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Impulse Control Disorders
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Impulse Control Disorders

The 5th Edition of the Diagnostic and Statistical Manual of Mental Disorders includes a category for Disruptive, Impulse-Control, and Conduct Disorders.

All of the disorders in this category involve problems controlling behavior and emotions. The disorders are typically seen in childhood or adolescence and are rarely first seen in adulthood.

The DSM-5 lists the following impulse control disorders:

  • Intermittent Explosive Disorder (characterized by uncontrolled fits of extreme anger and violence)
  • Pyromania (characterized by irresistible urges to set fires)
  • Kleptomania (characterized by irresistible urges to steal various items from stores and homes)
  • Conduct Disorder (characterized by repetitive and persistent behaviors that violate the basic rights of other people or that violate age-appropriate societal rules)

Several disorders were previous...

 
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What are Impulse Control Disorders?

The 5th Edition of the Diagnostic and Statistical Manual of Mental Disorders includes a category for Disruptive, Impulse-Control, and Conduct Disorders.

All of the disorders in this category involve problems controlling behavior and emotions. The disorders are typically seen in childhood or adolescence and are rarely first seen in adulthood.

The DSM-5 lists the following impulse control disorders:

  • Intermittent Explosive Disorder (characterized by uncontrolled fits of extreme anger and violence)
  • Pyromania (characterized by irresistible urges to set fires)
  • Kleptomania (characterized by irresistible urges to steal various items from stores and homes)
  • Conduct Disorder (characterized by repetitive and persistent behaviors that violate the basic rights of other people or that violate age-appropriate societal rules)

Several disorders were previously listed in this category, but have now been moved to other sections. These include:

  • Exhibitionism (characterized by recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving the exposure of one's genitals to an unsuspecting stranger)
  • Pathological Gambling (characterized by compulsive, uncontrollable gambling)
  • Trichotillomania (characterized by uncontrollable hair twisting and pulling, often resulting in bald spots on an otherwise normal-haired person)

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What is Intermittent Explosive Disorder?

  • Intermittent Explosive Disorder is classified in the DSM-5 in the category of Disruptive, Impulse-Control, and Conduct Disorders. All of the disorders in this category involve problems controlling behavior and emotions.
  • The major symptom of this disorder can be either one of the following:
    • Recurring behavioral outbursts or aggressive impulses that the person is not able to control. This can be verbal aggression (temper tantrums, verbal arguments, name-calling, etc.) or physical aggression toward people, animals, or property. The physical aggression does not result in damage to the property or physical injury to other people or animals. These outbursts must occur at least twice a week, on average, for at least 3 months in order for a diagnosis to be made.
    • Three behavioral outbursts in a 12-month period that involve damage to property and/or causes physical injury to other people or animals.
  • These outbursts are not planned or thought about ahead of time and are not designed to intimidate or get something from others. In the heat of the moment, the person is completely unable to control their angry or aggressive impulses and react toward others because of these feelings.
  • The outbursts also cause either distress in the individual or impairment in their relationships with others, problems at school or work, and are typically associated with financial or legal consequences.
  • The person must be at least 6 years old (or at an equivalent developmental level) in order to receive a diagnosis of Intermittent Explosive Disorder.
  • According to research, approximately 2.7% of the United States population meets the criteria for this disorder. It is typically more common in younger individuals and in those with a high school education or less.
  • Onset for the disorder is generally in late childhood or adolescence and is rarely seen for the first time in those over 40 years of age.
  • Disorders that are most commonly seen with Intermittent Explosive Disorder include depressive disorders, anxiety disorders, substance use disorders, antisocial personality disorder, borderline personality disorder, and other disruptive behavior disorders (ADHD, conduct disorder, oppositional defiant disorder).
  • There are two main treatments for this disorder, which are psychotherapy and medication.

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What is Pyromania?

  • Pyromania is classified in the DSM-5 in the category of Disruptive, Impulse-Control, and Conduct Disorders. All of the disorders in this category involve problems controlling behavior and emotions.
  • The symptom of this disorder include:
    • Deliberately and purposefully setting a fire more than one time.
    • Tension or emotional arousal being present before the act of setting the fire.
    • Having a fascination with, interest in, curiosity about, or attraction to fire and its uses and consequences. The person may be a "watcher" at neighborhood fires, set off false alarms, spend time at the local fire station and want to be associated with the department.
    • Feeling pleasure, relief or gratification when setting fires or when seeing the damage causes by and aftermath of the fire.
    • The fires are not set for monetary gain, to cover up criminal activity, to express anger or vengeance, in response to any hallucinations or delusions, or as a result of impaired judgment (from another disorder or substance).
    • The fire setting is not better explained by conduct disorder, a manic disorder, or antisocial personality disorder.
  • It is not currently known what how common pyromania is, but it appears to be very rare as a main diagnosis.
  • Disorders that are most commonly seen with pyromania include substance use disorders, gambling disorder, depressive and bipolar disorders, and other disruptive, impulse-control, and conduct disorders.
  • There are two main treatments for this disorder, which are psychotherapy and medication.

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What is Kleptomania?

  • Kleptomania is classified in the DSM-5 in the category of Disruptive, Impulse-Control, and Conduct Disorders. All of the disorders in this category involve problems controlling behavior and emotions.
  • The symptoms of this disorder include:
    • compulsive stealing of items that are not needed for personal use or for their monetary or other value. The items stolen typically have very little value to the person and they often could have paid for it instead of taking it. After stealing the item, the person will often throw it away or give it to someone else, rather than keeping it, but sometimes will hoard the items or eventually return them in secret. The thefts are usually not planned ahead of time and do not involve the help of others, instead it is an impulse in the moment that is not resisted.
    • feeling an increased level of tension before the stealing occurs.
    • feeling pleasure, gratification or relief when committing the stealing.
    • the stealing is not done to express anger or vengeance and isn't related to a delusion or hallucination.
    • the stealing is not better explained by conduct disorder, a manic episode, or antisocial personality disorder.
  • Research has found that 4-24% of individuals arrested for shoplifting have kleptomania. In the general population, it is very rare at about 0.3-0.6% and is found in females at three times higher a rate than in males.
  • The DSM-5 reports that kleptomania is associated with compulsive buying, as well as depressive disorders, bipolar disorder, anxiety disorders, eating disorders (particularly bulimia nervosa), personality disorders, substance use disorders (especially alcohol use disorder), and other disruptive, impulse-control, and conduct disorders.
  • Those with this disorder often feel a lot of shame at their inability to resist stealing and therefore, often do not seek treatment on their own. When they do finally enter treatment, there are two main treatments for this disorder, which are psychotherapy and medication.

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What is Conduct Disorder?

  • Conduct Disorder is one of the most frequently diagnosed mental disorders in children. A child with Conduct Disorder engages in repetitive and persistent behaviors that violate the basic rights of other people or that violate age-appropriate societal rules and norms for behavior with others.
  • This behavior falls into four different categories including aggression to people and animals, destruction of property, deceitfulness or theft, and serious violations of rules.
  • Symptoms of conduct disorder may include:
    • Bullying, threatening, or intimidating behavior towards other children
    • Frequent starting of physical fights
    • Use of weapons or tools capable of causing serious physical harm to people or property (e.g., bricks, bats, broken bottles, knives, guns)
    • Physical cruelty toward animals or people
    • Stealing while confronting a victim (e.g., mugging, purse snatching, armed robbery)
    • Physical violence towards others (in the form of rape, assault, homicide, etc.)
    • Destruction of property (e.g., fire setting, breaking of windows, breaking into homes, buildings or cars)
    • Frequent and manipulative telling of lies or breaking of promises in order to obtain goods, favors, or to avoid debts or obligations (e.g., "conning" people)
    • Staying out at night despite parent's curfew rules (before the age of 13)
    • Repeatedly running away from home, or running away from home for a lengthy period of time
    • Use of alcohol or drugs
    • Truancy (skipping school) before the age of 13
  • Symptoms of conduct disorder vary with age, changing as children develop increased strength, cognitive abilities and sexual maturity. Less severe behaviors, such as lying and shoplifting, usually emerge first, while other, more severe behaviors, such as burglary or auto theft, usually emerge later.
  • According to the DSM-5, the child/adolescent must display at least three of the identified 15 behaviors in the past 12 months from any of the four categories and at least one must have occurred in the last six months for a diagnosis to be made.
  • The prevalence rate for Conduct Disorder ranges from 2-10% of the general population across various countries, races and ethnicities. The rates increase from childhood to adolescence, and are higher in males than females.
  • Treatments for Conduct Disorder can include behavior therapy, cognitive-behavior therapy, parent management training, cognitive problem-solving skills training, functional family therapy, and medication.

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What is Exhibitionism or Exhibitionistic Disorder?

  • Prior to the release of the DSM-5 in 2013, Exhibitionism was classified as another impulse control disorder.
  • The symptoms of this disorder include a person having recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving the exposure of one\'s genitals to an unsuspecting stranger over a period of at least 6 months. The person has either acted on these impulses with a nonconsenting person or the fantasies and sexual urges are causing clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  • In the DSM-5, this disorder has been reclassified to be a Paraphilic Disorder and renamed Exhibitionistic Disorder.
  • A paraphilia involves intense and persistent sexual interest (recurrent fantasies, urges or behaviors of a sexual nature) that center around children, non-humans (animals, objects, materials), or harming others or one\'s self during sexual activity. Sometimes this sexual interest focuses on the person\'s own erotic/sexual activities while in other cases, it focuses on the target of the person\'s sexual interest.
  • Please see our Sexual Disorders center for more information.

What is Pathological Gambling?

  • Prior to the release of the DSM-5 in 2013, Pathological Gambling was classified as an impulse control disorder.
  • This diagnosis is made when a person is unable to resist impulses to participate in gambling activities even though doing so has resulted in negative consequences.
  • In the DSM-5, this disorder has been reclassified to be an Addiction Disorder. Gambling disorder was included in Addictions because it has been well researched and neurological similarities between gambling addiction and drug addiction have been found. There also appears to be a genetic basis as well with gambling disorder (APA, 2013).
  • Please see our Addictions center for more information on Gambling Addiction.

What is Trichotillomania?

  • Prior to the release of the DSM-5 in 2013, Trichotillomania, also known as hair-pulling disorder, was classified as an impulse control disorder.
  • This disorder involves the recurrent pulling (removal) of one\'s hair from any part of their body with the most common sites are the scalp, eyebrows, and eyelids. These behaviors are usually performed in private, are more common in women and often begin during the onset of puberty.
  • Many people with trichotillomania try to stop the behavior but feel unable to do so. This sense of being unable to avoid performing a particular behavior is very similar to the compulsions in obsessive-compulsive disorder (OCD). While there are differences from OCD, the DSM-5 moves this disorder to the same classification family of Obsessive-Compulsive Disorder Spectrums.
  • Please see that center for more information on Trichotillomania.


 
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