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Although there has been great diagnostic activity within the conditions formally included under the general rubric of neurosis in the last 20 years, there is little evidence that the many new diagnoses (i.e., generalized anxiety disorder, panic disorder, social anxiety disorder, and dysthymic disorder) have helped clinicians and improved the health of those diagnosed. This is largely because of the extensive comorbidity between these disorders negates much of their attempted separation and it is argued that the core of neurosis is a mixed anxiety-depressive disorder, or cothymia, combined with significant personality disorder of any type. The specific association of the anxious-fearful personality cluster (cluster C) and neurosis, called the general neurotic syndrome, is also relevant but appears to have lesser significance as the personality elements are not stable. Data are presented that justify these conclusions from a long-term follow-up study of anxiety and depressive disorders.
The landscape of the disorders formerly subsumed under the title of neurosis has been transformed radically in the past 20 years. Before this time we had a rather fuzzy picture of a group of disorders all retaining close links with each other (i.e., anxiety, depressive, phobic, and obsessional neurosis) with a presumed common core despite their superficial similarities. These paid some attention to the presenting symptoms) which is reflected in the first adjective of each condition, but regarded neurosis as central and in which the specific symptom presentation was relatively unimportant.
However, since the introduction of what, could be described as "the age of diagnosis by operational criteria" in the form of DSM-III (American Psychiatric Association, 1980), the original diagnoses covered under the heading of neurosis have been distributed through the diagnostic spectrum. Thus we have (a) major depressive disorder, dysthymic disorder, substance-induced mood disorder (in the mood disorder diagnostic group); (b) substance-induced anxiety disorder, panic disorder, agoraphobia with and without panic disorder, specific and social phobias, obsessive-compulsive disorder, and generalized anxiety disorder (in the anxiety disorder diagnostic group); (c) somatization disorder, conversion disorder, hypochondriasis and body dysmorphic disorder (in the somatoform disorder group); and (d) dissociative amnesia, fugue, identify disorder, and depersonalization disorder (in the dissociative disorders group) (American Psychiatric Association, 2000). This also could be extended to include several diagnoses in the sleep and sexual and gender...