Ambivalence: Causes, Symptoms & Treatment

In psychology, ambivalence is spoken of when there are conflicting emotional feelings, thoughts, or desires. Bleuler sees ambivalence as a causative factor in disorders such as schizophrenia. Thus, increasing tolerance for ambivalence could prevent mental illness.

What is ambivalence?

For a person with ambivalence, the opposition of two points of view gives rise to opposing response options, which have an inhibiting effect on decision-making ability. Both/and attitudes such as love-hate are probably familiar to everyone. Opposing values in the form of thoughts or feelings are combined in such attitudes. These attitudes are described in psychology under certain conditions with the term ambivalence. Accordingly, ambivalence is a psychological function. All things always have two sides. The psychological concept of ambivalence, however, does not refer exclusively to this multi-sidedness, but above all to the resulting inner conflict. For a person with ambivalence, the opposition of two points of view gives rise to opposing reaction options, which have an inhibiting effect on the ability to make decisions. Karl Abraham describes children as typically ambivalent because they are driven by drive fluctuations. For adult humans, he assumes freedom from ambivalence. According to him, then, mentally healthy adults do not experience ambivalence. Some psychoanalysts disagree with this view and recognize ambivalence in most all human emotions. The term psychological ambivalence goes back to Eugen Bleuler, who first used it in the early 20th century. Synonymous terms are that of ambitence and ambiguity. Freud adopted ambivalence in his psychoanalysis, developing it further and transferring it primarily to social psychology.

Causes

Bleuler, the first describer, sees the cause of psychological ambivalence in drive control, which is characteristic of children. In adults, he considers ambivalence to be basically pathological and caused by a mental illness. He gives the larger framework of schizophrenia as the causal context of ambivalence. Bleuler describes the simultaneous existence of contrary feelings and thoughts in the sense of ambivalence as the triggering moment of schizophrenia. For him, ambivalent conflicting feelings are affective ambivalences. Ambivalent needs he refers to as ambitendencies, and intellectual ambivalence for him is the juxtaposition of opposing thoughts, which causes conflicts in the patient and ultimately leads to the splitting of the personality. Schizophrenic tendencies and ambivalence are thus mutually dependent. These statements contradict the theories of many other sources. Numerous psychoanalysts recognize ambivalence as typically human and do not necessarily consider it a pathological phenomenon. Accordingly, they do not speak of a disease as the cause, but attribute the phenomenon to physiological processes in the human mind, body, or spirit. Many of them speak of an ambivalence of libido and thanatos, as it characterizes a large part of human emotions. By libido and thanatos is meant the simultaneous presence of love and drive to destruction.

Symptoms, complaints, and signs

Ultimately, a person with ambivalence behaves in a contradictory or discordant manner and thus does not seem in harmony with himself. This inconsistency in behavior is not unusual for people in principle. However, strong ambivalence can become a psychological impairment due to certain situations, resulting in psyche dysbalances that require therapy. Inconsistencies and contradictions in one’s own behavior are thus widespread to a certain degree, but according to Bleuler they can certainly cause mental illnesses as soon as they get out of hand. The simultaneous existence of contrary feelings, impulses or wills does not necessarily have to express itself in phenomena such as love-hate relationship, but can also manifest itself in a life between obedience and rebellion. Especially in the emotional behavior towards certain persons, ambivalence is often present. Freud describes the extreme case of ambivalence, for example, as the Oedipus complex. For two different persons, the tolerance of ambivalence moves at different levels, that is, the ability to tolerate ambivalence.The more ambivalence-tolerant a person is, the more positively adjusted his personality appears and the better he can deal with humanly natural ambivalence. Consequently, for individuals with low ambivalence tolerance, the risk for mental illness is higher.

Diagnosis and course

Assessment of ambivalence tolerance is performed by psychologists or psychotherapists. The goal of the assessment is often to estimate an individual’s risk for mental illness. What Bleuler described as ambivalence in the context of schizophrenia should ultimately be understood as a low tolerance for ambivalence. Thus, the inability to properly deal with physiologically ambivalent emotions and desires can result in illnesses such as schizophrenia and plays a crucial role in the context of its diagnosis.

Complications

Since ambivalence is a purely psychological disorder, it also usually results almost exclusively in psychological complications. The affected person is often under stress and has difficulty making decisions. This often leads to panic attacks and sweating. These can even occur at night, when the patient has a bad dream and can no longer assess reality. In most cases, ambivalence leads to psychological problems and depression. As a result, the relationship with the family or partner may also suffer. The patient loses the zest for life and is often accompanied by aggression and a sense of dissatisfaction. Most often, ambivalence is a symptom of schizophrenia and must be treated by a psychologist in any case. The treatment itself can last several months, and there is no promise that success will occur. The further course depends greatly on the effect of the ambivalence and the patient’s physical and psychological condition. In the worst case, ambivalence can lead to suicidal thoughts and eventually suicide if the internal tensions become very high. Treatment is given alongside with medication and is intended to calm the patient. Due to the symptom, ordinary everyday life without stress is often no longer possible for the patient.

When should one go to the doctor?

Whether ambivalence needs to be treated by a doctor usually depends on the severity of the condition. If the affected person is not subject to any particular restrictions in everyday life and is not dangerous to himself and other people, treatment is not mandatory. It is not uncommon for treatment to have to be initiated by other people in the family, because the person affected does not want to admit the disease to himself. In severe cases, treatment in a clinic may be necessary. A doctor should be consulted for this if the affected person can no longer distinguish reality from dreams. Treatment is also advisable in cases of panic attacks, severe stress or permanent sweating. A medical examination must also take place if the affected person appears aggressive for no particular reason and loses the zest for life. In this case, without treatment, dangerous psychological complications may arise. Urgent treatment is necessary if the patient shows suicidal thoughts or has already attempted suicide. In this case, the affected person may also be admitted to a hospital.

Treatment and therapy

Pathological ambivalence triggers various diseases of the psyche. Thus, the phenomenon of ambivalence plays an increased role in the causal therapy of various diseases. In Bleuler’s definition, several diseases of the psyche could be prevented by learning appropriate strategies for dealing with ambivalence. Furthermore, strategies for dealing with ambivalence could trigger the cause of a mental illness, if low ambivalence tolerance indeed plays a causal role for the respective illness. Modern society is aware of the mental overload it is exposed to on a daily basis. For this reason, offers such as psychotherapy are being taken up more and more frequently. In psychotherapeutic treatments, a healthy way of dealing with ambivalence can be learned. In addition, modern approaches such as cognitive behavioral therapy can reconcile seemingly conflicting desires and emotions so that ambivalence is mitigated.If amivalence and low ambivalence tolerance have already caused mental illness, treatment will depend on the particular disorder and may include symptomatic drug therapy steps as well as causative therapeutic steps.

Outlook and prognosis

Ambivalence usually results in relatively severe psychological limitations and complications. The patient’s quality of life is significantly reduced by the disease. Without medical treatment, there is also no positive course of the disease or spontaneous healing in most cases. As a result, the affected person has difficulty socializing with other people, which can lead to exclusion or other social discomfort. Likewise, feelings cannot be interpreted correctly, which leads to difficulties in interpersonal relationships. In part, the ambivalence thus leads to psychological upsets or depression. In severe cases, the affected person may also suffer from suicidal thoughts as a result of the illness and continue to do so. Treatment for ambivalence is provided by a psychologist. In most cases, medication is not used. However, a positive course of the disease does not occur in every case. The affected person himself must also decide in favor of the therapy and want to carry it out. In severe cases, treatment can also be carried out in a closed clinic. As a rule, it cannot be universally predicted whether this will result in a positive course of the disease.

Prevention

Mental illness due to increased ambivalence can be prevented by learning appropriate coping strategies and thus attenuating ambivalence in the course of psychotherapy.

Follow-up

Whether follow-up care is necessary depends on the intensity of the disorder. A mild form of ambivalence can be countered by changes in the environment. New leisure activities or different social contacts are sometimes enough to stop the typical symptoms. There is no immunity after a cure. The ambivalence can occur again and again depending on the situation. A certain degree of conflicting feelings is not uncommon. In a pronounced form, scheduled follow-up visits become necessary. Affected persons receive help from psychologists and psychotherapists. Sometimes medication is indicated. In severe cases, behavioral therapy and the use of psychotropic drugs are the main elements of aftercare. The patient should thereby bring his feelings and desires into better harmony. Social life functions more easily in this way. In everyday life, hardly any stresses occur. Sometimes outpatient treatment extends over years until a patient can apply behavioral strategies on his own. Aftercare also aims to eliminate possible complications in advance. They are particularly present when the disease develops pathologically. The ambivalence develops further into schizophrenia, depression or similar. For the success of treatment, the closest social environment plays an important role.

This is what you can do yourself

Whether an ambivalence needs to be treated depends primarily on its severity. Mild fluctuations can often be regulated by even minor lifestyle adjustments. This can be a new hobby, sporting activity or a change of job or environment. However, before these measures can be applied, the ambivalence must be recognized by the affected person. It is therefore advisable to consult a doctor or therapist if inconsistencies and contradictions in one’s own behavior are repeatedly noticed. The professional will first determine whether it is actually a case of pronounced ambivalence. Appropriate measures can then be worked out to establish a healthy emotional life. The therapist will show the affected person suitable coping strategies and, in severe cases, consult an expert in borderline personality disorder. In the course of further discussions, the affected person will then also learn measures of cognitive behavioral therapy in order to better reconcile his or her own desires and emotional feelings. If mental illnesses have already developed as a result of the ambivalence, medication must also be administered. Alternative therapy approaches can be tried in consultation with the responsible doctor or therapist.