At 32 and a mother of two, Caroline came to consult me because she suffered from a particularly disabling phobia: it was impossible to handle knives or dangerous objects near other people. He explained to me that it all started three years ago, from a tragic news:
"One day, I heard on the radio that a mother had suddenly stabbed her children before ending her life, nothing could explain or scare this act, the woman is not known as sick or violent".
Since then, Caroline is invaded by the fear of giving in to such an attack of madness. "If it can happen, why not me?". The young woman suffers from a particular form of obsessive-compulsive disorder (DOC), impulsive phobias (or impulsive obsessions).
The fear of losing control
Caroline does not suffer from a simple phobia of knives or scissors. Contrary to what people with animal phobias or closed spaces think, they do not fear these objects in themselves. On the other hand, he fears the acts he could commit with these dangerous instruments if he were seized by a violent, sudden and irrepressible impulse.
This extremely painful fear belongs to the DOC category. All these diseases are linked to a deep fear of not sufficiently controlling one's behavior or thought, and therefore of making mistakes, even serious ones (so-called "verifications" or "bad thoughts" OCD), to contaminate due to poor protection or poor cleaning (TOC "washing"), or poorly controlled environment (TOC "order and storage").
All this causes very strong anxieties, at the height of the gravity of the feared misfortunes
Concretely, people suffering from impulsive phobias are afraid of hurting others or themselves, physically or morally. They can thus "see" attack their relatives or strangers with weapons or dangerous objects, throw them into the void or, in a less dramatic way, insult them. These unacceptable impulses are often linked to moral values and social and cultural fears. Today, for example, we see that sexual themes are increasingly present in the phobias of impulses, particularly as regards the fear of acts on children.
The same types of aggressive impulses can be feared against themselves in the form of impulsive suicidal gestures. In response, patients look for patterns to get away from dangerous places or objects (windows, underpasses, needles, blades, etc.) or to symbolically neutralize their "bad thoughts" (repetition of sentences, numbers or actions). conjuration). All this causes very strong anxieties, at the height of the gravity of the feared misfortunes.
Several hundred thousand people interested in France
There are no accurate statistics on the number of people suffering from impulsive phobias. It is also important to distinguish this pathology, defined by a high level of anxiety and disruption in everyday life, fears of the same type but slight and transitory, which can affect almost all, without gravity.
About 2% of adults are diagnosed with DOC OCD. About a quarter of these cases involve impulsive phobias. Several hundred thousand people would have been affected in France by this type of obsessive compulsive disorder, which affects more men than women.
There is no single clearly identified cause that can explain the occurrence of impulsive phobias. These are probably the result of a combination of vulnerability factors.
First of all, as in all the DOCs, there must be a certain internal predisposition, of a psychological nature, but probably based on cerebral peculiarities. The latter concern the cognitive systems of the control of action or of thought, too demanding and generators of doubts and excessive need for control. This explains why a person suffering from impulsive phobias may have, at the same time or at another time in his life, other types of DOC, verification, order or washing.
To this psycho-biological vulnerability are added emotional factors and disruptive events, various stresses and sometimes real traumas. Life changes, especially if accompanied by an increase in personal or professional responsibility, can lead to the appearance of the disorder. A typical example is motherhood, with forms of transient or long-lasting impulsive phobias of young mothers towards their newborns, probably related to the addition of hormonal, emotional and psychological factors of Postpartum.
Impulse phobias can also be favored by the existence of other mental disorders, including depression or severe anxiety disorders.
The treatments exist
Like all OCDs, impulse phobias can be treated effectively. Affected individuals often take time to seek help because they have difficulty understanding what is happening to them. Furthermore, they are generally ashamed to talk about it. Furthermore, diagnosis is not always easy to do: one or more consultations with a psychiatrist are often necessary to evaluate symptoms carefully and to identify the disorder and any other associated problem.
The treatments are mostly psychological and behavioral, but a prescription medication can be very useful in addition. Antidepressants are effective even without associated depression. They can gradually reduce the level of mental invasion by obsessions, as well as the level of anxiety. They can be prescribed for long periods, without risk of dependence and, in general, without too troublesome side effects.
But most of the treatment is based on psychotherapies and more often on behavioral and cognitive therapy. It consists primarily of analyzing the subject's reactions to obsessive ideas, then gradually modifying them through an understanding of what they are: fears and nothing else.
In fact, impulse phobias do not in themselves pose any risk, and in particular none of the feared risks. People who suffer from impulsive phobias never perform a dangerous act of self-treatment for themselves or others (except, of course, if these acts are caused by other conditions such as depression or psychosis, or even when you take the 39; alcohol).
Being afraid of committing a violent act, when you do not want it, does not cause any loss of control. Therapy makes it possible to become aware of this essential difference between fears and desires, and to regain self-confidence by adopting healthier and more serene attitudes to obsessions. So, these will gradually fade away.
To go further: Antoine Pelissolo, You're your best psychiatrist!, Flammarion (2017).
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