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Classification according to ICD-10
F48.0 neurasthenia
ICD-10 online (WHO version 2019)

Neurasthenia ( nerve weakness ; from τὀ νεῦρὀν neuron "nerve" and ὰσθενὴς asthenès "weak") is a mental disorder contained in the ICD-10 . It is rarely diagnosed and hardly plays a role in psychotherapeutic or psychiatric practice, since other clinical pictures (including depression and burn-out ) have now been described that include the symptoms of neurasthenia. In German it is often referred to as "irritable weakness". Neurasthenia was one of the fashion diseases of an upper class in the late 19th and early 20th centuries . A variety of promising and stimulating treatment in the spa procedure was carried out according to the principles of Brownianism .

It is often diagnosed in China (here in Chinese  神經 衰弱  /  神经 衰弱 , pinyin shénjīng shuāiruò ) and Japan (in Japanese 神 経 衰弱 shinkei suijaku ), especially since it does not carry the stigma of a mental disorder , so that it sometimes leads to diseases such as schizophrenia be concealed. In Japan, Morita therapy is used for treatment.


The main symptom of neurasthenia is exhaustion and fatigue, which can be caused either by insufficient resilience due to external stimuli and exertion or by insufficient or too monotonous stimuli itself ( Boreout syndrome ). In addition to fatigue , anxiety , headaches , impotence in men and frigidity in women, neuralgia , concentration disorders , joylessness and melancholy , the inability to relax, tension headache and increased irritability should also be mentioned. The symptoms can be described as variable. There is a cultural and social nature of symptoms.

History of therapy

In the early days of the company, neurasthenia was treated by means of spa procedures based on the principles of Brownianism . It was often seen by those affected as a matter of vitalizing , purely external applications and therapy methods and not as a personal, inner change. This dictated the popularity of the rapidly expanding name. In this respect it is significant that the initial ideas about the treatment came from Beard, a New York neurologist and electrotherapist, even if it was originally just a simple stimulus current application as a somatic treatment ( somatotherapy ).

Due to the dynamic view of the disease, neurasthenia differed from irreversible mental disorders caused by physical degeneration and endogeneity (see also the medical history term of endogenous psychosis ). Personal psychological involvement was thus excluded by emphasizing the organic aspect of nerve weakness as a result of exhaustion. However, social problems were increasingly included in the therapeutic considerations. The resulting therapeutic consequences were aimed at restoring the nervous system and changing working conditions.

From the “English Malady” described by George Cheyne (1671–1743) to the “American Nervousness” described by George Miller Beard (1839–1883) was not a further step. This development trend can also be observed up to the appearance of occupational medical publications in which neurasthenia - especially in women - appears as a result of an economic policy that intensifies the pressure of competition between companies and leads to progressive mechanization. If one follows these writings, then these changes are not without effects on the working conditions and thus also on the mental health including the formation of organ neuroses . In 1913 the collective work “Illness and Social Situation” appeared on the ›wedding‹ of social hygiene in the German Reich.

Freud was originally also a user of stimulation current treatment (see also the case of Elisabeth von R mentioned below). However, according to the general view of his time, he distinguished neurasthenia from his later concept of neuroses and the signal anxiety that was effective in anxiety neurosis from neurasthenia. He counted neurasthenia among the actual neuroses . The therapeutic consequences followed an attitude of socially oriented gain from illness, which was particularly widespread in this group of diseases, and were tailored to changes in external conditions.


There have been descriptions since ancient times which grouped the symptoms mentioned under melancholy and hypochondria . The phenomenon of the " nervous " was only introduced into the scientific discussion along with moral treatment in the age of sensitivity through the physiological literature of the 18th century and the subsequent arguments between psychics and somatics . Here, too, the sociological view of diseases, which was later favored by George Miller Beard, was referred to for the first time. B. by George Cheyne (1671–1743), who saw the English as particularly "nervous" and therefore spoke of " English Malady ". Brownianism , in particular , had emphasized the importance of too weak and too strong nervous stimuli as a cause of disease (opposition of stenia and asthenia).

The term neurasthenia was not coined by Miller Beard in 1869, but it found an extremely wide domestic and international distribution through him and his writings that were published from then on. Following the historical trend of his time, Beard attributed the symptoms of nervous exhaustion to a lack of certain chemical elements such as: B. Phosphorus and thus favored the idea of ​​medical spa treatment, including the use of diet, which was eagerly taken up at this time . Beard also initiated a further rethinking in that he brought the disease into connection with the “American lifestyle” and thus gave further attention to the idea of ​​a sociological view of disease .

Also the later u. a. The aspect of sexual morality taken up by Sigmund Freud and Richard von Krafft-Ebing was dealt with by Beard in his own book. At that time, neurologists such as B. Dubois-Reymond , Remak , Waller and Magendie mainly interpreted as physically caused. In 1895 Freud differentiated the anxiety neurosis from neurasthenia , see the following section Freud's explanation of neurasthenia . At the same time, Krafft-Ebing also attached great importance to sociological aspects.

Today neurasthenia z. Sometimes described as being neurotic , functional or psychosomatic . The decline of the term neurasthenia is related to its increasing psychiatricism, similar to the term neurosis , which originally represented a somatic battle term against the moralizing approach advocated by psychics. In many cases the term psychasthenia was used instead of the term neurasthenia .

Freud's explanation of neurasthenia

In his early writings, Freud regarded head pressure, spinal irritation and dyspepsia with flatulence and constipation as typical symptoms of neurasthenia . However, he was rather unconvinced that this widespread term neurasthenia is a specific disease unit , especially with regard to its etiology and the “mechanism” of its triggering. He therefore wrote: "It is difficult to say anything generally valid about neurasthenia as long as one lets this name of the disease mean everything that Beard used it for." In terms of differential diagnosis, Freud already delimited those that were quite similar in terms of symptoms, but differing in origin organically caused pseudoneurasthenia and the depressive or cyclothymic disorders differ from the general neurasthenic symptoms. In his own book, he focused his attention on the distinction between neurasthenia and anxiety neurosis .

In a special case study, Freud also defines neurasthenia as hypochondria afflicted with anxiety neurosis. It is of psychiatric historical interest that in this case Miss Elisabeth v. R ... an electrical stimulation treatment was carried out based on the Beard model. According to Freud, hypochondria is the anxious expectation related to an illness which is preceded by certain physical abnormalities. Since Freud was convinced of the importance of sexuality in the diagnosis and treatment of hysteria , he saw similar trigger mechanisms in the other neuroses. Freud saw the specificity of anxiety neurosis in the diversion of somatic sources of sexual excitement from the normal goal of satisfaction by the sexual partner. The alienation between somatic and psychological processes is decisive for the lack of satisfaction.

But he saw sexual satisfaction as a psychological moment. Freud regarded the averted sexual arousal as the energetic equivalent of the libido . The mechanisms that led to the triggering of the anxiety neurosis were certain for Freud and others. a. Coitus practices aimed at preventing pregnancy, such as B. Coitus reservatus or Coitus interruptus . However, it is not the fear of pregnancy, but rather the purely psychological element of sexual satisfaction that is responsible for triggering the anxiety neurosis, since women who are not concerned about the consequences of pregnancy also tend to develop anxiety neuroses. All those moments which prevent the psychological processing of the somatic sexual excitation lead to anxiety neurosis. Neurasthenia, on the other hand, for Freud was mainly caused by exhaustion of the libido through habitual masturbation .

Freud counted neurasthenia, along with anxiety neurosis and hypochondria, to the three actual neuroses . He considered this group of neuroses to be caused by an inadequate processing of mental energy (libido). It was only with his second fear theory (signal anxiety) that Freud conceded the development of fear neuroses as a function of internal psychological factors. Anxiety neurosis was thus not only an external incorrect processing of stimuli, but also a result of the inadequate ego organization. With these views, Freud turned out to be a successor in the tradition of moral treatment . From today's perspective, the psychological component in the triggering of the anxiety neurosis is more likely to be seen in the frequent fear of loss towards a reference person, which at the same time often indicates deficiencies in the ego organization.

Differentiation from neuropathies

Although the organic character was originally in the foreground when defining neurasthenia, on the other hand pathological organic changes in the nerves were excluded, as defined by the generic term neuropathy . In this way, greater importance should be attached to the influence of external factors in an originally healthy nervous system. In this respect, the term developed into a reservoir for organically not quite comprehensible complaints, which it has remained to this day.

Today's view

There is an opinion that neurasthenia corresponds to what is now known as burn-out syndrome or exhaustion depression. However, there are no conclusive studies on this, as neurasthenia is a disease that has been forgotten and is no longer researched. In 2011, Wolfgang Seidel wrote in the foreword to his burn-out book:

“Neurasthenia was considered a typical teacher's disease 100 years ago. It didn't have a particularly good reputation, it was rather a taboo subject. Hardly anyone would have said that they like to suffer from it. This is completely different with burnout, which has been diagnosed and discussed with increasing frequency for around 40 years. In the case of burnout, the external circumstances , especially the working conditions, are assigned an essential part in the development. This triggers pity and offers of help in people ... "

Some aspects of neurasthenia can be found in today's diagnosis of chronic fatigue syndrome .


  • Alfred Adler : About the nervous character. (1912) Verlag Vandenhoeck & Ruprecht, Göttingen, 2007–2009, study edition, volume 2. Edited by Karl Heinz Witte, Almuth Bruder-Bezzel and Rolf Kühn, ISBN 978-3-525-46053-5 and Fischer paperback 1972.
  • Wolfgang Eckart : The growing nervousness of our time. Medicine and culture around 1900 using the example of a fashionable disease. In: Gangolf Huebinger , Rüdiger vom Bruch , Friedrich Wilhelm Graf (ed.): Culture and cultural studies around 1900. Volume II: Idealism and positivism . Franz Steiner Verlag, Stuttgart 1997, pp. 207 ff.
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  • Michael Schäfer: On the history of the neurasthenia concept and its modern variants, Chronique Fatigue Syndrome, Fibromyalgia and multiple chemical sensitivity. In: Advances in Neurology and Psychiatry. Volume 70, 2002, pp. 572-580.
  • The weak nerves (neurasthenia) . In: The Gazebo . Issue 1, 1887 ( full text [ Wikisource ]).

Web links

Individual evidence

  1. ^ A b Klaus Dörner : Citizens and Irre . On the social history and sociology of science in psychiatry. Fischer Taschenbuch, Bücher des Wissens, Frankfurt am Main 1975, ISBN 3-436-02101-6 , p. 64.
  2. Thomas Dixon Savill: Clinical Lectures on Neurasthenia . HJ Glaisher, 1908.
  3. Pamela Yew Schwartz: Why is neurasthenia important in Asian cultures? In: Western Journal of Medicine . tape 176 , no. 4 , 2002, ISSN  0093-0415 , p. 257-258 , PMID 12208833 , PMC 1071745 (free full text).
  4. H. Dilling et al. a. (Ed.), World Health Organization: International Classification of Mental Disorders. 2nd Edition. ICD-10 Chapter V (F). Hans Huber Verlag, Göttingen 1993, ISBN 3-456-82424-6 , p. 192 f.
  5. ^ Adrien Proust: The Treatment of neurasthenia . ER Pelton, 1903.
  6. ^ A b Edward Shorter A historical Dictionary of Psychiatry. 1st edition. Oxford University Press, New York 2005, ISBN 0-19-517668-5 , pp. 29, 38, 187 f. (Text online) ( Memento of the original from March 28, 2010 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot /
  7. a b George Cheyne : The English Malady; or, A Treatise of Nervous Diseases of All Kinds, as Spleen, Vapors, Lowness of Spirits, Hypochondriacal and Hysterical Distempers. Dublin 1733. (Facsimile: Scholars' Facsimiles & Reprints, 1976, ISBN 0-8201-1281-X )
  8. ^ A b George Miller Beard: American nervousness, with its causes and consequences . A Supplement to Nervous Exhaustion (Neurasthenia). 1881. (German von Neisser 1881)
  9. a b c Erwin H. Ackerknecht : Brief history of psychiatry. 3. Edition. Enke Verlag, Stuttgart 1985, ISBN 3-432-80043-6 . (a) to chap. “Therapy” - Stw. “Zeitgeist der Praxispsychiatrie”, p. 30; (b) on Stw. "Freud as an original electrotherapist", p. 91; (c) to chap. “History” - complete overview, pp. 30, 67 (irritable weakness), 81 f., 99; Reference to the polyetiological classification of neurasthenia today, p. 81.
  10. ^ Franz Koelsch : Textbook of occupational medicine. Volume 1, 4th edition. Enke, Stuttgart 1963, p. 161. ( Textbook of industrial hygiene. Enke, Stuttgart 1937)
  11. M. Mosse, G. Tugendreich (Ed.): Illness and social situation . JF Lehmanns Verlag, Munich 1913.
  12. Thure von Uexküll (Ed. And others): Psychosomatic Medicine. 3. Edition. Urban & Schwarzenberg, Munich 1986, ISBN 3-541-08843-5 , p. 1108.
  13. George Miller Beard : Neurasthenia, or nervous exhaustion. In: The Boston Medical and Surgical Journal. (1869), pp. 217-221.
  14. George Miller Beard: A practical treatise on Nervous Exhaustion (Neurasthenia) . 1880.
  15. George Miller Beard: Sexual Neurasthenia . 1884.
  16. ^ Richard von Krafft-Ebing : Nervousness and neurasthenic conditions . 1895. See there the etiological chapter "Sociological or general predisposing causes"
  17. Pierre Janet : Les obsessions et la psychasthénie. 2nd Edition. Paris 1908.
  18. a b c d e f Sigmund Freud : About the justification to separate a certain complex of symptoms from neurasthenia as an "anxiety neurosis". 3. Edition. [1895 b] In: Collected works. Volume I (Studies on Hysteria - Early Writings on Neurosis), S. Fischer, Frankfurt am Main 1953, ISBN 3-10-022703-4 ; (a) Title page, p. 313 ff .; (b) Definition “Hypochondria”, p. 318; (c) Assumed importance of sexuality as a triggering factor for all neuroses, p. 332; (d) Somatic and psychological pole of anxiety states, p. 337; (e) Psychological factors in triggering anxiety neuroses, p. 333; (f) Comparison of triggering conditions in anxiety neurosis and neurasthenia, p. 335 f.
  19. ^ Sigmund Freud: Studies on hysteria. 3. Edition. Cape. D, Miss Elisabeth v. R ... [1925] In: Collected Works, Volume I (Studies on Hysteria - Early Writings on Neuroses), S. Fischer, Frankfurt / M., 1953, ISBN 3-10-022703-4 ; Keyword “neurasthenics” p. 197.
  20. Stavros Mentzos : Neurotic Conflict Processing. Introduction to the psychoanalytic theory of neuroses, taking into account more recent perspectives. Fischer-Taschenbuch, Frankfurt 1992, ISBN 3-596-42239-6 , pp. 171 ff., 180 f.
  21. Neurasthenia. In: Uwe Henrik Peters : Dictionary of Psychiatry and Medical Psychology. 3. Edition. Urban & Schwarzenberg, Munich 1984, p. 320.
  22. Sabine Bährer-Kohler (Ed.): Burnout for Experts: Prevention in the Context of Living and Working. Springer, Heidelberg 2013.
  23. Wolfgang Seidel: Burnout: Recognize, prevent, overcome. Learn to control your own emotions. How the latest findings help . Humboldt-Verlag, 2011.