Impulse phobia, that haunting fear of attacking someone

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“I had, in my head, images of me committing a violent act towards someone. I had the constant fear that at any moment I could lose control and do it. Although I obviously didn’t want to. It gave me panic attacks and regularly kept me awake at night. What Laura*, 22, describes is of the order of phobia impulse.

Although it is called a “phobia”, it is actually a Obsessive Compulsive Disorder (OCD), characterized by aggressive obsessions. It is not a sign of a psychosis or hallucinations. They are like visual flashes, repetitive thoughts of a violent, immoral or sexual act that impose themselves on the person, resulting in anxiety and compulsions.

Once considered an anxiety disorder, impulse phobia is a psychiatric disorder in its own right, according to the reference manualthe DSM-5 – Diagnostic and Statistical Manual of Mental Disorders. From 2 to 3% of the population suffering from OCD, 24.2% have aggressive intrusive thoughts30.2% of a sexual or religious nature and 43% of a moral nature.

“0% acting out”

Actions seen in thought are always egodystonic, that is to say contrary to one’s own values ​​or beliefs. And because it does not correspond to the patient’s principles, he never acts out. “It really is the disease of doubt. The fact of being afraid shows that the people affected are not going to do it. Infanticidal mothers are not afraid to kill their child. They do. Someone who presents this OCD will doubt, but there is 0% acting out”, confirms Delphine Py, psychologist co-founder of Psynergy, an application of psychology online.

By constantly seeing these projections, the person will, in fact, end up questioning their desire to do so. “I feel like I’m a microsecond away from a crucial decision, especially when it’s thoughts that seem too easy to pull off. It’s excruciating and in those moments, fear quickly takes over.”says Alice *, 29, computer engineer, affected since she was 8 years old.

One TOC has two specificities: obsessions and compulsions. The first are intrusive and recurring mental images. There are many types of impulse phobias, such as the fear of blasphemenot to love his or her partner, or even the obsession of being homosexual or heterosexual without really being so.

But regarding the violence, there is the thought of harming oneself by mutilation, suicide or otherwise. Gabriel, 24 and affected by impulse phobias for about eight years, explains: “When I took a knife, I had the feeling that I was going to stick it in my eyes or in my genitals. When I had to take the train, I was afraid to throw myself on the tracks.

It can also be images where one physically or psychologically hurts others in any way. “I have all kinds of thoughts: beating, choking, stabbing my companion or my cat. Yelling a curse at someone. Or pulling a stranger’s hair… And there are also thoughts of a sexual nature”lists Alice. Indeed, some see images where they commit sexual assaults, pedophiles, incestuous or zoophiles.

With obsessions come compulsions. These are acts performed to calm theanguish provoked by aggressive thoughts. “I’ve had mums tie their hands at night to make sure they weren’t going to kill their children, put bells on doors and say, ‘If I wake up at night, will allow me to realize what I am doing”», details Delphine Py. This can be avoidance such as putting knives out of reach, not going out so as not to meet anyone, not being alone with children.

There is also distraction, such as playing an excessive sport or watch series binge-watching. Others check by recollection or actual actions, such as turning around on the road, a compulsion common to those who fear inadvertently knocking someone down.

To reassure themselves, some will also read several times a day information on the trouble to prove to themselves that there is no risk. Others will regularly ask their shrink or their loved ones if they are really incapable of the acts that come to their mind.

“I started repeating key phrases to myself in my head”

Compulsions can also take the form of mental rituals such as prayerscounts or repetitions of specific phrases. “I started repeating key phrases to myself in my head every day. “It’s a disorder”, “these thoughts don’t reflect who you are”. And above all, this sentence of Wikipedia page which marked me deeply: “In typical impulse phobia, the risk of acting out is considered nil”», says Laura, who suffered severely from this OCD for eighteen months.

To treat OCD, behavioral and cognitive therapy (CBT) has shown its effectiveness. It is used to examine how the patient interprets and reacts to aggressive thoughts. As soon as a negative pattern is identified, it is analyzed and then modified.

Among the many exercises that CBT includes, there is the therapy per exposure. This is done in a supervised and progressive manner. “In session, I sometimes take out a sharp knife, put it on the table and then ask the patients to take it in their hand to observe what is happening in terms of emotions and thoughts., illustrates Delphine Py. This makes it possible to see that it is not because there is a sharp knife that something serious is happening. Gradually, there is a decrease in emotional responses and compulsions.

Thanks to the therapy, the patient will be able to distance himself from his thoughts. He will, gradually, integrate that he is not obliged to dissect, understand, believe and above all obey his thoughts by compulsion. He doesn’t even have to try to block them anymore. “The more we forbid ourselves to think about something, the more it will be present, says the psychologist. The idea is to say to yourself: ‘I don’t have to believe it, I don’t have to pay attention to it, I can let this thought pass like I let a cloud pass in the sky.

*Names have been changed.