What is impulsive phobia?

ANDIt is typical that before someone talks about the symptoms of this disorder (or this format of a well-known disorder) they say something similar to:

“I’m very embarrassed to tell it, I don’t know whether to tell you because I don’t know what you will think of me.”

And then, discuss thoughts that you have had at some point that you found shocking or morally reprehensible, but that you cannot prevent from resurfacing again and again in your mind. It is precisely this egodystonic quality, which makes these thoughts unpleasant, anxiety-inducing and scandalous for those who think them, which causes them to become what we call intrusive thoughts.

Intrusive thoughts are those whose content is perceived as foreign or contrary to the person’s values ​​or principles, or raises alarms due to their theme related to topics perceived as dangerous.

All people have thoughts at some point that could be considered intrusive, since they are part of the normal mental activity of human beings. The brain continually generates associations between what is present, or between what is present and recent or current contents in short- and medium-term memory. The result of these associations can turn out to be useful, beautiful, useless… or sometimes unpleasant. The reaction to these thoughts will determine their importance and whether or not they become a problem. For example, a person may stand next to a garbage can to wait for the traffic light and the idea of ​​rummaging through the bin may cross his mind. He will probably think it is stupid and do nothing about it, he will dismiss the thought without giving it any importance and in a few moments he will even forget having even thought about it.

How does it happen

This process of not giving importance and discarding a useless thought is repeated throughout the day on numerous occasions in the mind of any normal person, without being particularly striking. But it can happen a little differently.

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Why did I think this?

Suppose a person is waiting for the subway. There really isn’t much to entertain you, since there are only a few tracks, the platform, advertisements and little else. His mind is active and at one point he makes a random association like “me-subway tracks” that presents itself as “what if I jump on the tracks?” If the person dismisses the thought, nothing happens. But suppose you read a few days ago that a man jumped onto the train tracks. He is scared by the thought of it because he understands that it is something people can actually do. Let us further suppose that he is a person of very strong morals and the idea of ​​suicide is blasphemous to him. Then he judges that what he has thought is horrible, and he asks himself: Why have I thought this? It’s a dangerous question. If he responds “it’s a stupid idea in my head” (or something like that), again nothing will happen. But there are other answers that can cause serious problems:

  • Because deep down I want to do it.
  • Because I’m going to do it
  • Because this is my true nature.
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If the person responds with any of these responses, they will probably generate anxiety about the thought, which will feel threatening. A threatening thought usually leads you to try:

  • Don’t think about it, “get it out of your head.”
  • Avoid situations where it appears (if it is triggered in relation to some external stimulus).
  • Ask for reassurance, that is, confirm with someone you trust that this thought is not really going to happen.

All of these responses have in common the consequence of confirming the emotional importance of the thought and, although they make it disappear in the short term, they prepare for a greater frequency and intensity of its appearance in the future. The multiplication of its frequency confirms the interpretations that the person makes of the meaning of that thought and further increases its anxiety-producing nature, as well as attempts at neutralization.

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Diagnostic classification, DSM IVTR vs ICD10

We are facing a variant of the Obsessive Compulsive Disorder (OCD onwards). The intrusive thought becomes an obsessive thought, although in the drive phobia There will be no compulsions (behaviors to prevent or neutralize the obsession, or its emotional consequences), since then it would be OCD in the usual sense.

The DSM IV-TR outlines the following criteria for OCD

DSM. Criteria for the diagnosis of F42.8 Obsessive-compulsive disorder (300.3)

  1. It is true for obsessions and compulsions:

Obsessions are defined by 1, 2, 3 and 4:

  1. recurrent and persistent thoughts, impulses, or images that are experienced at some point during the disorder as intrusive and inappropriate, and cause significant anxiety or distress
  2. thoughts, impulses, or images are not simply excessive worries about real-life problems
  3. The person attempts to ignore or suppress these thoughts, impulses, or images, or attempts to neutralize them through other thoughts or actions.
  4. The person recognizes that these obsessive thoughts, impulses or images are the product of their mind (and are not imposed as in thought insertion).
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Compulsions are defined by 1 and 2:

  1. behaviors (e.g., washing hands, putting objects in order, checking) or mental acts (e.g., praying, counting or repeating words silently) of a repetitive nature, which the individual is forced to perform in response to an obsession or according to certain rules that must be strictly followed
  2. The objective of these behaviors or mental operations is the prevention or reduction of discomfort or the prevention of some negative event or situation; However, these behaviors or mental operations are either not realistically connected to what they are intended to neutralize or prevent or are clearly excessive.
  3. At some point during the course of the disorder the person has recognized that these obsessions or compulsions are excessive or irrational. Note: This point is not applicable to children.
  4. Obsessions or compulsions cause significant clinical distress, represent a waste of time (taking more than 1 hour per day), or markedly interfere with the individual’s daily routine, work (or academic) relationships, or social life.
  5. If there is another disorder, the content of the obsessions or compulsions is not limited to it (e.g., preoccupations with food in an eating disorder, hair pulling in trichotillomania, concerns about one’s appearance in body dysmorphic disorder, worry about drugs in a substance use disorder, worry about suffering from a serious illness in hypochondria, worry about sexual needs or fantasies in a paraphilia or repetitive feelings of guilt in major depressive disorder).
  6. The disorder is not due to the direct physiological effects of a substance (e.g., drugs) or a medical illness.

Strictly, according to the DSM, this format of OCD would be on the border of being considered as such, since there are obsessions, but not compulsions. In the ICD-10 a finer distinction is established in which this TOC format is explicitly contemplated.

ICD-10. Criteria for the diagnosis of obsessive-compulsive disorder

For a definitive diagnosis, obsessive symptoms, compulsive acts, or both must be present and be a significant source of distress or disability on most days for at least two successive weeks. Obsessive symptoms must have the following characteristics:

  1. They are recognized as one’s own thoughts or impulses.
  2. There is ineffective resistance to at least one of the thoughts or acts, even if others are present to which the patient no longer resists.
  3. The idea or performance of the act should not in itself be pleasurable (simply relieving tension or anxiety should not be considered pleasurable in this sense).
  4. The thoughts, images or impulses must be repeated and annoying.
  5. Includes: Obsessive-compulsive neurosis. Obsessive neurosis. ananchastic neurosis.
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F42.0 With predominance of obsessive thoughts or ruminations:

They can take the form of ideas, mental images, or impulses to act. Their content is very variable, but they are almost always accompanied by subjective discomfort. For example, a woman may be tormented by the fear that at some point she will not be able to resist the impulse to kill her beloved child, or by the obscene or blasphemous and self-alien quality of a recurring mental image. Sometimes the ideas are simply banal around an endless, almost philosophical consideration of imponderable alternatives. This indecisive consideration of alternatives is an important element in many other obsessive ruminations and is often accompanied by an inability to make decisions, even the most trivial ones, but necessary in everyday life.

In the ICD-10, a finer distinction is established in which this TOC format is explicitly contemplated.

The relationship between obsessive ruminations and depression is particularly intimate and the diagnosis of obsessive-compulsive disorder will be chosen only when ruminations appear or persist in the absence of a depressive disorder.

F42.1 With a predominance of compulsive acts (obsessive rituals):

F42.2 With a mixture of obsessive thoughts and acts:

F42.8 and F42.9

Other obsessive-compulsive disorders and Obsessive-compulsive disorder unspecified.

As suggested by the ICD-10, in the event that there are these obsessive thoughts, generally associated with situational contexts, and in the absence of compulsions, this variant of OCD, which is known as as obsessive-compulsive disorder with predominance of obsessive thoughts or ruminations. Other names that can be found in literature are pure obsessive disorder Impulse phobia either Rumination.

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Obsessive content

Although it is apparently not well known, it turns out to be about a third of people with OCD. However, the egodystonic nature of obsessive content often makes those who experience it reluctant to communicate it or seek help, as it usually produces deep feelings of guilt and/or shame.

The primary evaluations that are made when faced with unpleasant intrusive thoughts may be the expression of certain dysfunctional beliefs about the origin

Typical contents are usually:

  • Aggressive: Either towards oneself (for example jumping out of the window, onto the train tracks, or crashing the car) or towards another person, especially if the person is considered vulnerable, defenseless or innocent (stabbing or harming the elderly, children , etc).
  • Morales: Uttering insults or obscenities, as well as undressing in public or in a church.
  • Sexual: Having sexual relations with strangers, pornographic images, participating in a disgusting sexual activity, images related to an orientation…