Impulse Control

Disorders
AbdelMuez Siyam
Ahmed AbdelRaheem
Impulse Control Disorders

 Impulse control disorders (ICDs) are psychological

disorders characterised by the repeated inability to
refrain from performing a particular action that is
harmful; either to individuals or properties.

 The individual fails to resist performing a potentially

harmful act, and it’s usually accompanied by a sense
of tension or arousal before committing the act, and a
sense of relief of pleasure when it’s committed.
Impulse Control Disorders

 Impulse control disorders are characterized by

problems in the self-regulation of emotions and
behaviours.

 The behaviours violate the rights of others,

destroy property and conflict with societal norms.

 Impulse control disorders are NOT caused by

another mental disorder, medical condition, or
substance use
Impulse Control Disorders

 Unable to restrain impulses

 Responses are out of proportion to the provocation

 Often leads to psychosocial impairment, or legal actions

Impulse Control Disorders
 Impulsivity is controlled by three major cognitive components,
which are all stressful for an individual who suffers from an
impulse control disorder. These factors are as follows:

 1- Failure to delay gratification: an individual with an ICD often

takes decisions that are aimed at seizing an immediate gain
without considering the long term unfavorable consequences of
his/her decision and regardless of how trivial this gain might be.

 2- Disinhibition: the inability to suppress behavior in a way that is

expected to be appropriate in view of social norms and constraints

 3- Distractibility: failure to maintain continuous attention on a

certain task.
Impulse Control Disorders

 Each disorder is characterized by the inability to resist an

intense impulse, drive or temptation to perform a particular
act that is obviously harmful to self or others or both.

 Before the event, the individual usually experiences mounting

tension and arousal, sometimes but not consistently mingled
with conscious anticipatory pleasure.

 Completing the action brings immediate gratification and

relief

 Within a variable time afterwards, the individual experiences

a conflation of remorse, guilt, self –reproach and dread.
Etiology

 Biological
 Psychological
 Social
Biological

 Many investigators have focused on possible organic factors in the

ICDs, especially for patients with overtly violent behavior. In some
cases, a family history of the disorder is present

 Experiments have shown that impulsive and violent activity is

associated with specific brain regions, such as the limbic system
and prefrontal cortex.

 Many intermittent explosive disorder (IED) patients, for example,

may report a history of head trauma during their childhood. The
exact significance of such an event on various brain sites is still to
be determined

 A decrease in CSF serotonin level might also play a part in IED

pathogenesis
Psychological

 Having a difficult temperament, difficulty with new

situations and failure of delayed gratification

 An impulse is a disposition to act to decrease

heightened tension caused by the buildup of
instinctual drives against the provoker

 The impulse disorders have in common an attempt to

bypass the experience of disabling symptoms or
painful affects by acting on the environment
Social/Environmental

 Psychosocial factors implicated causally in ICD are related

to early life events. The growing child may have had
improper models for identification such as parents who
had difficulty controlling impulses.

 Childhood history of hard discipline, physical/sexual

abuse, parental neglect or rejection, frequent change of
caregivers, parental criminality or a family history of
substance abuse disorder.

 Other psychosocial factors associated with the disorders

include exposure to domestic violence, alcohol abuse,
promiscuity and antisocial behavior.
Intermittent Explosive
Disorder
 IED manifests as discrete episodes of losing control
of aggressive impulses; these episodes can result in
serious assault or the destruction of property.

 The aggressiveness expressed is grossly out of

proportion to any stressor that may have helped
elicit the episode.

 The symptoms which patients may describe as spells

or attacks appear within minutes or hours and
regardless of duration, remit spontaneously and
quickly.
Intermittent Explosive
Disorder
 More common in men than women.

 Onset usually in late childhood or adolescence.

 May be episodic, but course is generally chronic and

persistent.
Intermittent Explosive
Disorder
 Behavioural theory
*Antecedents: A sense of tension or arousal
*Behaviour: Explosive behavior, aggressive episodes
*Immediate consequences: A sense of relief and release
*Delayed Consequences: Feeling upset, regretful or
embarrassed of self
 Biological factors: low serotonin levels, head trauma, possibly
high testosterone
 Personality factors: generalized impulsivity or aggressiveness,
chronic anger management problems
 Social: childhood history of temper tantrums, impaired
attention, hyperactivity and other behavioral difficulties
 Early learning: parenting styles and family conflict
 Stress
IED- Diagnosis and DSM-5
Criteria
 (1) Recurrent behavioural outbursts resulting in verbal
and/or physical aggression against people or property.
 Either:
1- Frequent verbal/physical outbursts (that do not result
in physical damage to people, animals, or property) twice
weekly for 3 months.
Or:
2- Rare (more than three times per year) outbursts
resulting in physical damage to others, animals, or
property.
IED- Diagnosis and DSM-5
Criteria
 (2) Outbursts and aggression are grossly out of proportion to
the triggering event or stressor.

 (3) Outbursts are not premeditated and not committed to

obtain a desired reward (no ulterior motive)

 (4) Aggressive outbursts cause either marked distress or

impairment in occupational/interpersonal functioning, or are
associated with financial/ legal consequences.

 Aggression is not better explained by another mental disorder,

medical condition, or due to the effects of a substance (drug or
medication).
Intermittent Explosive
Disorder
 Age must be ≥ 6 years old

 If age is between 6-18, and aggressive behavior due to

an adjustment disorder (stronger than expected
response to a stressful stimulus) not considered towards
this diagnosis.
IED- Treatment

 Lifestyle modifications
 Psychological
 pharmacological
Lifestyle changes

 (1) Stress management:

 Learning stress reduction skills (release stress before
committing the behavior)
 Progressive muscle relaxation (7 sec. tightening and
releasing of specific muscle groups)
 Visualization (release muscle tension without first
tensing the muscle, and visualization of the tension
being released)
 Cue controlled relaxation (with relaxing words)
 Mindfulness techniques: mindful seeing and listening,
increasing willpower and controlling emotions
Lifestyle changes

 (2) physical activity, meditation, regular sleep

 Routine (found to increase serotonin levels, decrease

anger and distractibility, reduces frequency of
outbursts)
Treatment - psychological

 CBT has been shown to be effective and is often used in

combination with medications
**Cognitive relaxation and coping skills (Relaxation
training, cognitive reconstruction and exposure therapy)

 Individual psychotherapy
 Group psychotherapy
 Anger management

 Group therapy and/or family therapy may be useful to

create behaviour plans to help manage episodes
Treatment-Pharmacological

 SSRIs

 Mood stabilizers (Anticonvulsants, Lithium)

Thank You