Impulse Control Disorders

Impulse-Control Disorders: I Can’t Stop Myself The origin of the word ‘impulse’ is the Latin word impellere, signifying ‘to impel’ or ‘to drive’. (Allen, Liebman, Park, Wimmer, 2001) An individual with an impulse-control disorder repeatedly receives a strong impulse to perform an unacceptable and potentially harmful action, feel they have no option except to perform it, and feel a sense of desperation if stopped. (Halgin, Whitbourne, 2008).They also go on to say that impulse-control disorders have three main components; individuals are unable to refrain on impulses, before the act, they experience tension and anxiety, or sometimes arousal that can only be relieved by the act itself, and they experience a sense of gratification or pleasure upon acting on their impulse. According to Hucker (2005) there are six major impulse-control disorders: intermittent explosive disorder, kleptomania, pyromania, trichotillomania, pathological gambling, and not otherwise specified, the first five being the most common.Dombeck (2009) indicates that the disorders are grouped together by one common condition: they all include a behavior that is done in an impulsive, uncontrolled manner that usually has self-destructive consequences. Intermittent Explosive Disorder An individual with intermittent explosive disorder has a pattern of aggressive outbursts with violent urges to hurt others, or destroy property. (Allen et al. , 2001) The individual’s behavior is bizarre for the situation; they overreact and are far more violent than an average person. Libal, 2004) Halgin and Whitbourne (2008) indicate that people with this disorder often feel as though they lose control over their words and actions. They go on to say that due to the outbursts, individuals with intermittent explosive disorders suffer with work and their personal lives. Allen et al. (2001) say that symptoms include sudden rages at stressful times, physical symptoms before the outbursts, and emotional symptoms after the outburst.They note that the physical symptoms consist of palpitations and tightness in the chest, and emotional symptoms include feelings of drowsiness and depression. Mental health association (2005) says that this disorder may become noticeable through domestic violence. Allen et al. (2001) indicates that between the outbursts, the individual may show no sign of a problem. The American Psychiatric Association (2000) notes that the intermittent explosive disorder diagnosis is only given after other mental disorders, that have similar symptoms, have been ruled out.They continue to indicate that this disorder is rare. The diagnostic criteria, consistent with the American Psychiatric Association (2000): • Several episodes of behavior resulting in serious assault or destruction of property • Aggressiveness expressed during the episode is bizarre compared to any sudden psychosocial stressors • The outbursts are not explained by another mental disorder or general medication.Intermittent explosive disorder is prevalent in males, and the individual usually denies responsibility of their outburst, blaming something, or someone else. (Franklin, 2003) He goes on to say that the individual’s lack of control is a big part of the problem, and inability to acknowledge responsibility for the destruction relieves the guilt, making it hard to make any changes in the behavior. Franklin (2003) also suggests that this disorder usually brings legal problems for the individual from the destruction and violence.An electroencephalograph (EEG), a machine that traces brain waves provided findings that show that individuals with this disorder display abnormalities. (Bayer, 2001) This disorder begins anywhere from childhood into the twenties, and the onset may be abrupt. (Allen et al. , 2001) They further note that as an individual reaches their fifties and older, the outbursts of aggression are less likely to occur. Treatment for intermittent explosive disorder depends on the individual, however, many respond well to psychiatric therapy, or medication. Libal, 2004) Even though individuals with intermittent explosive disorder are unlikely to look for help, self-help treatments include anger management classes, while professional help consists of medication, therapy, or hospital treatment, depending on the individual’s state of being. (Allen et al. , 2001) Kleptomania Kleptomania is an impulse control disorder in which an individual repeatedly fails to resist the impulse to steal. (Libal, 2004) Usually, the stolen objects are of little value and the individual has no real use for the item. Bayer, 2001) The theft is executed to achieve a feeling of tension before stealing, and a sense of pleasure at the time of the theft. Franklin (2003) He also indicates that the items are not being stolen to express anger, or vengeance.Symptoms of kleptomania include recurrent theft of un-needed items, theft not due to lack of money and stealing alone and discretely. (Mental Health Association, 2005) Shoplifting is commonly mistaken as kleptomania, however; people with kleptomania are driven by the excitement of stealing something, rather than an object of desire. Halgin and Whitbourne, 2008) They go on to say that a lack of interest in the stolen item is a key difference between plain shoplifters and individuals with kleptomania. Allen et al. (2001) indicate that since they know stealing is wrong, they may feel guilty and depressed later, and may fear being arrested. The American Psychiatric Association (2000) lists the diagnostic criteria for kleptomania to be the following: • Repetitive theft of useless items • High sense of tension before the act of stealing • Pleasure at the time of theft Not caused by vengeance, anger, or response to hallucination or delusion • Not caused by conduct disorder, manic episode, or antisocial personality disorder. Kleptomania is rare and occurs mostly in women. (Franklin, 2003) This disorder occurs in less than 5% of identified shoplifters. (American Psychiatric Association, 2000) Allen et al. (2001) suggest that the acts of stealing are a child’s substitute for love, or punishment on others by hurting themselves. They also indicate a childhood history of family problems.This disorder can develop anytime between childhood and adulthood, but is rare to develop in late adulthood. (Libal, 2004) Halgin and Whitbourne (2008) suggest that kleptomania could be a variant of obsessive-compulsive disorder. Allen et al. (2001) indicate there may be a pattern of compulsive buying as well. They go on to describe three courses of kleptomania: brief episodes followed by long periods of remission; long and intense periods of stealing; courses without a clear pattern.Bayer (2001) states that research estimates the disorder usually lasts between 3 and 38 years, but an average of 16 years. Treatment for kleptomania is not a very popular thing since kleptomania is so rare, however; there are certain treatments available. (Bayer, 2001) Patients with kleptomania respond to SSRIs. (Halgin and Whitbourne, 2008) Allen et al. (2001) note that self help consists of emotional support combined with family insistence on counseling can help, as well as supportive organizations including Shoplifters Alternative.They go on to indicate that unfortunately, people with kleptomania are likely to get treatment only after having legal problems that require the treatment, but can seek therapy with an expert to provide supportive empathy and help put a troubled childhood and personal life into perspective. Bayer (2001) specifies electrotherapy- in which a controlled burst of electricity is delivered to the brain- as a successful treatment for some people. Pyromania Pyromania is an impulse control disorder where an individual fails to resist the urge to set fires. Libal, 2004) According to Bayer (2001) pyromaniacs are fascinated by fire and anything related to it. She goes on to say that the person might be indifferent to any damages or deaths the fire setting causes; some individuals may derive pleasure from thinking of the resulting danger to people’s lives, destruction, and legal consequences. The sole reason the individual sets a fire is for their own excitement and their urge to do so. (Allen et al. , 2001) The symptoms of pyromania are recurring deliberate fire-setting, fascination with anything related to fire, igniting a fire for pure excitement and nothing else. Mental Health Association, 2005)Feelings of tension or a sense of stimulation before starting the fire are common with pyromania. (Allen et al. , 2001) They further state that individuals with this disorder always try to be around a fire and might even become firefighters to be near it. The following diagnostic criteria are from the American Psychiatric Association (2000): • Several occasions of deliberate fire-setting • Tension or arousal prior to the fire Fascination, curiosity, or interest in fire and anything related to it • Pleasure, or relief when starting fires, participating in or watching the outcome • Fire is set for no reason other than personal excitement • The fire-setting has not occurred due to a conduct disorder, manic episode, or antisocial personality disorder. Pyromania is an extremely rare disorder, even though fire-setting in children and adolescents is fairly common, most fires started by young people are due to external influences. Libal, 2004) She continues to state that males are prevalent in pyromania compared to females. Pyromania occurs more often in people with a history of poor social skills, learning problems, or attention-deficit disorder. (Allen et al. , 2001) Bayer (2001) indicates that pyromania typically begins in childhood. Since the disorder is so rare, the course of pyromania is unknown, except for the significant risks like serious property damage, deaths of firefighters and citizens, and criminal prosecution and incarceration. Allen et al. , 2001) Most people with pyromania have other problems or disorders, and in most individuals, the disorder is originated in childhood problems. (Halgin, Whitbourne, 2008)Treatment for pyromania exists, but is much more effective in childhood years. (Bayer, 2001) She goes on to specify treatments like re-education, family therapy, and behavior education. Halgin and Whitbourne (2008) indicate that treatment programs aimed at youths seem much more effective. Allen et al. (2001) describe self help as consisting of rehabilitative resources available and professional help as treatment aimed at children, which has suggested that at least 70% ceased fire-setting after treatment. Trichotillomania Trichotillomania, also known as TTM, is the impulse control disorder that fails to resist an impulse to habitually pull out your own hair, causing noticeable hair loss. (Libal, 2004) Bayer (2001) describes this activity as occurring during periods of relaxation or distraction, decreasing stress, relieving tension, and being pleasurable for the individual.For individuals with this disorder, they are so preoccupied with the act of hair-pulling that they are oblivious about the fact that they could be making themselves look worse. (Halgin, Whitbourne, 2008) The individual feels tense before, mainly while resisting the impulse, with relief or even pleasure when giving in. (Allen et al. , 2001) Symptoms of trichotillomania include a preoccupation with hair pulling from any part of the body, especially scalp, eyebrows, and eyelashes. (Bayer, 2001) Individuals may closely inspect the hairs they pull out, eat the hairs, or even pull hair from other people. Libal, 2004) Halgin and Whitbourne (2008) indicate that the individual is unable to stop this behavior, even when the pulling results in lost eyebrows, eyelashes, armpit hair, pubic hair, and bald patches. The American Psychiatric Association (2000) gives the following as diagnostic criteria for trichotillomania: • Numerous pulling out of an individual’s hair, resulting in visible hair loss • A high sense of tension before pulling hair or when resisting behavior • Pleasure or relief when pulling out hair Hair pulling is not better explained by general medical condition or mental disorder • The hair pulling causes significant distress or impairment in important areas of functioning. Allen et al. , (2001) show that when it comes to children, the hair-pulling occurs equally between females and males, however; in adults, it is much more frequent in females than males. They go on to say that most individuals with this disorder have other disorders for example, mood, anxiety, eating, and substance abuse disorders.People with this disorder deny their behavior, usually because they are ashamed of it. (Halgin, Whitbourne, 2008) The onset of trichotillomania is usually during childhood or early teens, during stages of stress and can clear up by itself. (Allen et al. , 2001) They continue saying that trichotillomania can become chronic in adults, continuously or in episodes, leading to the need for hairpieces, covers, or even plastic surgery. Allen et al. (2001) indicate a major risk of embarrassing social isolation.Treatment includes medications, habit reversal therapy, social and emotional support, and methods that combine more than one of the methods. (Halgin, Whitbourne, 2008) Allen et al. (2001) indicate several books as self-help for individuals with trichotillomania, as well as internet sites and chat rooms. For professional help, pediatricians can give tips on how to make the environment at home less stressful, which in turn should cease the hair-pulling. (Allen et al. 2001) They also say that proper professional treatment of other disorders present should yield less hair-pulling. Pathological Gambling Pathological gambling is a disorder where an individual gambles to such an extreme, uncontrolled extent, that it disrupts his life functioning. (Libal, 2004) This impulse is an addiction, the individual acts from feelings rather than mental discipline. (Allen et al. , 2001) According to Halgin and Whitbourne, (2008) pathological gamblers often end up spending their entire lives in a quest for big winnings.Symptoms for pathological gambling include “jeopardizing personal relationships, career, or family life in order to keep gambling, recurrent and persistent problem gambling behavior that disrupts personal and/or family life, continued gambling despite financial problems, ‘chasing losses’, magical and incorrect beliefs about gambling odds. ” (Mental Health Association, 2005, pg. 2) Halgin and Whitbourne, (2008) say that multiple efforts to control gambling are unsuccessful; individuals are likely to be irritable and restless during attempts.The American Psychiatric Association (2000) has diagnostic criteria for pathological gambling that is listed in the appendix. Pathological gamblers spend all of their time thinking about gambling and are in an excited, energized state when around it. (Allen et al. , 2001) They also state that individuals with pathological gambling disorder could lie about gambling and steal as their losses escalate. Children of pathological gamblers are more likely to become pathological gamblers themselves. Halgin, Whitbourne, 2008) Franklin (2003) indicates that men are more likely to begin this gambling problem in their teenage years, while women pick it up when they are older. According to the American Psychiatric Association (2000) the prevalence rate is influenced by availability, and duration of availability. They report that prevalence rates in adolescents and college students are much higher, ranging from 2. 8% to 8%. Allen et al. (2001) state that pathological gambling occurs in 1% to 3% of adults, and 1 in 3 compulsive gamblers are females. Allen et al. 2001) say that the onset of pathological gambling is younger in males than females; males begin exhibiting it in their early teenage years, while women begin showing symptoms later. They continue to state that pathological gamblers may be workaholics with need for approval, the urge to gamble increases with stress. Halgin and Whitbourne (2008) indicate that the gambling lifestyle has consequences not only on the individual’s finances, but their psychological health as well, leading into problems like depression. Problems that come along with pathological gambling include risks of job loss, unpaid debts, divorce, and even suicide. Allen et al. , 2001) Treatment for this disorder includes support groups like Gamblers Anonymous, psychotherapy, contract therapy, behavior modification, individual and group therapy, residential care, halfway houses, and inpatient and outpatient programs. (Bayer, 2001) Allen et al. (2001) lists accommodating self-help options like support groups and videos, and they also list what kind of professional treatment to seek, including psychological support, treatment of depression, learning about the illness, and sometimes hospitalization.Not Otherwise Specified These impulse control disorders are disorders involving impulsive behaviors not mentioned in the first five disorders. This section includes disorders like sexual impulsivity, internet addiction, self-mutilation, compulsive shopping, and dermatillomania, “that do not meet the criteria for any specific impulse-control disorder or for another mental disorder having features involving impulse-control described elsewhere in the manual. ” (American Psychiatric Association, 2000, pg. 77) Impulse-control disorders are a very prominent epidemic in our society. If people were more attentive to these disorders, there could be fewer problems in the United States with things like gambling, debt and theft. If doctors and researchers could find the etiology of these disorders, the treatments would be that much closer. Appendix Diagnostic criteria for Pathological Gambling A. Persistent and recurrent maladaptive gambling behavior as indicated by five (or more) of the following: • Is preoccupied with gambling (e. . , preoccupied with reliving past gambling experiences, handicapping or planning the next venture, or thinking of ways to get money with which to gamble) • Needs to gamble with increasing amounts of money in order to achieve the desired excitement • Has repeated unsuccessful efforts to control, cut back, or stop gambling • Gambles as a way of escaping from problems or of relieving a dysphoric mood (e. . , feelings of helplessness, guilt, anxiety, depression) • After losing money gambling, often returns another day to get even (“chasing” one’s losses) • Lies to family members, therapist, or others to conceal the extent of involvement with gambling • Has committed illegal acts such as forgery, raud, theft, or embezzlement to finance gambling • Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling • Relies on others to provide money to relieve a desperate financial situation caused by gambling B. The gambling behavior is not better accounted for by a Manic Episode (American Psychiatric Association, 2000, pg. 674)