient to present surroundings and validate distress.
- Do not use a paper bag for hyperventilation because an unrecognized medical cause may be worsened.
- Escalate for suicide risk, severe functional collapse, psychosis, substance withdrawal or uncertain medical diagnosis.
Psychological and social treatment
- Psychoeducation: explain the anxiety cycle, sleep, caffeine/alcohol effects and gradual recovery.
- Cognitive behavioural therapy (CBT): links thoughts, feelings and behaviour; uses cognitive restructuring, skills practice and relapse planning.
- Exposure therapy: gradual planned approach to feared cues; exposure and response prevention is first-line psychological treatment for OCD.
- Trauma-focused therapy: delivered by trained clinicians when the person is stable and consenting; never force detailed retelling during immediate crisis.
- Address violence, poverty, bereavement, academic/work stress and family support through practical referral.
Pharmacological treatment
| Class | Use/action | Precautions, adverse effects and interactions |
|---|
| SSRIs | First-line medicine for many anxiety, OCD and PTSD presentations; benefit develops over weeks. | Early nausea, sleep change, sexual dysfunction, activation, hyponatraemia; serotonin toxicity with interacting drugs. Monitor suicide risk initially. |
| Benzodiazepines | Rapid short-term relief only for selected severe situations/withdrawal under protocol. | Sedation, falls, respiratory depression, tolerance/dependence; dangerous with alcohol/opioids. Avoid routine long-term use. |
| Beta-blocker | Selected performance-related physical symptoms. | Avoid/caution asthma, bradycardia, hypotension and conduction disease. |
Nursing care
| No. | Intervention | Rationale/outcome |
|---|
| 1 | Rate anxiety, identify triggers, assess suicide risk and monitor physical observations. | Establishes severity and excludes deterioration. |
| 2 | Remain calm; reduce stimulation; teach grounding and paced breathing. | Decreases autonomic escalation and restores control. |
| 3 | Set small graded activity/exposure goals and record progress. | Reduces avoidance and builds mastery. |
| 4 | Administer prescribed medicines; monitor adherence, activation, sedation and interactions. | Promotes safe therapeutic response. |
| 5 | Develop relapse/safety plan and arrange follow-up. | Supports self-management and early help-seeking. |
Revision questions
- Why is “neurosis” no longer a precise diagnosis?
- Differentiate panic disorder, GAD, OCD and PTSD.
- Outline immediate nursing care during a panic attack.
References
- WHO. mhGAP Guideline, 2023.
- WHO. mhGAP Intervention Guide, Version 2.0.
