What does it mean to be neurotic?
I'm Dr. Tracey Marks, a psychiatrist
and I make mental health education videos.
There's different ways to look at personality.
I've talked a lot about personality disorders
as defined by the diagnostic
and statistical manual of mental disorders.
But another well established approach
to looking at personalities
is to look at the personality traits.
In the 1980s Lewis Goldberg, a psychologist,
developed the five factor model of personality traits.
And you can remember them with the acronym OCEAN.
All of these are measured on a spectrum.
O is for openness.
If you score low on the scale,
you tend to be cautious and safety focused.
Unfamiliar things cause anxiety.
People at the high end of the spectrum are very curious.
You like being outside of your comfort zone
and boredom stresses you.
C is for conscientiousness.
If you're low on this scale,
you like to live loose and carefree.
You need a maximum amount of flexibility
and get stressed when things are too rigid
or black and white.
If you're high on the scale, you tend to be a rule follower.
You like having conventions and standards.
And because of this, you're very dependable.
Situations that have unclear expectations
make you feel anxious and stress.
E is for extroversion, introversion.
Scoring low on this scale puts you in the introversion range
and you tend to be private and you draw energy
from having time alone.
Overstimulation from too much interaction stresses you.
At the high end of this scale is extroversion.
For you contact with others is an energy exchange.
It's like being plugged into a charging station.
On the other hand, isolation deplete you.
A is for agreeableness.
People who score low on this scale or who are disagreeable,
tend to be more competitive and mistrustful.
When assessing someone's intentions,
you don't give them the benefit of the doubt.
And if you're not sure,
you assume that they have negative intentions
and not getting what you want, stresses you.
People who are high on the scale, like to please others.
And they may put other people's happiness before their own.
But they are also seen as very easy to get along with.
You are stressed by disapproval and conflict.
And then the N is for neuroticism, the topic of this video.
Neuroticism measures how vulnerable you are
to negative emotions like anxiety, depression, and anger.
People who score low on this scale
tend to have more self-confidence,
are slow to become frustrated
and don't ruminate or worry that much.
If something upsets you, you can calm down from it
in a reasonable amount of time.
People high in neuroticism or more emotionally reactive
and easily stressed.
Because of this people who are highly neurotic
are more prone to depression and anxiety disorders.
So think of it as being more vulnerable to stress,
kind of like the difference
between having a bowl that's made of delicate fine china
versus one that's made of stone.
Both can break, but the fine china will break more easily
with less effort.
I use this analogy because both materials have value.
Some people prefer fine china, over a cheaper stoneware.
And if you can take care of the china,
it can serve you well and last a long time,
but it is vulnerable.
Similarly, being more emotionally reactive
doesn't always have to be negative.
There's value to being in touch with your emotions
or having your emotions closer to the surface.
People know where you stand and don't have to guess
about what you mean or how you really feel about something.
I mentioned scoring high or low on these scales.
There are different tests or inventories as they're called
they're used to measure these traits.
One such inventory is the big five inventory.
It has 44 items that you rate as to how they apply to you.
The items corresponding to neuroticism are:
you see yourself as a depressed person,
you're not very relaxed or you don't handle stress well,
you tend to be tense,
you worry about a lot of different things,
you're easily upset, you can be moody,
meaning you're easily triggered to have an assume,
a negative mood, you get nervous a lot.
These scales are not all or nothing.
You can be somewhere in the middle between the extremes.
Someone who's typically calm can become very nervous
and upset under certain circumstances
like being isolated in a pandemic.
If you're highly neurotic,
meaning very prone to negative emotional states,
you have to prioritize yourself care
and optimize your coping skills.
I talk about coping skills and this video.
That video comes with a handout of positive coping skills.
Self-care or things that you do
to promote your own physical, emotional, mental,
and relational wellbeing.
It means being aware of what your mind and body needs.
Some examples of these activities or interventions
would be things like decluttering your home,
taking a break from digital devices,
setting limits with your work hours
or saying no to things that you don't have time to do.
Taking time to exercise,
reducing junk food in your diet, et cetera.
So that's neurotic based on the five factor model
of personality traits.
There's another explanation that I want to mention
that you may hear, especially if you're in a country
outside of the United States.
Sigmund Freud, a neurologist, considered a neurosis
to be a disorder of the nervous system.
Under this construct, neurotic behaviors
are things that you do to manage unconscious anxiety.
An example of a neurotic reaction
would be to fixate on worst case scenarios.
Your speech may be filled with lots of always and nevers.
I'll never be able to get a good job.
I'll always end up at the bottom of the list.
Neurosis was taken out of the DSM,
or diagnostic and statistical manual
with the third edition in 1980.
But internationally, it's still used
to describe mental conditions.
The International Classification of Diseases
has a coding system that we use for research
and insurance billing, and that coding system
still uses neurosis to describe a mild mental condition.
One more way that it's used in psychoanalytic circles
is to describe a personality organization.
Otto Kernberg, a psychiatrist and psychoanalyst,
is known for his theories
on borderline personality organization.
He described three levels of personality organization,
neurotic, borderline, and psychotic.
Neurotic was considered the highest level of functioning
with intact reality testing, which means,
you know what's real and what's not real,
you have mature defense mechanisms,
and you have a stable concept of yourself and others.
Borderline was in between neurotic and psychotic,
and is characterized as using a lot of primitive defenses
and sometimes having trouble knowing what's real
and not real.
A person with a psychotic personality organization
would have the lowest level of functioning
with a lot of psychotic symptoms
and predominantly primitive defense mechanisms.
So this can get complicated.
But the terminology of neurosis developed by Freud
and neurotic personality organization
developed by Kernberg,
isn't used as much as the five factor neuroticism
developed by Goldberg.
And this neuroticism refers to a proneness
to negative emotions like anxiety, depression, and anger.
But I do think that people have come
to associate the term neurotic more with anxiety
than they do with depression.
And that may be because of the Freudian influence.
Watch this video for more on defense mechanisms.
See you next time.