Impulse Control Disorders

Definition

Impulse control disorders (ICDs) are a variety of behaviors related to excessive urges and impulsive actions. These behaviors have a negative impact on daily life that may interfere with school, work, and personal relationships. It is common for people with ICDs to have other psychological disorders.

ICDs include:

• Pathologic gambling—compulsion to gamble despite negative financial outcomes
• Kleptomania—stealing items that have little value and offer no financial gain
• Trichotillomania—compulsion to pull one’s hair, eyebrows, or eyelashes, often resulting in baldness
• Intermittent explosive disorder—excessive outbursts of verbal and/or physical rage that can result in injury to oneself and/or others
• Pyromania—compulsion to repeatedly start fires without personal or financial gain
• Sex addiction—repetitive sexual acts and compulsive sexual thoughts that interfere with normal daily life
• Internet addiction—uncontrolled or compulsive use of the Internet, which may serve as an outlet for other ICDs

Causes

The exact cause of ICDs is unknown, but they may be related to chemical imbalances in the brain. The area of the brain, called the frontal lobe, controls impulses. Changes in this area of the brain may be associated with impulse control disorders.

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Risk Factors

Factors that may increase the chance of ICDs include:

• Current or history of other psychological problems, such as bipolar disorder or obsessive-compulsive disorder (OCD)
• Personal or family history of substance abuse and/or other addictive behaviors
• Family history of psychological disorders
• Tourette syndrome
• Problems with family dynamics, such as fighting, abuse, or aggression
• Using certain medications to treat Parkinson's disease
• Complications of late-stage Parkinson's disease

Symptoms

ICDs can start at any age. Some compulsive behaviors start in childhood or adolescence. All ICD symptoms may not be present in everyone. Symptoms are specific to the disorder, but may include:

• Injuries from physical fights or burns from starting fires
• Lying and/or stealing
• Compulsive or repetitive behaviors
• Irritability, impatience, or aggravation (more than expected in specific situations)
• Marital or family problems
• Repeated problems with social relationships, or at school or work, legal or financial problems, or incarceration

People with ICDs associate their behaviors with feelings of:

• Growing tension before the act
• Pleasure, gratification, or elation during the act
• Tension relief after the act, which may or may not accompany feelings of guilt or distress

Diagnosis

You will be asked about your symptoms, and medical and substance use history. A psychological exam will be done. Some impulse control disorders are easier to diagnose because physical symptoms are visible. In others, the diagnosis may be made when a pattern of behavior has no better explanation than the presence of a psychological disorder.

Treatment

Treatment includes a combination of medications and psychotherapy.

Medications

There are no specific medications approved for ICDs, but some may provide benefits. One or a combination of medications may be necessary. It may take some time to find the right one(s). Options may include:

• Mood stabilizers
• Antidepressants
• Anticonvulsants
• Medications to control euphoric high feelings
• Antipsychotics
• Glutamatergic agents

Psychotherapy

Counseling or therapy may be done individually or in a group. Therapy will help to cope with underlying problems that contribute to ICD. It is also useful for changing and adapting behaviors that are destructive. Common approaches include:

• Cognitive behavioral therapy (CBT)—a form of talk therapy focusing on stressful situations. CBT helps you alter unhealthy thinking patterns to better manage problems that are beyond your control.
• Family therapy—to help other members of the family with communication skills, support, and understanding.

Prevention

There are no current guidelines to prevent impulse control disorder because the cause is not known. However, if you suspect that you or someone close to you has a mental illness, early treatment and intervention may help.