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Impulse Control Disorders (ICD)

Impulse Control Disorders, or ICDs, touch many areas of life. These disorders include Pathological Gambling or Gambling Addiction (see detailed information on this disorder in the related title article), Intermittent Explosive Disorder, Pyromania,Kleptomania and Trichotillomania. Intermittent Explosive Disorder includes episodes of extreme aggression and causing bodily harm or property damage. With Kleptomania patients act out their impulse by stealing objects without any plan to sell them. Pyromaniacs set fires for the pleasure of watching them burn. Pathological Gamblers partake in habitual, gambling with no sense of financial or social consequences. In Trichotillomania patients exhibit recurrent hair pulling and often pull hair out of their heads, resulting in large bald spots or areas of thin hair. This is motivated by feelings of self-gratification and stress relief. These are the major disorders that typically comprise the family of Impulse Control Disorders. Previously, the term ‘impulse control disorder’ was used to refer to these five specific disorders, but the concept has expanded to include some types of substance use behaviors, suicide, conduct disorder (CD), eating disorders, and even some attention deficit hyperactivity disorders (ADHD), as well as Tourette's disorder and obsessive-compulsive disorder (OCD). These disorders of impulse control have similarities, in diagnostic overlap, but the coincident clusters of disorders have different risk factors, and clinical courses, and they respond to different therapies. Other residual category impulse control disorders include compulsive skin picking, compulsive sexual activity, compulsive shopping, computer or video game use, eating activities, and self-mutilation, among other things. Patients with an impulse control disorder have a specific psychological style. They are typically selective in the information they consider and process, and they have difficulty with abstract thought, and are often depressed. They overgeneralize and personalize most situations, and are always in search of sensational, exciting and novel experiences. The patient’s chosen method of self-soothing helps them to relieve uncomfortable thoughts and feelings. Patients often have a high incidence of depression and impulse control in their family history, and may come from a family environment with high stress, or a family that moved numerous times during the patient’s childhood. There is some evidence to indicate that people who have sustained significant head injury or trauma may be at more risk for developing an Impulse Control Disorder

What are the symptoms?

The symptoms of the five major categories of Impulse Control Disorders are:

Intermittent Explosive Disorder: severe episodes of assault or destruction of property. Aggression is out of proportion to the precipitating events

Kleptomania: stealing objects that are not needed, and of little monetary value. Stealing is not out of anger or revenge.

Pyromania: setting fires deliberately, more than once, fascination and attraction to fire and objects associated with fire. Patient does not seek monetary gain, or expression of anger, or wish to conceal some other criminal activity.

Pathological Gambling (Gambling Addiction): gambling in spite of continued losses and financial strain. Patients are often competitive, easily bored, and very generous.

How is it diagnosed and treated?

Diagnosis of impulse control disorders can only be made after all other medical and psychiatric disorders, with similar symptoms, have been ruled out. For diagnosis of Gambling Addiction or Pathological Gambling, see detail in the related title article.

Treatment(s) can include:

• Psychotherapy
• Self-Help Groups for Gambling Addiction (12-Step Program)
• Medication as appropriate for associated depression or anxiety
• Cognitive Behavioral Therapy and Behavioral Modification
• Anger Management training for Intermittent Explosive Disorder

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