What Are Impulse Control Disorders?
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.
In the DSM-5, this category includes, among others, 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). Pathological gambling was once classified as an impulse control disorder but is now considered an addiction-related disorder in the DSM.
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.
Though the disorders themselves are rare—each affecting approximately 1 to 3 percent of the population—overall, ICDs affect a significant number of children and adults. 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 Do You Treat Impulse Control Disorders?
Though ICDs often feel uncontrollable, treatment is possible. While results vary depending on the disorder’s severity and on patient cooperation, the prognosis is considered to be generally positive. Children generally see greater improvement than adults, who are more likely to dismiss treatment or be uncooperative.
Because the disorders are often comorbid with other conditions that must be factored into treatment, such as substance abuse or depression, approaches vary. Effective treatment may draw on both psychopharmacological methods, such as antidepressants, and psychotherapy.
Cognitive behavioral therapy, or CBT, has been found to be effective for many impulse control disorders. In addition, relaxation techniques and aversion therapy have both been found to be beneficial. In cases of interpersonal conflict resulting from impulsive behavior, family therapy or couples therapy may provide additional support.