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Impulse Control Disorders

Reviewed by Psychology Today Staff

Impulse control disorders (ICDs) are a class of psychiatric disorders characterized by difficulties controlling aggressive or antisocial impulses. Because they can involve physical violence, theft, or destruction of property, the disorders often have harmful effects on both the person with the disorder and on others around them.

Impulse control disorders include intermittent explosive disorder (characterized by a failure to resist aggressive or violent impulses); kleptomania (the impulse to steal things not needed for use); and pyromania (an uncontrollable impulse to set fires). In the DSM-5, antisocial personality disorder and oppositional defiant disorder are included in the same category, which is broadly categorized as “disruptive, impulse-control, and conduct disorders.” Pathological gambling was once classified as an impulse control disorder but is now considered an addiction-related disorder in the DSM.

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Understanding Impulse Control Disorders
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Impulse control disorders are thought to develop through a combination of biological and environmental factors. They often co-occur with other psychiatric disorders—most notably depression, anxiety, and substance abuse—but it’s not always clear whether comorbid conditions develop independently or whether mental health challenges result from difficulty managing impulses and the consequences thereof. Regardless, many (but not all) people with impulse control disorders report significant distress or interpersonal conflict as a result of their behavior, which often feels out of their control.

How common are impulse control disorders?

The disorders themselves are rare, each affecting approximately 1 to 3 percent of the population. Combined, however, ICDs affect a significant number of children and adults. 

How do the symptoms of impulse control disorders usually manifest?

The behaviors and emotions associated with impulse control disorders often follow a similar trajectory. Before the impulse is acted on, many with ICDs report mounting internal tension, which can become seemingly unbearable. The tension is temporarily relieved when the impulse is carried out, but afterward, there may be a rush of guilt.

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Intermittent Explosive Disorder
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Intermittent explosive disorder usually begins in late childhood or adolescence, and can have a serious negative impact on sufferers' lives. Aggressive "episodes" can result in property damage or physical assault, possibly leading to trouble with the law or other long-term consequences—and in many cases, angry explosions damage relationships with others, sometimes beyond repair. For this reason, many with intermittent explosive disorder feel genuine regret after their outbursts, even if they feel relief in the moment. Luckily, treatment, while challenging, can be highly effective, particularly if it's started as early as possible.

To learn more about causes, symptoms, and treatment of intermittent explosive disorder, see our Diagnosis Dictionary.

What causes intermittent explosive disorder?

Since intermittent explosive disorder appears to run in families, it’s likely that there is a genetic component. However, since many with intermittent explosive disorder grew up in homes where explosive behavior or violence was common, it’s highly possible that their explosive behavior is learned to some degree.

Is intermittent explosive disorder a neurological disorder?

Intermittent explosive disorder is associated with differences in brain structure and function. Some research, for example, suggests that IED is linked to disruptions in serotonin pathways in the brain and limbic system. Additional research has found that the disorder is associated with lower white matter integrity and lower grey matter volume in the connections between the frontal lobe and other brain regions, which may contribute to impaired social cognition and greater difficulty regulating emotions.

Woman stealing red clothing item in store

Someone with kleptomania frequently feels compelled to steal items—often small items, or those of little value—and finds it immensely difficult to resist these urges. Unlike many other people who steal—who may do so for monetary gain, for revenge, or because they are in grave need of certain things—those with kleptomania do so for no clear purpose: they steal purely for the sake of stealing. Taking the item may temporarily provide pleasure or a sense of relief, but many individuals report feelings of guilt or shame afterward. Though some people with kleptomania are able to steal without being caught, many find themselves in trouble with the law—some estimates suggest that up to 20 percent of people arrested for shoplifting suffer from kleptomania.

For more on causes, symptoms, and treatment of kleptomania, see our Diagnosis Dictionary.

What causes kleptomania?

Similar to intermittent explosive disorder, kleptomania is thought to be caused, at least in part, by disruptions in neurotransmitter pathways that deal with serotonin and dopamine, which play a role in aggression and how the brain responds to reward. There may also be imbalances in the brain’s opioid system, which influences one’s ability (or inability) to resist urges.

When does kleptomania usually start?

Kleptomania can develop as early as childhood, though in most cases it begins to manifest in adolescence or young adulthood. In very rare cases, it develops in later adulthood.

Child holding lit match

Many people experience some interest in or even fascination with fire. But those with pyromania take this fascination to an extreme—and by purposely setting fires to fuel it, they often put themselves and others at great risk. Because pyromania is exceedingly rare, it's a difficult disorder to understand and treat. However, some approaches have shown promise, especially if they are started immediately upon diagnosis and, when possible, incorporate other members of the family.

To learn more about causes, symptoms, and treatment of pyromania, see our Diagnosis Dictionary.

What causes pyromania?

The exact cause of pyromania is unknown, though the small amount of research that has been done on the condition suggests there may be a genetic component. Researchers speculate it may share roots with other behavioral addictions, such as gambling, as well as other compulsive behaviors.

Why do some people like setting fires?

Individuals with pyromania often feel deeply fascinated by fire, and may feel a sense of euphoria upon setting one and watching it burn. They may feel an internal tension before a fire is set, which gives way to immense relief once it is. 

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