Impulse-control disorders

Impulse-control disorders

Definition

Impulse-control disorders are psychological disorders characterized by the repeated inability to refrain from performing a particular action that is harmful either to oneself or others.

Description

Impulse-control disorders are thought to have both neurological and environmental causes and are known to be exacerbated by stress . Some mental health professionals regard several of these disorders, such as compulsive gambling or shopping, as addictions. In impulse-control disorder, the impulse action is typically preceded by feelings of tension and excitement and followed by a sense of relief and gratification, often—but not always— accompanied by guilt or remorse.

The Fourth Edition Text Revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IVTR, a handbook that mental health professionals use to diagnose mental disorders) describes several impulse-control disorders:

• Pyromania. This disorder is diagnosed when a person has deliberately started fires out of an attraction to and curiosity about fire. In order to meet the criteria for this diagnosis , the firestarter cannot seek monetary gain or be trying to destroy evidence of criminal activity, or be trying to make a political statement or improve one's standard of living.
• Trichotillomania. This disorder is characterized by compulsive hair-pulling.
• Intermittent explosive disorder. This diagnosis is indicated when a person cannot resist aggressive impulses that lead to serious acts of assault or property destruction.
• Kleptomania. The recurrent failure to resist the urge to steal, even though the items stolen are not needed for personal use or for their monetary value, is required for diagnosis of this disorder.
• Pathological gambling. This form of persistent gambling disrupts the affected individual's relationships or career.
• Impulse-control disorders not otherwise specified. This category is reserved for clinicians' use when the clinician has established that a patient's disorder is caused by lack of impulse control, but does not meet the criteria for the disorders listed above or the criteria for any other disorder listed in the DSM-IV-TR.

A condition not listed in the DSM-IV-TR that some experts consider an impulse-control disorder is repetitive self-mutilation, in which people intentionally harm themselves by cutting, burning, or scratching their bodies. Other forms of repetitive self-mutilation include sticking oneself with needles, punching or slapping the face, and swallowing harmful substances. Self-mutilation tends to occur in persons who have suffered traumas early in life, such as sexual abuse or the death of a parent, and often has its onset at times of unusual stress. In many cases, the triggering event is a perceived rejection by a parent or romantic interest. Characteristics commonly seen in persons with this disorder include perfectionism, dissatisfaction with one's physical appearance, and difficulty controlling and expressing emotions. It is often seen in conjunction with schizophrenia , post-traumatic stress syndrome, and various personality disorders . Usual onset is late childhood or early adolescence; it is more frequent in females than in males.

Those who consider self-mutilation an impulse-control disorder do so because, like the other conditions that fall into this category, it is a habitual, harmful activity. Victims often claim that the behavior is accompanied by feelings of excitement and that it reduces or relieves negative feelings such as tension, anger, anxiety, depression, and loneliness. They also describe it as addictive. Self-mutilating behavior may occur in episodes, with periods of remission, or may be continuous over a number of years. Repetitive self-mutilation often worsens over time, resulting in increasingly serious forms of injury that may culminate in suicide .

Resources

BOOKS

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fourth edition, text revised. Washington DC: American Psychiatric Association, 2000.

Koziol, Leonard F., Chris E. Stout, and Douglas H. Ruben, eds. Handbook of Childhood Impulse Disorders and ADHD: Theory and Practice. Springfield, IL: C.C. Thomas, 1993.

Stein, D.J., ed. Impulsivity and Aggression. Chichester, NY: Wiley, 1995.