Impulse control disorders are psychiatric disorders characterized by the repeated inability to refrain from performing an action that is harmful to either oneself or to others.
The American Psychiatric Association (APA) in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) classifies impulse control disorders as disorders of behavioral and emotional control. Impulse control disorders are closely related to conduct disorder and obsessive-compulsive disorders and frequently occur in individuals with attention deficit/hyperactivity disorder (ADHD). Many individuals with impulse control disorder have other mental problems such as anxiety, depression, and substance abuse.
Specific impulse control disorders include pyromania (intentional fire setting), intermittent explosive disorder, and kleptomania (compulsive stealing). Other disorders such as sexual compulsions, compulsive gambling, compulsive shopping, Internet addiction, hoarding, and trichotillomania (compulsive hair pulling) have strong elements of impulsivity but are considered either addictions or obsessive-compulsive disorders.
Pyromania involves the repeated setting of fires that are not related to such motives as sabotage, insurance fraud, or revenge. Rather, the pyromaniac is someone who tends to have a fascination with fire itself, often expressed as an interest in firefighters and their procedures and equipment. It is common for a pyromaniac to set a fire, report it himself, and then watch as firefighters put it out, even offering to assist them. Pyromania can occur in a child as young as age three, although it is rare at any age and even rarer in childhood. While children and adolescents account for over 40% of those arrested for arson in the United States, only a small percent of fires set by young people indicate the presence of pyromania. Juvenile fire setting is usually attributed to more generalized conditions characterized by a broad range of impulsive and/or antisocial behavior, such as conduct or adjustment disorders or ADHD.
Impulse control disorders are thought to have both neurological and environmental causes and are known to be exacerbated by stress. These disorders have five stages. The impulse thought occurs and is typically followed by feelings of increased tension and excitement. Acting on the impulse produces pleasure followed by a sense of relief and gratification, and then often—but not always—accompanied by guilt or remorse.
Treatment includes both psychotherapy and medication. Researchers have discovered a link between the control of impulses and the neurotransmitter serotonin, a chemical agent secreted by nerve cells in the brain. Selective serotonin reuptake inhibitors (SSRIs) drugs such as fluoxetine (Prozac) often used to treat depression or clomipramine (Anafranil), often used to treat obsessive-compulsive disorders, have had mixed success in treating impulse control disorders. Treatment is complicated by the common presence of other mental health problems in individuals with impulse control disorders.
See also Conduct disorder ; Obsessive-compulsive disorder .
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed. Washington, DC: Author, 2013.
Grant, Jon E., and Marc N. Potenza, eds. The Oxford Handbook of Impulse Control Disorders. New York: Oxford University Press, 2012.
Parks, Peggy. Impulse Control Disorders. San Diego: ReferencePoint Press, 2013.
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National Institute of Mental Health. “Aggression-related Gene Weakens Brain's Impulse Control Circuits.” http://www.nimh.nih.gov/science-news/2006/aggression-relatedgene-weakens-brains-impulse-control-circuits.shtml (accessed July 24, 2015).
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