The General Neurotic Syndrome: A Re-Evaluation

The presence of these features, often waxing and waning in response to life events, approximated closely the old diagnostic concept of neurosis and so was called the general neurotic syndrome [4, 5] . This syndrome is defined as ‘a persistent or relapsing disorder of combined anxiety and depressive symptoms (cothymia) associated with anxious, dependent and obsessional personality dysfunction, often interspersed with episodes of social anxiety, panic and somatoform symptoms’. The personality dysfunction is currently included under cluster C of personality disorders in the DSM classification, but in the new ICD-11 classification it would be described as mild or moderate personality disorder with negative affective-domain traits [6] . But when these articles were published they fell on somewhat stony ground. Although some people recognised the clinical validity of this concept (it was praised by Robert Kendell [7] in his Paul Hoch lecture to the American Psychiatric Association because it examined a spectrum rather than a single mood disorder), it was not taken up by others, apart from Gavin Andrews et al. [8] , in Australia. It has to be remembered that this was the era in which nobody questioned the DSM classification. The DSM-III had just been published and the word ‘neurosis’, despite having been introduced by Cullen in Edinburgh as a neurological concept, had been imbued with too many additional meanings by psychoanalysis and the atheoretical apThe recent editorial on euthymia in Psychotherapy and Psychosomatics [1] emphasised the importance of the many subtle mood and functional states that are present in many people with mood disorders. These are often ignored in research studies, and any mood state that escapes formal diagnosis tends to be put into an undefined hinterland called euthymia. Many of these conditions are often hidden in short-term studies that use standard DSM criteria for diagnosis and wrongly assume that the absence of the relevant diagnosis constitutes ‘recovery’ [2] . It seldom does, and a longer longitudinal perspective shows a very different pattern. This pattern for many patients with anxiety and depressive disorders, the majority of whom probably have sufficient symptomatology and functional impairment to be referred to a psychiatrist, shows a fluctuating course in which the following features are almost always present: (i) varying degrees of anxiety and depression, with neither being absent entirely; (ii) the frequent co-occurrence of obsessive-compulsive, social phobic and agoraphobic symptoms manifested more frequently when the anxiety and depressive symptoms are more pronounced; (iii) prolonged periods of subthreshold depression and anxiety associated with impaired social function, and (iv) personality dysfunction within what is commonly known as the cluster C group (dependent, anankastic and avoidant/anxious) of personality disorders [3] . Received: December 3, 2015 Accepted after revision: January 23, 2016 Published online: May 27, 2016