Mental and Behavioural Health Clinical Reference Group

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Paul Amos

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1992 View 13 Comment Resolved Comments enabled In the category: Undefined

We have received a request to review the synonyms of 111475002 |Neurosis (disorder)|.

Current synonyms include:
Neurotic disorder
Nonpsychotic mental disorder

The requestor suggests that these synonyms are not true synonyms and that they should be inactivated and 2 new concepts of |Nonpsychotic mental disorder (disorder)| and |Neurotic disorder (disorder| should be added as subtypes of 111475002 |Neurosis (disorder)|.

We would be grateful for the views of yourself and the CRG.

Many thanks
Kind regards
Paul

Contributors (5)

13 Comments

  1. Piper Allyn Ranallo

    Hi Paul Amos,

    We will add this to the agenda for the Dec 2 call.

  2. Piper Allyn Ranallo

    Paul Amos

    Question in preparation for the CRG meeting on Dec 2- the concept "nonpsychotic mental disorder" would have to be modeled as a mental disorder in which psychotic symptoms are known absent (situation with explicit context).  Can we check with one of the authors to see whether it's possible to even model this meaning if we model it as a disorder concept? 

    Can we also clarify whether the requesters are proposing to add neurosis (finding) and add neurotic disorder (disorder) as a child? 

    As an aside, the CRG did have some discussion about this concept previously. If I remember correctly, the jist of the conversation was that it was unclear whether the concept 'neurotic disorder' has any unambiguous, intrinsic meaning, other than representing a mental disorder without psychotic symptoms....

    Thanks,

    Piper

    1. Maria Braithwaite

      Hi Piper Allyn Ranallo thanks for taking a look at this question, the submitter wishes to have a new concept Nonpsychotic mental disorder (disorder) in the disorder hierarchy, this could potentially group many other concepts and so would require further discussion with the Head of Terminology before being added however, is there agreement that Nonpsychotic mental disorder should not be a synonym for 111475002 |Neurosis (disorder) and would it be clinically accurate and useful if added as a separate concept?

      To answer your question - Can we also clarify whether the requesters are proposing to add neurosis (finding) and add neurotic disorder (disorder) as a child? - it is proposed that Neurotic disorder (disorder) is added as a child of 111475002 |Neurosis (disorder) along with a second concept Nonpsychotic mental disorder (disorder).  Is there a sufficient clinical distinction between 111475002 |Neurosis (disorder) and Neurotic disorder (disorder) to require two concepts or are Neurosis and Neurotic disorder actually synonymous?

      Many thanks,

      Maria Braithwaite (Senior Terminologist)

      1. Piper Allyn Ranallo

        Thanks Maria Braithwaite. This helps. 

        I'm going to defer to the clinical experts on this (Laura Fochtmannand  Michael First), but my understanding is that neurosis (disorder) IS synonymous with neurotic disorder (disorder). It is also my understanding that while both concepts were used in earlier mental health nosologies, the concept has been removed from more contemporary nosologies – it was essentially used as a way of distinguishing between two very general categories of mental disorders - neurotic (psychosis absent) v. psychotic (psychosis present). In other words, the term 'nonpsychotic disorder' does appear to be an appropriate synonym for the concept. 

        There is also a more contemporary concept, 'neuroticism' (concept 365420001 | Finding of level of neuroticism (finding) |)  that is used primarily in personality research and new clinical models of personality disorder (ICD-11, DSM-5 Section III: Emerging measures in models). Here, neuroticism describes a specific cluster of personality traits. I'm not sure if, or how,  these two concepts are related (I have never seen a definition of 'neurotic disorder' defined in terms of the personality trait 'neuroticsm' - which is defined in terms of the entity 86693004 | Level of neuroticism (observable entity) |).  

        To your point about making other mental health concepts children of the concept 'neurotic disorder', it does seem that virtually any mental disorder in which psychosis is absent would need to be made a child of this concept. 

        Can you go back to the folks requesting the change, to see if there is a definition of 'neurotic disorder' they have in mind that includes some meaning beyond just 'psychosis absent' ? 

        Laura Fochtmannand  Michael Firstcan you add your thoughts on what SNOMED authors may need to consider in deciding how to proceed with this concept? 

        Best,

        Piper

        1. Michael First

          Piper is absolutely correct. "neurosis"  is a Freudian concept and is conceptually equivalent to milder mental disorders in contrast to psychosis, which is for more severe and disabling disorders.   It is still used by therapists with a psychodynamic orientation. It does not apepar in the DSM or ICD anymore.  Neuroticism is a personality trait that is characterized by a proneness to develop negative emotions such as anxiety and depression.

          1. Laura Fochtmann

            I concur with what Michael says regarding neurosis. 

            I have some concern about adding a category "non-psychotic mental disorder".  My concern is that many disorders can have associated psychosis but not all individuals with that diagnosis will necessarily exhibit psychosis either in an episode or in their lifetime.  For example, the majority of people with major depressive disorder will not develop psychotic symptoms but for the fraction that do, it's an essential issue to address and monitor.  There are other disorders where I think there has been debate as to whether psychosis might exist or not.  For example, in OCD, there are some patients who lack insight into the unrealistic nature of their obsessional concerns and it's been questioned whether that should be viewed as delusional or not.  Similarly, individuals with borderline personality disorder have sometimes been described as having mini-psychotic episodes which may or may not be truly psychotic (vs. dissociative vs. some other phenomenon).   

            For these reasons, I think it would be hard to make a clearcut delineation of which disorders are (or are not) psychotic disorders.  It would be much easier and probably more clinically relevant to have "findings" of psychosis and absence of psychosis.  However, it would help to know more information on the rationale for a new non-psychotic mental disorder category from the people who're requesting the concept change.

  3. Darrel Regier

    Michael and Laura have provided excellent summaries of how the neurosis, neurotic disorders, and neuroticism terms have been treated in DSM-5 and ICD-11—the former two dropped as archaic and the latter incorporated into a summary personality trait. This personality trait is broken down into several facets in the alternative model for personality disorders in section 3 of the DSM-5 and in ICD-11. Neurosis and neurotic disorders are not included in the meta structure of these mental disorder classifications, which is organized along developmental, and related dimensional spectrum conditions. As Laura mentioned, psychotic phenomena can emerge in almost any of the various disorder groups from Neurodevelopmental to Neurocognitive disorders. There was a nice monograph on “Deconstructing Psychosis” edited by Tamminga et al. as part of the NIH sponsored conference series prior to when the DSM-5 and ICD-11 Task Forces and Committees were established.
    Darrel Regier

  4. Maria Braithwaite

    Hello Piper Allyn Ranallo Michael First Laura Fochtmann Darrel Regier

    Thank you all for your very informative responses.  I have reviewed the information provided and summarised below: 


    1. CRS request - Add new concept Nonpsychotic mental disorder (disorder) and inactivate synonym Nonpsychotic mental disorder from the concept 111475002 |Neurosis (disorder) 

    Response:

    Nonpsychotic mental disorder is a valid synonym for the concept 111475002|Neurosis (disorder)|

    Seek clarification on request for new concept "Non-psychotic mental disorder" from the submitter to obtain a definition that includes some meaning beyond 'psychosis absent'.


    2. CRS request - Add new concept Neurotic disorder (disorder) as a child of 111475002 |Neurosis (disorder) and inactivate synonym Neurotic disorder from concept 111475002 |Neurosis (disorder)

    Response:

    Neurosis (disorder) IS synonymous with neurotic disorder and therefore the current FSN 111475002|Neurosis (disorder)| with synonym Neurotic disorder is accurate.


    Best wishes,

    Maria

    1. Laura Fochtmann

      I'm a little confused by this summary.

      Under #2, I think it's probably fine to say that that "Neurosis (disorder)" is a synonym of "Neurotic disorder" although both terms are outmoded in the most recent classifications.  

      However, in terms of #1, I don't think I would say that "non-psychotic mental disorder" is currently synonymous with "neurosis" although prior conceptualizations split disorders into psychosis and neurosis.  For example, someone could have a neurocognitive disorder without associated psychosis and I don't think any one would label that a "neurosis". 

      1. Maria Braithwaite

        Hi Laura Fochtmann

        The summary from point 1 is based on this comment: but my understanding is that neurosis (disorder) IS synonymous with neurotic disorder (disorder). It is also my understanding that while both concepts were used in earlier mental health nosologies, the concept has been removed from more contemporary nosologies – it was essentially used as a way of distinguishing between two very general categories of mental disorders - neurotic (psychosis absent) v. psychotic (psychosis present). In other words, the term 'nonpsychotic disorder' does appear to be an appropriate synonym for the concept. 

        I have asked the original requestor for clarification about a new concept 'Nonpsychotic mental disorder' as discussed above but whilst awaiting a response are you in favour of inactivation of the synonym 'Nonpsychotic mental disorder' from the concept 111475002|Neurosis (disorder)|?

        Best wishes, 

        Maria

  5. Piper Allyn Ranallo

    Michael First, when psychodynamically-oriented clinicians use the term "neurosis" or "neurotic disorder" what is the specific meaning they have in mind? 

    If this is the only group of  clinicians using the concept clinically, I wonder if it makes sense to explicitly define the concept in terms of the more specific, contemporary meaning of the concept (v. the outdated meaning of 'nonpsychotic' mental disorder) ?

    If the authors take this approach to modeling 'neurotic disorder', then the original meaning (nonpsychotic mental disorder) many not in fact not be an appropriate synonym (is that correct Michael First and Laura Fochtmann?) 

    Per Laura Fochtmann's observation that many disorders considered to be nonpsychotic disorders sometimes have associated psychotic symptoms, it seems that creating a concept 'Nonpsychotic mental disorder' might not be meet SNOMED's URU criteria. For example, there might be misunderstanding about whether the concept represents a) a disorder not classified in current nosologies as a psychotic disorder, b) a disorder known to never have associated psychotic symptoms, or c) the subtype of a disorder that can sometimes have associated psychotic symptoms (i.e., major depressive disorder) that does not have associated psychotic symptoms ((i.e., major depressive disorder without psychotic features).

    Just some thoughts...

    Piper



  6. Piper Allyn Ranallo

    Following up on this post with the goal of identifying any additional information required and closing the issue as resolved.

    Paul Amos and Maria Braithwaite do you need additional input from Michael First, Laura Fochtmannand Darrel Regier?


    Best,

    Piper


    1. Maria Braithwaite

      Hi Piper Allyn Ranallothank you to all for the contributions relating to this question, the issue can be marked as resolved.  Best wishes, Maria