Impulse Control Disorders

Impulse Control Disorder Not Elsewhere Classified

Impulse Control Disorder Not Elsewhere Classified is considered a residual diagnostic category. A number of other disorders have features of impulsiveness, but no other group of disorders is distinctly classified as impulse control disorders. All the current impulse control disorders include the following features: Failure to resist an impulse to perform some act that is harmful to the person or others, an increasing sense of tension before the act, and a sense of relief or pleasure after committing the act. This category of disorders has been changed for a variety of reasons. For example, isolated explosive disorder was listed in the DSM-III and then removed from the DSM-III-R due to the high likelihood that the diagnosis would be based on a single episode of aggressive behavior. Further, serious questions have been raised about the validity of intermittent explosive disorder. The DSM-III-R had a disclaimer noting the doubt of intermittent explosive disorder as a clinical syndrome and noting that other disorders that have features of impulsive violent behavior must be ruled out before using this diagnosis.
 

Intermittent Explosive Disorder

Despite the concerns that this is a distinct disorder not some feature of another disorder; Intermittent Explosive Disorder was retained in the DSM-IV. The diagnosis requires several incidences of failure to resist aggressive impulses that result in violent behavior that is grossly out of proportion to the precipitating psychosocial stressors. Of course, the episode is not better accounted for by some other disorder or medical condition. While episodic violence is common in this society, the diagnosis is rare. Some studies have been conducted suing drug trials in treating this disorder, however, they have not been placebo controlled. This may be due to ethical factors in giving no treatment of violent behaviors. Currently, no drug has been approved by the FDA for treatment. However, drug treatments are the only treatments that have any efficacy (according to the poorly designed research that has been conducted) in treating this disorder. Psychosocial treatments such as anger management have proven ineffective, probably because the violent behavior has less to do with anger than with impulse control.
 

Kleptomania

Kleptomania is the failure to resist the impulse to steal objects that are not needed, either for personal use or for their monetary value. There is increasing tension before the event and pleasure of gratification after the event. The act is not committed to express anger or vengeance and is not in response to a delusion or hallucination. This is not better accounted for by another disorder.

There is very little research on Kleptomania in part, because of the secretive nature of the disorder. There is not a clear distinction between Kleptomania and shoplifting and treatment is not well defined. Behavior therapy apparently has some efficacy, as do somatic therapies (ECT). In some cases ECT used in combination with antidepressants has shown some efficacy.

Behavior therapy, using covert sensitization has been shown effective in some case studies. Systematic sensitization may be helpful in reducing the anxiety or tension that leads to the stealing behavior.