5 forms of ICD's.
What are Impulse Control Disorders? Impulse Control Disorders are disorders in which a person acts on a certain impulse, that is potentially harmful, but they can not resist. Intermittent Explosive Disorder: This aptly named disorder is diagnosed if an individual manifests several obviously excessive and unjustified outbursts of anger that result in significant property damage or injury to others. The diagnosis is subject to some of the usual caveats; that is, the outbursts cannot be better accounted for by another diagnosis or be substance-induced or the result of a medical condition. Voluntary acts for gain also do not qualify. However, DSM-IV does not state that the disorder must interfere with any aspect of the individual's life, although it obviously interferes with the lives of others. Some investigators believe that this disorder is a version of bipolar disorder, and have had some success treating the disorder with medication carefully tailored to fit the affective history and state of the patient. One investigator reported success in treating patients with biofeedback. However, it is fair to say that relatively little is certain about treatment of people with IED. Left untreated, symptoms of the disorder are certainly likely to recur, so treatment is certainly indicated. Kleptomania: People with Kleptomania usually do not steal because they need the object stolen; 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. The stealing is not accounted for by an external motive like hunger or financial deprivation or vengeance, or accounted for better by another disorder of which stealing is a part (for example, Antisocial Personality Disorder or a manic episode). Kleptomania is rare overall, but more common in females than in males. It is obviously difficult to document the precise number of people with Kleptomania. People with Kleptomania often have another psychiatric disorder, often a mood disorder. Treatment is largely untested, and the disorder often persists despite many convictions of shoplifting. It may decrease as the individual ages, however. Pathological Gambling: Unlike the other disorders classified as impulse control disorders, pathological gambling is far from rare. The best current estimate is that 2 to 3% of the citizens of the United States are pathological gamblers. The costs to patients and their families is almost incalculable. A summary of the criteria for diagnosis from DSM-IV includes the following: the person is preoccupied with gambling, needs to gamble with increasing amounts of money to experience the original thrill, has tried to cut back (without success, of course), is restless when not gambling, lies to all concerned about the gambling, has lost a relationship, job, and money, and relies on others to get out of trouble. The typical pathological gambler is affable, self-centered, and often likeable. Most are male, and many have committed illegal acts to support their habits. With the rise in the number of Indian casinos, there may well be an associated increase in the number of pathological gamblers. Individual cures are extremely difficult to come by. Gamblers Anonymous (GA), patterned after Alcoholics Anonymous, offers some hope, and Gam-Anon offers support for families of Pathological Gamblers. Few who only enter GA actually quit gambling, but if they enter GA and go to an inpatient treatment facility, recovery rates approach 50% for those who complete the program. Families of pathological gamblers may have a better chance of adapting to the problems than the gambler has of stopping the creation of the problems. Pyromania: Pyromania involves more planning than most of the impulse control disorders, so it is more compulsive than impulsive. It requires that the person set more than one deliberate fire (not in a barbecue or fireplace - a destructive fire). The usual impulse disorder sequence of strong arousal before and pleasure or tension reduction after the act must be present. 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 not have pyromania, unless they meet the criteria above. The fire setting must not be accounted for by another diagnosis. People with pyromania often have poor learning skills and emotional difficulties. Behavioral interventions may be helpful for pyromania. Most people with pyromania in childhood get better, but untreated adults (the majority of sufferers) don't. Perhaps because so little is known about pyromania, other web sites we visited added little to what we said above. We did, however, find one interesting reference to a program to prevent or treat juvenile firesetters. About half of all arson fires are set by children. Trichotillomania: Trichotillomania (T) has 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. T was thought to be rare, but earlier estimates may have been too low because victims are usually secretive about the behavior. As many as 1 to 2% of college students have had T at some time. Hair may be pulled from any part of the body, but the scalp, eyebrows, and eyelashes are the most frequent targets. T must cause significant distress before it can be diagnosed. Most cases of hair-pulling don't qualify as T, and many cases remit over time. Others continue indefinitely. A January, 2000, study by Dr. Philip T. Ninan at the Emory University School of Medicine with a small group of patients who had been pulling out their hair for an average of 20 years indicated that cognitive-behavioral therapy was markedly superior to the anti-depressant drug, clomipramine, or to a placebo pill, for treating T; of five patients in the therapy group, four had completely stopped pulling out their hair by the end of the study, and the fifth was much improved. The placebo group showed no improvement; four of the six patients in the clomipramine group improved, but none were "cured," despite the fact that patients in the placebo and drug groups were also seeing a psychiatrist once a week.
places to go for more help
the history of gambling in timline form
www.healthinmind.com
www.psyweb.org
