Impulse-Control Disorders Not Elsewhere Classified Assessment & Diagnosis SW 593

Introduction  There are a variety of situations in which a client fails to resist an impulse, drive, and/or temptation to engage in behaviors with a clear potential for negative effects.  The client’s actions are believed to be an attempt to relieve some growing sense of tension or arousal.  The client experiences a sense of relief or gratification followed by feelings of regret or guilt.

Intermittent Explosive Disorder  Key criterion:  Failure to resist aggressive impulses that result in actual assault and/or property destruction.  The degree of aggressiveness involved is judged to exceed a reasonable response to the specific provocation.  Must rule out a wide range of other mental disorders that could include outbursts.

Kleptomania  Key criterion:  Cycles of growing internal discomfort and a sense of relief when performing the theft.  Objects stolen are not needed for personal or monetary use or to express anger or revenge toward their owner.  Other mental disorders should be ruled out before making this diagnosis.

Pyromania  Key criterion:  Relates to the building and relieving tension.  Client evidences a general fascination with fire.  Fire setting is not motivated by receiving material gain, expressing some ideological viewpoint, or concealing other criminal activity.  Rule out other mental disorders.

Trichotillomania  Key criterion:  The individual pull out own hair in sufficient quantities to be noticeable.  To relieve the building sense of tension and to achieve some sense of relief or gratification.  No question of some alternative gain related to the behavior but rule outs should still be done.

Pathological Gambling  Key criterion:  Persistent and recurrent pattern of gambling is continued despite negative consequences.  Addictive-like behaviors are exhibited with preoccupation, need to escalate amounts of money, and an inability to control the behavior.  Engages in behavior to “feel better” or “solve problems”.

Pathological Gambling  The client often engages in lying to conceal the amount of gambling.  Engages in illegal activities to fund the gambling.  Becomes reliant on others for financial support.  Jeopardizes a variety of important relationships or occupational opportunities.

Assessment  Few specifically focused instruments have been developed.  General personality profiles may be useful.  In-depth interviewing regarding the problematic actions is commonly used.  Interviews should focus particularly on the internal experiences of the client in the times prior to, during, and after action.

Cultural Considerations  It appears that Intermittent Explosive Disorder and Pyromania occurs more frequently in males.  Kleptomania seems to occur more frequently in females.  With Trichotillomania the incidence is similar for both females and males.  3.5% of adult population and 8% of the adolescent population is affected by PG.