Will I Act on My OCD Urges?

Will I Act on My OCD Urges? 

Almost two decades ago, impulse control disorders (ICD) was a part of the obsessive compulsive spectrum (Grant et al 2006). How clinicians conceptualize OCD and impulsive control disorders are quite different now. Impulse issues have long been a source of frustration for some individuals with OCD. Many people who have OCD (not all) often struggle, not knowing if their urges will eventually turn into behaviour that will implicate them in the future. For instance, a person with Harm OCD may struggle with the urge to grab a knife and hurt a family member or a person with Incest OCD may become anxious with sexual urges around their siblings. What we are aware of now is that there isn’t a significant overrepresentation of impulse control disorder symptoms in OCD patients. Despite OCD patients reporting urges and impulses, there are clear distinctions that are made that separate OCD patients from those with impulse control issues.  

The Relationship Between Thoughts and Urges 

Many individuals who experience difficulties with Obsessive Compulsive Disorder may describe difficulties with feeling urges or impulses in combination with their intrusive thoughts. At times, these can be described as overwhelming and anxiety provoking. Jon Hershfield’s text, Harm OCD, indicates, “people with harm OCD often describe their intrusive thoughts as ‘urges’ because it’s difficult to find another word for the marriage of an intrusive thought and a sensation in the body that seems to indicated an imminent action. If you feel like your hand wants to move near a knife, you may interpret that as a scary urge to grab the knife and use it for harm. But this is actually better understood in OCD as a feeling obsession or intrusive feeling, not a genuine urge. (Hershfield 2016)” The feared feeling can bring on overwhelming anxiety, but it doesn’t have to be feared. Obtaining an understanding that the feeling is manifested by your fears (for example, what you really don’t want to happen, such as killing someone) can help manage the urges. The fear may be brought on by the thought that the feeling may alter your feelings so you aren’t feeling what you believe you should be feeling (Grayson 2014). In other words, you believe that your thoughts, feelings and more specifically your urges will alter who you are, your values and your beliefs. But, this is far from true. This shift in personality and belief structure is highly unlikely.  

Do Thoughts Lead to Action?

Although it is true that thinking about an action is part of the process of beginning a series of behaviours, it is not true that having a thought about an action always leads to that action. This can be said with activities that you may have had the thought to do this past week, but didn’t begin doing. For instance, you may have had the thought to exercise, but didn’t. You may have also had the thought to do work, but chose to do something else instead. The link between thoughts and actions are indirect. Purdon and Clark’s text, Overcoming Obsessive Thoughts, indicates “you maybe have read that people can ‘act on impulse’ behaving in ways they regret later. That certainty is true; there are people who at without considering the consequences. However, the action such people engage in are actions that they enjoy or are desirable in the moment, such as shopping or gambling or yelling at someone they are angry with. They may regret the action later because of its consequences, but at the moment, the idea is quite attractive. (Purdon and Clark 2005)” Urges that come with OCD are not pleasurable. Acting on urges may go against your values and go against what you enjoy doing. This makes it far less likely that you would act on an urge. 

Purdon and Clark also argue that it is typical that many individuals who experience difficulties with OCD and urges will argue that they may become worried that they will enjoy the act at some level. This may certainly be true, but highly unlikely because personality is considered stable over time (Purdon and Clark 2005). This would mean that there would need to be a shift in who you are, what you believe in, and what your values are for this to occur. This would be quite a shift in character and identity (Purdon and Clark 2005). What we do know is that generally people usually retain considerable control and people's actions typically don’t deviate from their morals and values. 

For Those Choosing Uncertainty

Of course, at any time you could wake up and act on what you dread the most. What we do know is that nothing is certain. This means that if you are choosing to work with your OCD you must recognize how you would cope with your fear and commit to living with the uncertain future.

For Clinicians: 

What separates those with OCD from individuals with Impulse Control Disorder?

Yes, there is indeed overlap between patients who struggle with impulsive control disorders (ICD) and OCD. OCD and ICD both feel an increase in emotional involvement when faced with an urge or impulse, but the difference is that pathological behaviour in OCD is more likely driven by anxiety. ICD patients are usually driven by arousal (for example, anger, frustration). Completing the activity or urge may reduce the tension, but that may be influenced by the need to feed the ‘reward center’ of the brain. Similar to those with addiction issues, individuals with OCD experience dependency through the use of compulsive behaviour because of the rewarding effects when performed adequately/just right or when compulsions reduce anxiety (Grassi 2015).  What separates those with ICD and OCD is that those with OCD have high moral standards and are likely to avoid following through on urges, because of the negative consequences that would likely follow (Ettelt et al 2006). 

Part #2: What is the difference between an impulse and urge?

Ettelt, S., Ruhrmann, S., Barnow, S., Buthz, F., Hochrein, A., Meyer, K., Kraft, S., Reck, C., Pukrop, R., Klosterkötter, J., Falkai, P., Maier, W., Wagner, M., Freyberger, H. J. & Grabe, H. J. (2007). Impulsiveness in obsessive-compulsive disorder: Results from a family study. Acta Psychiatrica Scandinavica, 115(1), 41–47.

Grant, J. E. & Chamberlain, S. R. (2014). Impulsive action and impulsive choice across substance and behavioral addictions: Cause or consequence? Addictive Behaviors, 39(11), 1632–1639.

Hershfield, Jon. (2016). Harm OCD. New Harbinger Publications.

Purdon, Christine., David, Clark, David. (2005) Overcoming Obsessive Thoughts. New Harbinger Publications. 

Grayson, Jon. (2014) Freedom From OCD. Berkley. 

G Grassi, S Pallanti, L Righi, M Figee, M Mantione, D Denys, et al.

Think twice: impulsivity and decision making in obsessive-compulsive disorder J Behav Addict, 4 (2015), pp. 263-272