In psychology, impulse control disorder refers to compulsive and uncontrollable behavior that affected individuals exhibit when under tension. The particular action performed impulsively results in a momentary lessening of tension.
What characterizes impulse control disorder?
Characteristic of impulse control disorders is that the affected people are not capable of resisting their impulse. The decision to perform a particular action is not consciously made and executed. In addition, the various impulses do not pursue any goal. A typical disorder of impulse control is, for example, pathological stealing, which is also referred to antiquatedly as kleptomania. People who steal compulsively do not pursue motives such as enrichment, envy, or harming another person. They steal involuntarily and have no interest in the stolen items, often even hiding or destroying them. Other impulse control disorders include compulsive buying, compulsive eating, compulsive gambling, compulsive masturbating, and compulsive hurting one’s body by scratching or pulling out hair and nails. Basically, an impulsive action can be divided into five different stages of action. After the first impulse, the desire to carry it out grows, which is associated with high tension. This is relieved by the execution of the compulsive action and leads to short-term relaxation. The last phase, which does not always take place, is characterized by feelings of guilt.
Causes
The causes of impulse control disorders have not been conclusively researched. In all likelihood, however, the disorders are triggered by a complex interplay of genetic and physical foundations, upbringing, environment, and experiential background. In addition, researchers suspect that the hormone levels of those affected are relevant to the problem and significantly influence the nature of the disorder. Men have higher testosterone levels than women and are more prone to aggressive disorders, such as compulsive arson. Women, on the other hand, engage in less aggressive compulsive behaviors, although these are often self-destructive in nature. Trichotillomania, or the compulsion to pull out hair, is a compulsive act frequently practiced by women. In addition, the extent to which impulse control disorders are associated with other mental disorders is explored. Of particular importance is the link with substance addictions and severe mental illnesses such as borderline personality disorder, for example.
Symptoms, complaints, and signs
Symptoms of impulse control disorder are not always specific, as many different manifestations of the disorder exist. In addition, those affected are usually unaware of their own behavior. In children, moreover, typical childlike behavior patterns such as spontaneity or seemingly purposeless actions can easily be mistaken for mental disorders. In the USA in particular, there is a tendency to administer psychotropic drugs quickly if a mental disorder is suspected in childhood. In any case, a possible mental disorder should always be considered in the context of the age and environment of the affected person. Possible behaviors that provide initial clues include lying, stealing, aggressive and autoaggressive behavior, and a tendency to engage in high-risk or obsessive sexual behaviors. Sores, bald patches, and bitten fingernails may also be signs of possible compulsive behaviors. Sufferers also often suffer from obsessive thoughts, pursue ideas that seem irrational, and have difficulty concentrating. Since impulse control disorders always occur when sufferers are overwhelmed by the situation they find themselves in, psychological makeup is an important factor. People who suffer from a lack of impulse control are often depressed, distrustful, feel alone, and suffer from low self-esteem.
Diagnosis and course of the disease
The diagnosis of whether impulse control disorder is present must always be made by a specialist. This is not always easy to diagnose because some disorders, such as compulsive eating or shopping, are on the one hand socially accepted to a certain extent and on the other hand also overlap with addictions.Compulsive fire setting is not necessarily comparable to gambling addiction, and eating disorders can also be understood as a conscious attempt to gain body control or as an unconscious compensatory act.
Complications
Complications vary widely in this clinical picture, as impulse control disorder can be a symptom of multiple disorders. The compulsion to buy, for example, often means a great financial burden. Some sufferers make major expenditures even when they cannot actually afford them, or they spend money that was intended for other purposes. This can lead to considerable interpersonal tensions with those around them. The same applies to some extent to gambling addiction. Gambling addicts also often neglect their family and circle of friends. Occupational complications can also arise – for example, absenteeism, poor performance, or gambling (for example, on the computer or cell phone) during work hours. Individuals with trichotillomania pluck out their own hair. This can cause bald patches to develop that are not very aesthetically pleasing. When eyebrows are completely removed, sweat can run from the forehead into the eyes. Eyelashes also serve to protect the eyes; if the trichotillomaniac pulls them out, their protective effect is also absent. In addition, the human body is unable to digest hair. As a result, a tangle of hairs can form in the intestine. Such a so-called bezoar can lead to intestinal obstruction. Kleptomaniacs may have to face the legal consequences of their pathological stealing. This also applies to pyromaniacs when they set fire to other people’s property or violate regulations. Pyromaniacs in some cases suffer injuries when they set fire to an object. All impulse control disorders can be associated with other mental illnesses, such as depression.
When should you see a doctor?
People with abnormal behavior or sudden changes in behavior should generally be examined and treated by a doctor. If spontaneous uncontrolled outbursts of anger, violence or verbal attacks occur, a doctor or therapist is needed. If an affected person’s mood repeatedly tips from a harmless to an aggressive or upset demeanor within seconds or minutes, a doctor should be consulted. The clinical picture of an impulse control disorder includes the non-existent insight of a disagreement. For this reason, special sensitivity is necessary in dealing with the affected person. A special relationship of trust is important for people with increased impulsivity or with problems of emotion control to see a doctor. If the behavior of the affected person is experienced as deviating from the norm, a doctor should be asked for advice. People who are colloquially perceived as choleric, raving, or rageful can learn to change their behavior through therapeutic care. Uncontrolled behavior is perceived as scary by people in the environment and should be discussed with the person and a physician. Relatives are well advised to seek specialist information so that they themselves can demonstrate proper behavior in dealing with the affected person. If the impulse control disorder increases in intensity or poses a danger to others, a medical officer can be appointed.
Treatment and therapy
In principle, affected individuals can be treated with medication under the supervision of a psychiatrist or choose a nonpharmacologic approach to therapy, such as talk therapy, behavior therapy, or psychoanalysis. It is important to clearly define the goals of therapy. Thus, on the one hand, there is the possibility of completely suppressing undesirable behavior and, on the other hand, the goal of modifying the compulsive behavior and reducing it to a harmless level. A preliminary consideration in determining the therapeutic goal is, for example, the extent to which the affected person is physically harming himself. In addition, the social and legal context of the act must be considered. For example, compulsive stealing is evaluated differently than compulsive buying. The therapist must also assess whether the patient is capable of reducing the harmful behavior to a harmless level. And, of course, whether the person is willing to cooperate must not be ignored. Especially in the case of children, patients are often unaware of the seriousness of the situation.
Outlook and prognosis
The prognosis is tied to the presenting cause or underlying disease of the affected individual. In many cases, behavioral therapy or other psychological care can improve symptoms. With an understanding of the disease and the patient’s cooperation, the affected person receives a good prognosis. With an optimal treatment plan, gradual changes are achieved until freedom from symptoms is achieved. If the intensity of the impulse control disorder is low, a significant alleviation of the symptoms can be achieved after only a few months. Behavioral regulation takes place, based on intensive training. The more pronounced the disorder, the longer the treatment usually takes. The difficulty is to keep the patient motivated until the end of the treatment. Discontinuations of initiated therapies may occur, making a good prognosis outlook difficult. If the impulse control disorder is based on a mental disorder, the prognosis worsens. In cases of diminished intelligence or severe mental illness, the affected person is dependent on daily care. In severe cases, medical care is needed. A cure is not achieved in many cases for these patients. Long-term therapy is needed so that incremental optimizations can be implemented. Once prescribed medications are discontinued, relapse can be expected.
Prevention
Mental illness, such as impulse control disorder, is not preventable and affects people of all ages, genders, or social environments. However, as with all mental illnesses, a stable environment that encourages and reinforces personality development minimizes the chance of becoming ill. Social contacts, abstinence from drugs and other addictive substances, and a fulfilling everyday life provide a good basis for a life without illness.
Aftercare
When impulse control disorder is successfully treated, it is necessary to follow up for the rest of the patient’s life. Otherwise, the risk of recurrence of this mental disorder is increased. In psychological therapy, sufferers have usually learned strategies for dealing with stressful situations without exhibiting impulsive behavior. During follow-up care, it is relevant to further internalize and always apply these learned mechanisms. As soon as patients notice that they are again prone to impulsive actions, they immediately contact their former psychiatrist. This is because follow-up care also involves taking measures to prevent new episodes of illness. Life situations associated with stress also increase the risk that sufferers will develop impulse control disorder again. It is then necessary to critically question one’s own actions and to consult a psychological counseling center or the former psychologist as soon as possible. Also helpful are all activities that promote mental stability, from yoga to sports to meditation. Self-help groups also offer many sufferers important support after professional treatment has taken place. Here, patients experience support from like-minded people and may be made aware of relapsing behavior even before they themselves admit it. In any case, aftercare for impulse control disorder is a lifelong process.
Here’s what you can do yourself
The actions that sufferers of impulse control disorder can take vary widely and depend on the nature of the disorder. It should be noted that holistic therapy for the disorder distinguishes, for example, between self-harming (compulsive hair-pulling) and criminal or other-harming (compulsive fire-setting) behaviors. It should be noted that impulse control disorders will not be able to be managed alone in the vast majority of cases. The decisive factor is a readiness for therapy on the part of those affected, with consistent adherence to the steps. Only afterwards and accompanying, one can speak of self-help measures. These essentially consist of finding substitute actions that relieve the built-up tension. This substitute action should be feasible without problems and everywhere, in order to protect maximally against relapses. For impulse control disorders involving the hands, for example, sufferers can sit on them to prevent impulse-driven action. Such measures may need to be worked out with a therapist.The goal with impulse control disorder is usually not to eliminate the disorder, as this is hardly possible at present. Instead, valves must be created that the affected person can use and that ideally also have a further benefit. Concomitant with the fact that the goal is to free the person from the urge to pursue his or her disorder, it is incumbent upon the affected person in the context of exploratory therapy to find suitable opportunities for this in his or her everyday life, which will be incorporated into the further course of therapy.
