Table of Contents
- Definition of Impulse Control Disorder
- Types of Impulse Control Disorder
- Pathophysiology of Impulse Control Disorder
- Causes of Impulse Control Disorder
- Signs and Symptoms of Impulse Control Disorder
- Diagnosis of Impulse Control Disorder
- Treatment and Management of Impulse Control Disorder
- Effects of Impulse Control Disorders
- Health Risk of Impulse Control Disorder
- Co-occurring Disorders
Definition of Impulse Control Disorder
Impulse Control Disorder is mostly defined as “psychiatric disorder or condition that is characterized by an extreme and/or harmful desire and behavior that can lead to significant damage or impairment in their societal and professional working and may also suffer legal and financial complications”.
Stages of Impulsivity
Impulse behavior is fast, insensitive and unrestrained. Persons getting impulsive mostly feel incapable to stop the desire to do something that can turn out to be dangerous. The Journal of Neuropsychiatry lays emphasis on the impulse action, and states that they can have five behavioral stages:
- Rising impulse
- Increase in the internal tension
- Action on the impulse brings pleasure
- There is a sense of relief after the action
- Guilt or remorse substitute the pleasure and relief
Types of Impulse Control Disorder
It is characterized by repeated betting behavior that can mostly have an effect on the person’s finances, profession, personal life or other relationships. It is mostly a chronic condition and has high chances of relapses. It is mostly associated with
- Impaired functioning
- Reduced quality of life
- High bankruptcy rate
- Divorce and incarceration
- Financial and marital problems
- A number of gamblers get engaged in illegal behavior like stealing or embezzlement
This condition is mostly characterized by the desire to steal things, in spite of being well aware that these that things are of no monetary or personal value. Mostly, the thefts made by them are unintentional and the items stolen are mostly disposed of or are never used. These people mostly have the desire to steal things when they get apprehensive or irritated, and they have a feeling of relief or relaxation when their act is complete.
It is characterized by repetitive or deliberate desire of pulling one’s hair and this can cause visible hair loss and resulting in clinically significant levels of misery or functional impairment. Most people suffering from trichotillomania tend to pull out hair from the head, eyelashes, eyebrows, legs, arms, face and pubic region.
It is characterized by persistent, significant outburst of aggregation which commonly leads to muggings against people or property. Outbursts happen regardless of outside stressors and are not explained by any other psychiatric disorder. The actions of people suffering from IED are as follows:
- Outbursts are mostly short-lived (usually less than 30 min ) and frequent
- They are more risky and aggressive than what the situation needs
- They mostly feel very incensed or irritated
- They feel energized and anxious when they blow out
- Feel washed-out of strength, relieved, ashamed and even depressed when the incident is over
- These individuals mostly suffer legal and occupational complications.
It is mostly characterized by the recurrent action of intentionally setting fire, most of the time at any random location. Individuals feel relieved or excited after the action. The objective of this action is not to harm anyone but it can result in harm to anyone. This disorder is mostly characterized by:
- The motive of setting these fires isn’t always to harm someone
- A deliberate and decisive desire to set fire, on more than one occasion
- Individuals feel a sense of tension or emotional arousal before the action
- Patient has an interest or curiosity about, or an attraction towards fire and its situational settings
- Pleasure, satisfaction, or a sense of relief while setting fire or even when witnessing or participating in their consequence
Pathophysiology of Impulse Control Disorder
The limbic system is the part of the brain which is mostly responsible for the functions of the memory and our emotions, and the frontal lobe is the part of the brain that responsible in decision-making abilities. When both of these areas are affected in someone, then the individual suffers from an impulse control disorder. Similarly, hormones such as testosterone that related to aggression, may also be elevated in the patient suffering of impulse control disorder.
Impulsivity, Addiction and Brain
Biochemical pharmacology suggests that there is a link between impulse, addiction and the brain’s production of dopamine. Neurotransmitter is a substance that can control the feelings of pleasure and satisfaction. When there are low levels of dopamine, it may increase the risk of getting impulsive, high-risk behavior like gambling, drinking, anonymous sex and drug abuse.
There are few other neurotransmitters that can also affect the desire and impulse control, these are GABA and serotonin. This is because the chemical imbalance in the brain has a genetic constituent and there might be a hereditary relationship between impulse control disorder and substance abuse.
Causes of Impulse Control Disorder
An exact cause of impulse control disorders is not known. It is presumed that the development of this disorder is mostly pre-dominated by both the biological and societal risk factors.
The common causes include:
Genetic: It has been noted that children and teens that have family members suffering from mental health disorder have a very high susceptibility of developing this disorder.
Physical: It has been noted that when the brain structures that are associated with the functioning of sentiments, memories and our planning may become imbalanced, it mostly leads to ICD.
Environmental: It has been noted that patients who have grown up in families or environment where unstable behavior, violence, physical and verbal abuse were common are more likely to develop ICD.
The most common risk factors for ICD include:
- A known history of drug abuse
- Young age
- Male sex
- Exposure to violence
- There is a history of mood disorders running in the family
- A history of substance abuse running in the family
Signs and Symptoms of Impulse Control Disorder
The most common signs and symptoms of impulse control disorder mostly vary based on the age of the child or adolescent suffering from them.
- Playing with fire
- Acting out in sexual behavior
- Difficulty in concentrating
- Absence or lack of patience
- Obsessive and disturbing thoughts
- Social isolation
- Low self-esteem
- There will be an increase in levels of anxiety or apprehension
- Transitory phase of emotional detachment
- Individuals participating in risky sexual behavior may be suffering from STDS.
- children and adolescents who tend experiment or play with fire might have burn mark son the skin
- Injury marks resulting from physical fights may be present
Diagnosis of Impulse Control Disorder
Chronic disruptive and impulsive behavior are striking apprehensions for psychiatric clinicians; this is because of their persistence and potential legal consequences.
Diagnosis of any of these conditions is mostly done once other medical and psychiatric conditions, that may present with similar symptoms, have been ruled out. Physicians provide questionnaire forms or psychiatric screeners as part of the differential diagnosis. Moreover, laboratory examinations, mainly CSF analyses, are performed to further define the condition. There are two instruments which are commonly used to specifically target the impulsive behavior, these include:
- Gambling urge scale (GUS)
- Lifetime History of Impulsive Behaviour Interview (LHIB)
Impulsive Control Disorder
DSM 1V-TR Criteria
Treatment and Management of Impulse Control Disorder
Most of the patients suffering from an impulse control disorder or substance use may not be willing to seek the medical advice for treatment by their own. A friend or family member might be able to help the patient to recognize the need for the treatment and the benefits of specialized treatment programs.
Treatment for ICD may involve any combination of the following:
Few individuals can benefit from a therapy known as “habit reversal”.
This therapy mostly provides a person with something they can do when they feel compelled to engage in any destructive impulse. For example:
- If a person pulls their hair, then they are asked to clench their fist
- If a person has a habit to pick their shin, then they might be advised to keep their eyes closed and relax.
- Therapists might teach some breathing exercises, which can help them relax their body, sooth their tense muscles, and control the urges.
Medication plays a very important role for both the treatment and prevention of ICD. Medication when combined with a therapy is an effective impulse control treatment.
The most common medications prescribed are as follows:
- Mood stabilizers /anti-epileptics
- Opioid analgesics
- Atypical neuroleptics
- Glutamatergic agents
Cognitive Behavioral Therapy
Cognitive behavioral therapy is a type of treatment that combines both the cognitive therapy along with the behavioral therapy. The CBT treatment mostly involves the following seven steps:
- Conducting an assessment and educating the patient
- Developing stress reduction skills
- Challenging distressing thoughts
- Prevent damaging behavior
- Development of emotion rules and pain tolerance skills
- Develop problem-specific coping skills
- Preventing relapse
Different medications may interact with each other leading to unintended consequences. There are few medications that are not recommended for patients who have a history of substance abuse as they may be habit-forming or may increase risk for their abuse.
There are no known guidelines that can help in preventing ICD. The most important thing is that a timely and disciplined pattern of treatment needs to be done.
Effects of Impulse Control Disorders
If ICD is not timely treated, then its long term-effects can be very detrimental and channeling, thus, they leave a negative impact on the child or on the adolescent’s life. Examples of few of these effects include:
- A sharp or relative decline in academic work
- Individual can get suspended or dismissed from the school
- There will be an extreme difficulty in the development and also maintaining healthy personal relationships
- Participation in self-harming activities
- Legal interaction, including possible detention
- Constantly decreasing feelings of self-worth or a lot of negative thoughts
Health Risk of Impulse Control Disorder
Most of the patients suffering from ICD are commonly involved with substance abuse, which mostly have an impact on their health. The common health risk linked with ICD include:
- Heart disease
- Heart attack
- Liver disease
- Respiratory disease
- Certain forms of cancer
Persons suffering from ICD along with substance abuse are more prone to suicide attempts, accidental injuries, and death by homicide.
The symptoms of ICD may mirror or overlap with other mental disorders. Some of these common symptoms include:
- Bipolar disorder
- Depressive disorder
- Anxiety disorder
- Post–traumatic stress disorder
- Conduct disorder
- Anti-social personality disorder
- Oppositional defiant disorder