The impulse control disorders are those which involve behavior that provides some satisfaction in the short term, but which causes negative or even extremely harmful outcomes in the longer term. Most impulse control disorders involve repeated failure to “get it” that the behavior is wrong or harmful to the self or to others. In many cases, the individual repeatedly tries, then fails to stop the behavior that is causing them problems.
Odd, strange, self defeating, or self destructive behaviors, along with the repeated behaviors that result in crimes, disfigurement, or physical violence, cause the behaviors to be classified as “disorders”. Many of the behaviors are illegal or, as with pathological gambling, they lead to illegal acts as a result of the damage. Included in the behaviors are violence, fire starting, self harming, sexually inappropriate acts, stealing or gambling beyond normal levels.
Not included, but easily confused with impulse control disorders are acts that are related to addictions, acts committed while under substance abuse, and other psychological disorders that might accompany the impulse control disorder. These do not qualify for classification as impulse disorders.
Diagnoses involve looking carefully at multiple and specific conditions and factors before specific disorders are identified. In many cases, the impulse control disorder may go undiagnosed or treated for a long time, as they may not be profound enough to cause alarm, may be helped through “enabling”, or the patient does not seek help until ordered to do so.
The onset of most impulse control disorders is in early childhood, where they are far more easily treatable through medications, cognitive behavioral therapy, behavior modification and other methods, such as 12 step programs for pathological gamblers.
Pathological Gambling, even where an individual may be a well controlled gambler for most of their life, is an acceptable behavior that can become pathological later in life. An arsonist may do so out of revenge, for profit or for other reasons. A kleptomaniac or stealer may do so under very specific and limited conditions, such as stealing only excessive quantities of hotel soaps and shampoos from the supply cart, never truly getting caught or causing much reaction.
Generally, there is some form of tension the precedes an impulse control behavior. The act provides either release of the tension or pleasure and gratification in some form.
The defined impulse control disorders that have the same term in the law as both psychological disorders and as criminal behaviors are kleptomania and fire setting or arson (but not all arsonists have impulse control disorders).
The defined impulse control disorders that may lead to criminal activity, such as embezzlement is pathological gambling.
The self harming impulse control disorders are hair pulling (trichotillomania), skin picking, and perhaps cutting, which is a newer disorder. The disfigurement can become profound enough to require intervention and treatment, hopefully early in life.
Explosive disorder is an inability to control temper, resulting in physical assault or damage to property, therefore being very likely to result in criminal prosecution. The triggering event can be petty, have occurred a while ago, or cause an immediate reaction.
In summary, the impulse control disorders are kleptomania or stealing; explosive disorder, pathological gambling, fire setting or arson, and hair pulling (trichotillomania), and skin picking.
