Phobia of Committing Impulsive Acts
PHOBIA OF COMMITTING IMPULSIVE ACTS
A phobia of impulsive acts is the fear of a sudden desire to commit an auto- or heteroaggressive act. This sudden desire is accompanied by anxiety stemming from a neurotic disorder within the sexual economy. Two types are generally described: defenestration phobias and phobias of knives; impulsive phobias of a sexual nature have also been described. The aggressive valence and symbolic nature of such phobias are obviously in the foreground.
In psychiatry, the term phobia of impulsive acts appeared at the end of the nineteenth century, in the midst of a catalog of more than two hundred phobias. Initially, phobias were not greatly differentiated from obsessive ideas. Philippe Pinel described "manias without delusions"; Jean-Étienne Esquirol placed them within the "monomanias" along with the notion of "obsessive fears." The notion of phobia per se appeared only in 1871, with agoraphobia (Karl Westphal). At the beginning of the twentieth century, phobias, still largely undifferentiated from obsessions, were thought to arise from hyperemotivity. In Les Obsessions et les Impulsions (Obsessions and impulses; 1902), Albert Pitres and EtienneRégis emphasized the fact that any phobia can become obsessive and placed these phobias of impulsive acts in the category "obsessions-impulses." The similarity between phobia and obsessional neurosis was pursued by Emil Kraepelin and Pierre Janet. Sigmund Freud, too, through his clinical examples, gave the impression of placing them alongside obsessional manifestations.
The syndrome of the phobia of impulsive acts is situated between hysterical anxiety and the modes of obsessive organization. The most frequent forms are defenestration phobia ("I'm afraid of wanting to throw myself out of the window") and phobias of knives. The phobic subject consciously fears what he unconsciously desires; he perceives his desires as being alien to himself. Sometimes it is objects that become phobogenic, dangerous, and to be avoided at all costs ("I'm afraid of hurting my child with a knife"). These phobias generate anxiety because they stage fantasies of narcissistic fusion with the forbidden oedipal object. If the primary object brings security, why not throw oneself into its arms, enter into it? If it is oedipal, sexually desirable, why not become one with it? (Bayle, Gérard, 1997) .The failure of repression cannot mask feelings of ambivalence; defenses are formed against loss of identity and the threat of castration. But in contrast to simple phobias, the subjects of the phobia of impulsive acts fear actions coming from themselves. They feel inadequately protected against their own impulses, and to defend themselves, resort to avoidance tactics that use a protective third party, enabling them to bolster their weakened narcissism. In "Contributionà l'étude des phobies" (Contribution to the study of phobias; 1956), Jean Mallet showed that a perceived absence of parental protection is an essential component in the choice of phobia.
Phobias of impulsive actions are to be considered not so much a symptom as an element to be situated in relation to the structure, history, and fantasies of the subject. Their outcomes are variable, depending on whether they involve an oedipal conflict or issues that are more narcissistic in nature. The conflict of ambivalence is always present, and obsessions will appear if anxiety and aggression overpower the ego's phobic defenses. Moreover, a phobia of obsessive acts may appear prior to a psychotic decompensation.
Christiane Guitard-Munnich and Philippe Turmond
See also: Phobic neurosis.
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