Impulse control disorders

• Impulse control disorders


  Addictions that don't involve drugs, such as gambling, sex, exercise, video games
• Characteristics of impulse control disorders

  • Salience - activity dominates thinking and behavior
  • Mood modification - feeling a buzz, high, escape
  • Tolerance - need to do the activity more to get the same feeling
  • Withdrawal - unpleasant feelings when the behavior is reduced
  • Conflict - compromises relationships, work, social activities
  • Relapse - return to the addiction even after years of controlling it
• Impulse control disorders are classified differently from substance-related addictive disorders in the DSM
• Process a person with an impulse control disorder goes through


  1. Feel an impulse/urge

  2. Tension builds

  3. Pleasure/relief after acting on the impulse

  4. May or may not feel guilt
• Kleptomania


  Impulse control disorder involving the urge to steal, affects 0.3-0.6% of the population, more common in females
• Kleptomania is different from being a thief - kleptomaniacs don't plan to steal valuable things, they just have an irresistible urge to take small, valueless items
• Stealing from others who don't know about the kleptomania is still a criminal offense, even if the person doesn't mean to do it
• People with kleptomania don't mean to steal, they have an uncontrollable urge to steal
• Kleptomania symptom assessment scale (KSCS)

  Scale that measures kleptomania symptoms from 0 (none) to 4 (extreme)
• KSCS questions


  1. Evaluate urges to steal during the past week

  2. Evaluate number of times experienced stealing urges during the past week
• The KSCS has 11 items and good retest reliability
• Concurrent validity


  When a scale measures in the expected direction compared to another related scale
• Self-report scales like the KSCS can contain bias as people may not report honestly
• Pyromania


  Impulse control disorder involving an irresistible urge to start fires
• Pyromania


  • Tension followed by pleasure when setting fires
  • Fascination with fire and explosions
  • Can feel indifferent or distressed about the consequences
• Jobs pyromaniacs may seek


  • Firefighter
• Gambling disorder


  Non-substance addictive disorder involving persistent and problematic gambling behaviour
• Gambling disorder


  • Stimulates the brain's reward centre like substance addictions
  • Causes lying and relationship problems due to inability to stop gambling
• Gambling disorder is unique as it is an addiction without a substance
• Dopamine


  Chemical in the brain related to rewards and pleasure
• In impulse control disorders like kleptomania and gambling

  Dopamine levels get reduced, leading to a vicious cycle of needing more of the behaviour to get the dopamine high
• Dopamine


  Neurotransmitter that is reduced in people with impulse control disorders like gambling, kleptomania, etc.
• Repeated behaviour


  Leads to reduced dopamine response due to tolerance
• Reward deficiency syndrome


  Compulsive behaviours like stealing, gambling, etc. are done to try to increase dopamine levels
• Causal relationship between dopamine and compulsive behaviours cannot be conclusively proven
• Positive reinforcement


  Rewarding stimuli that increases the likelihood of a behaviour occurring again
• Positive reinforcers

  • Stealing for kleptomaniacs
  • Seeing fire for pyromaniacs
  • Anticipating winning for gamblers
• Continuous reinforcement


  Desired behaviour is reinforced every time it occurs
• Partial reinforcement


  Desired behaviour is reinforced intermittently, creating a stronger desire to repeat the behaviour
• Feeling state theory


  Intense positive feelings become linked with specific behaviours, creating a compulsive desire to repeat those behaviours
• Underlying negative thoughts and experiences can also create feeling states related to impulse control disorders
• Cognitive factors


  Negative beliefs about the self or the world, which are temporarily alleviated by the compulsive behaviour
• Biochemical treatment


  1. Opiates

  2. Covert sensitization

  3. Imaginal desensitization

  4. Impulse control therapy
• Opiates have been shown to significantly reduce gambling behaviour in studies
• Yale-Brown Obsessive Compulsive Scale (Y-BOCS)


  A scale used to measure obsessive-compulsive behaviour, modified to measure gambling behaviour
• The operational definition of success was a 35% reduction in gambling behaviour
• Opiates (nalmefene and naltrexone) significantly reduced gambling behaviour
• Gambling disorder


  May be linked to biological symptoms like dopamine
• The Grant et al. 2008 study should be read in detail and evaluated
• Grant et al. 2008 study

  • Large sample size is a strength
  • Experimental research method should be evaluated