Treatment Centers

Impulse-Control Disorders are psychiatric conditions defined by behaviors characterized by the inability to control impulses, temptations and/or drives that are harmful to self or others. Examples of behaviors involved in Impulse-Control Disorders are:

• aggression
• stealing
• fire setting
• gambling
• hair pulling

These and other behaviors that result from repeated lack of control over impulses, temptations and/or drives meet the diagnostic criteria for an Impulse-Control Disorder with certain exceptions. Behaviors originating in the course of other disorders are not considered to be caused by an Impulse-Control Disorder. Impulsive behaviors that are not considered symptoms of an Impulse-

Control Disorder are those caused by other conditions such as:

• delirium
• dementia
• substance disorders
• substance intoxication
• substance withdrawal
• personality disorders
• purposeful behavior
• mania
• psychosis
• sexual disorders
• social activity
• obsessive-compulsive disorder
• tics
• factitious disorder
• malingering

The DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) lists several distinct Impulse-Control Disorders. These are:

• Intermittent Explosive Disorder
• Kleptomania
• Pyromania
• Pathological Gambling
• Trichotillomania
• Atypical Impulse-Control Disorders (Impulse-Control Disorders NOS)

Intermittent Explosive Disorder

Intermittent Explosive Disorder is a psychiatric condition characterized by the following symptoms:

• episodes in which there are assaultive acts or destruction of property
• aggressive behaviors that are markedly out of proportion to precipitating factors or stressors

Kleptomania

Kleptomania is a psychiatric condition characterized by the following symptoms:

• stealing items that are not needed for personal use or their value
• building up of tension before stealing
• release of tension, experience of pleasure or gratification while stealing
• stealing without angry or vengeful motivation
• stealing without response to delusion or hallucination

Pyromania

Pyromania is a psychiatric condition characterized by the following symptoms:

• intentional fire setting
• building up of tension before fire setting
• emotional arousal before fire setting
• a preoccupation or fascination with fire
• a preoccupation or fascination with items, activities or consequences related to fire
• release of tension, experience of pleasure or gratification associated with setting and/or witnessing fires
• release of tension, experience of pleasure or gratification associated with the aftermath of fires
• fire setting is done without motivation of anger, vengeance, monetary gain, concealment of criminally activity, expression of ideology, to improve one’s living circumstances or in response to delusions or hallucinations

Pathological Gambling

Pathological Gambling is a psychiatric condition in which there is a persistent pattern of maladaptive gambling. The condition is characterized by the following symptoms:

• preoccupation with gambling by reminiscing or planning
• increased gambling activity to achieve the desired emotional effect of gambling
• repeated and unsuccessful attempts to stop, reduce or control gambling
• restlessness when attempting to stop, reduce or control gambling
• irritability when attempting to stop, reduce or control gambling
• gambling to escape problems
• gambling to alter mood
• attempts to remedy loss of money by further gambling
• lying about gambling
• concealing gambling activity or information about the effects of one’s
gambling
• committing crimes to support gambling
• experiencing negative consequences in major realms of functioning such as employment, relationships and education as a result of gambling
• depending upon others for financial support to compensate for financial distress caused by gambling

Trichotillomania

Trichotillomania is a psychiatric condition characterized by the repeated pulling out of one’s hair. This condition is characterized by the following symptoms:

• recurrent episodes of pulling out of one’s hair
• pulling out of one’s hair resulting in hair loss that is noticeable
• the experience of pleasure, relief or gratification when pulling out the hair
• significant distress about pulling out of one’s hair
• impairment in important areas of life functioning because of the pulling out of one’s hair

Atypical Impulse-Control Disorders

Impulse-Control Disorder Not Otherwise Specified, also known as Impulse-Control Disorder NOS or Atypical Impulse-Control Disorder, is a psychiatric diagnosis given when there are repeated behaviors resulting from uncontrolled impulses, drives or temptations that cause harm to one’s self or others and do not meet the criteria for the other diagnoses in this category of conditions. Preoccupation with behavior (obsessive thinking about past behavior or planning future behavior); lack of control over the behavior; mood alteration prior, during and after the behavior are some of the characteristics of Atypical Impulse-Control Disorders. Examples of impulse involved atypical disorders cover a broad spectrum of behaviors and can include such diverse conditions as self-injury, compulsive shopping, hypersexuality and compulsive Internet use.

Etiology of Impulse-Control Disorders

Impulse-Control Disorders are typically considered to have both neurological and environmental causes. Decreased levels of serotonin have been associated with many behaviors that characterize these disorders. Environmental stressors also appear to precipitate and exacerbate behaviors associated with these disorders. Onset of the maladaptive behaviors of certain Impulse-Control Disorders can be correlated with significant and distressful events.

Co-Occurring Disorders

Impulse-Control Disorders frequently co-occur with substance use, Substance Abuse and Substance Dependence. Individuals with Impulse-Control Disorders frequently experience significant tension, guilt and remorse and may use substances to alleviate these.

Treatment of Impulse-Control Disorders

Various modalities of treatments are successful in controlling Impulse-Control Disorders. Typically, a multi-disciplinary approach to treatment is used and includes a combination of approaches. Outpatient treatment for the long-term management of these disorders is typical. Inpatient psychiatric treatment may be used for acute episodes in which potential harm to self or others requires a structured environment and psychiatric support. Some of the modalities used to treat and manage Impulse-Control Disorders are:

• psychiatric services
• behavioral therapy
• group therapy
• hypnosis
• relaxation techniques
• stress reduction techniques
• anger management
• self-help groups
• Cognitive Behavioral Therapy
• medication
• supportive counseling
• psychotherapy

Several classes of psychotropics are used to treat Impulse-Control Disorders. Some of these medications are:

• antidepressants, particularly SSRI’s such as Prozac, Paxil, Lexapro, Celexa and their generic formulations
• mood stabilizers such as Lithium, Depakote, Lamictal, Neurontin and their generic formulations
• anti-psychotics such as Risperdal, Zyprexa, Seroquel and their generic formulations
• opiate antagonists such as naltrexone