Loss of control over impulses happens to everyone at some point. For example, you have decided not to eat sweets today, but when you walk past Jamin you can’t resist buying a bag of sweets. Another example is when you have an argument and you don’t really want to hurt the other person, but because of your anger you say things to the other person that you don’t mean. This behavior is generally quite normal, unless you cannot control your impulses to such an extent that it limits your (daily) functioning, you (and/or others) suffer greatly from it and you cannot resist the impulses. If this is the case, there is an impulse control disorder.
Contents
- Intermittent explosive disorder
- Kleptomania (cleptomania)
- Pyromania (pyromania)
- Pathological gambling
- Trichotillomania (trichotillomania)
Intermittent explosive disorder
This disorder means that the person has no control over aggressive impulses. This often leads to the destruction of property or the commission of serious acts of violence. The aggressiveness shown is very out of proportion to the stressors the person experiences. The symptoms – which the people themselves describe as an attack – subside spontaneously and quickly. After such an episode, people often feel guilty. The disorder can begin at any age, but largely occurs in late adolescence/early adulthood. In most cases, the severity of the disorder decreases as they get older. This disorder is more common in men than in women and there appears to be a lot of comorbidity (multiple disorders in addition to this disorder) with other impulse control disorders, substance use and mood and anxiety disorders. Often people with this disorder have a history of alcohol dependence, violence and emotional instability. They also report that they have often lost jobs, had marital problems and had run-ins with the police. This disorder is best treated with a combination of medication and psychotherapy.
Kleptomanie (kleptomania)
In this disorder, the person cannot control the impulse to steal objects that are not used for personal purposes or for the monetary value of the object. Often they simply have enough money to buy the objects. The prevalence for this disorder is unknown, but is estimated at 0.6% of the population. Three times as many women as men have kleptomania. The disorder generally begins in late adolescence, but it can begin in childhood and is usually chronic. The stealing is not planned and they usually do it when they are alone. The stolen objects are often given away by the kleptomaniac to others, secretly returned or kept and hidden. The person does this just for the thrill and feels pleasure, satisfaction or relief from committing the theft. The person does not do this out of feelings of anger or revenge. These people usually steal from stores, but they also sometimes steal from family members in their own households. Kleptomaniacs often feel guilty and ashamed of their behavior. They often have serious interpersonal problems and show signs of personality disturbances. This disorder also appears to have a high comorbidity, especially with mood disorders, anxiety disorders, eating disorders, substance use and alcoholism. The disorder can be treated with insight-oriented psychotherapy, but the effectiveness depends on the client’s motivation. Treatment with medication and electroconvulsive therapy also appear to be effective.
Pyromania (pyromania)
Individuals with this disorder deliberately and purposefully set fires several times. It is much more common in men than in women: a ratio of 8 to 1. People with pyromania can often be recognized by their fascination and great interest in fire and the surrounding situation. Curiosity about fire and being attracted to fire can also be characteristic of pyromaniacs. During the act they also feel pleasure, satisfaction and relief and it is often the case that they look at the consequences of the fire. These acts are also aimed at getting a kick out and not anger, revenge, covering up a crime or expressing a certain belief. Unlike kleptomania, a pyromaniac prepares himself for his act. They show no remorse for their actions and are indifferent to the consequences for the lives and property of others. Pyromania is often associated with other disorders such as substance abuse, mood disorders, personality disorders such as borderline personality disorder and antisocial personality disorder, ADHD and mental retardation. Also, pyromaniacs are often drunk, have chronic personal frustrations, sexual dysfunctions, and a grudge against authorities. Research still needs to be done into the age of onset of the disorder and type of treatment. Children are easier to treat than older people, because they have almost no motivation to stop their behavior. Prevention is very important for pyromania in children. Family therapy and behavioral therapy could be possible therapies.
Pathological gambling
Pathological gambling means that the person exhibits recurrent and persistent maladaptive gambling behavior and must have at least five of the following characteristics:
- The person is preoccupied with gambling (thinking about ways to get money, planning the next gamble, etc.)
- The person needs more and more money to gamble to achieve the desired level of excitement.
- The person has made few successful attempts to control, reduce, or stop gambling.
- The person is irritable or restless when attempting to reduce or stop gambling.
- The person uses gambling as a means of escaping from problems or a negative mood (depression, anxiety, guilt, sadness).
- The person often returns to try to win back the money gambled.
- The person lies to family, friends and/or therapist about gambling.
- The person has done illegal acts to pay for gambling (fraud, scamming, theft).
- The person has lost or at least jeopardized many relationships, work or career opportunities due to gambling.
- The person relies on others for financial support to alleviate the financial loss from gambling.
The prevalence of this disorder is estimated at around 1% of the population. It is three times more common in men than in women. The disorder usually begins in adolescence in men and somewhat later in women. It is a chronic disorder if not treated properly. Comorbidity with pathological gambling occurs with mood disorders, substance abuse, ADHD, personality disorders (narcissistic, antisocial and borderline personality disorders) and other impulse control disorders. Individuals with this disorder appear overconfident and energetic and often spend their money on everything without thinking too much. They usually show signs of personal stress, worry and depression. They often think that money is both the problem and the solution to all their problems. Rarely do these people seek help for this problem themselves: they are often more or less forced by family members or come to the psychologist for other problems, such as their depression. Treatments may include: Gamblers Anonymous (GA, where pathological gamblers come together to talk about their problems and try to solve the problem), insight-oriented psychotherapy, family therapy, cognitive behavioral therapy or temporarily removing them from their triggering environment for their gambling impulses. When these people suffer from other disorders such as depression, medication is often also given.
Trichotillomanie (trichotillomania)
People with trichotillomania keep pulling out their own hair. This leads to noticeable hair loss. Not only scalp hairs are pulled out; Eyebrow hairs, eyelashes, beard, armpits, hair on the torso and pubic area are also plucked bald. Some also put the hair in their mouth and then chew on it. These individuals feel intense tension before pulling out their hair or feel tension when they attempt (unsuccessfully) to control their impulses. When the person pulls out his or her own hair, they feel relief, pleasure, or satisfaction. This makes it more likely that they will repeat the actions. The prevalence is estimated at between 0.6% and 3.4% of the population, with women 9 times more likely to have the disorder than men. The prevalence may be higher in men as they are likely to be better at hiding it. The disorder is chronic and usually begins in adolescence before the age of 17. However, there is also a child variant of this disorder where it occurs equally often in girls and boys. This form is somewhat milder dermatologically and psychologically. Head banging, nail biting, scratching and other forms of self-harm are common with this disorder. The disorder is often co-morbid with obsessive-compulsive disorder, Tourette syndrome, mood disorders (especially depression), eating disorders and personality disorders. Individuals with trichotillomania are often treated by psychiatrists and dermatologists simultaneously. Medicines and therapies are used as treatment. Therapies used include behavioral therapy, insight-oriented psychotherapy and hypnotherapy.
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