People maintain a continuous mental activity. We are rational beings who build our reality through thought, so this does not cease in its effort to give meaning to what surrounds us.

Every human work, without exception, was a thought before it became tangible. That is why we must appreciate its importance in the creative process, as well as its intimate relationship with behavior and emotion.

The phobia of impulse supposes the accent on this indivisible link between thinking and acting , but adopting a pernicious nature that generates a great discomfort in those who live it.

In this article we will review the concept, as well as its characteristics and consequences on health and quality of life, together with the therapeutic modalities available today to successfully address it.

Phobias: characteristics and symptoms

Phobias are anxiety disorders characterized by the appearance of a disproportionate fear response to the presence of very specific stimuli or situations, which activate the 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 arise as excessive reactions of the immune system to substances or other elements that are generally harmless (but which are faced as a dangerous pathogen).

It is also important to bear in mind that its initiation and maintenance depend on different explanatory mechanisms. They are formed from direct and adverse experience with the object to be feared later, or by vicarious/social learning (seeing another person exposed to the stimulus or hearing negative stories about it), but the continuity of the problem is rooted in attempts to avoid it or escape from it. The latter give rise to a misguided sense of relief, as they end up spreading the problem over time.

In this sense, the affected person articulates cognitive and behavioral strategies aimed at avoiding any coincidence with what he or she is afraid of, because when he or she does so, he or she experiences a succession of sensations (autonomous hyperactivation) 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 seldom 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 brings about is simple and does not affect either autonomy or well-being. On the other hand, when what is feared cannot be avoided, fear becomes an omnipresent and disabling emotion, which generates anxiety related symptoms: 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 escape can be really difficult: intrusive thoughts and their possible behavioural consequences (impulses).

The phobia of impulse

The phobia of impulse is a concrete form of fear that does not project 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. These are mental contents that seem innocuous, but are understood in terms of threat and that burst in unexpectedly.

To illustrate the problem, we will divide it into smaller parts and address each of them separately. We will thus distinguish between thought, interpretation and behaviour.

1. 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 it and discard it, because we do not recognize anything in it that can be useful to us, or because we understand it as a harmless word or image that will fade away as soon as we decide to focus our attention on other things around us.

In other cases it is possible that an idea may arise that generates a severe emotional impact, as we interpret it in terms of harm or danger. This may involve issues related to acts of violence directed at ourselves or others, sexual behaviour that we judge to be deeply abhorrent, or expressions that offend deep-seated values (blasphemy in people with deep-seated religious beliefs, for example).

It is a mental content that appears suddenly and may or may not be associated with a situation we are living. Thus, it would be possible that walking along a cliff the idea of throwing oneself 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 may happen without an obvious environmental trigger.

The very fact of being receptive to these ideas can alert the person to possible underlying motives, since they are in direct opposition to what he would do in his daily life (he 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 thoughts seem to suggest we are.

2. The interpretation

The interpretation of intrusive thoughts is an essential factor in precipitating this phobia . If the person disposes of all sense of transcendence, they become diluted and cease to generate a pernicious effect on his 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 sense of distrust towards oneself and one’s 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 relate to him. Following the previous example, he would feel an irresistible fear of rushing from a great height or harming the family member who was accompanying him. A fusion between thought and action therefore arises.

This connection can generate 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 moment in the past. All of this causes emotions that are very difficult to tolerate and important confusion, which also forces doubts about the reason that could be at the base of thinking as one thinks (considering oneself a bad person, losing one’s mind, suffering from hidden impulses or being an offense in the eyes of a God one believes in).

For this reason, impulse phobia is not only linked to an intense fear of thoughts that could precipitate a loss of control, but ends up conditioning the self-image and severely deteriorating the way in which the person perceives himself . It is for this reason that talking about what is happening can be extremely painful, delaying the therapeutic approach to the problem.

3. Conduct

As a result of the fear generated by these thoughts and their possible consequences, the person tries to avoid them by using all means at his disposal.

The most common thing is that, first of all, it tries to impose its will before the mind’s discourse (which seems to flow automatically), looking for 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. As it is a purely subjective phobic object, the person feels the source of his fears as omnipresent and erosive, quickly emerging a sense of loss of control that leads to helplessness.

Other behaviours that can take place are re-insurance behaviours. They consist of persistently investigating whether or not the events that have been thought about have occurred, which implies checks that come to acquire the severity of a compulsive ritual. Moreover, there may also be a tendency to continually ask others about these same facts , pursuing the judgment of others to draw one’s own conclusions about them.

Both types of conduct, avoidance of subjective experience and reassurance about 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 the normal development of daily life ends up being hindered (avoiding situations or people that have been associated with the appearance of thoughts, for example).

Treatment

Impulse phobia can be treated successfully. For this purpose 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 start having an effect occur (approximately two or three weeks). Selective serotonin reuptake inhibitors are often used, which help to reduce the presence of negative automatic thoughts.

As for psychological treatments, which are absolutely necessary, specific strategies of a cognitive and behavioural nature are usually used, aimed at modifying the way in which thoughts and associated sensations are perceived (exposure to a live being, cognitive restructuring, etc.). Acceptance and commitment therapy is also useful, as it emphasizes the importance of experiential avoidance, a key phenomenon in impulse phobia.

Finally, it will be necessary to rule out the presence of other mental disorders that could be expressed in a similar way as this particular type of phobia does, such as Obsessive-Compulsive Disorder, and to rule out pathologies of the state of mind in which their appearance can also concur (especially major depression).

Bibliographic references:

  • Coelho, C. and Purkis, H. (2009). The Origins of Specific Phobias: Influential Theories and Current Perspectives. Review of General Psychology, 13(4), 335-348.
  • Vallejo, J. (2007). Neurotic disorders secondary to stressful situations and somatomorphism (III). Obsessive disorders. Psychiatry Treaty. Marbán: Madrid