Impulse Control Disorder

Definition: Impulse control disorders (ICDs), as defined by the ICD-11, involve repeated inability to resist urges to engage in behaviours that feel rewarding short-term but have harmful long-term effects, such as personal harm, distress, or significant life impairments.

Types of Impulse Control Disorders

• Gambling Disorder: A condition where a person struggles to control their gambling actions, often violating the rights of others or conflicting with societal norms and the law.

• Kleptomania: The urge to steal objects with little value or that can be afforded.

• Pyromania: The compulsion to deliberately start fires for pleasure or satisfaction.

Characteristics of Kleptomania

• Intrusive thoughts

• Urges to steal

• Inability to concentrate

• Guilt/shameOften leads to consequences such as arrest, prosecution, or job loss.

Characteristics of Gambling Disorder

Persistently engages in gambling behaviour, prioritizes gambling over other activities, and continues despite negative consequences. Symptoms must be present for at least one year for diagnosis.

Measures for Diagnosis

Kleptomania Symptom Assessment Scale (K-SAS)

• An 11 item self-report scale measuring impulses, thoughts, feelings, and behaviours related to stealing over the past week.

• Rated on a scale from 0 (no symptoms) to 4 or 5 (severe symptoms).

• Test-retest reliability and concurrent validity with Global Assessment Functioning Scale.

Yale-Brown Obsessive-Compulsive Scale Modified for Pathological Gambling (PG-YBOCS)

• Clinician-administered scale assessing gambling severity based on past week symptoms.

• Provides quantitative data to measure treatment outcomes.

Explanations of ICDs

Biological Explanations

• Dopamine: A ‘happy’ chemical whose release is triggered by rewarding stimuli. Stealing or gambling leads to a dopamine release, rendering these behaviours compulsive.

• The Striatum: Part of the basal ganglia involved in reward mechanisms; dysfunction can lead to reward deficiency syndrome.

• Genetic Factors: Evidence suggests a genetic predisposition to impulsive behaviours (e.g., kleptomania as a side effect of synthetic dopamine treatments for Parkinson's).

Behavioural Explanations

• Focuses on Positive Reinforcement: Winning in gambling operates on variable reinforcement schedules, which encourage continued behaviour despite losses.

• Schedules of Reinforcement: Unpredictable win patterns in gambling lead to compulsive behaviours.

Cognitive Explanations

• Feeling-State Theory: Associates intense positive feelings with behaviours. Negative beliefs can lead to the reinforcement of these behaviours.

• Example: A pyromaniac may feel “powerful” when setting fires, which reinforces the behaviour through positive feelings.

Treatment and Management

Biological Treatments

• SSRIs: Mixed effectiveness, particularly for gambling disorder.

• Opiate Antagonists: Show promise for gambling disorder, by dampening the reward response.

Key Study: Grant et al (2008)

Aim: To identify clinical variables associated with treatment outcomes in pathological gambling.

Procedures:

• Conducted two double-blind placebo trials with 284 diagnosed problem gamblers (equal male and female)

• Random assignment to conditions: placebo or various doses of Nalmefene or Naltrexone.

Findings:

• Family history of alcoholism and intense gambling urges were predictive of positive responses to treatment.

• Younger patients showed more positive responses to placebo than older patients.

Conclusion: Understanding the relationship between family history and positive response to treatments like opiate antagonists can help target interventions more effectively.

Evaluation:

• Use of double-blind trials minimised bias, increasing validity.

• Ethical concerns around treatment deception exist, especially given the potential for distress regarding health outcomes.

Psychological Treatments

1. Imaginal Desensitisation: Guided imagery to reduce urges.

2. Covert Sensitisation: Associates negative stimuli (like vomiting) with the undesired behaviour (e.g., stealing).

   • Example Study: Glover (1985) examined a case study of a woman suffering from kleptomania using covert sensitisation to annul her behaviour.

Strengths:

• Less participant resistance.

• Ethical and safe.

Weaknesses:

• Limited generalisation from case studies.

• Varying effectiveness among individuals.