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Impulse Control Disorder

The behaviors that develop from an impulse control issue can quickly take over a patient's life, and they tend to escalate cumulatively.
Impulse Control Disorder
Treatment will be significantly shorter if you deal with it in the early stages rather than letting it develop deep within your psyche.
By Jenna Jarrold, MS, LPC | Updated: January 25, 2023

What Are Impulse Control Disorders?

Many people struggle to understand impulse control disorders and the impact they can have on the lives of those who struggle with them. Often, the symptoms inherent to impulse control disorders are thought (by those who do not personally struggle) to be easily managed. Yet, this is far from the truth. The name of the disorder is self-explanatory in that impulse control disorders make it very difficult for individuals to resist the impulse or urge to do something harmful. This includes everything from addiction to stealing (kleptomania).

In most cases, an individual with impulse control disorder feels powerless over impulsivity. This means it is extremely difficult to resist the urge or temptation to “act out.” The impulse typically develops in response to increased stress or feeling out of control. Participating in the act itself generally results in feelings of pleasure and gratification, but shortly after, feelings of guilt and grief may arise. However, the more dangerous form of impulse control relates to individuals who do not have any regrets for their negative actions and therefore have no desire to change.

There are considered to be five main behavioral stages that characterize impulsivity:

  • An impulse
  • Increased tension
  • Pleasure on acting (decreased tension)
  • Relief and/or excitement from acting on the urge or impulse
  • Guilt

There are different types of impulse control disorders including:

  • Pyromania – when a person gets pleasure or joy from setting fires. This is different from a person classified as an “arsonist” in that the fire-setting is not for the purpose of financial gain, an act of revenge, or to hide a crime.
  • Pathological gambling – when a person struggles with the inability to stop gambling (regardless of winning or losing). Pathological gamblers have an obsession with gambling and use it as a way to escape negative feelings. Unfortunately, many pathological gamblers end up engaging in illegal behavior like embezzlement, stealing, or writing bad checks to fund their habit. To be diagnosed with this impulse control disorder the gambling must not be better explained by another disorder, such as a manic episode.
  • Trichotillomania – when a person intentionally pulls their hair, causes hair loss (often noticeable hair loss). This hair picking can cause significant distress and functional impairment. Many people with this impulse control disorder avoid social situations, such as dating, out of embarrassment. In extreme cases of trichotillomania, individuals may also ingest the pulled hair, causing additional medical complications.
  • Kleptomania – when a person engages in repetitive, uncontrollable stealing. Kleptomaniacs gain pleasure from stealing, even though the items most often stolen are very small, monetarily insignificant items. Most individuals with this impulse control disorder have been arrested at some point due to kleptomania.
  • Intermittent Explosive Disorder – when a person has persistent and recurrent outbursts of aggression. These outbursts often result in violence to self or others, and/or property damage. Legal and/or occupational difficulties are common in those with intermittent explosive disorder.
  • Pathological Skin Picking – when a person engages in repetitive or compulsive picking of the skin to the point of tissue damage. Pathological skin pickers tend to spend much of their time picking, often numerous hours of the day. Most often, pathological skin pickers pick the skin of the face, but any part of the body could be an area of focus.
  • Unspecified Impulse Control Disorder – when a person has symptoms of various impulse disorders, not specified to only one.

Also important to note is the distinction between an impulse control disorder and other mental health disorders such as depression, bipolar, or ADHD is that the lack of impulse control is the primary focus. For example, while individuals struggling with ADHD have to fight to keep their attention focused and thus may have impulses that have a negative impact, the impulse control issue is not the primary symptom.

Post-Pandemic, Increase in Impulsivity

Diagnostic rates for impulse control disorders stayed fairly consistent before and after the COVID-19 pandemic. Nonetheless, research on the effects of the pandemic point to a considerable increase in impulsive and addictive behaviors, especially during lockdown periods. Problem drinking, pornography use, eating, and gambling were the behaviors that seem to have been most significantly aggravated by the pandemic. But the pandemic did not only exacerbate impulsivity in adults; impulse-control became a problem for COVID-isolated children as well. Parents and teachers saw more fights amongst kids, more “clinginess”, and more kids struggling to self-soothe and settle.

What Causes Impulse Control Disorders?

While there is no specific identified cause of impulse control disorders they likely stem from a combination of environmental and genetic factors, as with many mental health disorders. Nonetheless, there are some factors that may make some individuals more likely than others to develop an impulse control disorder, such as:

  • Childhood trauma or neglect
  • Chronic stress
  • Having another mental health disorder – impulse control disorders most commonly co-occur with another mental illness
  • Being male – males are slightly more prone to impulse control disorders than females

Approaches to Therapy for Impulse Control Disorder

Impulse control disorders do not manifest exactly the same in each person, thus, each treatment plan will look different. Regardless, there are some commonly used approaches for treating impulse control disorders such as:

  • Cognitive behavioral therapy (CBT) – cognitive behavioral therapy is widely used in the treatment of impulse control disorders (and mental health disorders in general). CBT helps individuals develop stress reduction tools, challenge distressing thoughts that drive unhealthy behaviors (impulsivity), replace unhealthy behaviors with approaches to emotion regulation, and prevent relapse.
  • Systematic desensitization therapy – also known as graduated exposure therapy, systematic desensitization therapy is a type of behavioral therapy that has shown to improve self-control in anxiety-provoking situations.
  • Group therapy and support groups – the group setting is helpful in terms of increased emotional support. Group therapy is also a place in which others will struggle with similar issues, thus the participants can relate with one another.

Additionally, mindfulness and other holistic techniques (i.e. – yoga, meditation, etc.) can be helpful in increasing willpower in times of increased stress (when otherwise one might act on an impulse).

Medications are, on occasion, prescribed for individuals with impulse control disorders. Although there are no drugs specifically approved for impulse control issues, psychiatrists sometimes prescribe SSRIs (selective serotonin reuptake inhibitors), which are typically used in the treatment of depression. SSRIs have shown to improve aggression and irritability in those with an impulse control disorder. Naltrexone is another medication that has shown some promise with impulse control disorder. Naltrexone (an agonist drug) has been studied in individuals with kleptomania and pyromania, helping them maintain long-term abstinence.

Reasons for Hiring a Therapist

In almost all cases, healing from an impulse control disorder will require professional intervention. This is because the symptoms, side effects, and behaviors associated with impulse control disorders can quickly take over a person’s life, affecting their relationships, work, physical and mental health, and overall quality of life and wellbeing. This means that the initial signs may be slow and even easy to ignore. However, as the symptoms continue to worsen, the speed of the destructive behaviors will increase as well. As soon as you start to notice an impulse control disorder, you need to start speaking with a therapist. Treatment will be significantly shorter if you deal with it in the early stages rather than letting it develop deep within your psyche.

What to Look for in a Therapist

There are various considerations to take into account when identifying a therapist for impulse control disorder treatment. One consideration might be based on the specific type of impulse control you struggle with. Another might be the particular age group in which a therapist specializes, or even the therapist’s gender (some people feel more comfortable working with one particular gender). Search TherapyTribe directory for a therapist that meets your specific needs and find the right therapist for you or your loved one.

References

  • Brewer, P. (2008). The neurobiology and genetics of impulse control disorders: Relationships to drug addictions”. Biochemical Pharmacology 75(1) 63–75.
  • Fontenelle, L., Oostermeijer, S., Harrison, B., Pantelis, C., & Yücel, M.(2011). Obsessive-compulsive disorder, impulse control disorders and drug addiction: Common features and potential treatments”. Drugs. 71 (7): 827–40
  • Weintraub, D. (2009). “Impulse control disorder: Prevalence and possible risk factors”. European Neuropsychopharmacology. 19: S196–S197
  • Schnell, T., & Krampe,H. (2020).  Meaning in life and self-control buffer stress in times of COVID-19: Moderating and mediating effects with regard to mental distress. Frontiers in Psychiatry. 11