How Obsessive Compulsive Disorder Affects Impulse Control

By: Suzanne Feinstein, PhD

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What is impulse control?

Impulse control is the ability to resist acting on temptation due to awareness of the negative consequences of your actions. For example, if you have strong impulse control, you can refrain from overeating, smoking a cigarette, or gambling. 

How do OCD and impulse control overlap? 

OCD and weakness in impulse control have some clinical characteristics that overlap with each other. Both OCD and impulse control issues are mediated by short-term gains despite the longer-term negative consequences. Thus, some impulse control issues are classified as obsessive compulsive spectrum disorders. 

People with OCD perform compulsions (cleaning, ordering, checking, etc) in order to ward off the short-term anxiety that is derived from their obsession (fear of dirt/germs, losing things, burglary/fire). The irony is that  the compulsions perpetuate and reinforce this feeling of a loss of control. Unfortunately, over time people need to perform longer and more frequent compulsions in order to get their ‘fix’. This causes people to lose confidence in their ability to resist urges and adds to their original fear that they are ultimately out of control. 

People who struggle with impulse control surrender to their urges by chasing short-term rewards despite those rewards being harmful in the long-term. The reward-seeking behavior is preceded by a feeling of tension and excitement and becomes habit forming similar to the compulsive nature in OCD. 

What is the difference between OCD and impulse control?

The difference is that OCD is categorized as an anxiety disorder generally motivated by a desire to avoid discomfort and not necessarily by a reward-based goal. Struggles with impulse control are generally motivated by the urge to chase a reward to feel a sense of pleasure or gratification. However, these disorders lie along a continuum since the goal of avoiding discomfort and the goal of feeling good heavily overlap. 

What is thought-action-fusion (TAF)?

Due to the overlapping nature of impulse control and ocd, many people with ocd struggle to understand the difference between a thought and an impulse. For people who struggle with certain types of ocd (like harm ocd), thoughts that are aggressive in nature cause confusion, doubt, and fear. They view the process of having thoughts and acting on the thought as equivalent. In other words, bad thoughts equal bad actions. In the study of psychology, this is known as thought-action fusion (TAF).

It is important to note that people who obsessively fear they are at risk of acting on impulse (ie harm ocd) are not at a higher risk of acting out. However, as long as the person engages in compulsive behaviors, the fear (not the act) of harming others will be reinforced. In turn, it will become increasingly more difficult to break free of the compulsions. 

What is Harm OCD?

Harm OCD (HOCD) features obsessive thoughts about hurting others or oneself. People with HOCD may fear engaging in unintentional acts of violence. And some individuals fear their own capacity for intentional violence.

For example, people may have obsessive thoughts about “snapping” and becoming violent. They may compulsively avoid knives or weapons. In order to alleviate their intrusive and fearful thoughts, they may also frequently check that others have not been harmed by their feared actions.

What is magical thinking and how does it play a role in harm OCD?

If one believes that their thoughts hold the absolute power to cause the occurrence of actions, it is known as magical thinking. An example of magical thinking is “if I think about something bad happening, it is likely to come true. And if I think about it repeatedly, it is increasingly more likely to come true. 

In order to feel in control, people with these types of magical thinking adopt compulsions to magically control the fear of the scary thoughts coming true. Example: If I step on a crack, I’ll break my mother’s back. So I will hop over the cracks to keep her safe.

Types of Obsessive Compulsive Disorder that feature fears of acting on impulse 

Below, we listed examples that involve thought-action fusion:

  • Suicidal OCD: If I have repeated images about suicide, I fear I will act on it unless I keep myself completely safe from myself 
  • Hit-and-run OCD: If I feel a bump in the road, I fear I drove over a pedestrian 
  • If I think about pushing someone into the subway platform, it is likely to come true unless I do everything in my power to stay away 

Treatment for OCD 

The good news is that treatment can help with these symptoms. When administered by an experienced behavioral therapist,  exposure and response prevention (ERP) therapy is a safe and effective way to treat different obsessive compulsive disorder and its various subtypes.

Need Help With Obsessive Compulsive Disorder in NYC?

Obsessive compulsive disorder (OCD) manifests in many different ways and in a multitude of subtypes. There are multiple highly effective treatment options available to those struggling with obsessive compulsive disorder and its effects.

Are you or a loved one searching for OCD treatment in New York? Advanced Behavioral Health LLP offers ERP and other types of supportive therapy in the NYC area. Contact Advanced Behavioral Health to schedule your first appointment.

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