Feeling off or Disconnected? It Could Be Neurosis or Psychosis

Explore the difference between neurosis and psychosis to better understand your symptoms, reduce shame, and take the next step toward support.

Learn more about our Clinical Review Process

Sometimes, it feels like your mind is working against you: racing thoughts, spiraling anxiety, or a complete sense of detachment from reality. Maybe you’ve wondered: Is this just stress? Or something more? When you’re feeling mentally off, it can be hard to find the right words to describe it, let alone figure out what’s going on.

Two terms that often come up in these conversations are neurosis and psychosis. They might sound clinical or even outdated, but they still help us talk about very real experiences of mental distress. Read on to unpack what each one means, how they differ, and why understanding that difference matters.

Defining neurosis and psychosis

While neurosis and psychosis are no longer used as official diagnostic terms in the DSM-5, they still appear in everyday language—and understanding them can offer helpful insight into how different mental health conditions affect a person’s relationship with reality. Below, we break down what each term historically meant and how those concepts continue to shape the way we think about mental health today.

What is neurosis?

Although neurosis isn’t a term you’ll find in modern diagnostic manuals, it still shows up in everyday conversations, and for good reason. It describes a cluster of distressing but reality-based experiences, like chronic worry, intrusive thoughts, low self-worth, or compulsive behaviors.

In the past, neurotic disorders referred to conditions like generalized anxiety disorder, obsessive-compulsive disorder, and certain phobias. Today, these fall under more specific diagnoses, but the concept of neurosis still resonates. A neurotic person might not meet the criteria for a formal diagnosis, but they can still experience a mild mental disorder that causes significant impairment in daily life.

Think of someone like Monica Geller from Friends: organized to the point of obsession, deeply anxious about how others perceive her, and often overwhelmed by everyday problems. Her behaviors aren’t delusional; they’re exaggerated responses to stress and fear. This is neurosis in action.

What is psychosis?

On the other end of the spectrum is psychosis, a more severe mental health condition characterized by a break from reality. People experiencing psychosis might see or hear things that aren’t there (hallucinations), believe things that aren’t true (delusions), or have disorganized thoughts and speech. These psychotic symptoms can feel disorienting, terrifying, and isolating. Psychosis isn’t a diagnosis itself but a symptom that can occur in several psychotic disorders like schizophrenia, bipolar disorder, schizoaffective disorder, and even psychotic depression. It may also appear during intense stress, substance use, or medical conditions affecting the brain.

Imagine someone who believes the government is tracking their movements through their phone or hears a voice giving them commands that no one else can hear. These aren’t just intrusive thoughts or passing fears; they feel completely real to the person experiencing them. Despite how psychosis is often portrayed in the media, most people navigating these symptoms are not violent or unpredictable. In reality, many are frightened and trying to make sense of a world that no longer feels stable. With the right support, such as antipsychotic medication, therapy, and compassionate care, recovery is not only possible but common.

Neurosis vs. psychosis: understanding the difference

So, how can you tell the difference between neurosis and psychosis? It mostly comes down to reality testing, i.e., whether or not a person is in touch with what’s objectively real.

Someone with neurosis might think, “Everyone’s judging me,” but deep down, they know it’s probably not true. Someone experiencing psychosis might believe, “Everyone’s watching me through hidden cameras,” and fully accept that as fact. One involves fear; the other involves a distorted reality. Here’s an overview of some of the differences between the conditions: 

Neurosis 

• Thoughts, fears, and beliefs are rooted in reality 
• Includes thoughts like “I’m going to mess this up” 
• Common symptoms include anxiety, guilt, worry, and rumination 
• Present in conditions like anxiety, depression, and OCD

Psychosis 

• Thoughts, fears, and beliefs are not rooted in reality 
• Includes thoughts like “The TV is sending me secret messages”
• Common symptoms include hallucinations, delusions, and disorganized thinking
• Present in conditions like schizophrenia, bipolar disorder, and delusional disorder

It’s very possible for someone to move between both experiences. For example, someone with borderline personality disorder may have largely reality-based struggles but experience transient psychotic episodes under extreme stress.

Where diagnosis fits in with neurosis and psychosis

Terms like “neurotic” and “psychotic” may still circulate, but they’re not part of current diagnostic frameworks like the DSM-5. Instead, clinicians use specific categories like anxiety disorders, mood disorders, personality disorders, and psychotic disorders to describe mental health challenges more precisely.

That said, these older labels can still be helpful in conversation, especially when trying to articulate what you’re feeling. The key is not to self-diagnose but recognize when something doesn’t feel right and seek support from a mental health professional.

When to seek help for neurosis or psychosis

If you’re feeling anxious all the time, like your mind won’t slow down, or if you’re experiencing disconnection from reality, it may be time to reach out. Consider talking to a therapist or psychiatrist if you:

• Feel consumed by worry or fear, even without clear reasons
• Notice patterns of intrusive thoughts or compulsive behaviors
• Have experienced hallucinations, delusions, or a sense that your thoughts aren’t your own
• Feel confused about what’s real or fear you’re “going crazy”
• Have a history of depression, panic attacks, or other psychiatric disorders

It’s okay to seek support even if you’re unsure which category these symptoms fall into—especially since some symptoms may feel blurry or overlap. In fact, early intervention is important. Treatments like cognitive behavioral therapy, medication, and structured support systems can make a big difference.

How Charlie Health can help

If you or a loved one is struggling with neurosis and or psychosis, Charlie Health is here to help. Charlie Health’s virtual Intensive Outpatient Program (IOP) provides mental health treatment for people dealing with serious mental health conditions, including both the emotional and physical symptoms of neurosis and psychosis. Our expert clinicians incorporate evidence-based therapies into individual counseling, family therapy, and group sessions. With support, managing your mental health and healing is possible. Fill out the form below or give us a call to start healing today.