Impulse-Control Disorders Not Elsewhere Classified

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

2. 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.

3. 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.

4. 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.

5. 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.

6. 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.

7. 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”.

8. 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.

9. 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.

10. 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.