impulse-control disorders nos

Impulse-ControlImpulse-ControlDisorders NOSDisorders NOS

Impulse Control DisordersImpulse Control DisordersThis DSM-IV section contains six diagnosesThis DSM-IV section contains six diagnoses

The essential features of Impulse-ControlThe essential features of Impulse-Control

Disorders are:Disorders are:• Failure to resist performance of act that is Failure to resist performance of act that is

harmful to the person or to others.harmful to the person or to others.• Individual usually feels an increasing sense of Individual usually feels an increasing sense of

tension or arousal before committing act.tension or arousal before committing act.• Then clients experience pleasure, gratification, Then clients experience pleasure, gratification,

or relief at time of committing act.or relief at time of committing act.• Following the act there may Following the act there may oror may not be may not be

regret, self-reproach, or guilt.regret, self-reproach, or guilt.

Intermittent Explosive DisorderIntermittent Explosive Disorder(criteria listed on p. 667)(criteria listed on p. 667)

Characteristics:Characteristics:• These clients have episodes during These clients have episodes during

which they act out aggressively.which they act out aggressively.• They physically harm others or destroy They physically harm others or destroy

property.property.• Not due to any other mental disorder.Not due to any other mental disorder.

Intermittent Explosive DisorderIntermittent Explosive DisorderTreatmentTreatment

No clearly effective treatmentNo clearly effective treatment Some clients have been helped by Some clients have been helped by

anticonvulsant medication (e.g., anticonvulsant medication (e.g., carbamazepine), beta-blockers (e.g., carbamazepine), beta-blockers (e.g., propranolol, metaprolol), lithium, propranolol, metaprolol), lithium, antipsychotics, and antidepressants. antipsychotics, and antidepressants.

Hypnoanxiolytics may worsen the Hypnoanxiolytics may worsen the condition by disinhibiting it. condition by disinhibiting it.

Group therapy is claimed to be more Group therapy is claimed to be more useful than individual therapy.useful than individual therapy.

KleptomaniaKleptomania(criteria listed on p. 669)(criteria listed on p. 669)

CharacteristicsCharacteristics Irresistible impulse to steal unneeded Irresistible impulse to steal unneeded

objects repeatedly.objects repeatedly. ““Tension and release" characterizes Tension and release" characterizes

this behavior.this behavior.

KleptomaniaKleptomaniaTreatmentTreatment

Almost nothing is known about the specific Almost nothing is known about the specific treatment of kleptomania. treatment of kleptomania. • However, treating the other disorders However, treating the other disorders

associated with it are essential. associated with it are essential. • Bulimia and obsessive-compulsive disorders Bulimia and obsessive-compulsive disorders

(and to some extent substance abuse) share (and to some extent substance abuse) share the tension-relief cycle/the tension-relief cycle/

The following approaches to this cycle, The following approaches to this cycle, might be:might be: • Response prevention, and Response prevention, and • Alternative forms of tension release, and Alternative forms of tension release, and

antidepressants (particularly the SSRIs) might antidepressants (particularly the SSRIs) might be helpful.be helpful.

Pyromania Pyromania (Criteria on p. 671)(Criteria on p. 671)

Characteristics:Characteristics: Deliberate and purposeful fire setting on Deliberate and purposeful fire setting on

more than one occasion.more than one occasion. Fire setting not done for monetary gain or Fire setting not done for monetary gain or

other "objective reasons."other "objective reasons." Tension or arousal before act.Tension or arousal before act. Fascination with fire and its situational Fascination with fire and its situational

contexts.contexts. Pleasure and relief in setting and Pleasure and relief in setting and

witnessing fires.witnessing fires.

PyromaniaPyromaniaTreatmentTreatment

No controlled studies assessing treatment.No controlled studies assessing treatment. Anecdotal reports indicate that most child Anecdotal reports indicate that most child

pyromaniacs recover fully, whereas adult pyromaniacs recover fully, whereas adult pyromaniacs do not. pyromaniacs do not.

The majority have mildly low intelligence and The majority have mildly low intelligence and ingrained impulsiveness; therefore, few ingrained impulsiveness; therefore, few pyromaniacs benefit from insight-oriented pyromaniacs benefit from insight-oriented psychotherapy.psychotherapy.

Behavior therapiy might be more useful by Behavior therapiy might be more useful by substituting healthy gratifications and by substituting healthy gratifications and by improving social skills.improving social skills.

Perhaps the most useful intervention is to ensure Perhaps the most useful intervention is to ensure that pyromaniacs don't drink.that pyromaniacs don't drink.

Pathological GamblingPathological Gambling(criteria on p. 674)(criteria on p. 674)

Characteristics:Characteristics:

Repeatedly gambling, often until money is Repeatedly gambling, often until money is lost, jobs are given up, and friends leave.lost, jobs are given up, and friends leave.

Gamblers are often restless/irritable when Gamblers are often restless/irritable when cut down or gambling is stopped.cut down or gambling is stopped.

Pathological GamblingPathological GamblingTreatmentTreatment

Many gamblers will enter treatment simply to get Many gamblers will enter treatment simply to get relatives off their back; once things cool down, relatives off their back; once things cool down, gambling resumes. gambling resumes.

If they remain in treatment, four attitudes If they remain in treatment, four attitudes frequently undermine therapy: frequently undermine therapy: 1. Lack of money is seen as the problem; 1. Lack of money is seen as the problem; 2. An instant or miraculous cure is expected; 2. An instant or miraculous cure is expected; 3. Life without gambling is inconceivable; and 3. Life without gambling is inconceivable; and 4. Repaying debts is desirable but impossible. 4. Repaying debts is desirable but impossible.

Pathological GamblingPathological GamblingTreatment (con’t.)Treatment (con’t.)

Denying these attitudes during Denying these attitudes during treatment, especially near the treatment, especially near the beginning, should raise doubts about beginning, should raise doubts about the authenticity of the client's the authenticity of the client's commitment to change. commitment to change.

Since these clients are often bright and Since these clients are often bright and have a gift of gab, place little stock in have a gift of gab, place little stock in what they say and far more in what what they say and far more in what they do.they do.


Treatment should be judged on:Treatment should be judged on: The duration of gambling-free The duration of gambling-free

intervals intervals On debts being paid, and On debts being paid, and On developing interests other than On developing interests other than

gambling.gambling.


Since substitute excitements and pleasures must Since substitute excitements and pleasures must eventually replace gambling,eventually replace gambling,

Vocational counseling and recreational therapy Vocational counseling and recreational therapy may be an invaluable adjunct to therapy.may be an invaluable adjunct to therapy.

Meeting periodically with relatives is also Meeting periodically with relatives is also important, as much for the relatives as for the important, as much for the relatives as for the gambler. gambler.

Clinicians should remind themselves and loved Clinicians should remind themselves and loved ones that pathological gambling is a chronic ones that pathological gambling is a chronic disorder in which lapses are expected and do not disorder in which lapses are expected and do not necessarily mean therapy is a bust.necessarily mean therapy is a bust.


Gamblers Anonymous (GA), founded in 1957, is Gamblers Anonymous (GA), founded in 1957, is modeled after Alcoholics Anonymousmodeled after Alcoholics Anonymous

Claims 12,000 members with affiliates for Claims 12,000 members with affiliates for relatives of gamblers (similar to Alanon). relatives of gamblers (similar to Alanon).

Only 5-8% of gamblers who join GA stop gamblingOnly 5-8% of gamblers who join GA stop gambling If GA is combined with comprehensive inpatient If GA is combined with comprehensive inpatient

care, 50% who complete the program refrain care, 50% who complete the program refrain from gambling for a year, and a third do so for from gambling for a year, and a third do so for several years. several years.

Given the similarities between gambling and Given the similarities between gambling and alcoholism, if a GA chapter isn't available, alcoholism, if a GA chapter isn't available, attending AA is a good substitute. attending AA is a good substitute.

TrichotillomaniaTrichotillomania(criteria listed on p. 677)(criteria listed on p. 677)

CharacteristicsCharacteristics Pulling hair from various parts of the Pulling hair from various parts of the

bodybody Accompanied by feelings of “tension Accompanied by feelings of “tension

and release” from distress or and release” from distress or pleasure/gratification.pleasure/gratification.

TrichotillomaniaTrichotillomaniaTreatmentTreatment

Behavioral approaches can be helpfulBehavioral approaches can be helpful Also helpful are antidepressantsAlso helpful are antidepressants As in obsessive-compulsive disorder, As in obsessive-compulsive disorder,

serotonin agents appear to be more serotonin agents appear to be more effective than standard effective than standard antidepressants.antidepressants.

Perhaps trichotillomania is a variant Perhaps trichotillomania is a variant of OCD.of OCD.

impulse-control disorders nos

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