Diseases

Impulse disorders (impulse control disorder) - causes, symptoms and therapy

Impulse disorders (impulse control disorder) - causes, symptoms and therapy



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Gambling addiction, pyromania, kleptomania, trichotillomania, dermatillomania
Impulse disorders, also known as “impulse control disorders” or “impulse control disorders”, describe an urgent impulsive behavior, for example in the form of buying, playing, eating, nail-biting, self-harm or excessive masturbation. These impulsively controlled actions are experienced consciously, but it is difficult to prevent them on your own initiative. With the actions, those affected release a perceived state of tension. Impulse control disorders are behavioral disorders that are common throughout society.

Definition

The technical term impulse control disorder comes from psychiatry and clinical psychology. What is meant by this is a certain behavioral pattern, which is triggered on an impulsive basis in order to release a perceived uncomfortable state of tension. The actions of those affected mostly have no apparent motivation, cannot be controlled or can only be controlled with difficulty and often damage the patient's own interests or the interests of others.

The impulsive behavior mostly follows the same patterns, which, although consciously experienced, can be deliberately not broken or only with difficulty. These affect acts can manifest themselves in numerous activities, such as excessive eating, buying, playing, nail-biting, lawning in traffic, masturbating or self-harm. Impulse control disorders often occur in patients with borderline personality disorder.

Root cause

The causes of impulse control disorders have not yet been fully understood. Doctors suspect a complex interplay of genetic, physical and social factors such as upbringing, environment and experience horizon. The hormone level of those affected is also suspected of being relevant to the problem and of significantly influencing the type of disorder. For example, men are more prone to aggressive disorders such as compulsive arson, whereas the compulsive actions of women are more self-destructive, such as is the case with trichotillomania (pulling out hair).

In addition, a close interaction with other mental disorders is suspected, such as substance dependencies and serious mental illnesses such as borderline. There are also drugs that can be used, for example, in the treatment of Parkinson's disease, that can trigger impulse control disorders.

Symptoms

Typical signs of impulse control disorders are when those affected repeatedly cannot resist their impulses. The decision to perform an impulsive action is not made consciously, but is based on an obsessive compulsion. Most of the time, the actions take place schematically and are similar in principle, although the deeds are completely different.

Almost the same mental process precedes all impulse control disorders. Those affected suffer from an uncomfortable tension before the action, which eases as a result of the act carried out. The unpleasant self-perception is suppressed and directed to the execution of the action. After the fact, many of those affected have feelings of guilt and shame, which have a negative effect on mental development, which in turn increases the inner tension and leads to repeated actions.

Diagnosis

The diagnosis is primarily made by a psychiatrist. For the symptoms to be diagnosed as a mental disorder, the compulsive behavior must be considered inappropriate or not reason-oriented. It also plays a role in the diagnosis whether the person in question harms himself or other people, for example by accumulating debts or causing accidents and injuries.

ICD classification

In the WHO (World Health Organization) diagnostic classification system, “abnormal habits and impulse control disorders” have the ICD key F63, which is further subdivided, for example into:

  • F63.0 pathological gaming
  • F63.1 pathological arson (pyromania)
  • F63.2 pathological stealing (kleptomania)
  • F63.3 plucking, twisting and pulling out hair (trichotillomania)
  • F63.8Other abnormal impulse control habits and disorders (e.g., pathological quick temper or dermatillomania)

Pathological gaming

Pathological gambling refers to the abnormal habit of repeatedly playing intensive games of chance, which have an enormous influence on or almost control the lives of those affected. As a result, some of the patients are no longer able to pursue their profession and maintain social contacts, which has a negative impact on the family, the environment and ultimately also on material supplies.

In colloquial language, this behavior is referred to as gambling addiction or gambling addiction. Again and again those affected try to detach themselves from playing, but this does not succeed. Gambling addicts, often men, are often keen to hide their addiction from relatives and friends. When you play, you don't think about the possible consequences such as unemployment, debts and relationship problems.

This compulsive action is triggered by problems or negative moods that trigger an unpleasant tension in those affected, which they can only reduce by playing or betting. Often, those affected lose considerable sums and thus trigger a downward spiral: The money is no longer enough to pursue the addiction and everything is still being tried to continue playing. Many addicts are heavily indebted and sometimes accept criminal acts in order to obtain the financial means to satisfy their addiction.

Pyromania

In the case of impulse control disorder in the form of pathological arson, those affected repeatedly deal with the fire and everything that is connected with it. They set fire to property or to other buildings or places, although no real motive can be seen for third parties. The pyromaniacs are under tension and excitement. Those affected experience joy or relief during the arson. You are not committing the act out of lust for revenge or destructive rage. Even with this disorder, those affected may have a tendency to commit crimes.

Kleptomania

Another impulse control disorder is pathological stealing. It doesn't just steal things that are needed. The stolen goods are often thrown away, given away or hoarded after the act. Sufferers experience a feeling of satisfaction during or immediately after the act. Kleptomaniacs do not steal in order to enrich themselves or others, but because of the inner tension before the theft and the subsequent satisfaction that results from the deed. Those affected often have a guilty conscience after theft, but they commit it again and again. Since theft is a crime, kleptomaniacs often come into conflict with the law.

Trichotillomania

Trichotillomania describes an uncontrollable urge to pluck, twist, and pull out his hair. As with the disorders already described, this is also associated with inner tension and a feeling of relief and satisfaction after the action. Those affected sometimes experience a large hair loss.

Loss situations, experiences of abuse or other serious cuts in life are discussed as the causes of trichotillomania. However, simpler incidents in the family or in the interpersonal area can lead to a reduction in self-esteem and thus trigger the impulse control disorder.

Most of the time, those affected are particularly susceptible to stress. Trichotillomania is often accompanied by other mental disorders such as massive anxiety, depression, eating disorders, obsessive-compulsive disorder or tic disorders. Many sufferers suffer from skin problems as a result of this impulse disorder. Rarely pulled out hairs are swallowed, which can lead to an intestinal obstruction in larger quantities.

Pathological anger

Pathological irritation or the disorder with intermittent irritability is an impulse control disorder characterized by explosive outbursts of anger and aggression. Often the outbreaks escalate into veritable frenzy that is out of proportion to the situation. For example, those affected suddenly start to scream impulsively in relatively trivial events. In most cases, these outbreaks are reactions to real or perceived provocations, arguments, discussions, or the behavior of others. Some people may experience an affective change in behavior before an outbreak, for example in the form of tension or mood swings.

Dermatillomania

Dermatillomania or skin picking disorder is an impulse control disorder in which those affected have an irresistible urge to repeatedly touch, squeeze and scratch diseased skin areas. This behavior can lead to significant tissue damage. Other possible consequences are feelings of shame and guilt, which is why many of those affected increasingly isolate themselves socially.

Treatment of impulse disorders

Medications such as antidepressants are used in the treatment of impulse disorders, since impulse control disorders often occur together with depression. Non-drug therapy approaches such as conversation therapy, behavioral therapy or psychoanalysis also play a crucial role. The aim of the therapy is to completely suppress the undesirable behavior or to modify the compulsory act so that it is reduced to a harmless level.

In addition, the social and possibly also the legal context of the action must be considered, since some of those affected have committed criminal offenses such as compulsive stealing or arson. The success of the therapy largely depends on the extent to which those affected are willing to cooperate. However, affected children in particular often do not recognize the seriousness of the situation.

Behavioral therapy
Behavioral therapy teaches people with impulse control disorders how to deal with their disorder and strategies on how to behave when tension occurs. An attempt is made to prevent the impulse and to learn other, alternative behavior. Therapy should always be adapted to the individual requirements of the patient and their special form of impulse disorder.

Psychoanalysis
Psychoanalysis examines the personal history of those affected. The processing of traumatic events and experiences with caregivers should lead to more mental stability and self-confidence with this form of therapy.

Self-help for impulse control disorders

Impulse control disorders require holistic therapy and, in most cases, cannot be managed on their own. The decisive factor for a healing process is the readiness for therapy and the consistent implementation of the steps. In therapy, self-help measures are often also learned, such as performing non-harmful substitute actions to resolve the tensions that have built up.

Habit reversal training
For some impulse control disorders such as trichotillomania and dermatotillomania, so-called habit reversal training (habit reversal) has proven itself. In this training, the problematic behavior is replaced by an alternative behavior. For example, those affected can learn to suppress the impulse by sitting on both hands.

Relaxation training
Relaxation procedures for stress relief such as autogenic training, special breathing exercises and Jacobsen progressive muscle relaxation support the treatment.

State of research

Impulse control disorders can also be triggered by drugs used in Parkinson's disease. An alternative treatment was recently presented in a study. Parkinson's patients benefit from a brain pacemaker. This enables a reduction in the medication required and can thus also reduce impulse control disorders. (sw, vb)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Graduate editor (FH) Volker Blasek, Barbara Schindewolf-Lensch

Swell:

  • Professional associations and specialist societies for psychiatry, child and adolescent psychiatry, psychotherapy, psychosomatics, neurology and neurology from Germany and Switzerland: causes of disorders in social behavior (access: 29.07.2019), neurologen-und-psychiater-im-netz.org
  • Amboss GmbH: Abnormal habits and disorders of impulse control (accessed: July 29, 2019), amboss.com
  • Pro Psychotherapie e.V .: F63.- Abnormal habits and impulse control disorders (accessed: 29.07.2019), therapie.de
  • American Addiction Centers: Impulse Control Disorders and Substance Abuse (accessed: July 29, 2019), americanaddictioncenters.org
  • American Psychiatric Association: What Are Disruptive, Impulse-Control and Conduct Disorders? (Access: 29.07.2019), psychiatry.org
  • Mestre, Tiago A. / Strafella, Antonio P. / Thomsen, Teri / et al .: Diagnosis and treatment of impulse control disorders in patients with movement disorders, Therapeutic Advances in Neurological Disorders, 2013, journals.sagepub.com
  • Bilke-Hentsch, Oliver / Wölfling, Klaus / Batra, Anil: Practice book behavioral addiction: symptoms, diagnostics and therapy in children, adolescents and adults, Thieme, 2014

ICD codes for this disease: F63ICD codes are internationally valid encodings for medical diagnoses. You can find yourself e.g. in doctor's letters or on disability certificates.


Video: Impulse Control Disorders (August 2022).