An impulse control disorder is a psychiatric condition which is mostly characterized by the inability to resist an impulsive action or behavior that can turn out to be harmful to them or others. Usually, people suffering from impulse control disorder mostly have a feeling of increased anxiety just before committing the action; this sensation is mostly pressure building up. Once the action is complete, they feel a sign of relief or even happiness, in spite of the possibly dangerous consequences. This psychiatric condition is mostly misunderstood by the general public, clinicians and even individuals suffering from it.

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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

Pathological Gambling

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

Kleptomania

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.

Trichotillomania

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.

Intermittent Explosive Disorder

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.

Pyromania

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.

Risk factors

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.

Behavioral Symptoms

  • Aggression
  • Theft
  • Playing with fire
  • Lying
  • Acting out in sexual behavior

Cognitive Symptoms

  • Agitation
  • Irritability
  • Difficulty in concentrating
  • Absence or lack of patience
  • Obsessive and disturbing thoughts

Psychosocial Symptoms

  • Social isolation
  • Depression
  • Low self-esteem
  • There will be an increase in levels of anxiety or apprehension
  • Transitory phase of emotional detachment

Physical Symptoms

  • 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

Kleptomania

  • Individuals are commonly unsuccessful in fighting with the impulses to steal things that are not required.
  • Individuals experience satisfaction, relief or even pleasure while carrying out the theft.
  • Individuals experience an upsurge in tension immediately prior to the action of stealing.
  • The act is mostly not an expression of anger or any other kind of emotion nor the result of delusion.
  • Behavior is commonly not due to any another mental disorder like conduct disorder, antisocial personality, or the manic phase of bipolar disorder

Pyromania

  • Effected individuals repeatedly set fire while there is no financial gain, political face, and criminal disguise, expression of revenge or anger, or impaired judgment.
  • Individuals most commonly experience a sense of arousal prior to setting the fire, followed by a sense of pleasure, relief or gratification when watching or participating in the fire
  • Behavior is mostly not due to any antisocial personality disorder, a manic episode, or conduct disorder

Pathological Gambling

  • According to DSM –III classification, the diagnosis of this behavior must include any 5 aspects of the maladaptive behavior.

Trichotillomania

  • Frequent pulling of hair, resulting in noticeable hair loss.
  • There will be a rush of tension before the action of hair-plucking
  • A sense of relief or reduced tension is felt when the hair has been pulled out
  • The condition might lead to substantial distress or damage in the individual’s social and professional functions.
  • Behavior is mostly not caused due to any other alternative mental or medical disorder

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:

Habit Reversal

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 management

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:

  • Anti-depressants
  • 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:

  1. Conducting an assessment and educating the patient
  2. Developing stress reduction skills
  3. Challenging distressing thoughts
  4. Prevent damaging behavior
  5. Development of emotion rules and pain tolerance skills
  6. Develop problem-specific coping skills
  7. 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.

Prevention

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
  • Stroke
  • Respiratory disease
  • Certain forms of cancer
  • Depression
  • Anxiety

Persons suffering from ICD along with substance abuse are more prone to suicide attempts, accidental injuries, and death by homicide.

Co-occurring Disorders

The symptoms of ICD may mirror or overlap with other mental disorders. Some of these common symptoms include:

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