Differential Diagnostic Considerations in Neurosis and Character Disorder

The diagnosis and treatment of the characterologically disturbed patient is often complicated by the appearance of classical symptoms of neurosis. The appearance of neurotic symptoms, however, does not necessarily signify that there has been a movement, in the characterologically disturbed patient, toward neurosis. Anxiety, depression, and phobia, for example, may appear in the absence of neurosis and are readily discerned in the psychoses, the perversions, and the borderline states as well as in the character disorders.

The following clinical material is taken from a case in which classical symptoms of neurosis were prominent. The elucidation of these symptoms however resulted in diagnostic and psychotherapeutic considerations relating to the differential diagnosis and treatment of the characterologically disturbed patient.

Mrs. K was a 40-year-old married mother of one. She was attractive despite her dyed hair, seductive manner, and excessive use of makeup. She arrived at the first interview with the chief complaint that on nearly every morning for the past two weeks she had experienced an overwhelming “sense of doom” which was associated with palpitations, shortness of breath and feeling faint. The episodes would last several minutes and then spontaneously subside. The episodes were terrifying, and the most recent episode was completely overwhelming.

In the beginning of psychotherapy, Mrs. K compared her symptoms of distress with her mother's symptoms prior to her death several weeks before the first interview. The mother, who had been chronically ill, often described to her daughter her symptoms of faintness, palpitations, and shortness of breath. On the evening she died these symptoms were prominent. Though Mrs. K recognized that her mother's symptoms and her attacks shared a number of features, neither the frequency nor the severity of her attacks had been affected. Mrs. K stated that her lack of medical training and nursing expertise had shortened her mother's l