Impulse Control Disorder Categories
(Also Known As: Kleptomania Categories, Trichotillomania Categories, Impulsivity Categories, Obsessive Compulsive Categories, Pyromania Categories, Obsessive Compulsive Disorder Categories, Monomanic Instinctives Categories)
(Reviewed by: Paul Peterson, Licensed Therapist)
Categories of Impulse-Control Disorders Not Elsewhere Classified
Intermittent Explosive Disorder
Intermittent explosive disorder manifests as discrete episodes of losing control of aggressive impulses; these involves aggressive outbursts that lead to assaults on others or destruction of property. These are usually unprovoked and the aggressiveness expressed by the patient is excessively out of proportion to any stressor or stimuli which may have initiated the incident. Patients describe these symptoms as spells or attacks which emerge within minutes or hours, last variably, and remit quickly and spontaneously. After each occurrence, patients usually demonstrate genuine remorse or self-reproach, and the signs of impulsivity disappear between episodes. Intermittent explosive disorder is not diagnosed as such if the loss of control is due to conditions of schizophrenia, antisocial or borderline personality disorder, attention-deficit/hyperactivity disorder, and conduct disorder or substance intoxication. The seizure-like quality of the characteristic outbursts, are called epileptoid personality, and several associated features suggest the possibility of an epileptoid state. These include hypersensitivity to photic, aural, or auditory stimuli and presence of auras: postictal-like changes in the sensorium and partial or spotty amnesia. 3
A particular form of intermittent explosive disorder is domestic violence. It is called as such because often, afflicted individuals only lose control within the context of a close interpersonal relationship. Conversely, these individuals have a generalized anger management problem but can suppress it better outside their homes. In the diagnosis of intermittent explosive disorder, criteria are almost always seen in domestic violence situations, except when the violence occurs under the influence of any substance or intoxication since such states eliminates normal social restraints, and also provides an excuse for loss of control.
People charged of domestic violence are not often given adequate psychological treatment since they are viewed more as criminals, rather than individuals with psychological problems. Treatment for this condition includes behavioral self-control techniques, stress management, and cognitive therapy to change the irrational belief system that triggers the violent behavior. 4
Kleptomania depicts recurrent failure to resist urges to steal objects not needed for personal use or for monetary value. Thefts of these objects are seemingly useless because they are given away, secretly returned, or kept and hidden. People with kleptomania do not pilfer to express anger or vengeance. They usually have the money to pay for the objects they impulsively steal, but the act itself provides relief to their mounting tension before the act, a feeling of pleasure while doing the act, and a feeling of reward and satisfaction after they have done it. The actual stealing is not planned and does not involve other people and these patients do not always consider the concept of punishment. Although they are aware that what they are doing is wrong and considered a crime, they don’t consider their chances of being apprehended, even though repeated arrests lead to pain and humiliation. 5 In addition, when the object stolen is the goal, it is not considered kleptomania; in kleptomania, the act of stealing itself is the goal. 6
The recurrent, deliberate, and purposeful setting of fire is known as pyromania. This psychological problem primarily involves tension or affective arousal before setting the fires; pleasure, gratification or relief while setting fires or when witnessing or participating in their aftermath. Pyromania differs from arson in that the latter is done for purpose of financial gain, revenge, or other pre-planned reasons. Individuals with pyromania have a significant fascination with fire. Moreover, the condition is not diagnosed when the fire setting activity is due to an underlying psychological problem such as conduct disorder in children, or part of a psychotic process in schizophrenia or bipolar disorder. 7
Compulsive Gambling Disorder/Pathological Gambling/Ludomania
Characterized by persistent and recurrent maladaptive gambling, compulsive gambling disorder, also known as pathologic gambling, causes economic or financial problems and significant disturbances in personal, social, and occupational functioning. In contrast,
social gambling is not characterized by loss of control. 8
The French dermatologist, Francois Hallopeau, first described trichotillomania in 1889. According to the DSM-IV-TR, this condition is depicted with recurrent pulling out of hair, although usually limited to hair on the head or scalp; it may also involve plucking hair from one’s face or body which can result in noticeable hair loss. 9
It often begins in childhood, and is associated with major depression or attention-deficit/hyperactivity disorder. The behavior involves manifestation of an increasing sense of tension before pulling the hair and a sense of pleasure, gratification, or relief when pulling out the hair. The diagnosis should not be made if the condition is a result of another mental disorder or any general medical disorders. The act is rarely carried out in public although family members may be aware of it. Many of these individuals will deny their behavior when asked and they often appear unaware of their actions and do not complain of pain from the plucking. The plucked or removed hair is sometimes caressed with the lips or cheeks. Some may even eat it, which can result in the formation of hairballs leading to gastrointestinal or other medical problems. 10
Impulse-Control Disorder NOS
According to DSM-IV-TR, disorders of impulse-control that do not fall within the category of specific impulse-control disorders are classified as impulse-control disorder not otherwise specified, or more commonly referred to as compulsive behavioral disorders. Impulse and Compulsion are slightly different from one another; the former is defined as a tension state that can exist without action while the latter is described as a tension state that always has an action component. These disorders are classified as such because the inflicted individuals feel compelled or obliged to give in to their pathological urges since they cannot resist the impulse. Some of the more common impulse control disorders contained in this category include:
Impulsive Sexual Behaviors
This condition includes individuals who repeatedly seek out sexual gratification, often in perverse ways.
Sexual addiction, habitual promiscuity, compulsive masturbation, compulsive use of telephone sex lines and/or internet pornography, and pornography dependence are some of the sexually related behaviors classified in this section.
This condition involves repeated cutting of one’s self or doing damage to one’s body in a compulsive manner. Individuals fail to resist impulses to episodically cut, carve, or burn their skin, interfering with healing of their wounds. This behavior commences in early adolescence and becomes the individual’s habitual way of dealing with personal distress. In between the episodes of inflicting harm, periods of calm are manifested through eating disorders, alcoholism and other substances of abuse, and kleptomania. These manifestations, however may lead to even further complications. Like with other impulse control disorders, people with this condition feel tension immediately before hurting themselves, which is then followed by feelings of relief or pleasure after the act has been done.
Originally referred to as oniomania, and also known as compulsive spending, this condition is not considered as a separate diagnostic category in DSM-IV-TR and ICD-10. Women seem to be more often afflicted than men and there is substantial co morbidity with mood and anxiety disorders. Therefore, mood regulation is a major determinant in impulse buying and it is through this that patients experience excitement and improvement of their moods, although the behavior is followed later on by remorse and regret. 11
Also called internet addiction, this behavior is characterized by spending most of one’s waking hours at the computer terminal. These individuals are unable to resist the urge to use the computer or “surf the net/web.” They tend to incline towards internet sites that may meet their specific needs such as shopping, sex, and interactive games among others.
Cellular or Mobile Phone Compulsion
Compulsive use of mobile phones to call others such as friends, acquaintances, or business associates is the most evident characteristic of this condition. Individuals afflicted justify their need to contact others by giving reasonable grounds for calling. However, underlying conflicts may be present in the behavior. Such conflicts may include: fear of being alone, the need to satisfy unconscious dependency needs or undoing a hostile wish towards a loved one. 12
Could You Have Impulse Control Disorder?
Impulse Control Disorder Topics
|Intermittent Explosive Disorder – Extreme Expression of Anger, Impulsiveness, Uncontrolled Rage, Outbursts in Moods|
|Kleptomania – Compulsion to Steal, Hoarding, Collecting of Things Illegally, Shoplifting|
|Obsessive Compulsive Disorder – Intrusive Thoughts, Impulsiveness, Strong Inclination for Something, Compulsive Behavior|
|Pyromania – Uncontrolled Desire to Set Fire Due to Psychosis, Revenge of Monetary Gains, Euphoria|