Verbal Impulse Control

[ryan1982]

Hey all,

I hope you're doing as well as can be expected. I have a new symptom that's crept in the past couple weeks and it's super uncomfortable. Anytime I speak with anyone, mostly at work, I fear I'm going to blurt out something highly inappropriate and ruin my career. It's ridiculous because the words that come to mind are nowhere near my regular vernacular but it makes speaking in any setting difficult. I can't figure out if it's because I'm so fatigued but it creates anxiety and makes normal conversations very difficult.

 

Anyone else experience this at all?

 

Thank y'all,

RR

[ChessieCat]

I have had trouble talking today at work.  Leading up to this I had several nights of very little sleep and last night I had 4 hours then awake for at least 2 and then slept for another 3.

 

Prior to this I had noticed that I have generally been doing really well with finding the words I want when I want and being able to string a sentence together without much problem.

[Ariel]

Hi @ryan1982

Would you say this is an anxiety symptom? It sounds like maybe the primary mechanism is a fear of losing control, in combination with intrusive thoughts about inappropriate interjections; this is then exacerbated by the workplace setting, which raises the stakes in more ways than one. Am I reading you correctly? 

 

My whole life (also prior to meds) I've experienced this thing where, no matter what the social situation, my mind generously offers up a smorgasbord of the most offensive, potentially destructive comments imaginable. The more delicate the situation, the higher the stakes -- the more outrageous the suggestions of my inner monologue. It seems to just be something my monkey mind finds amusing. (To be fair, it does come up with some bonafide hilarious jokes; sometimes I regret not having anybody to share them with. Maybe this is why some people become professional comics.)

 

I share this with the intention of showing that these kinds of thoughts may be more common than we realize. Given that they are by definition thoughts we don't share, it's easy to feel like we might be the only ones whose minds do this. I have no way of knowing, of course, but it would make sense if many people had taboo-subject stream-of-consciousness thinking once in a while, especially in social settings with strict codes of conduct.

 

Perhaps it's a little bit like, Don't think of an elephant. Our minds can't do negation. If we are in a situation where we hold any kind of tension around conformity or performance, and are therefore consciously or subconsciously preoccupied with the rules, our minds are likely to conjure up behavioral scenarios based on what they know to be prohibited. This is also a function of the mind, to run simulations. Probably the more anxiety our bodies carry, the more intense such ideation can get. For example, if we perceive a situation as being high-stakes, our arousal and alertness may rise, and that fear/vigilance/attention/excitement may feed the feeling of pressure, which in turn may fuel cognitive patterns, which may increase our perception of feeling out of control... etc. It can quickly spiral into a negative feedback loop. Thing is, it's the mind's job to concoct escape plans and conjure worst-case scenarios in anticipation of possible life-threatening events; this is how the mind works to protect us, help us survive. It's just that in withdrawal our brains and nervous systems are hyperactive and not calibrated to actual reality (whatever that is -- not an expert), so these evolutionarily vital functions go haywire sometimes and, shall we say, overdeliver. 

 

(Again, I'm not sure whether I'm understanding your post correctly. Feel free to jump in.)

 

I can imagine an experience of withdrawal-chemical-fueled cocktail of intrusive thoughts and physiological arousal response coinciding with office interactions, and it does not sound fun at all. In addition, something I've struggled with throughout withdrawal is feeling like my insides are visible to everyone else; not my organs, but my thoughts and emotions. I've often had this strange feeling of being unsure of the boundaries between inside and outside, feeling like I'm somehow transparent and everyone can clearly see what a sh*t show my mind is. Don't know whether that resonates with you. For me it has definitely contributed to discomfort and anxiety in social interactions. Again, it's one of those things, like DP/DR and the others, where it's not always clear what comes first, the anxiety or the other, but they definitely feed into and off of each other. 

 

[Ariel]

In terms of verbal impulse control I've struggled with talking too much. It often feels like once I start speaking I can't stop. I find it pretty embarrassing to not be able to control myself. Especially since most of the time I have no particular desire to speak; I don't enjoy speaking. It's like if I open my mouth, speech production just takes on a life of its own and gets away from me. 

 

I've noticed a few aspects connected with this. I find that speech production -- the actual, physical act -- is very activating to my nervous system. I find it profoundly stressful. The neuromuscular effort required combined with the cognitive demands, and then on top off that the social context in which this takes place -- it's really all too much. My nervous system accelerates from 0 to 100 and suddenly I'm in hyperarousal, unable to pull back or stop, feeling out of control. And it takes a long time for me to wind back down again afterwards.

 

This pattern is classic for autonomic dysregulation. The underlying mechanisms and responses are not yet calibrated to work together in a smooth, supple way. It's all very fits and starts and jerks and crashes. When you really pick it apart, speech production is a wonderfully complex function that involves many simultaneous processes in the body across various systems. We take it for granted but it's quite marvelously impressive. Same goes for social interaction, both verbal and non-verbal. There are so, so many cues and signals being exchanged, so much information being processed responded to in real time. It's amazing! 

 

I think maybe, because we are fundamentally extremely social animals, communication and our experiences of/around/with it strike deep at the core of who we are -- identity, sense of self, how comfortable, uncomfortable we feel in the world, questions of belonging and safety. Because our ability to communicate effectively connects so essentially to our membership in a group, our social viability and thus our survival, any challenges in this area can be experienced as destabilizing. We might even subconsciously perceive such difficulties as potential threats to survival, activating some primal physiological mechanisms. I don't know, I'm just musing really, extrapolating from personal experience. I guess what I'm trying to get at is: it makes sense in every way if difficulties with verbal communication are anxiety-provoking. 

[Ariel]

1 minute ago, Ariel said:

In terms of verbal impulse control I've struggled with talking too much.

 

as part of withdrawal, i mean 

[Ariel]

I find that all of this is aggravated by fatigue. The more sensitized my system is, the worse these sorts of symptoms can get. Fatigue is a principal sensitizer (tenderizer?) for me. When I'm particularly tired, be it from too little sleep or too much effort/stimulation, exhaustion can provoke anxiety as well as intensify sensory symptoms, and then those aspects can get rowdy and egg each other on. 

 

Of course in withdrawal I ultimately have little to no control over sleep. I do what I can to facilitate good sleep, but all of us here know that beyond good sleep hygiene and the known non-drug techniques, the rest is out of our hands.

 

It's nice to have a bit more agency when it comes to shielding oneself from sensory overload wherever whenever possible. This can sometimes offset some of the trickiest nervous system overextending. Dark glasses can be very helpful in social situations (not sure everyone can get away with this in the workplace, depends on how open one is in those relationships and how casual/restrictive the setting is), in my experience they assist in putting a damper on nervous system overexcitement. Ear plugs are great if you don't have to talk to anyone (I carry them with me at all times, just in case). I sometimes get extremely sensitive to smells, too -- they can trigger anything from nausea to extreme anxiety to trauma flashbacks. I've worked out a system with my mother where she keeps a fragrance-free tracksuit at my flat; when she comes over, she changes into what I call her "work clothes" or "care uniform" to hang out with me. She also knows that on days when she sees me, she doesn't use perfume or scented lotion/soap/shampoo/products. Otherwise I react to trace smells on her "street clothes" and in her hair, etc., and it can bring on unpleasant symptoms. (In the beginning she found this to be quite over-the-top but luckily has accepted it and cooperates, bless her heart.)

 

So many of our contemporary indoor environments are not what I would call withdrawal-friendly. A trip to the local grocery store can be super intense. A school classroom or office with those buzzing, flickering lights and maybe air-conditioning and printers, computers, copiers, phones, heaters, any number of electrical appliances whirring making noise; not to mention all the other people with their voices and scents and synthetic fragrance and flavored coffees and snacks and you name it, the list goes on. It can really add up and be quite violent to our delicate withdrawal sensibilities! Even when we take measures to protect ourselves and mitigate the worst effects, the cumulative load is considerable. Now add to that the expectation to perform and be productive and "act normal" under these conditions, and do so consistently. It's a big ask, to say the least. 

 

 

[Ariel]

ChessieCat, would you describe this symptom as being related primarily to cognitive function? e.g. word retrieval 

 

12 hours ago, ChessieCat said:

I have had trouble talking today at work.  Leading up to this I had several nights of very little sleep and last night I had 4 hours then awake for at least 2 and then slept for another 3.

 

Prior to this I had noticed that I have generally been doing really well with finding the words I want when I want and being able to string a sentence together without much problem.

 

Do you find there's any emotional component to this? Is your sense that it's largely fatigue-driven?

 

I recognize my own experience in your account. Throughout withdrawal, to varying extent, I have felt functionally impaired in the area of verbal communication, especially speech production. Sometimes it has felt like neuromuscular blockage, e.g. dealing with tight throat muscles that made sounds feel funny and full in my mouth; at time I felt like I might as well be gargling and gurgling everything came out so garbled (to my ears, anyway). Other times it felt more like not being able to find the right word on demand, or losing my train of thought mid-sentence. And a range of combinations of those. 

 

Once upon a time I used to work teaching foreign languages. It's normal for some learners to naturally progress faster in either spoken or written skills (very rarely both at the same pace). One's temperament (for lack of a better word) plays a role in each of these modes -- crudely put, speech production is more socially, on-the-spot performative, while writing is more of an internal process. Many of my students had a good level of written language but struggled in conversation and oral presentations. In those cases we'd often work on confidence, practicing speaking and doing casual exercises to help them relax. I'd suggest to them that it was not a knowledge issue so much as it was a performance issue -- speech production in real time in front of a live audience is absolutely a physical performance, and stressful. It requires cognitive processes to coordinate with neuromuscular function under perceived social scrutiny and pressure. Pretty intense. A lot of people feel more comfortable expressing themselves in writing than speaking, and one doesn't have to be a foreign language learner for that to apply. 

 

I mention this because it's something I thought about when I was at peak speaking challenge in withdrawal. In moments when I'd hit a wall looking for a word or struggling to articulate a thought, I would start to feel stressed. When that stress began to rise, it of course only became harder to express myself. I would remember how I'd learned to view speech production as a performance, and I sure was having performance issues!

 

To this day I find speech production to be quite taxing. Something as benign as casual conversation, if it exceeds, let's say 5 minutes' duration, is highly activating for my system. Be it on the phone or in person, I start sweating profusely, sometimes get hot-cold chills and shivers, and can even start actually shaking. I find it difficult to control the volume of my voice, which tends to get louder the longer the stimulation continues. I'm accustomed to it now, and it is improving, but I still find it rather unpleasant and try to keep it to a minimum. 

 

 

 

 

 

 

[Heath]

@ryan1982 3 things I caught in your statement , fear, fatigue, and unusual words coming to mind in conversations. 
 

I would think each one listed could cause the other 2. 
 

Ssri side effects and wd and fatigue cause me to not be able to form words and easily forget what I am talking about in a conversation. Multitasking at work will make it 10 times worse. 
 

Sometimes ssri side effects and wd have caused me to be a chatterbox when I need to be quite and no talking when I need to talk. 
 

As far as the thinking of unusual words to say. I have had thoughts I’ve never had before and said things I never would have said before ssris. I can look back and see where I have been colder to people ( not me)and sometimes I have been overly sensitive to people words (not me).
 

This stuff has definitely changed my thoughts at different times so I would say that would create words not commonly used. 
 

“This medication will not change you the dr says” . what a joke. 

[Ariel]

What @Heathsaid!

 

 

[ryan1982]

@Ariel, @Chessie and @Heath- Thanks so much for taking the time to respond and I apologize it's taken me as long as it has to respond to y'all. I was running around this weekend coaching my son's baseball team. Lots of fun but exhausting.

 

Ariel- you have a gift with writing. I'm serious. There's nothing funny about the subject but you did such a phenomenal job making light of it. My wife and I read your post multiple times because it was so entertaining.

 

"Speech production in real time in front of a live audience is absolutely a physical performance, and stressful"- this is IT! It's the anxiety about the performance that gets me; I hate having all eyes on me, even not when in withdrawals, but it's gotten so bad since I had my adverse reaction. I just wish so badly that I cared less.

 

Heath- you're absolutely right- fatigue, fear and unusual words are quite the trio. I honestly think that if my head pressure and fatigue would relent, it would be much easier to focus on the message and not be constantly freaking out about what I'm saying. It's the feeling of being out of control that's so hard to handle.