Impulse-Control Disorders

Abnormal Psychology

Chapter 12 (p. 445)

Apr 9, 2009

Class #22

Impulse-Control Disorders

Pathological Gambling Kleptomania Pyromania Trichotillomania Intermittent Explosive Disorder

These disorders are characterized by an inability to resist an impulse to perform behaviors that are dangerous to others or to themselves

What these disorders have in common is a tension building to irresistible levels before engaging in the behavior, and a feeling of relief or pleasure afterward

Impulse-Control Disorders

As always, look at these five disorders with your usual critical analysis… Should DSM experts keep these here?

Pathological Gambling

Different than other disorders in that gambling (at least to a point) is encouraged by our society… Probably at least 3% of the population

Not officially recognized by APA until 1980 (DSM-III) and is now classified as an impulse control disorder (an irresistible urge to do something)

Gender difference: M > F but this is probably an opportunity based

difference and is changing (getting closer)

Let’s try to make a distinction…

Probably at least half of us gamble at one time or another… Poker game on Friday night Super Bowl NCAA March Madness Lottery Casino

Its not a big deal, win or lose most get on with their lives immediately

But not for some…

Loss of control over gambling Lies about the extent of involvement with

gambling Family and job disruption Stealing money

Even from friends and family From their child’s piggybank or savings bonds is not

uncommon The game (activity) wagered on precludes all

other interests

Personality Characteristics

Better than average intelligence Immaturity Rebellious Thrill-seeking

Gamblers habitually take chances Superstitious

In many ways, sounds like what other disorder we recently covered???

Behavioral Characteristics

The pathological gambler is always full of optimism and never learns from defeat Sometimes there is initial caution but the

gambler will eventually risk too large sums of money

They never stop after winning Worse yet they “chase losses”

Some interesting sex differences…

Potenza (2001) Males have more problems with sports

gambling, dog and horse racing, card games, roulette, dice, etc.

Females have more problems with slot machines, bingo, etc.

Phases of Gambling

Gammon (1986) Reported that pathological gamblers go

through 4 major stages

Phases of Gambling

Social Phase This is recreational gambling for fun

Winning Phase They win large amounts of money

Losing Phase Here they lose larger amounts than they won in Phase 2 and

begin using lies and deceit to cover up the amount lost

Depression Phase Everything is now out of control Can lead to loss of one’s life savings, loss of family and friends,

loss of job, ultimately in worst cases can lead to suicide

Pathological Gambler: Typical Scenario

Many potentially severe problems will affect both the gambler and his/her family… Psychological Social Financial Medical Legal

A severe negative effect

“The Hidden Illness”

Pathological gambling is often referred to this…

Part of the reason may have to do with cultural perspective… See short video documentary…

Athletes seem to be particularly susceptible...

Explanations

Not well understood by psychologists... Psychoanalytic Theory

Freud saw pathological gamblers as… does anyone want to take a guess???

Humanistic Theory These psychologists believe that gambling can

satisfy a basic need to confirm one’s worth Cognitive Theory

These psychologists believe we get false sense of power from gambling and make an otherwise dull existence existing

Explanations

Biological Theory Arousal Theory (Hebb,1955); Hare,1968)

May apply here as we are seeing under-aroused people needing this added stimulation

Problem is they may only get what they need from losses

Possible genetic link There appears to be a heritable component to pathological

gambling and genetic overlaps between pathological gambling and alcohol dependence (Potenza, 2005)

Treatment

Psychotherapy Can be effective but most don’t take this route. Why?

Gambler’s Anonymous Self-help group founded in 1957 Bar far the treatment of choice They hope to control their gambling tendencies by talking about

their experiences Also, allows them to bring up self-worth by helping others Unfortunately, only works for about 8% (all others are back

gambling within one year) Gam-Anon

Support system for spouses and children

Complications

Various studies of pathological gamblers in treatment reveal that approximately 50 percent have histories of alcohol or drug abuse

Females are more likely to be depressed, and gamble as a means of escaping the depression

Kleptomania

People with Kleptomania usually do not steal because they need the object stolen In fact, they sometimes secretly replace the

object after stealing it They steal "for the thrill of stealing," and they

don't want to get caught at it To be diagnosed, a person must have

the typical pattern: Recurrent tension leading to the behavior,

leading to relief or pleasure after performing the behavior

Prevalence

Kleptomania is rare overall Literature is vague; social stigma discourages

patients from seeking treatment Thought to be more frequent in females

Treatment

Not much here… Treatment is largely untested, and the

disorder often persists despite many convictions of shoplifting

Complications

High rates of comorbid psychiatric disorders: Mood disorders

Much higher rates of depression Other impulse-control disorders Substance abuse Nicotine dependence

Burn-out after 40…

Kleptomania tends to decrease as the individual ages

More research needed in this area

Trichotillomania

An impulse control disorder that involves intentionally pulling out ones hair

Has all the usual features of impulse control disorders… Relief after the behavior, and

usually a buildup of tension before, at least when the individual is attempting to control the behavior

Trichotillomania

Once, thought to be rare, but earlier estimates may have been too low because victims are usually secretive about the behavior As many as 2% of college students

have had this disorder at some time  Females > Males

Hair may be pulled from any part of the body, but the scalp, eyebrows, and eyelashes are the most frequent targets

Can, in some cases, lead to baldness Must cause significant distress before it

can be diagnosed

Trichotillomania

Sometimes seen in children, although most grow out of it

If the disorder appears in adolescence or adulthood, it is more likely to be seen in women

They usually have other problems as well…

These people are also likely to suffer from OCD and depression… Drugs that are effective for OCD also have

shown some improvements in those with Trichotillomania

Increase serotonin levels

Treatments

Also treated with response prevention therapy But, no established treatment that’s been very

effective More research needed here as well

Intermittent Explosive Disorder

Several discrete episodes of failure to resist aggressive impulses that result in serious assaultive acts or destruction of property

The degree of aggressiveness expressed during the episodes is grossly out of proportion to any precipitating psychosocial stressors They usually “flip out” for little or

no reason

Prevalence

Intermittent explosive disorder occurs most often in young men and may affect as many as one in 14 U.S. adults.

Complications

The violent behavior that's part of intermittent explosive disorder is not always directed at others

People with this condition are also at significantly increased risk of harming themselves, either with intentional injuries or suicide attempts

Other complications of intermittent explosive disorder may include job loss, school suspension, divorce, auto accidents or incarceration

Treatments

Many different types of drugs are used to help control intermittent explosive disorder, including: Anticonvulsants Anti-anxiety agents Mood regulators Antidepressants

Group counseling sessions focusing on rage management, also have proved helpful

Some people have found relaxation techniques useful in neutralizing anger.

Prognosis

Since most do not seek help the prognosis is usually not good

Pyromania

Pyromania is deliberate and purposeful fire-setting behavior

DSM criteria requires that the person set more than one deliberate fire (destructive fire)

The usual impulse disorder sequence of strong arousal before and pleasure or tension reduction after the act must be present

Pyromania

There must not be an external motive that accounts for setting the fire People who set fires to collect insurance or

cover up crimes, do it as an expression of anger, vengeance, etc. do not qualify

The fire setting must not be accounted for by another diagnosis

Complications

People with pyromania often have poor learning skills and emotional difficulties

High rates of mood disorders High rates of substance abuse

Treatment

Behavioral interventions may be helpful for pyromania sufferers… Most people with pyromania in childhood get

better But untreated adults (the majority of sufferers)

don't get better

More research needed on this one too…

Little is known about pyromania

Any DSM-V suggestions???

Impulse Control Disorders Keep them? Move them? Eliminate them?