Differential diagnosis

• Personality disorder: personality disorder is a more persistent condition than neurosis, and tends to present with disturbance of behaviour and social adjustment, whereas neurosis presents with symptoms. The distinction between 'neurotic illness' and 'neurotic personality' is clear-cut in some patients - for example if an anxiety state develops in a previously well-adjusted subject following a stressful event - but in other cases they coexist, as when a habitually nervous, dependent subject has an episode of particularly intense distress.

• Other psychiatric illnesses such as major depression or psychosis. If delusions or hallucinations are present, the main diagnosis must be a psychotic disorder, although the patient may have neurotic symptoms too.

• Medical illness, including systemic disorders such as thyrotoxicosis, and brain disorders such as temporal lobe epilepsy.

• Substance misuse: alcohol, caffeine (in tea, coffee, or cola drinks), or other drugs.

• Stress reactions of normal degree: anxiety is to be expected in certain situations and, if not excessive, may actually improve ability to cope (the Yerkes-Dodson curve - performance improves with initial increases in stress, but beyond a certain point, further increases result in performance declining).

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