Atypical Impulse Control Disorders

Question 1

essential features

Answer 1

failure to resist and impulse or drive or the temptation to perform an act that could be harmful to the person or others

Question 2

Preoccupation

Answer 2

increasing sense of tension or arousal prior

Question 3

Intoxication

Answer 3

pleasure, gratification, or relief duing

Question 4

Wtihdrawal

Answer 4

regret, self-reproach, or guilt following

Question 5

Intermittent Explosive Disorder

Answer 5

characterized by discrete episodes of failure to resist aggressive impulses resulting in serious assaults or destruction

Question 6

Kleptomania-essential features

Answer 6

-recurrent failure to resist impulses to steal objects not need for personal use or monetary value

1. hoard or return objects
2. chances arrest-not likely to steal but will preplan to avoid arrest
3. tension increases if resist urge; tension relief upon act completion
4. no help from others

Question 7

Kleptomania-associated features

Answer 7

1. impulse to steal is ego dystonic, conflict with the ego and one’s self image
2. fears capture; fell depressed or guilty
3. may cause legal, family, career and personal difficulties
4. a possible variant of OCD

Question 8

Kleptomania-DSM Diagnostic

Answer 8

• sense of tension before committing act
• pleasure, gratification or relief at time of committing act
• stealing is not committed to express anger and is not in response to a delusion or a hallucination

-not better accounted for by conduct disorder, a manic disorder, or antisocial personality disorder

Question 9

Kleptomania- course

Answer 9

• can go on for years
  1. sporadic
  2. episodic
  3. chronic
  4. may appear in childhood and continue into adulthood

Question 10

Kleptomania- relationship to shoplifting

Answer 10

1. shoplifters rate high on inner tension before and relief after stealing
2. similar descriptions of impulsivity in both groups

Question 11

Kleptomania- underregulation: strength

Answer 11

• temporary weakness-anxiety or stress

- externally-mediated weakness deficit- goods displayed to attract interest

Question 12

Kleptomania- misregulation

Answer 12

symptoms relief from anxiety or depression

Question 13

Pyromania- essential features

Answer 13

presence of multiple episodes of deliberate and purposeful fire setting

Question 14

Pyromania- associated features

Answer 14

1. advance preparation for starting fire
2. indifferent to consequences
3. lead to property damage, legal consequences, or injury/loss of life

Question 15

Pyromania- DSM Diagnostic

Answer 15

A. deliberate and purposeful fire setting on more than one occasion
B. tension or affective arousal before the act
C. fascination with, interest in, curiosity about, or attraction to fire and its situational
D. pleasure, gratification, or relief when setting fires, or when witnessing or participating in their aftermath
E. done for monetary gain, as an expression of sociopolitical ideology, to conceal criminal activity, to express anger or vengeance, to improve one’s living circumstances, in response to a delusion or hallucination or as a result of impaired judgment
F. not better accounted for by conduct disorder, a manic disorder, or antisocial personality disorder

Question 16

Pyromania- course

Answer 16

1. episodic: fire setting incidents wax and wane in frequency
2. no typical age of onset

Question 17

Trichotillmania- essential features

Answer 17

-disorder of compulsive hair pulling that ofter results in alopecia

1. pulling hair from scalp, eyebrows, eyelashes
2. itch-like sensation

Question 18

Trichotillmania- associated features

Answer 18

1. Examining hair root, twirling it off, pulling strand between teeth, or eating the hairs (trichophagia)
2. hair-pulling does not occur in the presence of others
3. social situations avoided
4. individuals deny hair pulling and conceal hair loss
5. some have urges to pull hair from others
6. pull hair from pets, dolls, other
7. majority pull hair from more than one site

Question 19

Trichotillmania- DSM Diagnostic

Answer 19

A. recurrent pulling out of one’s hair resulting in noticeable hair loss
B. increasing sense of tension immediately before pulling out the hair or when attempting to resist the behavior
C. pleasure, gratification, or relief when pulling out of the hair
D. disturbance is not better accounted for by another mental disorder and is not due to a general medical condition
E. disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

Question 20

Trichotillmania- Types of hair pulling

Answer 20

1. Focused (similar to OCD rituals)
   - associated with mounting tension prior; relief after
   - attention focused on act of pulling, which distracts
   - more elaborate rituals (hair pulling symmetry)
2. “automatic”
   - not associated with prodromal urge or sensation
   - occurs during sedentary activities

Question 21

Trichotillmania- physical changes

Answer 21

1. no inflammation of follicle but evidence of damaged follicles; evidence of short/broken hairs
2. patterns of hair loss are highly variable
   - areas of complete hair loss
   - noticeably thinned hair density
   - eyebrows and eyelashes completely absent
   - scarring and infection

Question 22

Trichotillmania- course

Answer 22

1. age of onset- 5-16 years
2. average- 13 years
3. many years or episodic

Question 23

Trichotillmania- comorbidity

Answer 23

80%

1. mood and anxiety disorders most frequent
2. eating disorders and substance use less frequent
3. OCD rare

Question 24

Trichotillmania- underregulation: strength

Answer 24

Temporary weakness

• causes significant shame and weakness
• stress causes vulnerability to relapes

Question 25

Trichotillmania- underregulation: monitoring

Answer 25

- treatment involves self-monitoring and relaxation training | - transcendence failure

Question 26

Trichotillmania- underregulation: inertia

Answer 26

- interruption of hair pulling causes extreme anxiety | - becomes automatic behavior similar to a habit

Question 27

Comorbidities

Answer 27

mood disorder spectrum - depression - antidepressants OCD spectrum - compulsive nature - SSRIs Group therapy is most commonly recommended