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Impulsivity

Very Sad Son with Changing Moods and Bad Anger

by Holly Counts, Psy.D.
written by Holly Counts, Psy.D.

My son was complaining about bullying issues and becoming very depressed in his high school (9th grade) so my husband and I decided to move him to a therapeutic school with therapy and academics.  Since doing that he is worse…..he says he is depressed and wants to kill himself/not live very often.  His psychiatrist increased his abilify to 10mg and he’s on 75mg fluvoximine.  We are on vacation together in florida and I see his fluctuating moods.  He gives us so much hassle when we want to spend time with our cousins who he has fun with.  When we get him to join us, he swims with them and plays football and is smiling and laughing.  He will then go out to dinner with us, be happy, eat well, have dessert, walk around and suddently get into a foul, disguisting, nasty, rude mood.  Part of me thinks he does this when he doesn’t want us to have fun or meet friends.  We used to leave him and his sister together if we wanted to go out for a little bit locally, but with his unstable behavior, I don’t feel comfortable doing this anymore.  I feel like we are walking on eggshells and am wondering how much his moods are possible mental issues or how much being a nasty teenager.  I feel like he may be saying he wants to die or he is going to kill himself for attention or to get what he wants at times.  Is this possible?  How do I know if he is really feeling this?  I know not to take anything like this for granted and I am praying this may be teenage angst, but it is so difficult to know what to say when he says he feels like this and can’t tell me why. (age 48, from US)

I’m sorry that your son is going through such a difficult time — which also means the family is, too. Without knowing your son, I’m not sure that I can help decipher things any more than you already have. The problems could be typical teenage angst and moodiness that can be influenced by hormones, developmental changes and social pressures, but it could also be a legitimate mental health issue. And you are correct in thinking that some teens talk about suicide as an attention seeking behavior, but it can also be a true expression of suffering. The combination of teenage impulsivity and depression can create a very serious risk.

It sounds like you have some resources in place with the therapeutic school and psychiatrist. Your best bet is to reach out to them and become as involved in his treatment as possible and make sure that he is getting the level of care that he needs. In addition, I would suggest helping your son find outlets that he finds enjoyable, build self-esteem and give him something to look forward to. This could include sports or clubs, volunteer work, martial arts, or it could be something like equine therapy or Outward Bound.

I hope this helps and things get better soon.

All the best,

Dr. Holly

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I Sometimes Want to Hurt Others?

by Dr. Marie Hartwell-Walker
written by Dr. Marie Hartwell-Walker

From a teen in the U.S.: I understand this type of question has been asked before, but none of the responses, or even questions themselves, really covered what I am feeling, so… Here goes.

I have the sudden impulse, when I am around loud, messy, or emotional people, to hurt them. Severely. Sometimes my impulses- which, mind you, I never act upon — go so far as to suggest I kill them; sometimes it’s just to inflict pain. At the same time, however, I don’t want to hurt them — it just seems like violence is the only way to get them to stop their actions. This only ever happens around the type of people who make any display of their emotions or eat/talk/etc. loudly, and as far as I can tell it’s just to make them go away, and stop their actions. A part of me suggest they’re too weak to be around if they’re displaying their emotions so overtly, or too simple-minded if they’re talking/eating/etc. too loudly.

Due to some childhood experiences I’d rather not share I tend to have zero tolerance for those I perceive as ‘weak’, which is not a conscious decision as far as I know. It is more of a reaction- when I see perceived ‘weakness’, I get annoyed incredibly fast and want them to either stop the action that displayed the weakness or for them to leave. Usually, in social situations, this can be generally avoided or ignored.

Unfortunately, this perception has spread to my mother, whom I am currently caring for. She and I share a room, and I am witness to her various emotional breakdowns, loud sounds, and other sensory annoyances. I have had to leave the room to get away from the sounds so I did not fall prey to the impulse to stop it myself.

Do you know of any way to get these unwelcome impulses to go away? I’m concerned I may just act on them. Several times I almost have, and it worries me, because I don’t want to hurt them, not really — I just want them to stop, which is not my decision nor within my realm of control. Is there anywhere you can point me towards that can help?

Thank you for writing. You have already shown that you do have control. You have resisted the impulse to hurt others thus far and now you are writing to us here at LifeHelper. There is a core of health at work here. Now let’s build on that.

There’s a saying: “Hurt people hurt people.” Your impulse to hurt others is probably a way you are dealing with your own pain. Your defense against any show of weakness is to feel aggressive. It’s understandable. It may even work for the short run as long as you confine the response to feelings, not action. But, as you already know, unless you find other ways to manage your fears, they will eventually pop and both hurt someone else and get yourself into serious trouble.

What you need is some focused therapy to help you deal with whatever happened that you don’t want to talk about. With help, you can find other ways to feel strong and be strong. With the support and advice that therapy can provide, you can get past whatever it was that hurt you so profoundly. Please take care of yourself by looking for a therapist who specializes in working with young people.

In the meantime: There are a number of hotlines available to teens. Calls are confidential and free. Go to #/lib/common-hotline-phone-numbers/ to find the phone numbers. Counselors are available to help you talk out whatever is troubling you at the time and to help you find further help if you need it.

I wish you well.
Dr. Marie

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What Professional Can I Trust?

by Dr. Marie Hartwell-Walker
written by Dr. Marie Hartwell-Walker

Hello everybody, I’m a 25 year old female from Greece. I suffer from borderline personality disorder, cannabis abuse disorder, Aspergers syndrome and ADHD (some psychiatrists believe I also have bipolar disorder). When I was a teenager I also had eating disorders.

I take psychiatric medication (an antipsychotic and a mood stabilizer) from when I was 17 y.o. and I recently started going to a psychotherapist for therapy (and I totally love therapy!). I’ve been hospitalized in mental hospitals for 8 times and 1 time I went to a rehab for drug abuse (cannabis, alcohol, benzodiazepines, MDMA and cocaine – now I smoke only weed but I do it daily). I’ve tried to commit suicide 5 times and I cut myself too. I was bullied (mentally and physically) constantly in elementary school for 6 years because of my strange behavior.

Here’s my problem: I have visited many doctors. All doctors say that I’m borderline but the half of them, they also believe that I have bipolar disorder. I don’t think I have it. I just don’t have the symptoms. For example, when they say I’m manic, I don’t have changes in my energy (I sleep 12 hours! 12 hours for a manic person? really?), I’m never hypersexual, I’m never grandiose, I’m never euphoric and of course I don’t have the “proper” duration for bipolar mood swings (my mood changes within a few minutes or hours, they don’t last for days/weeks/months).

I’m very impulsive, moody, self-destructive, aggressive and I easily get angry and that’s why I got the diagnosis of bipolar disorder. I talked about this to these psychiatrists and they said I don’t have the typical clinical picture of a bipolar person but I still have it. And that’s why they don’t prescribe medication for my ADHD, they think it can make me go manic. But, like I said, they don’t agree all of the doctors with that diagnosis and one of them asked me If I wanted to take stimulant medication and I said “Ill think about it.” Who can I trust? Thank you very much for your answer!

What a complicated collection of diagnoses. I can’t tell you whether or not you have bipolar disorder. I can tell you that smoking marijuana every day is not helpful to any of your problems and may be making things worse. Especially since you are taking medication, it is essential that you talk to your prescriber about it to determine if the weed is interacting in any negative way with your medicine.

Besides the drug use, I think the borderline personality disorder (BPD) diagnosis impacts everything else — even your concerns about who to trust. For that reason, if you were seeing me, I’d be working on the borderline diagnosis first. The most researched treatment for BPD is Dialectical Behavior Therapy. I encourage you to research it and to look for a therapist in your area who has expertise in that technique. It will provide you with practical tools for managing and regulating the emotional responses that often cause you to hurt yourself or to be confused about who to trust in relationships.

I wish you well.
Dr. Marie

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Intense Anger and Urges

by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP
written by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP

I’m not sure when it began, exactly, or if I’ve always been like this, but for as long as i can remember, I’ve had random – and quickly suppressed – urges to throw dishes, slap family members and peers, break phones, anything violent. These urges almost never arise when I’m actually angry, but when I am angry I tend to have problems with then cooling down. I often dream of following through with those urges, and those dreams never have a nightmare quality to them. If anything, I sleep better. What concerns me most, however, is why the urges arise. Though random in appearance, there is a pattern to who is typically nearby me when these urges pop into my head and my hands begin to twitch with the need to follow them through. My parents, my brother, and myself included are all snippy. We don’; fight constantly—not like it is seven days a week, but when we do have arguments because of our sharp tongues we often end things in tears. Most anytime I’m doing dishes, if my parents are nearby, I will have the urge to throw a glass in their direction and see who it hits. Again, never when I’m actually mad.

As I expressed before, I often have trouble cooling down after a bout of anger. I could be sitting in my room, reading a book or drawing a picture, and the smallest thing – such as getting a paper cut or crumpling part of the paper – can send me in such a rage that the sketchbook is thrown against the wall or the page is almost torn out of the book (which is horrifying as I love to read). Sometimes there is no spark to light the flame, and I’;m simply standing around and then so furious I could scream. I’m not sure what to do.

Every family has a culture that is influencing our thoughts, feelings and behaviors. There is a ”norm” or familiarity that gets woven into our way of being with our families that becomes a way of life.

The most telling of your concern is who is most often around when these feelings are activated: your family. You also say that most of the encounters you have with your family that involve anger end in tears. The important element here is what you DON’T experience. There is never a working-through of the anger. It ends badly and it seems clear from your statement that there is a residual that stays with you. This unresolved anger is like hydrofluoric acid and will eat through you. It doesn’t get contained because it is never neutralized through resolution.

In these instances it is best treated with family therapy with a highly skilled therapist. But if the family is unwilling or unable to go it may be good to find an individual therapist who can help you find appropriate outlets, alternatives, and resolutions for these invasive thoughts.

Wishing you patience and peace,
Dr. Dan

 

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There Are Three People Inside of This Body & I’m The Only One With a Desire To Kill

by Kristina Randle, Ph.D., LCSW
written by Kristina Randle, Ph.D., LCSW

Inside of this fleshy prison live the three of us: Harry, George, and me. Normally, we get along perfectly, each respecting one another’s problems, such as George’s ‘depression’ and Harry’s ‘schizophrenia’ (both of which have not been diagnosed or discussed with a professional). Unlike the other two, I seemingly lack a few emotions, such as grief, remorse, and empathy. Normally, this is more of a strength than a weakness, but as of late, it has been rather difficult to deal with.
It’s perfectly normal for me to experience urges to kill living creatures or to break inanimate objects, and these urges are understood by Harry and George. However, with each passing day these urges seem to grow stronger, and Harry and George seem to grow more…’on edge’. When we discuss the subject, the others seem to react with more fear, or aggression, than they used to, and they don’t seem to understand my situation as well as they used to.
Previously, I could control my urges perfectly. I fidget a lot, which used to calm the urges, and I can also be quite destructive if I want something (I chewed through a television remote so that I could play with the rubber buttons inside), which also helped. Leaving windows open and then killing the insects that entered the house was another good way to calm myself. However, none of these methods seem to do much good anymore. I want something more, something bigger. Hunting is out of the question for me – there isn’t anywhere to go in my local area and if I ask an adult it will arouse suspicion (they all believe that Harry, George, and myself are a singular, ‘normal’ entity).
With each day these urges growing stronger, I also grow more impatient and frustrated with tiny details. Things – and people – are bothering me more and more, and this is encouraging my fantasies of killing them. There’s only two people I would never be able to kill, and they’re not a part of my family, which means I have to control myself greatly each day around the people I’m supposed to ‘love’.
With all of that said, it brings me onto my questions. What can I do to calm my desire to kill? And, lastly, is calming my urges that only way to make Harry and George feel comfortable with me again? Thanks.

You state that these urges are becoming increasingly difficult to control. They are signs that you should seek professional help. Don’t ignore these important warning signs.

I receive many questions from people with similar problems. As I’ve mentioned in my response to each of those writers, I have studied the biographies of many people who kill. They have often described feeling increasingly out of control leading up to their crimes. I’m thoroughly convinced that had they sought professional help, many of those people would have never killed.

Right now, you’re spending a great deal of time indulging your fantasies and interacting with Harry and George. Avoid this. You need to find other ways to expend your energy that are nonviolent in nature. There are many activities that could occupy your time. Here are a few ideas: hiking, running, sail boating, learning to play the guitar, drawing, sewing, cooking, podcasting, making a documentary, writing, photography, meditation, and so forth. The idea is to redirect your energy towards positive thoughts and behaviors. Choose healthy activities over unhealthy activities.

Of course, hobbies are not a cure for homicidal ideation, but distraction can be powerful. Ideally, you should consult a mental health professional who can address this problem in a meaningful way. That would be the most responsible course of action.

Finally, contact the authorities if you feel that you are at risk of losing control. They can protect you from doing something that you would later regret. Depending on the nature of the violent act, you could be sent to prison for life or be executed for your crimes. Should you go to prison you will regret the actions or inactions that got you there. Prisons are very violent places. They are designed for punishment. Get help if you need it. It is not an exaggeration to say that mental health treatment has the potential to save lives. Please take care.

Dr. Kristina Randle

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Do I Have Antisocial Personality Disorder?

by Kristina Randle, Ph.D., LCSW
written by Kristina Randle, Ph.D., LCSW

Over the past few years I have been curious as to what is wrong with me. I feel different, detached and slightly alienated. I have no interest in friendship or relationships (emotional or physical). I feel very emotionally cold and distant, I do still have emotions, but they are very diminished, I also have difficulty understanding what emotion I am feeling at any given time, in addition to lacking empathy. I often find myself being very manipulative and lying almost compulsively. It has gotten to the point where I will lie frequently for no reason, simply for the sake of lying. I am very impulsive and lack direction in my life, I pick up and drop new hobbies very frequently and I find it almost impossible to plan ahead and stick to life goals that I have set for myself.

During my childhood I was a ‘problem child,’ very angry, aggressive and cruel to animals and insects. Up until the age of five I would throw tantrums and purposefully projectile vomit. Now at the age of 19 my aggressiveness and irritability still remain. Finally, when I am in social settings (such as college) I find myself putting on a façade, pretending to be normal, pretending to feel the same as those around me.

Whilst I do not feel that these symptoms are affecting me negatively in my daily life, I would like to know if I do in fact suffer from antisocial personality disorder.

Thank you for your time.

It’s impossible to provide a mental health diagnosis over the Internet. I do not have enough information to determine a diagnosis.

Some of your symptoms might be indicative of disorders other than antisocial personality disorder. For example, feeling detached, different, alienated, and lacking emotion, could be a sign of depression. It’s common for people with depression to isolate themselves.

You mentioned struggling with emotions. That’s not necessarily a symptom of any one mental illness; it is something with which many people struggle, even those without mental illnesses. It’s relatively common to misunderstand one’s emotions.

You believe that you lack empathy but did not provide any examples. Examples would’ve helped me to determine if you do lack empathy.

You said that you lie but did not provide any context. There is a difference between “white lies” and pathological lying. For instance, if a friend asks you “how do you like my new haircut?” and you reply “I love it ” even when you don’t, that might be considered a “white lie.” White lies are often used when you don’t want to hurt someone’s feelings.

That is a qualitatively different type of lie, than the person who lies about being a war hero or a September 11, 2001, terrorism survivor or a cancer victim. Those types of lies, might be characteristic of pathological liars, who seem to tell untruths for the purpose of manipulating others.

In all of the aforementioned examples, lies were told but only the latter examples are more likely to be associated with antisocial personality disorder.

Aggression is a concerning symptom but impulsivity and being unclear about your path in life, at the age of 19, may be developmentally normal. According to the latest brain science, the teenage brain isn’t fully developed until about age 25.

I’m not suggesting that you do or do not have antisocial personality disorder but I wanted to point out that your symptoms could be indicative of other mental health disorders or perhaps none at all. More information would be necessary to make a determination about a diagnosis.

The best way to determine a diagnosis, is to be evaluated by a mental health clinician.

You stated that your symptoms are not negatively impacting your life but I would disagree. You should not simply accept these symptoms as your reality. When you notice a problem developing or have concerns about a potential problem, you should investigate and attempt to correct whatever might be wrong. Writing to us was a good first step. Your next step should involve consulting mental health professionals. Please take care.

Dr. Kristina Randle

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