Sims A
Psychiatr Dev. 1986 Winter;4(4):273-87.
Although DSM III has removed the category of neurosis, the implied fragmentation of the generic concept has been regretted by some investigators. Since its introduction in 1769, when the term was used to denote conditions which had a hysterical and hypochondriacal character, the technical use of the term has undergone revisions and reinterpretations which at one extreme have been embedded in psychoanalytic theory, and at the other have resulted in the replacement of the single concept by a proliferation of operationally defined syndromes. The present paper discusses some of the nosological problems implicit in recent trends. Whereas depression appears in 10 ICD9 categories does the psychiatric/neurotic dichotomy in relation to depression still have meaning in the absence of the generic term 'neurotic'? The hierarchical principle is widely accepted as a basis for classification, and yet the hierarchically minor syndromes may be a source of major distress. The paper reviews epidemiological studies of prognosis and follow-up of neuroses, and shows a significant excess of mortality, which is both behavioural and organic in origin. One important difficulty with the loss of the generic term is the potential loss of generic research where, for example, evaluation of treatment of panic disorder is considered distinct from other types of anxiety and phobia. The paper argues for the practical and theoretical benefits of retaining an umbrella term such as 'neuroses'.
尽管《精神疾病诊断与统计手册》第三版（DSM III）已取消了神经症类别，但一些研究者对这一通用概念隐含的碎片化表示遗憾。自1769年该术语被引入以来，当时它用于指代具有癔症和疑病症特征的病症，该术语的技术应用经历了修订和重新解释，一方面它被融入精神分析理论，另一方面导致单一概念被大量操作性定义的综合征所取代。本文讨论了近期趋势中隐含的一些疾病分类学问题。鉴于抑郁症出现在《国际疾病分类》第九版（ICD9）的10个类别中，在没有“神经症”这一通用术语的情况下，与抑郁症相关的精神病学/神经症二分法是否仍有意义？层级原则被广泛接受为分类的基础，然而层级较低的综合征可能是主要痛苦的来源。本文回顾了神经症预后和随访的流行病学研究，结果显示死亡率显著过高，其源于行为和器质性两方面。失去通用术语带来的一个重要困难是可能失去通用研究，例如，惊恐障碍治疗的评估被认为与其他类型的焦虑和恐惧症不同。本文主张保留“神经症”这样一个总括性术语在实践和理论上的益处。
