Psychological and clinical terminology is used in the medical field. However, when it comes to my counseling practice, I avoid labeling or analyzing as much as possible. I primarily try to understand my clients’ personal experiences through their eyes, descriptions, and stories. I find that psychological labels often get in the way of truly, genuinely connecting with my clients.
With that being said, learning about some of these terms and descriptions can be an incredibly important part of raising awareness and overcoming the stigma that can often be attached to mental illness or diagnoses. For individuals who have been diagnosed, whether it be Depression, Anxiety, Bipolar Disorder, Post Traumatic Stress Disorder, or Personality Disorder, it is crucial that both the professionals doing the diagnosis and the individuals receiving the diagnosis speak the same language.
Today, I’m going to take a moment to elaborate and explain several terms that are often used to describe behaviors, often resulting from experienced anxiety. The terms I will be explaining are compulsion, obsession, impulsion, and dependence. Each of these shares some similarities, meaning that they describe an individual’s thoughts or actions that are often perpetuated by anxiety. An example of such anxiety can be something simple like worrying about whether or not you remembered to turn off the oven when you left the house this morning.
When such anxiety occurs, it is common for individuals to fixate on the thought and become crippled by the need to do something to alleviate the experienced worry. Oftentimes, a person will be unable to move beyond the anxious thoughts until a certain act or behavior is completed to calm the worry. These acts are done with the sole purpose of silencing or relieving the anxiety once the act is completed. Using our earlier example, a relief-giving act could be calling home to ensure that the oven is turned off or returning home to check or re-check the oven’s state.
Let’s take a moment now to explore the differences between the clinical terms of compulsion, obsession, impulsion, and dependence.
Compulsions
Compulsions can be described as repetitive behaviors or acts in which the primary goal is to prevent or reduce experienced anxiety. These actions have nothing to do with having a good time or being gratified in any way but rather serve a protective purpose of needing to do ____________ in order to directly lower one’s unpleasant experience with anxiety or discomfort. Compulsion can be helpful for individuals who desire to check out from negative feelings of pain, inadequacy, worthlessness, fear, low self-esteem, or loneliness. An example of this can be seen with individuals who readily seek out sexual pleasure (i.e., watching pornography or having sex). These individuals are repeatedly seeking a way to achieve a calmer state of functioning by decreasing experienced negative emotions. These individuals have learned to turn to something that works for them. This same pattern can be true for individuals who seek out extensive exercise, work, cleaning, drinking, shopping, etc.
Obsessions
Obsessions are persistent thoughts, impulses, ideas, or images that individuals find it difficult to move beyond. They differ from compulsions in that acting on them does not necessarily reduce their intensity or an individual’s anxiety. Obsessions can often perpetuate into fantasies or beliefs that one’s anxiety will diminish only if certain behaviors are performed in specific ways. This can be seen within employment environments, where individuals become obsessed with the need for achievement or affirmation. Experienced anxiety remains constant until an individual is able to obtain specific recognition or acknowledgment. Common obsessive thoughts result in believing the desired behavior is a necessity and must be attained at all costs. Buying into such beliefs can result in unrealistic expectations in personal and professional relationships, as well as an increased likelihood of disappointment and failure.
Impulsions
Impulsion can be defined as the increasing tension experienced when an individual is struggling with anxiety. The internal tension remains present until the individual acts out in ways to relieve it. This tension creates a powerful and addictive urge for individuals struggling with addictive behaviors. Individuals are forced to decide between acting out on their impulsions or having to tolerate their internal and emotional discomfort. For example, a married woman desires an open relationship but experiences crippling anxiety that her partner will not respond positively, bringing her marriage to an end. This undesirable situation leaves her internal desires directly contradicting her external reality. She is left to experience a double bind, feeling helpless, guilty, and consumed with shame. Within such double-binds, individuals can neither win nor escape from their lingering emotional pain.
Dependency
Dependence can be defined as behaviors that require increased amounts of time, energy, or money to maintain similar effects. Individuals experiencing dependence report that their minds and bodies respond with increasing tolerance towards the situation, often leaving them wanting more in order to achieve a similar outcome. An example of this can be seen with caffeine usage. For someone who does not drink any caffeinated beverages, drinking one can of Red Bull will have significant effects. However, if that same person were to drink a Red Bull every day for several months, the individual would develop a dependence on the levels of ingested caffeine. One’s body would become used to the daily levels of caffeine, getting used to operating with that amount in his or her system. In order to experience the same level of alertness or buzz, this individual will have to drink increasing amounts of Red Bull.
When dependence is present, whether that be within caffeine, substance, or alcohol use, or behavioral patterns such as shopping, gambling, or sexual activity, individuals will often begin to neglect relationships or responsibilities in order to perform the desired activity. Withdrawal symptoms begin to emerge if the familiar activity ceases. Dependence can be identified and subsequently diagnosed if 3 of the criteria are met:
- Tolerance
- Withdrawal
- Behavior engaged in longer and greater amounts than intended
- Unsuccessful efforts to control behavior
- Significant time spent
- Important activities reduced or given up due to addictive behavior
- Continued engagement in addictive behavior despite negative consequences
When individuals are caught in a state of dependence, they may have good intentions or make some efforts towards change, but they are unsuccessful in stopping or achieving different behaviors.
