Impulse Control Disorders

Abstract

In the fourth edition of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-IV-TR), the category “impulse control disorders not elsewhere classified” included kleptomania, intermittent explosive disorder, pyromania, pathological gambling, and trichotillomania. In the fifth edition of the DSM (DSM-5), however, several classification changes were made. Pathological gambling is called “Gambling Disorder” and included in the category of “Substance-Related and Addictive Disorders”; Intermittent explosive disorder maintains the same name but is included in the category of “Disruptive, Impulse-Control, and Conduct Disorders”; Trichotillomania is called “Hair Pulling Disorder (Trichotillomania)” and included in the category “Obsessive-Compulsive and Related Disorders” along with, among others, another body-focused repetitive behavior called excoriation (skin picking) disorder. Despite classification or categorization changes, however, these disorders continue to share common core qualities, including (1) a repetitive or compulsive engagement in a behavior despite adverse consequences; (2) a diminished control over the problematic behavior; (3) an appetitive (“▶Urge”) or craving state prior to engagement in the problematic behavior; and (4) a hedonic quality during the performance of the problematic behavior (“▶ Impulsivity”). Despite being fairly common among adolescents and adults, impulse control disorders (ICDs) have been relatively understudied (Grant 2008). Currently in the USA, for example, there are no Food and Drug Administration (FDA)-approved medications for the treatment of any of the impulse control disorders. These essays review the available research on the pharmacological treatments of kleptomania, intermittent explosive disorder, and pyromania (gambling disorder and hair pulling disorder [trichotillomania] are discussed elsewhere), and the advantages and disadvantages of different agents, as well as the reason for the preference of one medication over another.