ICD

• Impulse control disorders (ICDs)

  Involve a build-up of tension, recurrent, irresistible urges to carry out specific behaviours, short-lived euphoria/relief when the behaviour is performed, and distress and dysfunction due to shame/guilt

  
• Kleptomania Symptom Assessment Scale (K-SAS)

  A 12-item self-report scale, scored from 0 to 4, where the respondent considers thoughts, feelings and actions in the past week. More than 31 out of 44 is considered severe; more than 21 is considered moderate
• Nomothetic approach


  Collecting extensive quantitative data over the years, enabling individuals' scores to be compared with normative data, facilitating judgments about symptom severity, and allowing for the prioritization of treatment using relatively objective quantitative information
• Idiographic approach


  Focuses on the unique characteristics of the individual
• Factors associated with positive treatment outcomes

  • Family history of alcoholism
  • Stronger baseline urges
  • Age (reduced placebo effect in older participants)
• Covert sensitisation


  Uses classical conditioning to create unpleasant associations with the behaviour the person wishes to stop
• Therapists help clients to visualise disturbing images (unconditioned stimulus) that create unpleasant feelings, such as disgust or shame (unconditioned response)
• Images are paired with thoughts about the target behaviour
• Eventually, thinking about the target behaviour elicits negative feelings that override urges to perform the behaviour
• Imaginal desensitisation


  Therapists interview clients to design personalised guided imagery scripts, including cues that trigger tension/urges and venues where the target behaviour will be performed
• Clients are taught progressive muscle relaxation (PMR) to combat tension
• Scripts have six stages separated by brief PMR, and clients practise guided imagery two to three times a day for five to seven days a week
• Impulse control disorders


  Disorders characterized by the failure to resist an urge or temptation to perform an act that is harmful to oneself or others
• Non-substance addictive disorder


  Disorders characterized by the inability to resist an urge or craving to engage in a behavior that provides short-term reward or pleasure, despite long-term harmful consequences
• Causes of impulse control disorders and non-substance addictive disorders

  • Biochemical (e.g. dopamine)
  • Behavioural (e.g. positive reinforcement)
  • Cognitive (e.g. feeling-state theory)

  
• Dopamine


  A neurotransmitter linked to impulse control and addictive disorders, its release is triggered by rewarding stimuli
• Positive reinforcement


  The frequency of a behaviour is increased by the use of a reward
• Feeling-state theory


  Intense positive feelings become linked with specific behaviours, leading to impulse-control problems and obsessions
• Reductionist nature of the causes of impulse control disorders and non-substance addictive disorders
• The causes do not take into account the background of the sufferer or the potential contribution of other factors (e.g. genetics)
• The causes have a deterministic nature
• There is a nature versus nurture debate with reference to the different causes
• Some theories of causes explain one addiction better than another (e.g. behavioural is effective for gambling but less so for pyromania)
• Imaginal desensitisation


  A technique involving teaching relaxation and then visualizing exposure to a trigger situation without acting on the urge
• Advantages of imaginal desensitisation

  • Reduces the strength of the drive to carry out an impulsive behaviour
  • Empowers the client by providing skills to resist urges
  • Enhances self-efficacy by demonstrating the client is in control
  • Can be used anywhere once learned
  • Can be applied to a range of similar problems
• Problems with relaxation monitoring tables

  • Patients may forget to fill them in
  • May fill them in even though they haven't completed a session
  • May lie about their progress
  • May not be able to complete them at the appropriate time each day
  • May misjudge the rating of 'feelings when planning the behaviour'
• Advantages of psychological techniques to treat impulse control disorders

  • Can be applied at home by the client
  • No drugs or side effects
  • Can be applied to a wide range of disorders
• Disadvantages of psychological techniques to treat impulse control disorders

  • More time with a therapist initially than with medication
  • A person may decide to withdraw from treatment to engage in the impulsive behaviour
  • Takes more time than taking a drug
• Feeling-state theory


  Positive feelings become linked with specific events, forming a 'state-dependent memory'
• Cognitive-behavioural treatments for impulse control disorders

  • Covert sensitisation
  • Imaginal desensitisation
• Strengths of using case studies to investigate impulse control therapy

  • The general principles can apply to other people
  • Provides in-depth detail on how therapy can work
  • If many case studies have similar results, it is possible to generalise
• Weaknesses of using case studies to investigate impulse control therapy

  • No standardised measurement
  • The therapist was the assessor
  • May not generalise to other people or other types of impulse-control problems
  • No objective behavioural assessments
  • Longer term follow-up needed
• Characteristics of kleptomania


  • Not being able to resist the urge to steal
  • Experiencing tension before the theft and pleasure/relief when committing it
• Possible limitations of answers participants may give to a kleptomania questionnaire


  • The question is ambiguous
  • What constitutes 'thinking about stealing' is vague
  • Participants may give socially desirable answers
  • Only quantitative data, no in-depth answers
• Reliability


  The consistency of a measure, assessed through test-retest or split-half methods
• Validity


  The extent to which a measure accurately reflects the construct it is intended to measure, assessed through concurrent validity or face validity
• Strengths of using self-report questionnaires to measure kleptomania

  • Provide the therapist with useful quantitative information to assess the extent of the problem
  • Allow for standardised administration and scoring
• Weaknesses of using self-report questionnaires to measure kleptomania


  • Participants may not be honest in their responses
  • Lack of in-depth qualitative data
  • Potential for social desirability bias
• Concurrent validity


  Compared with an alternative measure (e.g. Global Assessment Functioning Scale)
• Face validity


  It looks like it measures kleptomania