What is the difference between an impulse and an urge?

This article attempts to explore the differences between an OCD urge and an impulse. Providing education on the two may help provide clinicians and patients with a better understanding of the differences and aid in assessment and diagnosis.

Individuals with OCD often experience difficulties with unwanted thoughts or urges. In an attempt to reduce the negative emotions that come from unwanted thoughts or urges individuals with OCD often perform rituals in an attempt to neutralize (‘get rid of’ or ‘reduce’) the emotion. An obsessional urge is a strong impulse to carry out a disruptive behaviour. An obsessional urge is different from an urge to perform a compulsion. Often many OCD sufferer experience difficulties with obsessional urges that they perceive may become impulsive. For instance, an individual may feel the urge to attack a loved one with a knife. They may be concerned that they may act on the urge because they have the thought or image. The urge may feel like an intense emotion or tension that they may want to seek relief. OCD sufferers may also experience concern that an urge may become impulsive and they may act without conscious evaluation.

Impulsivity is naturally a trait that is part of the human experience. Development of the prefrontal cortex of the brain allows one to develop the skills necessary to practice self-control (Leckman 2010). The prefrontal cortex is a part of the brain that is responsible for logical thinking. Our practice with self-control helps us manage our impulses and is done so through the use of considering what is beneficial for one’s future self. Individuals with impulse issues tend to experience difficulties resisting temptation and are often driven to perform an act that is often not beneficial for their future. Psychopathology arises when self-regulation is impaired which gives rise to a lack of restraint (disinhibition). Individuals who experience impulse control issues will then perform the act, feel the drive to perform the act or fail to resist which then leads to harm. There are differences between those who experience difficulties with OCD and an Impulse-Control Disorder (ICD). For instance. Individuals with OCD are fearful of the outcome, while those with ICDs are more drawn to want to satisfy the urge as it likely alleviates tension, depression, feelings of being alone, fatigue, or brings on excitement (e.g. sexual) (Abramowitz 2006). Also, those with OCD are more likely to resist the urge while those with an ICD typically do not resist. An OCD obsessional urge doesn’t influence a person's ability to maintain self-control when triggered. Although individuals struggle with urges from time to time, our normal urges are usually driven by a desire. OCD obsessional urges are resisted because of undesirable consequences.

Leckman, J. F., Denys, D., Simpson, H. B., Mataix‐Cols, D., Hollander, E., Saxena, S., ... & Stein, D. J. (2010). Obsessive–compulsive disorder: a review of the diagnostic criteria and possible subtypes and dimensional specifiers for DSM‐V. Depression and anxiety, 27(6), 507-527.

Abramowitz, J. S. (2006). Understanding and Treating Obsessive-Compulsive Disorder: A Cognitive Behavioral Approach. United States: Taylor & Francis.