Impulse Control Disorders

Impulse control disorders are characterized by an inability to resist the impulse to perform an action that is harmful to one's self or others. This is a relatively new class of personality disorders. The most common of these are intermittent explosive disorder, kleptomania, pyromania, compulsive gambling disorder, and trichotillomania.

Description

All of these impulse control disorders involve the loss or lack of control in certain specific situations. The hallmark of these disorders is the individual's inability to control impulses that may cause harm to themselves or others. Affected individuals often feel anxiety or tension in considering these behaviors. This anxiety or tension is relieved or diminished once the action is performed.

Intermittent explosive disorder is more common among men, and involves aggressive outbursts that lead to assaults on others or destruction of property. These outburst are unprovoked, or seem to be out of proportion to the event that precedes them.

Kleptomania is more common among women, and involves the theft of objects that are seemingly worthless. The act of stealing relieves tension and is seen by the individually to be rewarding. The actual stealing is not preplanned, and the concept of punishment for the crime doesn't occur to these individuals—although they are aware that what they are doing is wrong.

Pyromania is more common among men, and involves setting fires in order to feel pleasure and relieve tension.

Pathological gambling occurs in roughly 1-3% of the population, and involves excessive gambling despite heavy monetary losses. These losses actually act as a motivating factor in continuing gambling in order to recoup some of what was lost.

Trichotillomania involves pulling hair from one's own scalp, face, or body, and is more common in women.

Causes and symptoms

The exact causes of impulse control disorders are still unknown. Individuals who have had serious head injuries, however, can be at a higher risk for developing impulse control disorders, as are persons with epilepsy.

Diagnosis

A diagnosis of any of these impulse control disorders can be made only after all other medical and psychiatric disorders that may cause the same symptoms have been ruled out.

Intermittent explosive disorder involves severe acts of assault or destruction of property. The aggression seen during these acts is vastly out of proportion to events that may seem to have precipitated the acts.

Kleptomania involves stealing objects that are unnecessary and of little monetary value. The act of stealing is not an expression of anger or vengeance. Again, there is an increased tension before the act is committed, and this is resolved or relieved once the object is stolen.

Pyromania is classified by the deliberate and repeated setting of fires. The individual will exhibit a fascination and attraction to fire and any objects associated with it. Before the fire is set, there is tension, with a resolving relief once the fire is set. Acts of true pyromania are not done for monetary gain, to express anger, to conceal criminal behavior, or in response to hallucination.

Pathological gambling is a disorder to gamble despite continuing losses and monetary insufficiency. This disorder typically begins in youth. Affected individuals are often competitive, easily bored, restless, and generous.

For a diagnosis of pathological gambling, five or more of the following symptoms must be present:

• a preoccupation with gambling
• a need to gamble with more money to achieve the "thrill" of winning
• repeated attempts to control or stop gambling
• irritability or restlessness due to repeated attempts at control
• gambling as an escape from stress
• lying to cover up gambling
• conducting illegal activities, such as embezzling or fraud, to finance gambling
• losing a job or personal relationship due to gambling
• borrowing money to fund gambling

Trichotillomania is the continuous pulling or tugging on one's own hair. Again, there is an increased sense of tension before pulling the hair, which is relieved once it is pulled out. Recurrent pulling out of one's hair resulting in noticeable hair loss. Affected individuals can undergo significant distress and impaired social, occupational, and functional behavior.

Treatment

A combination of psychological counseling and medication are the preferred treatments for impulse control disorders. For kleptomania, pyromania, and trichotillomania, behavior modification is usually the treatment of choice. For pathological gambling, treatment usually involves an adaptation of the model set forth by Alcoholics Anonymous. Individuals are counseled with the goal of eventual response to appropriate social limits. In the case of intermittent explosive disorder, anger management and medication may be used in extreme cases of aggression.

Prognosis

These disorders can usually be controlled with medication, although it may need to be continued long-term to help prevent further aggressive outbursts. Long-term counseling is usually necessary as well. Support groups and meetings may also help these individuals.

The prognosis for intermittent explosive disorder, kleptomania, and pyromania is fair. Little is known about the prognosis for trichotillomania, and studies have shown that the condition can disappear for long periods (months to years) without any psychological counseling. For pathological gambling, the prognosis varies greatly from person to person. While total cure for this condition is unlikely, much like alcoholism, long periods of abstinence or continuous abstinence are possible.

Prevention

There are no known preventive treatments or measures for impulse control disorders.