12 Psychopathology Of Impulses

Psychopathology Of Impulses

What is impulsivity (general definition)?

Failure to resist a temptation, urge, or impulse; acting without thinking or conscious judgment.

Impulsivity – DSM‑5 definition

Aspect of:

• Disinhibition → immediate

• unplanned reaction to stimuli → poor programming/adherence to plans

• urgency → possible self‑harm during emotional distress.

Three psychopathological definitions of impulsivity

• Fast reaction without thinking

• Acting without enough thinking

• Tendency to act with less thinking than peers with similar ability

Impulsivity as a diagnostic feature

Present in ADHD, depression, anxiety disorders, personality disorders (especially Cluster B: antisocial, borderline)

What is compulsivity (APA)?

Repetitive behaviors or mental acts performed to reduce anxiety/distress or prevent a feared event

Core features of compulsive behavior

• Repetitive urges

• Limited voluntary control

• Reduced ability to inhibit/delay behavior

• Habitual or stereotyped actions

Disorders associated with compulsivity

• OCD and related disorder

• Behavioral and substance addictions

• Eating disorders

• Neurological disorders (e.g., Parkinson’s)

Compulsivity in the general population

• 10% show subthreshold OCD‑related compulsive symptoms

Are impulsivity and compulsivity opposites?

• No.

• They are distinct but positively correlated traits.

Current model Impulsivity vs Compulsivity

Two separate dimensions (not a single continuum)

Why are they important? Impulsivity vs Compulsivity

Act as intermediate phenotypes explaining comorbidity across many psychiatric disorders

Impulsivity, Compulsivity & Addiction → Shared neurobiological basis

• Dysfunction in prefrontal cortex–striatal circuitry

Disorders linked to impulsive–compulsive dimensions

• Drug addiction

• OCD

• Trichotillomania

• Gambling disorder

• Aggression

• Obesity

What defines eating disorders (EDs)?

Persistent disturbance of eating behavior impairing physical health or psychosocial functioning

DSM‑5 Feeding & Eating Disorders

• Pica

• Rumination disorder

• ARFID

• Anorexia nervosa

• Bulimia nervosa

• Binge‑eating disorder

Transdiagnostic perspective

• Shared psychopathology

• Diagnostic crossover common over time

Pica definition

Persistent eating of non‑nutritive substances for more 1 month

PICA Key exclusions

• Not developmentally appropriate

• Not culturally sanctioned

characteristics of Rumination Disorder

Repeated regurgitation of food for less than 1 month

characteristics of ARFID (Avoidant/Restrictive Food Intake Disorder)

• Restrictive/selective eating without body‑image concern

Common causes of ARFID (Avoidant/Restrictive Food Intake Disorder)

• Sensory sensitivity (texture, smell, taste)

• Fear after aversive events (choking, vomiting)

Anorexia Nervosa (AN)

• Criterion A
  * Restriction leading to significantly low body weight

• Criterion B
  * Intense fear of gaining weight

• Criterion C
  * Distorted body image or lack of insight

Bulimia Nervosa (BN) characteristics

• Recurrent binge eating

• Compensatory behaviors (vomiting, laxatives, fasting, exercise)

• more than 1 day/week for 3 months

Binge‑Eating Disorder (BED)

• Objective binge episodes

• Loss of control

• Marked distress

BED vs BN

No compensatory behaviors in BED

BED & obesity

• 42% of BED patients are obese

• Strongly linked to impulsivity

Compulsive Sexual Behaviour (CSB)

Repetitive sexual fantasies/urges/behaviors causing distress or impairment

DSM‑5 status of (CSB) Compulsive Sexual Behaviour

Not officially recognized

Two categories of CSB

• Non‑paraphilic CSB

• Paraphilic behaviors

Paraphilia

• Atypical sexual interest (Criterion A only)

Paraphilic Disorder

Paraphilia + distress, impairment, or harm (Criteria A + B)

Main Paraphilic Disorders (know list)

• Voyeuristic

• Exhibitionistic

• Frotteuristic

• Sexual masochism

• Sexual sadism

• Pedophilic disorder

• Fetishistic disorder

• Transvestic disorder

Disruptive, Impulse‑Control & Conduct Disorders

• Poor emotional &/or behavioral self‑control

Disruptive, Impulse‑Control & Conduct Disorders

• Oppositional Defiant Disorder (ODD)

• Conduct Disorder (CD)

• Impulse‑control disorders (pyromania, kleptomania, IED)

Oppositional Defiant Disorder (ODD)

• Angry/irritable mood

• Argumentative/defiant behavior

• Vindictiveness

Oppositional Defiant Disorder (ODD)

• Mild (1 setting)

• Moderate (2 settings)

• Severe (more 3 settings)

Conduct Disorder (CD)

• Repetitive violation of rights of others or societal norms

Conduct Disorder (CD) Domains

• Aggression

• Destruction of property

• Deceit/theft

• Serious rule violations

Pyromania

• Deliberate fire‑setting

• Tension before act

• Pleasure/relief afterward

Kleptomania

• Stealing without need or gain

• Tension before theft

• Relief afterward

Intermittent Explosive Disorder (IED)

Recurrent, disproportionate aggressive outbursts

Antisocial Personality Disorder (ASPD)

• Disregard for rights of others since age 15

• Age older than 18

• Evidence of conduct disorder before 15

Substance‑Related & Addictive Disorders

• DSM‑5 substance classes (10)

• Alcohol, caffeine, cannabis, opioids, stimulants, hallucinogens, sedatives, inhalants, tobacco, other

Substance Use Disorder (SUD) DSM-5

• Abuse + dependence → single continuum

• Mild: 2–3 symptoms

• Moderate: 4–5

• Severe: more than 6

SUD Criteria Clusters

• Impaired control

• Social impairment

• Risky use

• Pharmacological

Impaired control

Loss of control, craving

Social impairment

Role failure, social problems

Risky use

• Hazardous use, continued use despite harm

Pharmacological

• Tolerance

• Withdrawal

Substance‑Induced Disorders

• Substance intoxication

• Substance withdrawal

• Substance‑induced mental disorders

Substance intoxication

• Reversible syndrome after recent use

Substance withdrawal

• Symptoms after reduction/cessation

Substance‑induced mental disorders

• Psychiatric symptoms caused directly by substance or medication

Gambling Disorder

• Only officially recognized non‑substance addiction

• Persistent gambling

• Loss of control

• Chasing losses

• Functional impairment

Other Behavioral Addictions

• Internet gaming

• Sex addiction

• Exercise addiction

• Shopping addiction

Why is Other Behavioral Addictions

• Insufficient empirical evidence