Psychoanalysis and DSM-III

The decision to include the term “neurosis” in the American Psychiatric Association's Third Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III)-but as a parenthetical aside for certain syndromes-has been regarded as a begrudging acquiescence to traditionalists in psychoanalysis. Its usage suggests a retreat from unconscious process as the theoretical model we consider vital to understanding the mental disorders. It seems to submerge the gains of decades of psychoanalytic experience beneath compliance with the wishes of behavioralists, psychobiologists, learning theorists, and cognitive psychologists.

Neurosis implies a nonpsychotic, nonorganic process owing its existence to unconscious conflict. Karen Horney believed that the developing child responds to destructive external influences by evolving a comprehensive neurotic solution and in repressing, compartmentalizing, externalizing, and idealizing entire spectra of feelings and attitudes. A tragic consequence of this neurotic process is alienation from one's real self.

Clinicians who seek a diagnosis for patients whose personality organizations result from this evolving neurotic process are likely to find the DSM-III definition of neurosis too restrictive. In DSM-III, neurosis refers to discrete symptom groups, not character pathology.

The classification “Personality Disorder” is actually nearer to Horney's concept of neurosis than is the DSM-III usage of the same term. Personality Disorder refers to “inflexible maladaptive patterns of sufficient severity to cause either significant impairment in adaptive functioning or subjective distress.” To meet the criteria for Personality Disorder, inflexibility of personality traits must be “characteristic of the individual's current and long-term functioning not limited to episodes of illness.”

DSM-III does succeed, though, in two important ways: first, by charting diagnostic criteria for mental disorders, mental health workers have more assurance tha