I am 18 and the last two weeks I have had a constant urge, especially when I am in a lecture, to scream out at the person speaking to shut up. I have no reason for that outburst, and I really don't know why I have this urge. Since I know screaming will sound crazy, I refrain from doing so, but this makes me very nervous and frustrated. Just thinking of this problem creates a new urge to scream out again, and it's like a chain reaction. Now I am having chest pain, which I assume is anxiety-related. I did have this problem four years ago, but it disappeared after a few days. Now it seems to linger forever. Will I ever get rid of these urges, or will I have to live with this for the rest of my life?

--Jane

You may want to look at the amount and type of stress you've been under lately -- and during the period a few years ago when you were experiencing similar urges. Because you're 18 and mention attending lectures, I wonder if you're in college, and whether these urges came when you were nearing the end of a semester, with all the pressure and strain that can entail.

I can't say for sure what's going on with you without more information. But sometimes people experience urges to act out physical or verbal violence toward others when they are extremely stressed or hurting in some way. It can be a way of striking out in pain or anger, much as a wounded animal may try to bite someone who attempts to help it. Sometimes the stress a person is experiencing isn't immediately apparent to them but is operating at an unconscious level.

A psychologist or other therapist can assess and address your situation further in a face-to-face consultation. If you're in college, there might be a university counseling center from which you could get free or reduced-fee services, or at least a referral. The psychologist or therapist might recommend your taking some psychological tests to get a better picture of what might be going on with you. If a medical examination seems in order, he or she will recommend that as well.

If your urges are anxiety or stress-related, or are made worse by stress, a therapist can help you identify the source of your anxiety or stress and teach you cognitive and behavioral techniques that can help you relax, lessen the intensity of the urges, and possibly eliminate them. So I don't think you're doomed to live with this problem the rest of your life.

You've taken an important step in asking for input and recommendations about what you're experiencing. I wish you well in resolving your problem.