The distinction between the actual neurosis and the neurosis of defense was made by Freud very early on in the context of his theory of the sexual origins of neurosis. In 1898, in an article entitled "Sexuality in the Aetiology of the Neuroses," he clearly described these two categories of neurosis in terms of both aetiology and treatment: "In every case of neurosis there is a sexual aetiology; but in neurasthenia it is an aetiology of a present-day kind, whereas in the psychoneuroses the factors are of an infantile nature" (1898a, p. 268). This contrast between actual and infantile sexuality in the causation of the two kinds of neurosis entailed correspondingly different therapeutic approaches, namely prophylaxis and deconditoning in the case of actual neuroses (pp. 275-76) and psychoanalysis in that of the defense neuroses.

Into the class of actual neuroses fell, chiefly, neurasthenia and anxiety neurosis. Later (1914c, p. 83),...