Psychology of impulse control disorders
Impulse control disorders are characterized by a person's inability to resist harmful urges, leading to spontaneous, often destructive behaviors. Individuals suffering from these disorders typically experience heightened cravings for instant gratification, resulting in actions that can disrupt their personal and professional lives. Stress and tension exacerbate these impulsive urges, and those affected may derive a sense of pleasure or relief from their actions, even when they lead to negative consequences. The American Psychiatric Association recognizes several types of impulse control disorders, including kleptomania, pyromania, intermittent explosive disorder, and conduct disorder, each defined by distinct patterns of behavior and underlying psychological mechanisms.
These disorders can also co-occur with other mental health conditions, complicating diagnosis and treatment. Treatment options typically involve psychotherapy and medication, tailored to individual needs, although success rates can vary. The stigma surrounding these disorders often leads to secrecy and reluctance to seek help, highlighting the need for increased awareness and understanding. Mental health professionals strive to help individuals develop coping strategies and healthier behaviors to manage their impulses, while addressing the underlying issues contributing to these disorders.
Psychology of impulse control disorders
- TYPE OF PSYCHOLOGY: Emotion; sensation and perception; social psychology; stress
- Impulse control disorders are represented by destructive behaviors resulting from the inability to control urges to act irresponsibly.
Introduction
Impulse control disorders are characterized by spontaneous behavior that satisfies a person’s urges to feel tension-induced exhilaration. Mental health authorities attribute impulse control disorders to neurological or environmental causes that are aggravated by stress. People with impulse control disorders have an intense craving for instant gratification of specific desires and are usually unable to ignore temptations that tend to cause negative results. Pressure increases these people’s impulsive urges until they become irresistible, and they feel pleasure and relief when yielding control to enjoy appealing yet unacceptable activities. They are compelled to engage in destructive, sometimes violent behaviors. Most people with impulse control disorders feel no guilt or remorse for their actions.
People who have impulse control disorders repeatedly indulge in a behavioral pattern of impulsivity, disrupting their lives. Their family and employment roles are often impaired. They frequently face legal ramifications for their recurrent impulsive behavior. People with impulse control disorders often experience associated anxiety, stress, and erratic sleeping cycles.
For centuries, people have been aware of behavior associated with modern impulse control disorders. By 1987, the revised third edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) defined impulse control disorders as representing mental disorders that involve uncontrollable impulsive behavior that can potentially result in danger and harm to the affected person or other people. According to this classification, individuals with impulse control disorders are unable to resist urges to engage in this behavior despite feeling tension prior to impulsive activity. During the impulsive behavior, the person usually experiences sensations of release, titillation, and then satisfaction.
The 1994 DSM-IV assigned codes to six types of impulse control disorders not elsewhere classified: pathological gambling (312.31), kleptomania (312.32), pyromania (312.33), intermittent explosive disorder (312.34), trichotillomania (hair-pulling) (312.39), and impulse control disorder not otherwise specified (312.30). These classifications were retained in the text revision, DSM-IV-TR, published in 2000.
The DSM-V, published in 2013, and its text revision (DSM-V-TR), published in 2022, added two childhood disruptive behavior disorders, oppositional defiant disorder, and conduct disorder, to the category of impulse control disorders, and renamed the category as a whole "disruptive, impulse-control, and conduct disorders." This new chapter combined disorders previously listed as "Disorders of Infancy, Childhood or Adolescence and Impulse-Control Disorders Not Otherwise Specified." Additionally, gambling disorder, previously considered an impulse disorder, was moved to the addiction category following research that established that impulsivity was not significantly higher in those who gambled compulsively than those who did not and that gambling, for those with this disorder, activated reward centers in the brain similar to those activated by addictive substances. Trichotillomania, meanwhile, was moved to the category of obsessive-compulsive and related disorders. Other changes include the elimination of exclusion criteria for conduct disorder, the addition of a severity rating emphasizing pervasiveness, and the inclusion of notes about the importance of frequency of behavior in diagnoses of impulse control disorders.
Sometimes, impulse control disorders are associated with other mental illnesses, such as bipolar disorders or behaviors like road rage. Patients are often identified with an impulse control disorder while undergoing treatment for another psychological problem. Some mental health professionals attribute behaviors classified as impulse control disorders to types of different mental conditions. Impulse control disorders are distinguished by being primarily characterized by people’s absence of control over potentially damaging impulses.
Risky Impulsiveness
Shoplifting and worker thefts cost retail stores billions each year. While many of these thefts are acts of poor judgment, financial desperation, or plain criminality, some offenders have kleptomania. This impulse control disorder is characterized by people submitting to urges to steal items that are not essential to sustain their lives or for the purpose of generating revenues. Instead, individuals with kleptomania, usually women, steal to experience thrilling sensations of fear. The threat of being caught, arrested, and prosecuted does not discourage most individuals with kleptomania. Occasionally, people with kleptomania experience guilt and discreetly return stolen items. Some mental health professionals state that these individuals have an addictive-compulsive disorder, not an impulse control disorder.
The DSM-V describes kleptomania as a pattern of impulsive stealing with the motive to achieve emotional release, then enjoyment. Therapists evaluate whether patients steal because of specific manic episodes or because they suffer from an antisocial personality or conduct disorder. A kleptomania diagnosis is made when patients continually steal unnecessary objects, do not steal because they are delusional, are not motivated by a resentful need to retaliate against businesses, and report feelings of tension, relief, and gratification.
People who have pyromania repeatedly set fires to experience similar emotions. The DSM-V defines pyromania as recurrent acts of arson for personal enjoyment. Pyromaniacs, usually men, cannot control impulses to spark fires because they are intrigued by the flames, the emergency response to fires, and the resulting destruction. Some children experience a temporary fascination with setting fires that might reveal other psychological problems. Therapists rule out manic episodes, antisocial personality and conduct disorders, delusional behavior, intoxication, and retardation before diagnosing patients with pyromania.
Behaviors associated with pyromania include anxious feelings prior to a deliberate fire setting that culminate in excitement. Patients are usually obsessed with fire and related equipment. They often collect information about disastrous fires, learn about firefighting techniques, and eagerly discuss fires. Sometimes, individuals with pyromania indulge in pleasurable emotions by remaining at fire scenes to watch emergency personnel while delighting in the damage they have caused. Individuals with pyromania do not set fires to make political statements, commit retaliatory sabotage, seek insurance money, or destroy criminal evidence.
Pyromania and kleptomania are both very rare disorders, affecting less than 1 percent of the population, according to the DSM-V-TR.
Childhood Behavior Disorders
Conduct disorder (CD) is a disorder in which a child or adolescent routinely behaves in an antisocial manner, violating major social norms or the rights of other people without remorse or empathy for those they may have harmed. CD often presents differently according to gender; boys with CD often engage in physical and verbal aggression, while girls engage in more covert behavior, such as stealing or lying. This may contribute to CD being diagnosed more often in males than females. CD is often viewed as a precursor to antisocial personality disorder, which cannot be diagnosed before the age of eighteen.
Oppositional defiant disorder (ODD) is a childhood disorder in which the child shows a pattern of conflict with others, especially authority figures, such as parents or teachers. The symptoms of the disorder are divided into three categories: angry mood, argumentative behavior, and vindictiveness. A child with ODD may act specifically to annoy others, pick fights, seek revenge when others behave in ways they do not like, blame others for their mistakes, or refuse to comply with rules or requests. A diagnosis of ODD is made when a child exhibits such behavior consistently over a six-month period and with a greater severity than is usual for the age group.
Both ODD and CD are commonly comorbid with attention deficit-hyperactivity disorder, and ODD may also be comorbid with other issues, such as depression. According to the DSM-V, a child with CD cannot be diagnosed with ODD and vice versa, although there is some dispute among clinicians about this rule. Around 3.3 percent of children and adolescents present with ODD.
Intermittent Explosive Disorder
Intermittent explosive disorder is a violent form of impulse control disorder. Patients repeatedly act out excessive aggressive impulses and often cause harm to the people and objects they attack. Sometimes, property is destroyed. Physically destructive behavior is not required for a diagnosis of intermittent explosive disorder, however; nondistructive physical aggression and verbal aggression are considered sufficient as of the publication of the DSM-V. Based on the DSM-V classification, therapists examine patients for possible medication reactions, medical problems such as Alzheimer’s disease or head injuries, and mental conditions such as psychotic, borderline personality, or attention-deficit hyperactivity disorders. Mental health professionals establish an intermittent explosive disorder diagnosis based on whether recurring aggressive behavior exceeds appropriate response to any stimuli and patients seem out of control.
People with intermittent explosive disorder frequently face legal charges of domestic violence, assault, and property destruction. Many patients do not feel guilty and refuse to accept responsibility for their attacks. They usually blame their victims, who they claim provoked them. Various forms of stress such as perceived insults and threats and fear of not having demands fulfilled also are offered as justification for intermittent explosive disorder assaults. Researchers have determined that some people with intermittent explosive disorder have irregularities in brain wave activity or chemistry.
Treatment
Psychotherapy and pharmacotherapy are the usual treatments for impulse control disorders. Based on a psychological evaluation, therapists choose treatment methods suitable for each patient and applicable to specific undesirable behaviors. Medication, outpatient therapy, and hospitalization at public or private facilities are options to treat impulse control disorders. Treatment success varies. Many individuals with kleptomania are secretive about their behavior and only encounter therapists because of court orders following arrests. The 1990 Americans with Disabilities Act does not recognize impulse control disorders as disabilities.
Some researchers suggest that selective serotonin reuptake inhibitors (SSRIs) can minimize impulses to steal, although they do not cure kleptomania. Therapists use behavior modification techniques to develop alternative behaviors and motivations to replace destructive impulses and responses. Patients learn to revise irrational thinking patterns with cognitive therapy. Anger management methods help some people with intermittent explosive disorder, while neurofeedback aids others to manage stress and develop self-control.
Bibliography
Barkley, Russell A. Defiant Children: A Clinician's Manual for Assessment and Parent Training. Guilford, 2013.
Bowler, Amelia. The Parent’s Guide to Oppositional Defiant Disorder: Your Questions Answered. Jessica Kingsley Publishers, 2020.
Dorwart, Laura. "Impulse Control Disorders: Symptoms, Types, and Treatments." VeryWell Health, 30 Nov. 2024, www.verywellhealth.com/impulse-control-disorders-5272073. Accessed 10 Dec. 2024.
Gaynor, Jessica, and Chris Hatcher. The Psychology of Child Firesetting: Detection and Intervention. Brunner, 1987.
Grant, Jon E., and Marc N. Potenza. The Oxford Handbook of Impulse Control Disorders. Oxford UP, 2012.
Hollander, Eric, and Dan J. Stein, editors. Impulsivity and Aggression. Wiley, 1995.
"Impulse Control Disorders." Cleveland Clinic, 8 July 2023, my.clevelandclinic.org/health/diseases/25175-impulse-control-disorders. Accessed 10 Dec. 2024.
Martel, Michelle M. The Clinician’s Guide to Oppositional Defiant Disorder: Symptoms, Assessment, and Treatment. Academic Press, 2019.
Matthys, Walter, and John E. Lochman. Oppositional Defiant Disorder and Conduct Disorder in Childhood. 2nd ed., Wiley-Blackwell, 2017.
Varley, Christopher K. "Overview of DSM-5 Changes." Seattle Children's Hospital, omh.ny.gov/omhweb/resources/providers/dsm-5-overview.pdf. Accessed 10 Dec. 2024.
Webster, Christopher D., and Margaret A. Jackson, editors. Impulsivity: Theory, Assessment, and Treatment. Guilford, 1997.
"What Are Disruptive, Impulse Control and Conduct Disorders?" American Psychiatric Association, Mar. 2024, www.psychiatry.org/patients-families/disruptive-impulse-control-and-conduct-disorders/what-are-disruptive-impulse-control-and-conduct. Accessed 10 Dec. 2024.