What is the psychology of impulse control disorders?

Introduction

Impulse control disorders are characterized by spontaneous behavior that satisfies a person’s urges to feel tension-induced exhilaration. Mental health authorities attribute impulse control disorders to neurological or environmental causes that are aggravated by stress. People with impulse control disorders have an intense craving for instant gratification of specific desires and are usually unable to ignore temptations that tend to cause negative results. Pressure increases these people’s impulsive urges until they become irresistible, and they feel pleasure and relief when yielding control to enjoy appealing yet unacceptable activities. They are compelled to engage in destructive, sometimes violent behaviors. Most people with impulse control disorders feel no guilt or remorse for their actions.

People who have impulse control disorders repeatedly indulge in a behavioral pattern of impulsivity, disrupting their lives. Their family and employment roles are often impaired. They frequently face legal ramifications for their recurrent impulsive behavior. People suffering from impulse control disorder often experience associated anxiety, stress, and erratic sleeping cycles.

For centuries, people have been aware of behavior associated with modern impulse control disorders. By 1987, the revised third edition of the American Psychiatric Association’s
Diagnostic and Statistical Manual of Mental Disorders
(DSM-III-R) defined impulse control disorders as representing mental disorders that involve uncontrollable impulsive behavior that can potentially result in danger and harm to the affected person or other people. According to this classification, individuals with impulse control disorders are unable to resist urges to engage in this behavior despite feeling tension prior to impulsive activity. During the impulsive behavior, the person usually experiences sensations of release, titillation, and then satisfaction.

The 1994 DSM-IV assigned codes to six types of impulse control disorders not elsewhere classified: pathological gambling (312.31), kleptomania (312.32), pyromania (312.33), intermittent explosive disorder (312.34), trichotillomania (312.39), and impulse control disorder not otherwise specified (312.30). These classifications were retained in the text revision, DSM-IV-TR, published in 2000.

The DSM-V, published in 2013, added two childhood disruptive behavior disorders, oppositional defiant disorder and conduct disorder, to the category of impulse control disorders, and renamed the category as a whole "disruptive, impulse-control, and conduct disorders." Additionally, gambling disorder, previously considered an impulse disorder, was moved to the addiction category following research which established that impulsivity was not significantly higher in those who gambled compulsively than those who did not and that gambling, for those with this disorder, activated reward centers in the brain similar to those activated by addictive substances. Trichotillomania, meanwhile, was moved to the category of obsessive-compulsive and related disorders.

Sometimes impulse control disorders are associated with other mental illnesses, such as bipolar disorders, or behaviors including road rage. Patients are often identified with an impulse control disorder while undergoing treatment for another psychological problem. Some mental health professionals attribute behaviors classified as impulse control disorders to types of different mental conditions. Impulse control disorders are distinguished by being primarily characterized by people’s absence of control over potentially damaging impulses.

Risky Impulsiveness

In 2002 it was estimated that shoplifters steal approximately thirteen billion dollars of merchandise from stores in the United States every year. While many of these thieves are criminals, impoverished people, substance abusers, or teenagers responding to a dare, some thieves have kleptomania. This impulse control disorder is characterized by people submitting to urges to steal items that are not essential to sustain their lives or for the purpose of generating revenues. Instead, kleptomaniacs, usually women, steal to experience thrilling sensations of fear. The threat of being caught, arrested, and prosecuted does not discourage most kleptomaniacs. Occasionally, people with kleptomania experience guilty feelings and discreetly return stolen items. Some mental health professionals state that kleptomaniacs have an addictive-compulsive disorder, not an impulse control disorder.

The DSM-V describes kleptomania as a pattern of impulsive stealing with the motive to achieve emotional release, then enjoyment. Therapists evaluate whether patients steal because of specific manic episodes or because they suffer from an antisocial personality or conduct disorder. A kleptomania diagnosis is made when patients continually steal unnecessary objects, do not steal because they are delusional, are not motivated by a resentful need to retaliate against businesses, and report feelings of tension, relief, and gratification.

People who have
pyromania repeatedly set fires to experience similar emotions. The DSM-V defines pyromania as recurrent acts of arson for personal enjoyment. Pyromaniacs, usually men, cannot control impulses to spark fires because they are intrigued by the flames, the emergency response to fires, and the resulting destruction. Some children experience a temporary fascination with setting fires that might reveal other psychological problems. Therapists rule out manic episodes, antisocial personality and conduct disorders, delusional behavior, intoxication, and retardation before diagnosing patients with pyromania.

Behaviors associated with pyromania include anxious feelings prior to a deliberate fire setting that culminate in excitement. Patients are usually obsessed with fire and related equipment. They often collect information about disastrous fires, learn about firefighting techniques, and eagerly discuss fires. Sometimes pyromaniacs indulge in pleasurable emotions by remaining at fire scenes to watch emergency personnel while delighting in the damage they have caused. Pyromaniacs do not set fires to make political statements, commit retaliatory sabotage, seek insurance money, or destroy criminal evidence.

Pyromania and kleptomania are both very rare disorders, affecting less than 1 percent of the population, according to the DSM-V.

Childhood Behavior Disorders

Conduct disorder (CD) is a disorder in which a child or adolescent routinely behaves in an antisocial manner, violating major social norms or the rights of other people without remorse or empathy for those they may have harmed. CD tends to present differently according to gender; boys with CD often engage in physical and verbal aggression, while girls engage in more covert behavior, such as stealing or lying. This may contribute to CD being diagnosed more often in males than in females. CD is often viewed as a precursor to antisocial personality disorder, which cannot be diagnosed before the age of eighteen.

Oppositional defiant disorder (ODD) is a childhood disorder in which the child shows a pattern of conflict with others, especially authority figures such as parents or teachers. The symptoms of the disorder are divided into three categories: angry mood, argumentative behavior, and vindictiveness. A child with ODD may act specifically to annoy others, pick fights, seek revenge when others behave in ways he or she doesn't like, blame others for his or her mistakes, or refuse to comply with rules or requests. A diagnosis of ODD is made when a child exhibits such behavior consistently over a six-month period and with a greater severity than is usual for the age group.

Both ODD and CD are commonly comorbid with attention deficit-hyperactivity disorder, and ODD may also be comorbid with other issues, such as depression. According to the DSM-V, a child with CD cannot be diagnosed with ODD and vice versa, although there is some dispute among clinicians about this rule.

Intermittent Explosive Disorder

Intermittent explosive disorder is a violent form of impulsive control disorder. Patients repeatedly act out excessive aggressive impulses and often cause harm to the people and objects they attack. Sometimes property is destroyed. Physically destructive behavior is not required for a diagnosis of intermittent explosive disorder, however; nondistructive physical aggression and verbal aggression are considered sufficient as of the publication of the DSM-V. Based on the DSM-V classification, therapists examine patients for possible medication reactions, medical problems such as Alzheimer’s disease or head injuries, and mental conditions such as psychotic, borderline personality, or attention-deficit hyperactivity disorders. Mental health professionals establish an intermittent explosive disorder diagnosis based on whether recurring aggressive behavior exceeds appropriate response to any stimuli and patients seem out of control.

People with intermittent explosive disorder frequently face legal charges of domestic violence, assault, and property destruction. Many patients do not feel guilty and refuse to accept responsibility for their attacks. They usually blame their victims, who they claim provoked them. Various forms of stress such as perceived insults and threats and fear of not having demands fulfilled also are offered as justification for intermittent explosive disorder assaults. Researchers have determined that some people with intermittent explosive disorder have irregularities in brain wave activity or chemistry.

Treatment

Psychotherapy and pharmacotherapy are the usual treatments for impulse control disorders. Based on a psychological evaluation, therapists choose treatment methods suitable for each patient and applicable to specific undesirable behaviors. Medication, outpatient therapy, and hospitalization at public or private facilities are options to treat impulse control disorders. Treatment success varies. Many kleptomaniacs are secretive about their behavior and only encounter therapists because of court orders following arrests. The 1990 Americans with Disabilities Act does not recognize impulse control disorders as disabilities.

Some researchers suggest that selective serotonin reuptake inhibitors (SSRIs) can minimize impulses to steal, althought they do not cure kleptomania. Therapists use behavior modification techniques to develop alternative behaviors and motivations to replace destructive impulses and responses. Patients learn to revise irrational thinking patterns with cognitive therapy. Anger management methods help some people with intermittent explosive disorder, while neurofeedback aids others to manage stress and develop self-control.

Bibliography

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