Summary
A reader with diagnosed Post-traumatic stress disorder (PTSD) and bipolar II describes frightening, involuntary thoughts and images about being harmed. They ask why these thoughts occur in the context of a history of childhood abuse.
The response acknowledges how distressing intrusive thoughts can be and presents several theories about their origins, rather than claiming a definite explanation.
Its practical focus is on cognitive behavioral approaches to understanding and responding to unwanted thoughts, with professional support when self-help is insufficient; it also discusses reducing stress and anxiety as part of that approach.
Question
Reader · Identity withheldI am a 42 year old woman and I often have these thoughts like, “I should just stab myself with this knife,” or, “I should just drive into that wall.” I also have visions of being chopped into peices with an axe or cut into peices with a knife. I have a diagnosis of PTSD and Bipolar II. I have a history of sexual and physical abuse as a child. Why do you think I have these kinds of thoughts?
Answer
Allan Schwartz, Ph.D.There is no doubt that intrusive thoughts are extremely unpleasant and troublesome. They occur involuntarily and seem to make no sense except that they can be scary. However, the reason why they occur is not easy to answer.
There are many theories about obsessional thinking. One is that its an attempt to keep depression and anxiety at bay. Even though the thoughts can be scary and annoying, it is said that they hide memories and feelings that are much more despairing. Another theory is that they are an attempt to give the obsessional person a sense of control over the environment.
This may seem counter intuitive but it is theorized that the thoughts can be magical in nature so that all kinds of disaster can be averted. These theoretical explanations come from an older type of psychology called psychoanalysis. However, even today, obsessional thinking is believed to be part of the anxiety disorders because it seems to be that intense anxiety brings on these intrusions into the mind.
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From a physiological perspective, it is hypothesized that these involuntary cognition stem from the brain’s attempt to discard irrelevant information. That means that there could be some brain dysfunction that might bring on obsessive compulsive disorder.
Regardless of the cause, the real question is, what can be done about this. There are many approaches, some self help and others requiring a cognitive behavioral therapist.
There are many self help manuals available in stores like Barnes and Noble, whose shelves are stocked with books for obsessional thinking. Basically, these manuals provide an explanation of the disorder and then give, in detail, cognitive behavioral exercises that can be done at home to eliminate or reduce these thoughts.
If self help does not work, which often happens, then it is time to see a professional who specializes in Cognitive Behavioral Therapy(CBT). In this type of therapy, you learn how to distract yourself from this thinking and refocus on more helpful types of thoughts. Part of the method, whether self help or with a professional, involves learning how to understand to question the reality of what you are thinking, come to realize that the thoughts are nonsense and replace them with realistic thoughts.
Added to CBT, whether self help or with a professional, is practicing stress and anxiety reducing methods. For example, its important to learn and use things such as, deep relaxation, deep breathing, meditation, yoga and etc.
You can learn more about both CBT and these other methods by going to our self help section.
Best of Luck
