Impulse Control And Addiction Disorders

Understanding Impulse Control Disorders

Impulse control disorders (ICDs) are characterized by urges and behaviors that are excessive and/or harmful to oneself or others and cause significant impairment in social and occupational functioning, as well as legal and financial difficulties. ICDs are relatively common psychiatric conditions, yet are poorly understood by the general public, clinicians, and individuals struggling with the disorder. Although impulse control and addiction disorders treatment research is limited, studies have shown that ICDs may respond well to pharmacological treatment. [1]

Oppositional Defiant Disorder

Oppositional defiant disorder (ODD) is mainly a type of childhood disruptive behavior disorder that primarily involves problems with the self-control of emotions and behaviors. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the main feature of ODD is a persistent pattern of angry or irritable mood, argumentative or defiant behavior, or vindictiveness toward others.

Oppositional defiant disorder symptoms are commonly seen initially during preschool years and often precede symptoms of conduct disorder. In a large-scale study using retrospective age-of-onset reports, 92.4% of those who met ODD criteria also met criteria for at least one other mental disorder, including mood disorders (45.8%), anxiety disorders (62.3%), impulse control disorders (68.2%) and substance use disorders (47.2%). [3]

Conduct Disorder

Conduct disorder (CD) lies on a spectrum of disruptive behavioral disorders, which also include oppositional defiant disorder (ODD). In some cases, ODD is a precursor to CD. CD is characterized by a pattern of behaviors that demonstrate aggression and violation of the rights of others and evolves over time. Conduct disorder often occurs comorbidly with other psychiatric conditions, including depression, attention deficit hyperactivity disorder (ADHD), and learning disorders. Thus, a thorough psychiatric evaluation is required before initiating an appropriate treatment plan.

The etiology of CD is complex and results from an interaction between multiple biological and psychosocial factors [4] including the following:

• Low levels of 5-Hydroxy Indole acetic acid (5-HIAA) levels in CSF correlate with aggression and violence in adolescence
• High testosterone levels are also associated with aggression
• Substance abuse, particularly alcohol dependence in parents
• Any traumatic brain injury, seizures, and neurological damage can contribute to aggression
• Exposure to increased gang violence in the community
• Trauma-related disorders, particularly repeated physical and sexual abuse with maltreatment in children, can lead to a diagnosis of post-traumatic stress disorder (PTSD) and other anxiety disorders.
• Mood disorders that include depression and bipolar disorder

Pyromania

According to American Psychological Association, pyromania means an impulse-control disorder characterized [6] by:

• A repeated failure to resist impulses to set fires and watch them burn, without monetary, social, political, or other motivations
• Extreme interest in fire and things associated with fire; and
• A sense of increased tension before starting the fire and intense pleasure, gratification, or release while committing the act

Pyromania may be related to other mental disorders, such as addiction, anxiety, or depression. Substance abuse and learning disorders are also common in people with pyromania.

The Relationship Between Impulse Control And Addiction Disorders

Impulse control disorders (ICDs), including pathological gambling, trichotillomania, kleptomania, and others, have been conceptualized to lie along an impulsive-compulsive spectrum. Recent data have suggested that these disorders may be considered addictions and may associate with drug or alcohol abuse.

Diagnostic criteria for ICDs like pathological gambling overlap with those for substance dependence, with specific criteria relating to tolerance, withdrawal, repeated unsuccessful attempts to cut back or quit, and interference in major areas of life functioning.

Causes Of Addiction And Impulse Control Disorders

Impulsivity has relevance for many psychiatric disorders, including impulse control disorders and substance addictions. Within the addiction process, impulsivity contributes to early stages such as drug experimentation. Trait impulsivity has multiple components; e.g., one study [7] identified four components:

Causes Of Impulse Control And Addiction Disorders

• Urgency
• Lack of premeditation
• Lack of perseverance
• Sensation seeking

Impulse Control And Addiction Disorders

People with an impulse control disorder can’t resist the urge to do something harmful to themselves or others. Impulse control disorders include addictions to alcohol r drugs, eating disorders, compulsive gambling, paraphilias sexual fantasies and behaviors involving non-human objects, suffering, humiliation from childhood, compulsive hair pulling, stealing, fire setting, and intermittent explosive attacks of rage.

Some of these disorders, such as intermittent explosive disorder, kleptomania, pyromania, compulsive gambling, and trichotillomania, are similar in terms of when they begin and how they progress. Usually, a person feels increasing tension or arousal before committing the act that characterizes the disorder. During the act, the person probably will feel pleasure, gratification, or relief. Afterward, the person may blame himself or feel regret or guilt. [9]

Difference Between Addiction And Impulse Control Disorder

A first key controversy in the field is whether pathological gambling and related conditions should be characterized as “behavioural addictions” and thereby be subsumed under a larger category that is more closely related to substance-related disorders.

There are a number of important differences between the proposals for the ICD-11 and the approach taken in the DSM-5. These stem in part from the WHO’s emphasis on clinical utility in a broad range of settings. In the DSM-5, the impulse control disorders grouping was dismantled, and pathological gambling was moved to the same section as substance addictions.

Is There Any Difference Between Impulse Control Disorders And Addiction?

Although the evidence may indicate that pathological gambling resembles substance addictions in many ways, data also support its relationship to other impulse control disorders such as kleptomania, intermittent explosive disorder, and compulsive sexual behavior. The outward clinical similarities of these disorders (that all of these behaviors are rewarding, at least initially, that they lead to feeling out of control, that the person reports urges or cravings, that no substance is taken into the body, and that there are no indications or outward signs of intoxication) further supports their unique categorization as impulse control disorders. [8]

Receive treatment for co-occurring disorders today.

As the addiction treatment community begins to realize that addiction is itself a mental disorder, the relationship between impulse control and addiction disorders becomes more complicated. The greater treatment community largely lacks a proper understanding of dually diagnosed conditions, so these conditions are still treated separately, or worse–not treated or diagnosed at all. We Level Up dual diagnosis treatment centers in We Level Up Florida, California, Texas, and New Jersey are some of the facilities that have professionals trained to help treat co-occurring disorders concurrently. This type of tandem treatment provides some of the best success rates.

Get dual diagnosis treatment for individuals struggling with impulse control and addiction disorders. Call us today!