Impulse Control Disorders

Question 1

Impulse control disorders are characterized by an inability to…

Answer 1

resist behaviors that may bring harm to oneself or to others

Question 2

What is experienced prior to impulses in an impulse control disorder? After?

Answer 2

Prior: Anxiety or tension

After: Relief and satisfaction

Question 3

What are the DSM-IV criteria for intermittent explosive disorder?

Answer 3

• Failure to resist aggressive impulses that result in assault or property destruction
• Level of aggressiveness is out of proportion to any triggering events

Question 4

What is the usual onset of intermittent explosive disorder? What are the etiological factors?

Answer 4

Onset usually in late teens or twenties

Etiological factors: Genetic, perinatal, environmental and neurobiological factors

Patients often have history of child abuse, head trauma, or seizures

Question 5

What is the treatment for intermittent explosive disorder?

Answer 5

SSRIs, anticonvulsants, lithium, and propanolol

Group therapy and/or family therapy may be useful

Question 6

What are the DSM-IV criteria for Kleptomania?

Answer 6

• Failure to resist urges to steal objects that are not needed for personal or monetary reasons
• Pleasure or relief is experienced while stealing
• Purpose of stealing is not to express anger and is not due to a halucination or delusion

Question 7

Kleptomania is more common in _____ (men/women)

Answer 7

Women

Question 8

What percentage of shoplifter are kleptomaniacs?

What are some common comorbid disorders?

Answer 8

5% of shoplifters

Increased incidence of comorbid mood disorders, eating disorders, and OCD

Question 9

What is the treatment for kleptomania?

Answer 9

Insight-oriented psychotherapy

Behavior therapy (systematic desensitization and aversive conditioning)

SSRIs

Question 10

What are the DSM-IV criteria for pyromania?

Answer 10

• More than one episode of intentional fire setting
• Tension present before the act and pleasure or relief experienced afterwards
• Fascination with or attraction to fire and its uses and consequences
• Purpose of fire setting not for monetary gain, expression of anger, making a political statement, and is not due to a hallucination or delusions

Question 11

Pyromania is more common in _____ (men/women)

Answer 11

Men

Question 12

What is the treatment for pyromania?

Answer 12

Behavior therapy, supervision, and SSRIs

Question 13

What are the DSM-IV criteria for Pathological Gambling? (10)

Answer 13

5 or more of the following

• Preoccupation with gambling
• Need to gamble with increasing amount of money to achieve pleasure
• Repeated and unsuccessful attempts to cut down on gambling
• Restlessness or irritability when attempting to stop gambling
• Gambling done to escape problems or relieve dysphoria
• Returning to reclaim losses after gambling
• Lying to therapist or family members to hide level of gambling
• Committing illegal acts to finance gambling
• Jeopardizing relationships or job because of gambling
• Relying on others to financially support gambling

Question 14

What are some predisposing factors to pathological gambling?

Answer 14

• Loss of a parent during childhood
• inappropriate parental discipline during childhood
• ADHD
• Lack of family emphasis on budgeting or saving money
• Etiology may involve genetic, biological, environmental, and neurochemical factors

Question 15

What are treatment options for pathological gambling?

Answer 15

Gamblers anonymous (12 step program) is most effective

After 3 months of abstinence from gambling, insight oriented psychotherapy may be attempted

Treat comorbid mood disorders

Question 16

What are the DSM-IV criteria for Trichotillomania?

Answer 16

• Reccurrent pulling out of one’s hair, resulting in visible hair loss
• Usually involves scalp, but can involve eyebrows, eyelashes, and facial and pubic hair
• Tension present before the behavior and pleasure or relief resulting afterwards
• Causes significant distress or impairment in daily functioning

Question 17

Trichotillomania is more common in _____ (men/women)?

Answer 17

Women

Question 18

What are some comorbid disorders seen with trichotillomania?

Answer 18

OCD, obsessive compulsive personality disorder, mood disorders, and borderline personality disorder

Question 19

What are some treatments for trichotillomania?

Answer 19

• SSRIs, antipsychotics, lithium
• Hypnosis, relaxation techniques
• Behavioral therapy, including substituting another behavior and/or positive reinforcement