Impulse Control Disorders

A psychological disorder characterized by the repeated inability to refrain from performing a particular action that is harmful either to oneself or others.

Impulse control disorders are thought to have both neurological and environmental causes and are known to be exacerbated by stress. Some mental health professionals regard several of these disorders, such as compulsive gambling or shopping, as addictions. In impulse control disorder, the impulse action is typically preceded by feelings of tension and excitement and followed by a sense of relief and gratification, often—but not always— accompanied by guilt or remorse.

Researchers have discovered a link between the control of impulses and the neurotransmitter serotonin, a chemical agent secreted by nerve cells in the brain. Selective serotonin reuptake inhibitors (SSRIs), medications such as Prozac that are used to treat depression and other disorders, have been effective in the treatment of impulse control disorders. The American Psychiatric Association describes several impulse control disorders: pyromania, trichotillomania (compulsive hair-pulling), intermittent explosive disorder, kleptomania, pathological gambling, and other impulse-control disorders not otherwise specified.

A condition not listed by the American Psychiatric Association that some experts consider an impulse-control disorder is repetitive self-mutilation, in which people intentionally harm themselves by cutting, burning, or scratching their bodies. Other forms of repetitive self-mutilation include sticking oneself with needles, punching or slapping the face, and swallowing harmful substances. Self-mutilation tends to occur in persons who have suffered traumas early in life, such as sexual abuse or the death of a parent, and often has its onset at times of unusual stress. In many cases, the triggering event is a perceived rejection by a parent or romantic interest. Characteristics commonly seen in persons with this disorder include perfectionism, dissatisfaction with one's physical appearance, and difficulty controlling and expressing emotions. It is often seen in conjunction with schizophrenia, posttraumatic stress syndrome, and various personality disorders. Usual onset is late childhood or early adolescence; it is more frequent in females than in males.

Those who consider self-mutilation an impulse control disorder do so because, like the other conditions that fall into this category, it is a habitual, harmful activity. Victims often claim that it is accompanied by feelings of excitement, and that it reduces or relieves negative feelings such as tension, anger, anxiety, depression, and loneliness. They also describe it as addictive. Self-mutilating behavior may occur in episodes, with periods of remission, or may be continuous over a number of years. Repetitive self-mutilation often worsens over time, resulting in increasingly serious forms of injury that may culminate in suicide.

Treatment includes both psychotherapy and medication. The SSRI Clomipramine (Anafranil), often used to treat obsessive-compulsive disorder, has also been found effective in treating repetitive self-mutilation. Behavioral therapy can teach sufferers certain techniques they can use to block the impulse to harm themselves, such as spending more time in public places (because self-mutilating behavior is almost always practiced secretly), using music to alter the mental state that leads to self-mutilation, and wearing protective garments to prevent or lessen injury. In-depth psychodynamic therapy can help persons with the disorder express the feelings that lead them to harm themselves.