Impulse-control disorders are characterized by the repeated inability to refrain from performing a particular action that is harmful either to oneself or to others.
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 (a handbook that mental health professionals use to diagnose mental disorders, also known as the DSM-IV-TR) 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. 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 his or her 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.
Process or behavioral addiction may also ultimately be classified as an impulse-control disorder, or even provide the umbrella classification for impulse-control disorders. Behavioral addiction has been suggested as the unifying theme of a number of other impulse disorders, including those in which the act or behavior is preceded by a feeling of tension or even eager anticipation. Individuals with these addictions cannot resist the behavior, even if they are aware it will cause harm to themselves or others. Once they have engaged in the behavior, there may be a feeling of pleasure or relief. For any impulsive behavior that process addiction may underlie, there is a consistent pattern of urge, anticipation or tension building, engaging in the behavior, release, and recurrence.
The behaviors now classified as impulse-control disorders may also fall into this category of behavioral addictions. These classifications include pathological gambling, kleptomania, pyromania, trichotillomania, compulsive buying, and compulsive sexual behavior. Another disorder that has arisen with the growing availability of the Internet is compulsive Internet/computer use, which studies are increasingly treating as a real and growing problem. It has been proposed that these disorders be grouped in the DSM-V into a new category of Substance and Behavioral Addictions. Compulsive buying and impulsive-compulsive sex behavior would fall into the category of Impulsive-Compulsive Behaviors Not Otherwise Specified under this construct.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Text rev. Washington, D.C.: 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.
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Pallanti, Stefano, MD, PhD, Silvia Bernardi, MD, and Leonardo Quercioli MD. “The Shorter PROMIS Questionnaire and the Internet Addiction Scale in the Assessment of Multiple Addictions in a High-School Population: Prevalence and Related Disability.” CNS Spectrums 11(2006): 966–74.
American Psychiatric Association, 1400 K Street NW, Washington, DC 20005. Web site; <http://www.psych.org>.
Sex Addicts Anonymous, ISO of SAA, PO Box 70949, Houston, TX 77270. Web site: <http://saa-recovery.org/>
Emily Jane Willingham, PhD