CHAPTER 9 IMPULSE CONTROL DISORDERS -A need or desire that must be satisfied immediately regardless of consequences. -Many of behaviors have adverse or even destructive consequences for individuals, & seldom they know why they do or why it is pleasurable.

Essential features of impulse control disorders: -Failure to resist impulse, drive, or temptation to perform some acts that is harmful to person or others. -There may or may not be conscious resistance to impulse. -The act may or may not be premeditated or planned. -Increasing sense of tension or arousal before committing the act.

-Experience of either pleasure, gratification, or release at, the time of committing the act. -The act is ego-syntonic: it gratifies a conscious wish of the individual’s at the moment. -Immediately after the act, there may or may not be genuine regret, self-reproach, or guilt.

1. Intermittent explosive disorder -Loss of control of violent/aggressive impulse that culminates in serious assaultive acts or destruction of property. -Some pts. report changes in sunroom, as confusion during episode or amnesia for events occurred during episode.

-Sx usually appear suddenly & terminate abruptly, lasting only minutes to few hours, followed by feelings of genuine remorse & self- reproach about behavior. -Often starts in second or third decade of age. -Social r/s disturb R/T unexpected aggressive behavior. -Disorder is rare & in males > females.

Rx -Drugs: phenothiazine sometimes anti- depression, anti-convulsant. -Psychotherapy: Individual psychotherapy maybe difficult, dangerous & mostly unuseful. -Family therapy: useful when pt. is adolescent.

2. Kleptomania -Recurrent failure to resist impulses to steal objects not needed for personal use or their monetary value. -Often stolen objects, for which individual usually has enough money to pay, are given away, discarded, returned, or kept hidden.

-kleptomaniac steals purely for sake of stealing & for sense of relief & gratification that follows episode. -Rare disorder. -In females > males. -Starts in childhood then increase then decreases & become chronic & usually has judicial problems.

Rx -Insight psychotherapy psychoanalytic psychotherapy succeeds well in treating these condition especially if pt. has motivation for Rx. -Behavioral Rx by desensitization or converted conditioning.

3. Pathological gambling -Chronic & progressive failure to resist impulses to gamble, & gambling behavior that compromises, disrupts, or damages personal, family, or vocational pursuits. -Impulse to gamble intensifies when individual is under stress.

-Many pathological gamblers exhibit characteristics associated with narcissism & grandiosity & often have difficulties with intimacy, empathy & trust. -Usually starts in adolescence (in males before females). -Fluctuates from exacerbation to remission. -Often becomes chronic.

Rx -Rarely that pt. comes by himself to Rx but usually comes for another psychological complaints or pressure of family or judicial problems. -Admission to hospital to make him away from gambling environment & to insight him of problem conditional by making him away of gambling for 3 months then to be treated by psychotherapy.

4. Pyromania -Inability to resist the impulse to set fires. -The act is proceeded by tension or affect in arousal, & pt. experiences intense pleasure, gratification, or relief when setting fires or witnessing or participating in their aftermath. -Some pyromaniacs may take precautions to avoid fear, many are totally indifferent to consequences of their behavior.

-Usually starts in childhood & when starts in adolescence it is more destructive. -In males who are less intelligent. -Often have behavioral hx of deviation, escaping from home, school, urine incontinence, aggressiveness against animals.

Rx -Children: psychotherapy: behavioral or psychoanalytic to keep then from continuing this behavior. -Adults: Depends on their motivation for Rx so it is necessary to them as the only way to prevent their dangers.

5.Trichotillomania -Recurrent failure to resist impulses to pull out one’s own hair. -Impulse is preceded by increasing sense of tension, & then individual experiences sense of release or ratification from pulling out hair. -Usually in childhood but may occur at geriatric. -In females > males.

Rx -Anti-anxiety, anti-depression or anti-psychotic. -Behavioral therapy (Biofeedback). -Mystification. -Individual or group psychotherapy.