Impulse control disorder

Impulse-control disorder

Impulse-control disorder (ICD) is a class of psychiatric disorders characterized by impulsivity – failure to resist a temptation, an urge, or an impulse; or having the inability to not speak on a thought. Many psychiatric disorders feature impulsivity, including substance-related disorders, behavioral addictions, attention deficit hyperactivity disorder, antisocial personality disorder, borderline personality disorder, conduct disorder and some mood disorders.

The fifth edition of the American Psychiatric Association's Diagnostic and statistical manual of mental disorders (DSM-5) that was published in 2013 includes a new chapter (not in DSM-IV-TR) on disruptive, impulse-control, and conduct disorders covering disorders "characterized by problems in emotional and behavioral self-control". Five behavioral stages characterize impulsivity: an impulse, growing tension, pleasure on acting, relief from the urge, and finally guilt (which may or may not arise).

Types

Sexual compulsion

Sexual compulsion includes an increased urge in sexual behavior and thoughts. This compulsion may also lead to several consequences in the individual’s life, including risky partner selection, increased chance for STDs and depression, as well as pregnancy.

Pyromania

Pyromania is characterized by impulsive and repetitive urges to deliberately start fires. Because of its nature, the number of studies performed for fire-setting are understandably very few. However studies done on children and adolescents suffering from pyromania have reported its prevalence to be between 2.4–3.5%. It has also been observed that the incidence of fire-setting is more common in juvenile and teenage boys than girls of the same age.

Intermittent explosive disorder

Intermittent explosive disorder or IED is a clinical condition of experiencing recurrent aggressive episodes that are out of proportion of any given stressor.

Kleptomania

Kleptomania is characterized by an impulsive urge to steal purely for the sake of gratification.

Signs and symptoms

The signs and symptoms of impulse-control disorders vary based on the age of the persons suffering from them, the actual type of impulse-control that they are struggling with, the environment in which they are living, and whether they are male or female.

Co-morbidity

Complications of late Parkinson's disease may include a range of impulse-control disorders, including eating, buying, compulsive gambling, sexual behavior, and related behaviors (punding, hobbyism and walkabout). Prevalence studies suggest that ICDs occur in 13.6–36.0% of Parkinson's patients exhibited at least one form of ICD. There is a significant co-occurrence of pathological gambling and personality disorder, and is suggested to be caused partly by their common "genetic vulnerability". The degree of heritability to ICD is similar to other psychiatric disorders including substance abuse disorder. There has also been found a genetic factor to the development of ICD just as there is for substance abuse disorder. The risk for subclinical PG in a population is accounted for by the risk of alcohol dependence by about 12–20% genetic and 3–8% environmental factors. There is a high rate of co-morbidity between ADHD and other impulse-control disorders.

Mechanism

Dysfunction of the striatum may prove to be the link between OCD, ICD and SUD. According to research, the 'impulsiveness' that occurs in the later stages of OCD is caused by progressive dysfunction of the ventral striatal circuit. Whereas in case of ICD and SUD, the increased dysfunction of dorsal striatal circuit increases the "ICD and SUD behaviours that are driven by the compulsive processes". OCD and ICD have traditionally been viewed as two very different disorders, the former one is generally driven by the desire to avoid harm whereas the latter one driven "by reward-seeking behaviour". Still there are certain behaviours similar in both, for example the compulsive actions of ICD patients and the behaviour of reward-seeking (for example hoarding) in OCD patients.

Treatment

Impulse-control disorders have two treatment options: psychosocial and pharmacological.

Medication

In the case of pathological gambling, along with fluvoxamine, clomipramine has been shown effective in the treatment, with reducing the problems of pathological gambling in a subject by up to 90%. Whereas in trichotillomania, the use of clomipramine has again been found to be effective, fluoxetine has not produced consistent positive results. Fluoxetine, however, has produced positive results in the treatment of pathological skin picking disorder, although more research is needed to conclude this information. Fluoxetine has also been evaluated in treating IED and demonstrated significant improvement in reducing frequency and severity of impulsive aggression and irritability in a sample of 100 subjects who were randomized into a 14-week, double-blind study. Despite a large decrease in impulsive aggression behavior from baseline, only 44% of fluoxetine responders and 29% of all fluoxetine subjects were considered to be in full remission at the end of the study. Paroxetine has shown to be somewhat effective although the results are inconsistent. Another medication, escitalopram, has shown to improve the condition of the subjects of pathological gambling with anxiety symptoms. The results suggest that although SSRIs have shown positive results in the treatment of pathological gambling, inconsistent results with the use of SSRIs have been obtained which might suggest a neurological heterogeneity in the impulse-control disorder spectrum.

Psychosocial

The psychosocial approach to the treatment of ICDs includes cognitive behavioral therapy (CBT) which has been reported to have positive results in the case of treatment of pathological gambling and sexual addiction. There is general consensus that cognitive-behavioural therapies offer an effective intervention model.

Pathological gambling

Systematic desensitization, aversive therapy, covert sensitization, imaginal desensitization, and stimulus control have been proven to be successful in the treatments to the problems of pathological gambling. Also “cognitive techniques such as psychoeducation, cognitive-restructuring, and relapse prevention” have proven to be effective in the treatments of such cases.

Pyromania

Pyromania is harder to control in adults due to lack of co-operation, however CBT is effective in treating child pyromaniacs.

Intermittent explosive disorder

Along with several other methods of treatments, cognitive behavioural therapy has also shown to be effective in the case of Intermittent explosive disorder as well. Cognitive Relaxation and Coping Skills Therapy (CRCST), which consists of 12 sessions starting first with the relaxation training followed by cognitive restructuring, then exposure therapy is taken. Later the focus is on resisting aggressive impulses and taking other preventative measures.

Kleptomania

In the case of kleptomania, the cognitive behaviour techniques used in these cases consists of covert sensitization, imaginal desensitization, systematic desensitization, aversion therapy, relaxation training, and “alternative sources of satisfaction”.

See also

• Behavioral addiction
• Body-focused repetitive behavior
• Child pyromaniac
• Dopamine dysregulation syndrome

External links

• Impulse control disorder at Wikipedia, the free Terran encyclopedia that anyone can edit.