Impulse-Control

Disorders NOS

Impulse Control Disorders

This DSM-IV section contains six diagnoses
The essential features of Impulse-Control
Disorders are:
Failure to resist performance of act that is
harmful to the person or to others.
Individual usually feels an increasing sense of
tension or arousal before committing act.
Then clients experience pleasure, gratification,
or relief at time of committing act.
Following the act there may or may not be
regret, self-reproach, or guilt.

Intermittent Explosive Disorder

(criteria listed on p. 667)
Characteristics:
These clients have episodes during
which they act out aggressively.
They physically harm others or destroy
property.
Not due to any other mental disorder.

Intermittent Explosive Disorder

Treatment

No clearly effective treatment

Some clients have been helped by
anticonvulsant medication (e.g.,
carbamazepine), beta-blockers (e.g.,
propranolol, metaprolol), lithium,
antipsychotics, and antidepressants.
Hypnoanxiolytics may worsen the
condition by disinhibiting it.
Group therapy is claimed to be more
useful than individual therapy.

Kleptomania
(criteria listed on p. 669)
Characteristics
Irresistible impulse to steal
unneeded objects repeatedly.
Tension and release" characterizes
this behavior.

Kleptomania
Treatment

Almost nothing is known about the specific

treatment of kleptomania.
However, treating the other disorders
associated with it are essential.
Bulimia and obsessive-compulsive disorders
(and to some extent substance abuse) share
the tension-relief cycle/

The following approaches to this cycle,

might be:
Response prevention, and
Alternative forms of tension release, and
antidepressants (particularly the SSRIs) might
be helpful.

Pyromania
(Criteria on p. 671)
Characteristics:
Deliberate and purposeful fire setting on
more than one occasion.
Fire setting not done for monetary gain or
other "objective reasons."
Tension or arousal before act.
Fascination with fire and its situational
contexts.
Pleasure and relief in setting and
witnessing fires.

Pyromania
Treatment

No controlled studies assessing treatment.

Anecdotal reports indicate that most child
pyromaniacs recover fully, whereas adult
pyromaniacs do not.
The majority have mildly low intelligence and
ingrained impulsiveness; therefore, few
pyromaniacs benefit from insight-oriented
psychotherapy.
Behavior therapiy might be more useful by
substituting healthy gratifications and by
improving social skills.
Perhaps the most useful intervention is to ensure
that pyromaniacs don't drink.

Pathological Gambling
(criteria on p. 674)
Characteristics:

Repeatedly gambling, often until money is

lost, jobs are given up, and friends leave.
Gamblers are often restless/irritable when
cut down or gambling is stopped.

Pathological Gambling
Treatment
Many gamblers will enter treatment simply to get
relatives off their back; once things cool down,
gambling resumes.
If they remain in treatment, four attitudes
frequently undermine therapy:
1. Lack of money is seen as the problem;
2. An instant or miraculous cure is expected;
3. Life without gambling is inconceivable; and
4. Repaying debts is desirable but impossible.

Pathological Gambling
Treatment (cont.)
Denying these attitudes during
treatment, especially near the
beginning, should raise doubts about
the authenticity of the client's
commitment to change.
Since these clients are often bright
and have a gift of gab, place little
stock in what they say and far more
in what they do.

Pathological Gambling
Treatment (cont.)
Treatment should be judged on:
The duration of gambling-free
intervals
On debts being paid, and
On developing interests other than
gambling.

Pathological Gambling
Treatment (cont.)

Since substitute excitements and pleasures must

eventually replace gambling,
Vocational counseling and recreational therapy
may be an invaluable adjunct to therapy.
Meeting periodically with relatives is also
important, as much for the relatives as for the
gambler.
Clinicians should remind themselves and loved
ones that pathological gambling is a chronic
disorder in which lapses are expected and do not
necessarily mean therapy is a bust.

Pathological Gambling
Treatment (cont.)

Gamblers Anonymous (GA), founded in 1957, is

modeled after Alcoholics Anonymous
Claims 12,000 members with affiliates for
relatives of gamblers (similar to Alanon).
Only 5-8% of gamblers who join GA stop
gambling
If GA is combined with comprehensive inpatient
care, 50% who complete the program refrain
from gambling for a year, and a third do so for
several years.
Given the similarities between gambling and
alcoholism, if a GA chapter isn't available,
attending AA is a good substitute.

Trichotillomania
(criteria listed on p. 677)
Characteristics
Pulling hair from various parts of the
body
Accompanied by feelings of tension
and release from distress or
pleasure/gratification.

Trichotillomania
Treatment

Behavioral approaches can be helpful

Also helpful are antidepressants
As in obsessive-compulsive disorder,
serotonin agents appear to be more
effective than standard
antidepressants.
Perhaps trichotillomania is a variant
of OCD.