A review of this disorder in which there is fear of losing control and giving in to impulses.
People maintain a continuous mental activity. We are rational beings who build our reality through thought, so it does not cease in its effort to give meaning to what surrounds us.
All human work, without exception, was a thought before becoming tangible. Therefore, we must appreciate its importance in the creative process, as well as its intimate relationship with behavior and emotion.
The impulse phobia emphasizes this indivisible link between thinking and acting, but adopting a pernicious nature that generates great discomfort in those who live it.
In this article we will review the concept, as well as its characteristics and its consequences on health and quality of life, together with the therapeutic modalities that we currently have to tackle it successfully.
Phobias: characteristics and symptoms
Phobias are anxiety disorders that are characterized by the appearance of a disproportionate fear response in the presence of very specific stimuli or situations, which activate natural alarm mechanisms in order to respond to what is perceived as a threat. To understand them we can resort to the metaphor of allergies, which stand as excessive reactions of the immune system to substances or other elements that are generally harmless (but which are faced as a dangerous pathogen).
As we will see, impulse phobia has this main characteristic, although it is true that it also shares traits typical of impulse control disorders and OCD.
Returning to phobias in general, it is important to bear in mind, in addition, that their onset and maintenance depend on different explanatory mechanisms. They are formed from direct and adverse experience with the object that will later be feared, or by vicarious / social learning (seeing another person exposing themselves to the stimulus or hearing negative stories about it), but the continuity of the problem is rooted in attempts to avoid or escape it. The latter motivate an equivocal feeling of relief, as it ends up extending the problem over time.
In this sense, the affected person articulates cognitive and behavioral strategies aimed at avoiding any coincidence with what scares them, because when they do, they experience a succession of sensations (autonomous hyperarousal) and cognitions that are difficult to bear. The range of situations or other stimuli that can be associated with this irrational fear is almost infinite, which is why so many labels are created to define it.
People who suffer from specific phobias rarely go to a psychologist to treat the problem, because if the triggering stimulus is infrequent or can be avoided without major consequences for life, adaptation to the changes it causes is simple and does not affect autonomy nor to well-being. On the other hand, when what is feared cannot be ignored, fear becomes an omnipresent and disabling emotion, which generates symptoms related to anxiety: cold sweats, irritability, muscle tension, etc.
The latter makes impulse phobia a really severe problem, because as we will see below, it constitutes an intense fear of a stimulus from which to escape can be really difficult: intrusive thoughts and their possible behavioral consequences (impulses).
The impulse phobia is a concrete form of fear that is not projected towards an external object, but towards the interior. Specifically, people who suffer from it feel an intense fear of certain types of thoughts, which is a fact that is very difficult for them to share.
It is about apparently innocuous mental contents, but that are understood in terms of threat and that erupt unexpectedly. But in the case of impulse phobia, just as important as the way these thoughts make us feel is the way they make us predict the way we will feel and act in the immediate future.
And it is that the impulse phobia generates a logic of self-fulfilling prophecy (as it happens many times with anxiety disorders in general), so that what is feared or that generates anguish captures our attention constantly.
To exemplify the problem, we will divide it into smaller parts and address each of them separately. We will thus distinguish between thought, interpretation and behavior.
1. The thought
All of us have experienced at some point a thought that arose automatically, without the mediation of our will. Very often we may be able to observe and discard it, because we do not recognize in it anything that can be of use to us, or because we understand it as a harmless word or image that will vanish as soon as we decide to focus our attention on other things around us.
In other cases, an idea may arise that generates a severe emotional impact, since we interpret it in terms of harm or danger. It can be about issues related to acts of violence directed at ourselves or others, sexual behaviors that we judge as deeply abhorrent or expressions that violate deep values (profanity in people who harbor deep religious beliefs, for example).
It is a mental content that appears suddenly and that may or may not be associated with a situation we are experiencing. Thus, it would be possible that while walking along a cliff the idea of jumping into the void would suddenly arise, or that being accompanied by a person (with whom we maintain a close bond) a bloody scene would emerge in which she was the protagonist. In other cases, however, it can happen without an obvious environmental trigger.
The very fact of being the recipient of these ideas can alert the person to the possible underlying motives, since they are directly opposed to what they would do in their daily life (they would never commit suicide or harm a loved one). It is at this precise moment that such mental contents reach the terrain of psychopathological risk, since they precipitate a cognitive dissonance between what we think we are and what our thoughts seem to suggest that we are.
2. The interpretation
The interpretation of intrusive thoughts is an essential factor in precipitating this phobia. If the person deprives them of all sense of transcendence, they are diluted and stop generating a pernicious effect on their mental life. On the other hand, if a deeper meaning is attributed to them, it takes on a new dimension that affects self-concept and promotes a feeling of mistrust towards oneself and towards their own cognitive activity.
One of the characteristic phenomena of this phobia is the connection that is forged between thought and potential behavior. In this way, when accessing consciousness, the person fears losing control of himself and being overwhelmed by the impulse to carry out the acts that are related to him. Following the previous example, she would feel an irresistible fear of falling from a great height or harming the family member who was accompanying her. Therefore, a fusion between thought and action arises.
This connection can lead to doubts about whether the thought is a product of the imagination or whether it is the memory of an event that really happened at a time in the past. All this causes emotions that are very difficult to tolerate and significant confusion, which also forces doubts about the reason that could be at the base of thinking as you think (considering yourself a bad person, losing your mind, suffering from hidden impulses or being an offense against the eyes of a God you believe in).
For this reason, impulse phobia is not only linked to an intense fear of thoughts that could precipitate a loss of control, but it ends up conditioning the self-image and severely deteriorating the way in which the person perceives themselves. It is for this reason that talking about what is happening can be extremely painful, delaying the therapeutic approach to the problem.
3. The conduct
As a result of the fear generated by these thoughts and their possible consequences, the person tries to avoid them by using all the means available to them.
The most common is that, in the first place, the will tries to impose itself on the speech of the mind (which seems to flow automatically), seeking a deliberate disappearance of the mental contents that generate the emotion. This fact usually precipitates the opposite effect, through which its presence becomes more frequent and intense. Being a purely subjective phobic object, the person feels the source of their fears as omnipresent and erosive, rapidly emerging a feeling of loss of control that leads to helplessness.
Other behaviors that may take place are reinsurance. They consist of persistently inquiring about whether the events that have been thought about have occurred or not, which implies verifications that come to acquire the severity of a compulsive ritual. In addition, there may also be a tendency to continually ask others about these same facts, pursuing the judgment of others to draw their own conclusions in this regard.
Both types of behavior, the avoidance of subjective experience and the reassurance of one’s own actions, constitute the basic elements for the aggravation and maintenance of the problem in the long term. Likewise, they can be articulated in a progressively more complex way, so that it ends up hindering the normal development of daily life (avoiding situations or people that have been associated with the appearance of thoughts, for example).
Drive phobia can be treated successfully. For this, there are both pharmacological and psychotherapeutic interventions.
In the first case, benzodiazepines are usually used occasionally and for a short period of time, while the changes required for an antidepressant to begin to generate its effect take place (approximately two or three weeks). Selective serotonin reuptake inhibitors are often used, which help reduce the presence of negative automatic thoughts.
Regarding psychological treatments, which are absolutely necessary, use is usually made of specific cognitive and behavioral strategies, aimed at modifying the way in which thoughts and associated sensations are perceived (exposure to a live, cognitive restructuring, etc. .). Acceptance and Commitment Therapy is also useful, as it emphasizes the importance of experiential avoidance, a key phenomenon in drive phobia.
This type of intervention in patients, in the case of those who have impulse phobia, helps them face the symptoms without giving up, getting used to associating the presence of this discomfort, on the one hand, with the non-occurrence of their fears, for the other.
Finally, it will be necessary to rule out the presence of other mental disorders that could express themselves in a similar way to how this particular type of phobia does, such as Obsessive-Compulsive Disorder, and to rule out mood pathologies in which it may also concur. onset (especially major depression).
- American Psychiatric Association (2013), Diagnostic and Statistical Manual of Mental Disorders (5th ed.), Arlington: American Psychiatric Publishing.
- Chamberlain, SR; Leppink, EW; Redden, SA & Grant, JE (2017). Are obsessive-compulsive symptoms impulsive, compulsive or both? Comprehensive Psychiatry, 68: pp. 111-118.
- Coelho, C. and Purkis, H. (2009). The Origins of Specific Phobias: Influential Theories and Current Perspectives. Review of General Psychology, 13 (4): pp. 335-348.
- Perugi, G; Frare, F; Toni, C (2007). Diagnosis and treatment of agoraphobia with panic disorder. CNS Drugs. 21 (9): pp. 741-64.
- Potenza, MN; Koran, LM & Pallantic, S. (2009). The relationship between impulse control disorders and obsessive-compulsive disorder: a current understanding and future research directions. Psychiatry Research, 170 (1): pp. 22 – 31.
- Tillfors, M. (2003). Why do some individuals develop social phobia? A review with emphasis on the neurobiological influences. Nord J Psychiatry. 58 (4).
- Vallejo, J. (2007). Neurotic disorders secondary to stressful and somatoform situations (III). Obsessive disorders. Treaty of Psychiatry. Marbán: Madrid