Lesson 1: Clinical Disorders - Part A

PART A

Impulse Control Disorders

Many psychological problems are characterized by a loss or lack of control in certain situations (such as OCD, alcoholism). The factor that makes impulse control disorder different from other disorders is a lack of other maladaptive thoughts and actions. With an impulse control disorder (ICD), a person cannot resist and will act on an impulse that is potentially harmful. All individuals with ICD have tension in common. Tension builds to an irresistible level that triggers action on the part of the individual. The action brings about a feeling of relief or pleasure and, on occasion, guilt or remorse.

Three well-known ICDs are kleptomania, pyromania, and trichotillomania. The first, kleptomania, differs from theft in that the individual taking the item does not need the item for its monetary value or practical use, and most often, items are not taken as an expression of anger or revenge. Before the theft, the individual feels rising tension, but after, the individual has a sense of pleasure followed by regret. People who steal as a career are generally not kleptomaniacs. Those individuals who steal because they have no regard for the law may have conduct disorder (if children) or antisocial personality disorder (if adult). Those individuals who steal out of need or desperation (adjustment disorder) or to support an addiction (substance abuse disorder) are not considered kleptomaniacs. Some kleptomaniacs, in fact, steal the same type of item over and over again – and sometimes the item is relatively worthless! Overall, true kleptomania is a somewhat rare problem that affects more women than men. Individuals do not want to steal, but they must as a way to relieve anxiety and obtain temporary gratification.

Pyromania is a psychological problem that involves setting fires for pleasure. The individual experiences a sense of relief or gratification from the experience. Pyromania differs from arson in that the individual does not set fires for financial gain, to hide criminal activity, or to express anger. If setting fires is a part of another disorder (conduct disorder or bipolar disorder), then pyromania is not diagnosed. In general, pyromania is a rare problem in which the individual has an unusual and uncontrollable fascination with fire.

Another rare ICD is trichotillomania. Individuals suffering from this disorder pull out their own hair in an habitual fashion while experiencing tension relief and/or pleasure. For a trichotillomania diagnosis to be made, the noticeable hair loss that results must not be due to underlying medical conditions. The disorder must also result in clinical distress or impairment in life functioning. Please read the next three case studies.