​Impulse Control Psychological Disorders:
Impulse-control disorders are characterized by the repeated inability to refrain from performing a particular action that is harmful either to oneself or to others(Gale Encyclopedia of Mental Health, Second Edition pg. 597). Impulse-control disorders are generally accompanied by another self-esteem or personality disorder. It's basically a "failure to resist an impulsive act/behavior in which the person has no self control."

It is usually classified into six main categories:
  • Intermittent Explosive Disorder
  • Kleptomania
  • Pyromania
  • Pathological Gambling
  • Trichotillomania
  • Not Otherwise Specified

Intermittent Explosive Disorder: This is in the presence of a reaccuring failure to resist impulsive aggressive destruction of property or assault of others in excess. It is the inability to control one's violent actions/behaviors. This is not to be confused with bad temper or behavior- it goes above and beyond that.

Symptoms
IED usually presents as explosive fits of anger lasting usually around ten to twenty minutes. Those episodes can and often will result in [[#|bodily injury]] and intentional destruction of items of value. Following episodes people with IED may feel remorse, regret or embarrassment for their actions. Additionally episodes may occur in clusters or be separated by months of nonaggression. IED is an uncontrollable impulse of anger, people with IED cannot control their anger.
Episodes may be accompanied by, preceded by or followed by:
  • Tingling
  • Tremors
  • Palpapations
  • Chest Tightness
  • Head Pressure
  • Hearing an echo

Case [[#|Study]]

Name: Kyle F.
Age: 27
History: Kyle has never maintained a stable relationship, and has difficulty keeping jobs. He has been an alcoholic for six years. Kyle has terrible bouts of road rage, and in a few instances, has admitted to intentionally hitting others who have earned his ire. A recent incident saw Kyle breaking his neighbor's windshield upon the discovery that his neighbor's car was parked in Kyle's driveway. He feels what he describes as "head tensions" prior to outbursts of anger, and after the episode, he feels exhausted, with a depressed mood, and he turns to drinking.

Risk Factors
Most people with IED grew up in families where similar aggressive behavior and verbal and physical abuse were common. Children exposed to this type of violence at an early age greatly increases their chance of exhibiting similar traits as they mature. People with traits that are common to personality disorders such as dramatic, antisocial or narcissistic behavior patterns are especially prone to having IED.

Domestic Violence: This disorder is majorly correlated with the disorder known as IED. With IED shown above it is an outbreak of rage and violence that can be taken out on objects or people. With IED, domestic violence is a common symptom with IED. With this they can hurt or destroy a close relationship such as a marriage or a close friendship. Domestic Violence is almost always present with IED.

As found on MayoClinic.com


IED video


Kleptomania:
This disorder is characterized by a constant urge to steal things that have little to no value to a person. People suffering from Kleptomania do not steal for personal gain other than a natural good feeling. Kleptomania is a complex disorder characterized by repeated, failed attempts to stop stealing. It is often seen in patients who are chemically dependent or who have a coexisting mood or eating disorder. Other coexisting mental disorders may include [[#|major depression]], panic attacks, social phobia, anorexia nervosa, bulimia nervosa, substance abuse, and obsessive-compulsive disorder. People with this disorder have an overwhelming urge to steal and get a thrill from doing so. Often there is no need to steal or the person has the means to pay themselves for the item they stole. The recurrent act of stealing may be restricted to specific objects, but the affected person may or may not describe these special preferences. People with this disorder usually exhibit guilt after the theft.

Start this video at 1:55

Symptoms
The DSM IV lists five diagnostic criteria for kleptomania:
    • Repeated theft of objects that are unnecessary for either personal use or monetary value.
    • Increasing tension immediately before the theft.
    • Please or relief upon committing the theft.
    • The theft is not motivated by anger or vengeance, and is not caused by a delusion or hallucination.
    • The behavior is not better accounted for by a conduct disorder, manic episode, or antisocial personality disorder.

Case Study
Name: Carolynn S. Kohn and David O. Antonuccio
Case Study: Little research exists examining the treatment of kleptomania, particularly in men. This case study illustrates the treatment of a male client with kleptomania in which depression, suicidal ideation, and potential legal complications were present. Strategies included covert sensitization, behavioral chaining, problem solving, cognitive restructuring, and use of homework. On completion of treatment, symptoms of depression and kleptomania had decreased significantly. At 16-week follow-up, the client reported continued remission of kleptomania and depressive symptoms. Treatment complications are discussed, and recommendations to clinicians are made (Abstract).

Name: N. Abrams
Age: 23
History: She comes from an upper middle class family, and though she has more than enough funds to pay for the items she steals, she continues to steal impulsively. When she is in shopping situations, she must be accompanied by a friend, for she does not trust herself to be alone. She gets greatly nervous and anxious in shopping situations or environments. In order to relieve the tension she feels, she smokes marijuana, finding that the high poses a distraction from her sudden urges to steal. She has turned to stealing low-value items, so that in the event she is caught, the penalty will be large.

Name: Terrence Shulman
History: Suffering from kleptomania since 1990, this attourney started the Shulman center to organize anonymous groups to help people recover from kleptomania or other addictions. Not only does it help others, but it is vital overcoming his own impulses to steal. He has appeared on shows many shows such as Oprah and the Today Show. He also runs a website, The Shulman Center.
“I have been in recovery from addictive-compulsive stealing since 1990. I have been an attorney at law since 1992 and an addictions therapist since 1997. I have counseled thousands of persons with theft and spending issues from across the globe. I know, intimately, the secret hell people feel: the guilt, shame, fear, confusion and desperation of not knowing where to turn. Helping people recover from addiction is more than my job… it’s my life.” - Terrence Daryl Shulman





Definition: Pyromania is defined as a pattern of deliberate setting of fires for pleasure or satisfaction derived from the relief of tension experienced before the fire-setting. The name of the disorder comes from two Greek words, pyr meaning "fire" and mania meaning "loss of reason" or "madness." The clinicians handbook, the Diagnostic and Statistical Manual of Mental Health, also known as the DSM, classifies pyromania as a disorder of impulse controlm, meaning that a person with pyromania fails to resist the impulsive desire to set fires - as opposed to the organized planning of an arsonist or terrorist.
As found on: http://psychology.jrank.org

Causes and Symptoms:
Most studies on the causation of pyromania have focused on children and adolescents who set fires. Early studies in the field used categories from Freudian psychoanalysis to explain the behavior. Freud hypothesized that fire setting represented the regression to a primitive desire to demonstrate power over nature.
Treatments:
Children and adolescents:
Treatment of children and adolescents involved with repeated fire setting appears to be more effective when it follows a case management approach rather than a medical model, because many young fire setters come from chaotic household. Treatment should begin with a structured interview with the parents as well as the child, In order to evaluate stresses on the family, Patterns of supervision and discipline, and similar factors. The next stage to treatment should be tailored to the individual child and his or her home situation. A variety of treatment approaches including problem solving skills, anger management, communication skills, aggression replacement training, and cognitive restructuring may be necessary to address all the emotional and cognitive issues involved in each case.
Adults:
Pyromania in adults is considered difficult to treat because of the lack of insight and cooperation on the part of most patients diagnosed with the disorder. Treatment usually consists of a combination of medication, usually one of the selective serotonin reuptake inhibitors, and long-term insight-orientation. Anger management, communication skills, aggression replacement training, cognitive restructuring, and psychotherapy.


Prognosis: If the pyromaniac is child or adolescent, the impulse may be a cry for help, and it the disorder may require, and improve from therapy. Adults do not fare as well considering spontaneous remission is a common experience for a recovering pyromaniac. Prognosis



Pathological Gambling: this disorder occurs when a person gambles compulsively to such an extent that the wagering has a severe negative effect on his or her job, relationships, mental health, or other important aspects of life. The person may continue to gamble even after they have developed social, economic, inter-personal, or legal problems as a result of gambling. It is uncontrollable gambling well beyond the point of a social or recreational activity. People who are addicted may lose their life savings and may even commit crimes (stealing, embezzling, or forging checks) relationships and jobs may also be lost as well.
Causes of Pathological Gambling:
  • Brain disease
  • The central pathway involved is the mesolimbic pathway of dopamine signaling
  • Depression and substance use disordercan contribute to excessive gambling
  • Many people with this disorder are highly superstitious or believe they can control the outcome of events




Trichotillomania:
Trichotillomania is a disorder that causes people to pull out the hair from their scalp, eyelashes, eyebrows, pubic area, underarms, beard, chest, legs or other parts of the body, resulting in noticeable bald patches. Hair pulling varies greatly in its severity, location on the body, and response to treatment. For some people, at some times, trichotillomania is mild and can be quelled with a bit of extra awareness and concentration. For others, at times the urge may be so strong that it makes thinking of anything else nearly impossible (Pulling).

It is grouped with nail biting and skin picking as a "Body-focused Repetitive Disorder" or BFRB. In the DSM-IV, it is classified as an Axis I disorder and has the following symptoms:
  • Recurrent pulling out of one's hair resulting in noticeable hair loss
  • An increasing sense of tension immediately before pulling out the hair or when attempting to resist the behavior
  • Pleasure, gratification, or relief when pulling out the hair
  • The disturbance is not better accounted for by another mental disorder or due to a general medical condition (i.e., dermatological condition)
  • The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning



Case Study:

Name: Ling C.
Age: 17
History: Ling wears a hat in public, and has done so for the past two years, as well as utilizing makeup to draw on her eyebrows. She often suffers from stomach pains due to the hair ingestion. She tells of hiding in her bathroom, tearing out her hair, and though her parents have expressed concern, Ling expressly denies it. She enjoys using her hair to caress her cheek inside her mouth. When she is deprived of the ability to pluck, such as in school, she feels uptight and tense, taking many trips throughout the day to pluck. Her friends and classmates have also become suspicious.

Name: Kurt D. Michael
Age: 21
Case study for treatment: Once considered a rare clinical condition, trichotillomania is now recognized as a psychological disorder that is more prevalent than previously thought. The behavioral treatment of a 21-year old college woman with a longstanding history of chronic hair pulling is described in this case study. The extent of the trichotillomania was measured during an 11-day baseline period (self-monitoring, photographs) followed by 4 months of behavioral treatment including prominent components of habit-reversal training. The results of the interventionwere suggestive of a substantial reduction in hair pulling incidents, hair regrowth in the affected parts of her scalp, and self-reported improvements in mood, anxiety, and self-esteem. Limitations of these data are reviewed and recommendations for clinicians who intend on treating trichotillomania are provided (Abstract).


Treatment
Since Trichotillomania is currently thought to be a variation of Obsessive Compulsive Disorder (OCD), similiar types of treatments are used. Behavioural therapy, stress reduction, and psychotherapy are used either singularly or in conjunction with pharmacological treatments such as SSRI’s (eg. Prozac).
http://forensicpsychiatry.ca/impulse/trich.htm

http://www.trichotillomania.co.uk/Home/Cure.htm

1. Community. A sense of belonging to something is crucial nurturing close relationships. Self-expression. You may feel shy, but isolation will increase your urges to pull.
2. Eat healthily and frequently. Regularity of food, sleep, exercise, activity, inactivity and companionship are essential for Growth.
3. Consciously choose positive thought when faced with negative thought.
4. Act happy, change body language, posture and smiling.
5. Meditate : live in the NOW and give full attention to everything you do.
How are they all connected?
Impulsivity is what links all of these disorders together which leads to sufferers seeking short term gain or feelings with the result of a long term loss. The biology of impulsive behavior has been linked to the prefrontal cortex of the brain, which is an area of the brain that is responsible for judgement and decision making. In addition, the neurotransmitter dopamine has been linked to impulse control, but scientists still are unsure the exact relationship. Like in TTM people have the short term gain while pulling out thier hair, but then they have to face the long term loss of their hair.
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Not Otherwise Specified:
Drug Addiction: A dependence on a street drug or prescription medication.
Symptoms: Interpersonal problems, legal problems, continual use of substance despite hazard to physical well being, cannot fufill roles in career and home, unable to control behavior under the influence, preoccupation with using of the drug, tolerance and physiological dependence.

Sex Addiction: This is addiction to masturbation, compulsive promiscuity, and compulsive use of telephone sex lines and porn.

Repetitive Self Mutilation: Individuals feel the need to cut, carve, and burn their skin- often not letting previous wounds heal.

Compulsive Shopping: Also known as oniomania, it's the inabilty to control the urge to shop- and often after shopping there is the release of endorphins, along with remorse and regret. It's often very mood enhancing.

Case Study

Name: Mary Cat.
Age: 32
History: Mary is habitually promiscuous, and has been so since the dissolution of her marriage to a sexually abusive man one year ago. She develops the sudden urge to have sex at inopportune times, and as a result she has lost jobs due to the onset of the urge, during which she asks co-workers if they would engage in the act with her. She has now turned to a male escort service to satiate her sudden sexual urges, and fears getting venereal disease. After the act, she feels a sense of relief and great pleasure, as well as the vanishing of the urge.

Many examples of people who are unable to control their impulses can be seen in the show "My Crazy Obsession." Each episode focuses on a different individual who faces a particular struggle in always giving in to their impulses. All individuals do so in a manner that gets in the way of their normal life functioning. One example of this can be noted in the episode where a couple is obsessed with purchasing cabbage patch dolls. This couple had such a hard time with controlling this impulse, that they ended up owning several hundred dolls as well as a multi-thousand dollar playground built in the backyard specifically for the dolls. This significantly harmed the couples living space, as well as their social life.


About these disorders