Impulse-control disorder (ICD) is a psychiatric disorders characterized by impulsivity defined as a failure to resist a temptation, urge, or impulse; or not having the inability to not speak on a thought. There are many psychiatric disorders that have impulsivity, such as substance-related disorders, behavioral addictions, attention deficit hyperactivity disorder, autism spectrum disorder, some personality disorders, and some mood disorders.
The fifth edition of the American Psychiatric Association’s Diagnostic and statistical manual of mental disorders (DSM-5) contained a new chapter on disruptive, impulse-control, and conduct disorders. It describes these disorders as having problems in emotional and behavioral self-control and lists five behavioral stages that characterize impulsivity: 1) an impulse, 2) growing tension, 3) pleasure on acting, 4) relief from the urge, and 5) guilt.
Types of Impulse-Control Disorders
Someone with an ICD has urges and behaviors that are excessive and/or harm and cause significant impairment in social and occupational functioning, as well as legal and financial difficulties. ICDs are relatively common, yet are poorly understood by the general public, clinicians, and individuals struggling with the disorder. There is some debate as to the official list of ICDs but the following are conditions considered by many mental health experts as either being an ICD or having many features of one.
- Intermittent explosive disorder
- Kleptomania
- Pyromania
- Oppositional defiant disorder
- Conduct disorder
- Trichotillomania
- Pathological gambling
- Compulsive buying disorder
- Compulsive sexual behavior disorder
- Pathological skin picking
- Behavioral addictions
- Substance use disorder
- Anxiety disorders
- Bipolar disorder
- Bulimia
- Antisocial personality disorder
Signs and symptoms of ICD
Research has shown that the signs and symptoms of impulse-control disorders vary based on the age of the person, the type of impulse-control they are struggling with, the environment in which they live, and whether they are male or female.
ICD mechanisms in the brain
Studies had found that a dysfunction of the striatum, the largest structure of the basal ganglia located in the center of the brain towards the bottom. This abnormality is thought to be the link between obsessive compulsive disorder (OCD), substance use disorder (SUD) and ICD. Impulsiveness that happens in advanced OCD can be caused by progressive dysfunction of the ventral (lower) striatal circuit. Whereas in case of ICD and SUD, increased dysfunction of dorsal (upper) striatal circuit increases the ICD and SUD behaviors that are associated with the compulsive processes.
Clinicians and researchers traditionally saw OCD and ICD as two distinctly different disorders, with OCD being driven by the desire to avoid harm whereas ICD has by reward-seeking behavior. In reality, there are similar behaviors in both, such as the compulsive actions of people with ICD and reward-seeking (i.e. hoarding) in OCD.
Treatment for ICD
Although ICD treatment research is limited, studies have shown ICDs may respond well to pharmacological treatment and psychotherapy. Treatment methodology is informed by the presence of comorbid conditions.
The most common form of ICD treatment in therapy is cognitive behavior therapy (CBT). CBT is effective in treating ICD because the focus of the treatment exposes the relationship between thoughts and behaviors.
The goal of CBT is to help clients with ICD to replace distorted thought processes with more positive and realistic thoughts that help clients to rationalize their thoughts to help in controlling their impulsive urges. An example would be an person whom has a shopping addiction. Once the person has a clear understanding of their distorted thinking, beliefs and attitudes towards shopping which is usually derived from cultural factors and values. The person can begin the process of restructuring their lifestyle to replace shopping behaviors with more productive ones.
Group therapy or support groups such as debtors anonymous allow people with the same condition a forum to explore the challenges and successes involve in treatment and recovery. The group’s members support each in helping them to refrain from the undesired behavior.
Interpersonal Therapy can also be useful in psychotherapy to explore the emotional inside of the thoughts and feelings to a person with ICD and how that feeling is contributing to a behavior. The goal of interpersonal therapy is addressing the hidden emotional issues that ultimately contribute to an impulsive control behavior. The belief is that once a client understands why they part take in the destructive behavior they will be less like to continue to engage in the act.
Biofeedback is another intervention that can help impulse control behaviors. Biofeedback monitors normal body functions such as heart and breathing rate while the person practices relaxation techniques and learns how to control the their body functions. The goal of biofeedback is to teach clients how to relax and reduce anxiety during impulsive triggers.
If you’re diagnosed as having ICD, you may be prescribed medication. Medication can work well to help with the symptoms, but outcomes are typically better when paired with therapy. Working with a therapist can help you determine how to deal with impulse control disorder and feel better in your daily life.
Randi Fredricks, Ph.D.
References
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision. Washington, DC: American Psychiatric Association, 2022.
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