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Impulse Control and Impulsive Behavior

Impulse control is the ability to delay the satisfaction of something that is desired. Impulsive behavior, or poor impulse control, is the tendency to act without taking into consideration the consequences of one’s actions. Impulsive behavior may be indicative of a more serious problem, such as an impulse control disorder.

Treatments for impulsive behavior include psycho-therapeutic models, particularly cognitive-behavioral therapy, and medication. Some types of impulsive behavior are treated primarily with therapy; others are treated with a combination of therapy and medication.

Impulsive Behavior and Impulse Control

Impulsive behavior is commonly defined as an action undertaken without due consideration or foresight of the possible consequences. Although some people may exhibit impulsive behavior from time to time, these occurrences are rare and generally do not lead to serious problems. Individuals who persistently engage in impulsive behavior may be suffering from an impulse control disorder.

Among the types of impulsive behavior that are recognized as impulse control disorders are intermittent explosive disorder, kleptomania, pyromania, pathological gambling, trichotillomania, onychophagia, and dermatillomania.

Some impulse control disorders exhibit gender differences. Kleptomania is more common among women, and intermittent explosive disorder is more common among men. Men are more likely to develop a pathological gambling disorder in their teen years; women are more likely to develop this disorder when they are older. Trichotillomania is more common in children than adults.

*Intermittent explosive disorder is characterized by outbursts of anger that are out of proportion to precipitating circumstances and may include the destruction of property or physical assaults on others.

*Kleptomania is the compulsion to steal items of little or no value. Unlike shoplifters or thieves, kleptomaniacs do no steal for monetary value.

*Pyromania is an impulse control disorder that is characterized by the setting of fires for pleasure. Pyromaniacs do not set fires for monetary gain or in connection with other criminal activity.

*Pathological gambling is an impulsive behavior characterized by an obsessive preoccupation with gambling to the detriment of one’s finances, employment, or family relationships.

Three types of impulsive behavior that focus on the body are considered impulse control disorders: trichotillomania, onychophagia, and dermatillomania. Trichotillomania is the persistent urge to pull one’s hair out. Onychophagia is compulsive nail biting. Dermatillomania is compulsive skin picking that can result in self-injury. Common to all three types of impulsive behavior is a sense of increasing tension preceding the act, followed by a sense of relief, either during the act itself or immediately after.

Signs of impulsive behavior include reckless driving, shoplifting, destruction of property, physical altercations, aggressive behavior, excessive skin picking, and obsession with fire. Repeated demonstrations of poor impulse control can indicate the presence of an impulse control disorder that warrants treatment.

Symptoms of Impulse Control Disorders

Symptoms of intermittent explosive disorder include extremely angry eruptions, lasting ten to twenty minutes, which frequently involve destruction of property. Symptoms of kleptomania include overwhelming urges to steal, feelings of tension preceding the theft, gratification during the theft, and strong guilt afterwards. Symptoms of pyromania include increasing tension leading up to the fire setting act, deliberate setting of fire on more than one occasion, and feelings of gratification during fire setting.

The symptoms of pathological gambling include intense preoccupation with gambling, preoccupation with obtaining money for the purposes of gambling, the need to gamble with increasing sums of money to achieve the same psychological effect, and lying to family members to conceal the extent of gambling. Pathological gamblers will exhibit poor impulse control by continuing to gamble despite incurring large gambling losses.

Symptoms of dermatillomania include shame and the attempt to hide the extent of their condition from others, while the symptoms of onychophagia include extremely short nails, compulsive nail biting, or skin damage around the nails. Symptoms of trichotillomania include bald areas on the scalp, toying with pulled out hair, and chewing on pulled out hair.

If unchecked, an impulsive behavior can adversely impact an individual’s life. Impulse control disorders tend to worsen over time if untreated. Pathological gamblers may resort to illegal activities, such as embezzlement, to fund their gambling habits. Pyromaniacs may cause grave physical harm to themselves or others if their obsession with fire setting is not checked. Kleptomaniacs may face embarrassing legal repercussions if they are caught. Individuals suffering from intermittent explosive disorder may be arrested and jailed for physical assaults. Severe cases of trichotillomania may result in significant hair loss.

Impulse control disorders have been linked to depression, Obsessive-Compulsive Disorder (OCD), and anxiety. Because impulse control disorders are believed to share many of the same neurobiological causes of OCD, they are categorized as one of the Obsessive-Compulsive Spectrum Disorders (OC Spectrum Disorders). Impulse control disorders are frequently found to be coexisting with OC spectrum disorders.

Selective serotonin reuptake inhibitors (SSRIs) are considered effective at treating certain types of impulsive behavior, such as dermatillomania, kleptomania, and intermittent explosive disorder.

Treatment for Impulse Control Disorders and Impulsive Behavior

Persistent impulsive behavior and impulse control disorders can be treated. Intermittent explosive disorder is treated with a psychotherapy approach similar to addiction-based models. In addition, medications, such as antidepressants, SSRIs, and mood stabilizers may be prescribed for treatment. Kleptomania is more frequently treated with a variety of psychotherapies; however, some success in treating kleptomania with SSRIs, such as fluoxetine or paroxetine, has been reported. Pyromania is not usually treated with medication; instead, it is treated with behavioral therapy that educates an individual on more socially acceptable forms of reducing tension. Pathological gambling is treated by psychotherapy models that have been successful with treating other types of impulsive behavior, such as alcohol abuse and substance abuse. Behavioral therapy, such as Habit Reversal Training (HRT), is useful in treating dermatillomania, onychophagia, and trichotillomania. Individuals suffering from dermatillomania may be prescribed an antidepressant to treat their disorder. Generally, onychophagia and trichotillomania are not treated with medications.

There is a general consensus within the psycho-therapeutic community that cognitive-behavioral therapies are effective at treating impulsive behavior. Whereas behavior therapy assesses all thoughts, feelings, and actions as behaviors, cognitive therapy assumes that thoughts are the most significant factor in treating impulsive behavior. Both therapeutic approaches emphasize the present moment, i.e., the “here and now,” in treating impulsive behavior. Cognitive-behavior therapy views our thoughts in the present moment, and not external influences, as the causes of our behaviors.

Cognitive-behavioral therapies teach an individual how to challenge unsettling thoughts, develop and utilize stress reduction techniques, prevent and avoid poor impulse control, and develop problem-specific strategies to avoid impulsive behavior.

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