Predictive validity of neurotic disorders: a 50-year follow-up study

INTRODUCTION: In 1965, Erling Jacobsen (1919-1988) defended his doctoral thesis on neurosis in which he tested the psychoanalytic theory of eridophobia as an internalising hostility factor with a specific causality for anxiety neurosis. He found no marked difference between anxiety neurosis and obsessive-compulsive neurosis, which, however, both differed from hysterical neurosis. The aim of this follow-up study was to evaluate to which extent anxiety neurosis and obsessive-compulsive neurosis when compared with hysterical neurosis co-existed with depression, both at the level of diagnostic behaviour, including committed suicide, and with regard to symptom profile. MATERIAL AND METHODS: A total of 112 patients were followed on the Danish Central Psychiatric Research Register and the Danish Cause of Death Register with regard to their diagnostic behaviour. In a subset of the sample (n = 24), the patients were assessed using the Hopkins Symptom Checklist (SCL)-90. RESULTS: Both at the diagnostic level, including suicide rate, and at the level of symptom severity (SCL-90), anxiety neurosis and obsessive-compulsive neurosis were similar, in contrast to hysterical neurosis which had no more association with the other two categories of neurosis than would be expected by chance. CONCLUSION: Anxiety neurosis and obsessive-compulsive neurosis are more severe disorders than hysterical neurosis, both in terms of symptom profile and depression, including suicidal behaviour. The identified suicides were committed within the first two decades after discharge from the index hospitalisation.