Impulse Control Disorders

An impulse control disorder is a reoccurring failure to resist impulses to do things that are harmful to self or to others.¹

For example:

A person with an impulse control disorder (pyromania) might experience an urge to set a fire, be unable to resist that urge and actually set a fire – with the likely consequence of harm to self or others.

A person with an impulse control disorder (trichotillomania) might experience urges to pull hair from the scalp, be unable to resist these urges (if even aware of them) and be left with embarrassing patches of baldness.

The Types of Impulse Control Disorders

Intermittent Explosive Disorder

– Characterized by a reoccurring failure to resist angry impulses and aggressive outbursts that result in violence or damage to property. These aggressive outbursts are far out of proportion to the situation and the behaviors are not better explained by another mental health condition (schizophrenia for example) or another medical condition (Alzheimer’s for example).

Kleptomania

– Characterized by recurring impulses to steal things that you do not need or even necessarily want and that have no great monetary value. People with kleptomania often feel rising anxiety prior to an act of theft that is relieved by stealing something. Immediately after the act, people with the disorder may feel relief or excitement for a while, but this is typically soon replaced by feelings of guilt or distress. To meet a diagnosis of kleptomania, you must not steal for financial reasons or out a desire for revenge or out of anger. Your thefts cannot occur as a result of a hallucination and no other medical or psychiatric condition may better explain your actions.

Pyromania

– Characterized by a fascination with watching and lighting fires and recurring fire setting - a recurring need to light fires and a feeling of tension or anxiety before fire-lighting that is relieved by the act. To meet a diagnosis of pyromania, you must not set fires for financial gain, as an act of violence or revenge, as an act of war, to hide a crime, as a result of substance impaired judgment or as a result of a hallucination. No other mental health disorder may better explain the behaviors. Although some arsonists are pyromaniacs, many are not.

Pathological Gambling

– Characterized by an obsession with gambling, an inability to control gambling behaviors despite legitimate attempts to stop or slow down, feeling irritable when unable to gamble, using gambling as a way to escape from negative feelings, committing crimes to raise gambling funds, losing a job or important relationship due to gambling, needing to bet ever large amounts of money to experience the same feelings of excitement, chasing losses with more gambling, lying to others about your gambling and asking for or borrowing money from those around you to help cover gambling debts. People with a pathological gambling disorder must display 5 of the above symptoms and their behaviors must not be better explained by a manic episode.

Trichotillomania

– Characterized be recurring urges that lead you to pull out your hair. This hair pulling is preceded by feelings of tension or anxiety and these feelings are relieved by the act of pulling hair. To meet a diagnosis of trichotillomania, your hair pulling must also cause you significant distress or social or occupational impairment and you may not have another mental health disorder that better explains your behaviors.

Impulse Control Disorders Not Otherwise Specified

– This is an umbrella term that can be used by clinicians to describe a disorder that is not explained by any of the above conditions but that occurs as a result of a failure to control impulses. Some examples may include compulsive sexual behaviors or exhibitionism, compulsive shopping or buying or compulsive self mutilation behaviors. ²

Prevalence

Impulse control disorders are relatively uncommon disorders.

It’s estimated that:³

• Between 1% and 3% of the general public suffer from pathological gambling disorder
• Less than 1% suffer from kleptomania
• Trichotillomania affects 1% to 4% of the general population
• Between 4% and 5% live with intermittent explosive disorder

What Causes Impulse Control Disorders?

The precise causes of impulse control disorders remains unknown, but like most mental health disorders, experts suggest that a combination of genetic and environmental factors interact to produce these conditions.

For example:

For intermittent explosive disorder, researchers think that environmental factors like growing up in a violent or volatile household may increase a person’s susceptibility to the disorder. Genetically, people with the disorder may have increased testosterone levels and altered serotonin functioning.⁴

Are People With Impulse Control Disorders at an Increased Risk of Other Mental Health Conditions?

Yes, people with most impulse control disorders are at an increased risk to also live with another mental health challenge. For example:⁵

• Pathological gamblers are at an increased risk of depression, suicidal ideation and suicide, drug and alcohol abuse and addiction, Obsessive compulsive disorder, borderline personality disorder and phobias.
• People with kleptomania are more likely to experience panic disorder and bulimia
• People with trichotillomania are very likely to also experience obsessive compulsive disorder

Impulse Control Disorder Treatments

Although treatments vary by condition and greatly by situation, treatments for most types of impulse control disorders combine psychotherapies, like cognitive behavioral therapy, with medications, like SSRI anti depressants.

Some treatments that have proven effective for impulse control disorder symptoms include:⁶

• Cognitive Behavioral Therapy (CBT) – CBT has proven itself an effective psychotherapy for the treatment of a range of impulse control disorders. The benefits of CBT include its relative speed of effectiveness and that it teaches ‘real world’ skills that can be put into practice immediately to reduce symptoms severity – and that last beyond the period of treatment. (Learn more about CBT).
• Group Psychotherapy – Group therapy is often used in the treatment of pathological gambling and other impulse control disorders.
• Self Help Groups – Gambler’s Anonymous offers free to attend meetings for those seeking support for compulsive gambling issues.
• Naltrexone – Used to reduce the cravings associated with pathological gambling⁴
  
• Anti Depressants – SSRI anti depressants have shown some efficacy in treating impulse control disorders, such as trichotillomania, pathological gambling, intermittent explosive disorder and kleptomania.

Parkinson’s Medications and Impulse Control Disorders

Parkinson’s patients taking medications that alter dopamine in the brain are at an increased risk to experience an impulse control disorder, particularly people with a history of substance abuse or a personal or family history of depression.

Because of this, it’s wise to be aware and to ask friends and family to be aware of altered behaviors that could indicate a problem.

Be on the lookout for problems with:⁷

• Overspending
• Problem gambling
• Compulsive sexual behaviors
• Overeating
• Other impulsive behaviors

Should you or a family member observe worrying behaviors that accompany your intake of Parkinson’s medications, discuss the problem with your doctor. Your doctor may recommend a dose reduction or a change in medication. In some cases, it’s best that you stay on the medication that’s causing the problem, and in such cases, the negative consequences of the impulse control behaviors can sometimes be minimized; by strategies such as having a spouse control the family’s finances, or blocking internet access to gambling sites, for example.⁸