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Impulse Control Disorder Causes

(Also Known As: Kleptomania Causes, Trichotillomania Causes, Impulsivity Causes, Obsessive Compulsive Causes, Pyromania Causes, Obsessive Compulsive Disorder Causes, Monomanic Instinctives Causes)

(Reviewed by: Paul Peterson, Licensed Therapist)

What Causes Impulse Control Disorder?

Three major factors play an important role in impulse-control disorders; this involves psychodynamic, psychosocial and biological factors. However, the primary cause remains unknown.

Psychodynamic Factors

The outlook or disposition to act in attempt to decrease intensified tension due to the upsurge of an individual’s instinctual drives or by diminished ego defenses against the drives is known as an impulse. All impulse disorders commonly are attempting to bypass the experience of disabling symptoms or painful affects by acting on the environment. August Aichorn, a researcher who worked with delinquent adolescents, described impulse behavior as related to a weak superego and weak ego structures brought about by psychic trauma produced from childhood deprivation. Another researcher, Otto Fenichel, claimed that impulsive behavior attempts to gain control over emotions such as anxiety, guilt, depression, and other painful affects by means of action. According to him, these actions defend an individual from internal danger by providing a distorted aggressive or sexual gratification. To most people, impulsive behavior may appear as irrational actions motivated by greed. As considered by Heinz Kohut, many forms of impulse-control problems which include gambling, kleptomania, and some paraphiliac behaviors, are related to an incomplete sense of self. According to his research and experiments, patients with impulse-control disorders have greater tendencies to self fragment when they do not receive the reassuring and affirming responses that they seek or want to receive from people in significant relationships with them. As a result, they engage in impulsive behaviors that to others appear as self-destructive. They are inclined to doing such as a way to prevent self fragmentation and at the same time regain their sense of wholeness or cohesion. This formulation declared by Kohut, is similar in some ways to Donald Winnicot’s view that impulsive or deviant behavior in children is their means to recapture a primitive maternal relationship. According to Winnicot, such behavior is hopeful in that the child searches for affirmation and love of the mother rather than abandoning any attempt to win her affection.

Psychosocial Factors

Psychosocial factors that are connected with impulse-control disorders are usually related to early-life events. A growing child will automatically take after what he sees in his parents as correct. Therefore, he may grow up having the same impulses if he had improper models for identification, such as parents who have difficulty controlling their own impulses. Other psychosocial factors include exposure to violence at home, alcohol abuse, promiscuity and antisocial behavior. Such factors may also be afflicted through various forms of mass media such as movies, television shows, and video games among many others.

Biological Factors

Research and experiments have proven that impulsive and violent activity is associated with specific brain regions, such as the limbic system. The inhibition of such behaviors, on the other hand is associated with other brain regions. Most research states that: low levels of cerebrospinal fluid (CSF) 5-hydroxyindoleacetic acid (5-HIAA) is said to be related to having impulsive aggression, while certain hormones like testosterone have also been associated with violence and aggressiveness. Additionally, a condition of temporal lobe epilepsy brings bouts of impulsive violent behaviors and aggressiveness in patients having histories of head trauma and other potential organic antecedents. 13

The exact causes of impulse control disorders are not fully understood. Individuals who have had serious head injuries or trauma may have a higher risk of developing any of the conditions. In some cases, side effects of general medical conditions are considered causative agents for onset of the disease. As of 2004, several groups of researchers claimed that older adults with Parkinson's disease develop pathological gambling as the disease progresses. It is thought that this gambling behavior is a side effect of dopaminergic drugs, as it does not respond to standard treatments for compulsive gambling but only to changes in the patient's medication. 14

1). Intermittent Explosive Disorder

Psychodynamic Factors:

As stated by psychoanalysts, explosive outbursts of violent emotions occur as a defense against narcissistic injurious events.

Psychosocial Factors: -

Typical patients have been described physically as robust but having a very poor sense of identity. This is usually seen in men with physically large bodies but are dependent and with weak masculine identity.

Psychosocial factors leading to violent outbursts:

  • Sense of being useless and impotent or being unable to change the environment or situation of the individual concerned
  • High levels of anxiety, guilt, and depression: Often associated with unfavorable childhood environment like exposure to alcohol dependence, beatings and life threats, and assaultive parents.
  • Predisposing factors in infancy and childhood: perinatal trauma, infantile seizures, head trauma, encephalitis, minimal brain dysfunction, and hyperactivity
  • Early frustration, oppression and hostility and situations that are reminiscent of these conditions

Biological Factors:

Biological factors leading to violent outbursts:

  • Brain physiology disorders particularly in the limbic system
  • Impaired or dysfunctional serotonergic transmission: consequently decreases the effect of punishment as a deterrent to behavior
  • Low levels of CSF 5-HIAA
  • High levels of CSF testosterone
  • Administration of antiandrogenic agents leads to decreased aggression

Familial and Genetic Factors:

  • First degree relatives are more prone to develop the condition
  • Biological relatives of patients with the disorder were more likely to have histories of temper or explosive outbursts than the general population

2). Kleptomania

Psychosocial Factors: Symptoms appear in times of great stress, emotional stress, losses, and separations

7 Categories of Stealing in chronically acting-out children:

  • As a means of restoring the lost mother-child relationship
  • As an aggressive act
  • As a defense against fears of being damaged
  • As a means of seeking punishment
  • As a means of restoring or adding self-esteem
  • In connection with, and as a reaction to, a family secret
  • As excitement (lust, angst) and a substitute for sexual acts

A number of psychoanalytic writers have emphasized the manifestations of aggressive impulses in kleptomania while others have stressed on a more libidinal aspect.

Biological Factors: Kleptomania disorder has often been associated with medical conditions such as brain diseases, mental retardation, and other disorders of impulse control. Indications such as focal neurological signs, cortical atrophy, and enlarged lateral ventricles were found present in most kleptomania patients, while disturbances or dysfunctions in monoamine metabolism subsequently impairing serotonin production were postulated. The latter, however, is currently being researched and evidence to prove it remains vague.

3). Pyromania

Psychosocial Factors: Different psychoanalysts have associated fire in various aspects and thus the strong urge to start fires and the adamant admiration shown by pyromania inflicted individuals reflect or symbolize certain emotions or desires kept hidden within them. These symbolisms include: Sigmund Freud’s claim that fire is a symbol of sexuality. According to Freud, the warmth emitted by fire evokes the same sensation that accompanies a state of sexual arousal. Moreover, Freud explained that the shape or general appearance of the flame imply a phallus in activity; other psychoanalysts relate pyromania with an atypical desire for power and social prestige. This is more commonly seen in pyromania patients who are volunteer firefighters. These people take pride in showing their colleagues their courage and power to extinguish raging flames; another symbolism states that the act of fire-setting is a way to release pent up rage over frustration caused by a sense of social, physical, or sexual inferiority; in other studies, patients with pyromania were found to have no presence of a father or a father figure in their lives , therefore their urge to start a fire represents their desire to have this father figure return home as a rescuer, to put out the fire, and to save the child from a difficult existence. On the contrary, female fire setters do not start fires for the same reason that most male pyromania patients do. Often, their reasons include promiscuity without pleasure and petty stealing eventually leading to kleptomania.

Biological Factors: Pyromania is often associated with conditions of having significantly low CSF levels of 5-HIAA and 3-methoxy-4-hydroxyphenylglycol (MHPG). This further determines serotonergic or adrenergic factors as possible underlying factors. Reactive hypoglycemia has also been pointed out as one main cause of pyromania based on analysis of blood glucose concentrations through glucose tolerance tests.

4). Compulsive Gambling Disorder/Pathological Gambling

Psychosocial Factors: There are a number of predisposing factors in which a person may develop pathological gambling including: loss of a parent by death, separation, divorce or desertion before a child is 15 years of age; inappropriate parental discipline (absence, inconsistency, harshness); exposure to gambling during adolescence; emphasis on material and financial symbols stressed by the family, and lack of family emphasis on saving, planning and budgeting. According to psychoanalytic theories, Sigmund Freud pointed out that compulsive gamblers possess an unconscious desire to lose and that they gamble to ease the unconscious feeling of guilt. Others suggest that gamblers have narcissistic behavior which leads them to believe that they can control events and even predict the outcome.

Biological Factors: Studies and further research suggests that certain neurobiological factors act as an underlying cause for a gambler’s risk-taking behavior. These principles were focused mainly on serotonergic and noradrenergic receptor systems. Investigations show that male pathological gamblers have below normal MHPG concentrations in plasma, increased MHPG concentrations in CSF and increased urinary output of norepinephrine. Furthermore, gathered data associated serotonergic regulatory dysfunction in pathological gamblers. Low levels of platelet monoamineoxidase (MAO) activity seen in chronic gamblers and a certain marker of serotonin activity are both being linked to difficulties in inhibition or avoidance of gambling urges. However, further studies are needed to support evidences to these findings.

5). Trichotillomania

Onset of trichotillomania, in most cases, has been associated with stressful situations. These stress stimuli includes: disturbances in mother-child relationships and fear of being left alone. In addition, loss of important objects is often mentioned as significant contributory factors to this condition. Other factors may include: substance abuse, which may further promote the progression of the disease, depression, and self-stimulation as a primary goal of hair-pulling.

6). Impulse-Control Disorder NOS

Compulsive disorders are not all ego-dystonic. Certain compulsions such as compulsive video game playing bring about bliss to the patient. Both impulsive and compulsive behaviors are repetitive and pleasurable in nature and for that fact, they are often referred to as addiction. 15

Could You Have Impulse Control Disorder?

Impulse Control Disorder Topics

Related Conditions

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