Impulse control disorders

clinical psychology, chapter 3

kleptomania

• recurrent, irresistible urge to steal

• no motivation for stealing (don’t need the item, might give it away)

• theft is often unplanned, done due to a build up of tension that releases after the act

• depression, shame, anxiety common

• in order to get a diagnosis other causes to stealing must be eliminted

  • manic?

  • voices telling to steal?

pyromania

• fascination with fire, fire equipment, firefighters etc.

• repeatedly, intentionally set fires but don't always mean to cause damage

• tension builds up until a fire is lit

• relief & pleasure as fire grows

• age of onset relatively young

• risk factors: boredom, stress, conflict at home/school

• most feel guilt over causing damage and risking others

gambling disorder

• Build up of tension, released after gambling

• Impaired control over gambling → how much and often they bet

• Gambling takes priority in life & difficult to stop

• Patterns usually exhibited for 12 months before a diagnosis 

• Eliminate mania as a cause

• Signs of tolerance have been found → regular gamblers’ heart rates returned to normal faster than non-regulars’ after placing a bet

• 65% experienced withdraws when abstaining: insomnia, headaches

• Withdraw symptoms were worse for gamblers than substance users

The kleptomania symptom assessment scale (K-SAS)

• measures severity of symptoms

• 11-item self report → each scored 0-4

• Consider thoughts & actions of the past week

• Score over 31 is severe, over 21 is moderate

• See changes in symptoms over time

• “During the past week, how many times did you experience urges to steal?”

The kleptomania symptom assessment scale (K-SAS) → evaluation

PROS:

• Applications to everyday life → Takes 10 min, covers aspects of kleptomania (thoughts, urges, behaviour, distress), quick diagnosis can be made, compare development of symptoms over time

• Nomothetic → large amounts of data collected over the years in order that scores can be compared → see if a score is mild, moderate, severe. HOWEVER, case studies (idiographic) would find causes & qualitative data

CONS:

• Low validity (it’s a self report)→ individual can lie (likely as kleptomaniacs are often ashamed) 

Biological explanation: Dopamine → early research

• Olds and Milner: when rats pressed a lever, they would electrically stimulate different brain regions → see how rats behaviour was affected

• when regions (eg septal region) with a high concentration of dopamine receptors were stimulated, rats pressed lever up to 2000 times an hour

→ These regions are important reward centres as stimulation caused the rats to experience a rush of pleasure that was irresistible

→ Operant conditioning, consequences determine whether an act is repeated

Biological explanation: Dopamine → anticipation

• Researchers found that animals experience a high level of dopamine activity before they perform behaviours that have previously been rewarded

  • Classical conditioning: just seeing the lever (conditioned stimulus) is enough to experience a high (conditioned response)

Biological explanation: Dopamine → reward deficiency syndrome

• ICD may result from low levels of dopamine

• hereditary or environmental hypodopaminergic state causes them to struggle finding pleasure in everyday life → seek opportunities offering a dopamine rush

• people with impulse control disorders are more likely to be carriers of the A1 allele of a gene which codes for D2 receptors 

  • Carriers of A1 allele can develop 30% fewer D2 receptors → low dopamine → impulse control disorders

evaluation of a biological explanation (dopamine) for impulse control disorders

PROS:

• applications to everyday life → explains why people with parkinson’s often develop ICD’s, Dopamine explanation helps in treatment plans for ICD’s (need to raise dopamine)

CONS:

• overlooks nurture → focused on A1 allele. Rats in a poor environment more likely to get addicted to morphine → behavioural addictions could be prevented by improving environment (nurture) 

• reductionistic → overlooks social & cognitive factors. Expression of genes related to impulses are influenced by environment

Psychological explanations → Behavioural: positive reinforcement

Behaviours that are rewarded are repeated → eg gambling can be reinforced by the thrill of a win 

Skinner’s research with rats

• Rats rewarded for pressing a lever

• A variable ratio (rewards unpredictable) lead to highest response rate

  • Gambling could be explained through this 

  • Anticipation of a win learned through previous wins can become rewarding itself 

• Found that with the variable ratio reinforcement, the behaviour stays even in the absence of reinforcement → THIS IS WHY GAMBLERS DON’T STOP WHEN THEY LOSE

evaluation of psychological (behavioural) explanation for impulse control disorders

PROS:

• focus on nurture → not everyone with the A1 allele develops an ICD → environmental factors may also be needed for a person with genetic vulnerability to develop the disorder

• applications to everyday life → explains why gamblers don’t stop when they lose

CONS:

• doesn’t take into account negative reinforcement

Cognitive explanation: Miller’s feeling-state theory 

• When a person with pyromania feels tension, they remember the last time they felt tension, they started a fire 

• The memory of the fire triggers the sense of euphoria associated with starting a fire → feeling-state

• underlying negative thought/experience likely creates a feeling-state → pyromaniac with the belief “I’m powerful” is insecure about being weak

• Memories can be context-dependent → seeing a casino may trigger the feeling-state, which triggers the gambling

• A sense of shame followed by the behaviour can also trigger a feeling-state → it’s a cycle

what is a feeling-state

positive emotion (eg euphoria) fuses with a behaviour → driving a compulse

• a person might link a feeling of power with overspending, leading to compulsive shopping

Evaluating cognitive explanation for impulse control disorders

PROS:

• Helps to explain why people continue compulsive behaviour despite negative effects (feeling-states are so strong)

• Looks at situational and individual

  • situational factors: how other people act (the behaviour of shopping assistants has an effect on compulsive shoppers)

  • Individual factors: internal negative feelings & tension 

• Holistic → due to looking at situational and individual factors the cognitive explanation gives a holistic view, which is helpful when designing treatment

CONS:

• Much of evidence comes from case studies → unreliable as it can’t be generalised

Psychological treatment: cognitive-behavioural therapies → Covert sensitization

• conditioning, unpleasant stimulus (nausea) is paired with an undesirable behaviour

• draws on classical conditioning

Example study - Glover (1985)

• covert sensation on a woman with 14 years of shoplifting

treatment

• imagery of nausea & vomiting to create an unpleasant association with stealing

• four sessions at two-weekly intervals

• muscle relaxation used to enhance visualisation

• imagined vomiting as she picked an item to steal

• practiced outside sessions → homework

• last session: imagined sickness going away as she replaced the item and walked away

• at 19 month checkup only 1 relapse → long term effectiveness

Psychological treatment: cognitive-behavioural therapies → Imaginal desensitisation

use of images to help individuals who have specific types of ICD’s

• desensitization script involves the person narrating in present tense from the point of urge through doing the act and until leaving the situation and feeling the consequences 

Example study - Blaszczynski and Nower (2003)

• describe imaginal desensitisation and explore evidence of its effectiveness

process

• muscle relaxation

• imagine a situation triggering an urge (eg stressful day)

• asked to think about acting on the impulse, but to mentally leave the situation

effectiveness

• shown to reduce the strength of compulsive drive by reducing psychological and physiological arousal 

• among gamblers, imaginal desensitisation has reduced anxiety associated with gambling impulses, even at a five year follow-up

covert sensitisation - evaluation

PROS:

• support by Glover → someone with 14 years of kleptomania can be treated

• applications to everyday life → offer treatment to those with ICD’s

CONS:

• relies on person’s ability to imagine scenes

imaginal desensitisation - evaluation

PROS:

• Long lasting effects → 5 year check up in Blaszczynski and Nower

• Applications to everyday life 

CONS:

• Reductionistic → doesn’t consider the biological side of the explanation, only focuses on psychological 

• Situational → assumes all individuals able to reach a state of relaxation and immerse themselves in the imagery