Impulse control disorders and non-substance addictive disorders

Impulse control disorders (ICDs)

Disorders characterised by failure to resist a temptation, urge or impulse, making it difficult to regulate thoughts and behaviour connected to a certain behaviour.

Griffiths' 6 components of addiction

Salience, euphoria, tolerance, withdrawal, conflict and relapse.

Salience

The addiction becomes the single most important activity in a person's life and dominates their thoughts, feelings and behaviour.

Euphoria

The addictive behaviour produces mood modification, such as feelings of being 'high', escape or peace.

Tolerance

The person gradually needs to engage in more of the addictive behaviour to achieve the same effect.

Withdrawal

Unpleasant feelings or physical effects that occur when the addictive behaviour is reduced or stopped.

Conflict

Conflict between the person and their relationships, work, education or other social activities; internal conflict can also occur when they cannot stop despite wanting to.

Relapse

Returning to addictive behaviour despite attempts to reduce or stop it.

Kleptomania

An impulse control disorder involving an urge to steal objects that are not needed for personal use or monetary gain.

Kleptomania prevalence

Approximately 0.3%-0.6% of the population.

Kleptomania characteristics

Intrusive thoughts and urges to steal; the disorder can lead to arrest, prosecution, embarrassment and loss of employment.

Pyromania

An impulse control disorder characterised by an impulse to start fires and deliberately doing so on more than one occasion.

Pyromania characteristics

Individuals are fascinated by fire and accelerants and experience satisfaction and arousal after starting a fire.

Kleptomania and pyromania emotional pattern

Individuals may experience tension before the act followed by gratification afterwards.

Gambling disorder

A non-substance addictive disorder involving persistent and troubled gambling, difficulty withdrawing despite losses, lying to conceal gambling and loss of significant relationships.

Gambling and the reward system

Gambling activates the brain's reward system in a way similar to substance abuse.

Kleptomania Symptom Assessment Scale (K-SAS)

An 11-item self-rated scale measuring impulses, thoughts, feelings and behaviours related to stealing during the previous 7 days.

K-SAS scoring

Items are rated on a 0-4 or 0-5 scale, where 0 indicates no symptoms and 4/5 indicates severe, frequent or enduring symptoms.

K-SAS reliability

It has high test-retest reliability.

K-SAS validity

It has good concurrent validity when compared with tools such as the Global Assessment of Functioning Scale.

K-SAS weakness

Because it is a self-report measure, it may suffer from response bias.

K-SAS advantage

It produces quantitative data, making intervention outcomes easy to compare.

K-SAS application

It produces quantitative data, making intervention outcomes easy to compare.

Dopamine explanation

Rewarding stimuli such as stealing or gambling stimulate reward centres and release dopamine.

Dopamine and tolerance

When behaviour becomes compulsive, tolerance develops and dopamine levels in the striatum decrease.

Striatum

A brain region involved in reward and behavioural control.

Reward deficiency syndrome

A deficiency of dopamine in the striatum that may lead to continued compulsive behaviour and addiction; proposed by Comings and Blum (2000).

Dopamine and impulse control disorders evidence

Kleptomania can occur as a side effect of synthetic dopamine treatment for disorders such as Parkinson's, while gambling disorder and compulsive shopping can emerge alongside dopamine drug use.

Positive reinforcement

When receiving a reward for an activity increases the likelihood that the activity will be repeated.

Positive reinforcement example

The enjoyment gained from winning at poker can reinforce gambling behaviour.

Partial reinforcement

Behaviour is reinforced only some of the time, which can make the behaviour resistant to extinction.

Gambling and partial reinforcement

Gamblers do not win every time, so they continue gambling because they believe that playing again may make up for losses and lead to victory.

Feeling-state theory (Miller, 2010)

A cognitive explanation proposing that positive feelings become linked to behaviours such as gambling, with underlying thoughts about the behaviour potentially leading to obsession.

Feeling state

A state-dependent memory created from an intense desire to perform an activity, the positive experience associated with it and the memory of the behaviour.

Feeling-state example in pyromania

A pyromaniac may associate fire-setting with the feeling 'I am powerful', positive emotions, physiological arousal and memories of setting fires, leading to compulsive fire-setting.

Negative beliefs and feeling states

Underlying negative thoughts or experiences may create feeling states that make the addictive behaviour more intense and desirable.

Feeling-state theory example

A person who believes 'I'm weak' may experience the feeling state 'I am powerful' while engaging in fire-setting, making the behaviour more desirable.

Negative beliefs after compulsive behaviour

Out-of-control behaviour can create further negative beliefs such as 'I mess up everything'.

Normal behaviour and feeling states

Normal behaviours in moderation can become problematic when they are associated with fixated and intense feeling states.

Feeling-state belief types

Negative beliefs about oneself/world, positive beliefs created during the behaviour and negative beliefs resulting from out-of-control behaviour.

Nature vs nurture in impulse control disorders

The biological explanation focuses on nature through dopamine function, while the behaviourist explanation focuses on nurture through environmental reinforcement.

Individual vs situational debate

The biochemical explanation focuses on individual brain impairment, while the cognitive explanation considers how individuals develop their own feeling states from experiences.

Grant et al. (2008) aim

To investigate whether opiate drugs could reduce gambling behaviour.

Grant et al. (2008) sample

284 participants, with roughly equal numbers of males and females.

Grant et al. (2008) design

A double-blind experiment.

Grant et al. (2008) procedure

Participants received either a 16-week course of nalmefene or an 18-week course of naltrexone/placebo according to the study notes.

Grant et al. (2008) measure

Gambling severity was measured using the Yale

Grant et al. (2008) operationalisation of improvement

A reduction of at least 35% in Y-Brown Obsessive Compulsive Scale (Y-BOCS).

Grant et al. (2008) results

The opiate group showed a significant reduction in gambling symptoms.

Grant et al. (2008) individual differences

Participants with a family history of alcoholism and those receiving higher doses showed greater reductions in Y

Grant et al. (2008) conclusion

Opiate treatment may be effective for gambling disorder, but effectiveness varies between individuals.

Grant et al. (2008) strength

The double-blind design reduces researcher and participant bias, increasing validity.

Grant et al. (2008) strength

Y-BOCS provided quantitative, objective and standardised data.

Grant et al. (2008) ethical issue

Use of a placebo may involve deception because participants may believe they are receiving active treatment.

Covert sensitisation

A cognitive-behavioural treatment using classical conditioning by pairing an undesirable behaviour with an unpleasant stimulus to reduce the behaviour.

Glover covert sensitisation study

A case study of a 56-year-old woman with a 14-year history of daily shoplifting without purposeful gain.

Glover study compulsive thoughts

The woman experienced compulsive thoughts about stealing that she found disgusting but difficult to resist.

Glover treatment procedure

The woman visualised nausea and vomiting while imagining herself stealing.

Glover treatment sessions

Four treatment sessions were conducted at two-week intervals.

Muscle relaxation in covert sensitisation

Muscle relaxation was initially used to relieve physical and mental tension and enhance treatment.

Glover visualisation procedure

The woman increasingly imagined vomiting while stealing, including the attention and disgust this would attract from others.

Glover homework

The woman practised the visualisation exercises between treatment sessions.

Glover final session

She imagined the sickness disappearing as she walked away without shoplifting.

Glover results

At a 19-month follow-up, she showed decreased desire and avoidance of stealing, with only one relapse, alongside improved self-esteem and social life.

Covert sensitisation evaluation

It demonstrated effectiveness in reducing kleptomania symptoms but was based on a single case, limiting generalisability to other impulse control disorders.

Imaginal desensitisation

A cognitive-behavioural treatment using imagery to reduce the strength of compulsive impulses.

Imaginal desensitisation procedure

The client learns progressive muscle relaxation, visualises a triggering situation while experiencing the associated arousal, then mentally leaves the situation while remaining relaxed and resisting the impulse.

Imaginal desensitisation homework

Sessions are often audio-recorded so clients can practise outside therapy.

Imaginal desensitisation effectiveness

It can reduce compulsive drive by reducing the psychophysiological arousal associated with impulse control disorders.

Blaszczynski and Nower (2003) finding

Imaginal desensitisation reduced arousal and anxiety associated with gambling impulses, with effects still found at a 5-year follow up

Impulse Control Therapy (Miller, 2010)

A treatment that aims to establish normal behaviour rather than completely eliminate the behaviour.

Impulse Control Therapy example

A compulsive shopper can continue shopping but avoid problematic behaviours such as overspending and hoarding.

Impulse Control Therapy basis

It changes distorted thoughts about behaviour based on feeling-state theory

Impulse Control Therapy first step

Identify the behaviour producing the most intense feelings, the positive feelings and the associated physical sensations.

Positive Feelings Scale

A standardised scale used to measure and compare the intensity of positive feelings.

Impulse Control Therapy and EMDR

Clients recreate the feeling state through imagery while performing eye movement desensitisation and reprocessing exercises.

EMDR

A technique in which the individual recalls behaviours or memories while the therapist directs eye movements using their hands or other stimuli.

Impulse Control Therapy sessions

Usually 3-5 sessions alternating between visualisation and eye movements until compulsive behaviour is reduced.

John case study

John was a compulsive gambler who became depressed after losing his first marriage due to gambling

John's feeling state

With help from his therapist, John identified his feeling-state memory as 'winning'.

John treatment outcome

After visualisation and EMDR, John's urge to gamble decreased over four sessions.

Cognitive-behavioural therapy evaluation

Case studies provide in-depth qualitative data but may have limited generalisability.

Case study weakness

Findings from individual cases such as Glover's woman and Miller's John may not generalise to other impulse control disorders or individuals.

CBT therapist bias

Having the therapist assess participants may introduce researcher or therapist bias.

Follow-up advantage

Follow-up assessments can determine whether treatment effects remain and whether relapse occurs.

Biochemical treatment application

Grant et al. demonstrated that opiates can be effective for gambling disorder and identified circumstances in which treatment may be more effective.

CBT application

Cognitive-behavioural treatments can be combined with drug therapy or used to improve symptoms in treatment-resistant impulse control disorders.

Reductionism in treatment

Drug treatments may reduce disorders to biochemical mechanisms while ignoring life circumstances that may have triggered the disorder.

Individual vs situational treatment issue

Cognitive and behavioural treatments such as covert sensitisation may focus on individual behaviour without sufficiently considering social and emotional circumstances.