Julie Miller's Mental Health Blog

Archive for the ‘"I" is for Impulse Control Disorder’ Category

Self-soothing/self-regulation are critical in management of this illness, along with most other psychiatric diagnoses.

To regulate the central nervous system, we can use external resources or behaviors (which include the negative behaviors listed in post #1 about this issue), or we can learn and practice new skills which rely on internal resources.

Internal resources are about using the central nervous system to calm and regulate itself.  An example is creative visualization/guided imagery.  I lump them together here because they use the same principal – if I can see something in my mind’s eye, my body will believe it’s actually happening.

I can imagine a peaceful, calm place, and my body will begin to calm and relax.  If I imagine a safe place, my body will calm and I will feel safe.

Use of a safe/peaceful place as a tool to regulate takes a great deal of development and practice to become second nature.  I use the safe place “exercise” as a beginning for therapy with every issue for which a person might seek treatment.

Try this – think of a place where you have been as an adult, or where you can imagine being, where you felt calm, peaceful, relaxed, safe, maybe the best you can remember feeling as an adult.

Then put yourself in that place, just by yourself, in your imagination, and see the sights.  Notice the sounds.  Breath in the smells and scents around you.  What are you doing in that scene?  Walking, standing, sitting, laying down?  If you could reach out and touch something there, what would it be?  What does it feel like?  Is it warm, cool, cloudy, sunny?

Then notice your body – any place where you feel any calm or peace?  Focus on that sensation, wherever it is in your body, and let your breath come in to where you feel it.  The use of EMDR by a qualified practitioner can enhance this experience and get it really “installed” in your psyche, but simply using your imagination to see and feel this place can be enough with practice.

What do you call this place?  “Beach,” “Mountains,” “Forrest,” etc.?  Practice going there daily, more than once a day, to really get that in the neural networks and enhance your ability to bring that place up in your mind and soothe your body.

Then, you can use this place in your imagination to calm and soothe if agitated, anxious, frustrated, afraid, etc.  Say the name of your safe place, bring up the images, hear the sounds and smell the smells.  Unless you are absolutely in danger in the moment, there’s no rush to respond to the situation you are in immediately.  Slow down.  Lower the temperature in your central nervous system – calm, soothe.

If I’m acting on my anxiety or other urgent feeling, my brain is not functioning at it’s highest level.  The blood flow has decreased to the brain, and is flowing to my extremities for a “fight or flight” response.  Again, unless I am in imminent danger, there is no rush, and it will best soothe me to slow down.

Using the safe place can help return the central nervous system to baseline and then be more in control of my behavior.

This is one possible tool for use with impulse control issues.  It is not a magic bullet.  It is not a cure.  It can be helpful.  It can help me learn to be in charge of my own central nervous system, and therefore in charge of my behavior.

Self-regulation/self-soothing is a tremendously important skill for all humans, and in American culture, we’re just not that good at it.

Self-soothing is a skill we are supposed to learn from our caregivers (parents, etc.) when we are small children.  We learn by observing our caregivers soothe themselves when distressed, and if they self-soothe in a healthy, internally-focused manner, we will learn to do that as well.  If they drink, rage, obsess, or act out in some other compulsive manner to soothe, then we’ll do the same.

We may have a slightly different “flavor” of acting out to self-soothe, but the principal will be the same.  Obsessive compulsive spectrum disorders, including impulse control disorders, are most certainly about soothing anxiety.

As a trauma therapist, my perspective is that trauma underlies the problematic behaviors.  The affect (emotion) and negative self-referencing beliefs can be targeted in therapy (especially EMDR).  We can trace back to the first time the individual believed this negative belief, or experienced the emotions.  We can also target the worst experience they had based on this belief or emotion.

Resolution of the underlying trauma can give the individual a “foot in the door” to gain a sense of control over the problematic impulses and behavior.

Impulse control disorders includes hot-headedness (intermittent explosive disorder), stealing (kleptomania), pathological gambling, fire-starting (pyromania), compulsive hair pulling (trichotillomania), compulsive nail biting (onychophagia), and compulsive skin picking (dermatillomania).  Individuals often resist these urges or attempt to quit in some way, and frequently fail.

The individual suffering with one or more of these conditions feels an irresistible urge to act out in the behavior, with increasing anxiety should the individual succeed in resisting for any length of time.  The anxiety is not relieved until the compulsion is fulfilled.

“What can be done?” you might ask.  “I chew my cuticles until they bleed.”  “I can’t stop raging.” “I can’t stop…..”  That is the key phrase here.  The urge appears for whatever reason, and resistance is futile, so the cycle continues.  Often there is shame or self-recrimination after the behavior, which may then trigger uncomfortable feelings, and then the urge to act out begins again, with ensuing anxiety if the behavior is resisted.

The solution is simple and complex.  The simple answer is that one just replace the troubling behavior with some other self-soothing behavior.  This is complex in that individuals are prone to relapse and often require treatment from a variety of perspectives, including medication, psychotherapy, spirituality, diet/exercise/stress management, and anything else that will help.