As it’s part of human nature, sometimes people find themselves acting out of impulse. Maybe they grab an extra candy bar in the check-out line at the grocery store, or they buy a new shirt from their favorite store without considering the cost. When these small impulsive actions occur from time to time, most people feel some kind of guilt and tell themselves that they won’t do it again, and for the most part people are able to hold themselves accountable. Looking back at your own life, you may notice that when you were younger, it might have been more tempting and more feasible to act impulsively. The younger children are, the more difficult it is to practice self-control measures in the same way adults can. Over time, individuals learn to become more cognizant of their actions and reign in their impulses as they age naturally. What separates an adult human from a child is the ability to exercise self-control in a firm, more consistent way. However, what happens when a person is unable to control their impulses? Despite their own efforts to behave in a controlled manner, their impulses take over and they make negative choices? In this blog, we will discuss impulse control disorder, a group of behavioral conditions that make it nearly impossible to control one’s actions and emotions.
What Are Impulse Control Disorders?
Impulse control disorders, or ICDs, are a group of five behavioral disorders defined by the DSM-5 as: oppositional defiant disorder, conduct disorder, intermittent explosive disorder, kleptomania, and pyromania.1 ICDs are characterized by an individual’s inability to control their actions and impulses to various degrees. Most of the time, these people are unable to control negative behaviors, such as aggression, lying, fighting, stealing, and rule-breaking. Overall, they tend to exhibit threatening behaviors and may cause physical and emotional harm to others and/or oneself. Symptoms related to ICD usually begin in childhood, and problematic behaviors persist into adulthood when consequences become more severe and behaviors become more negative.
Each of the five disorders has its own set of criteria that one must meet to be diagnosed, but as a whole, each ICD causes individuals to have a decreased ability to control their behaviors and an overwhelming need to carry out a specific behavior that is usually negative in nature. Most individuals with ICDs are aware of the fact that their behavior is improper, but they do not have the ability to stop. When a person with an ICD carries out a behavior, it is usually following an internal tension within themselves to do or not do the behavior. After they carry out the behavior, these individuals experience a relief or release of tension as a result. It is important to keep in mind, however, that most individuals will exhibit some sort of defiance in one way or another as they are growing up or even in adulthood. Especially for children, exhibiting defiance is a way to understand what kinds of behaviors are appropriate or not. They need time to learn that certain words, actions, and behaviors fall within or outside others’ boundaries, and sometimes defiance is what will teach them acceptable from unacceptable. ICDs, on the other hand, become an issue when defiance and impulsive behaviors become uncontrollable and recurrent. Behaviors displayed become more and more severe, and they disrupt the individual’s life and their close relationships.
ICDs are described as being externalizing disorders, in which individuals express their resentment and distress outwardly, while those with internalizing types of disorders express their hostility and anxieties onto their own selves.2 Externalizing disorders like ICDs result in conflicts with other individuals and even the law. Boys are more likely to develop ICDs when compared to girls, except for kleptomania. Girls are actually 3x more likely to develop kleptomania than males.2
Listed below are the five types of ICDs and how prevalent they are in the US population:
- Oppositional defiant disorder (ODD) – 3.3% of children/adolescents
- Conduct disorder (CD) – 4% of children/adolescents
- Intermittent explosive disorder – 2.7%
- Kleptomania – 0.6%
- Pyromania – less than 1% 1,2
The Five Types of Impulse Control Disorders
For mental health professionals to diagnose an ICD, they employ at least two different assessment methods. To start, the patient’s family history and parenting styles are accounted for. Clinicians then look at the patient’s development history and academic records as well. Research shows that the Minnesota Impulse Disorders Interview (MIDI) provides quality diagnostic information for the assessment and diagnosis of ICD.
Oppositional Defiant Disorder
Oppositional defiant disorder, or ODD, is a behavioral disorder diagnosed in children and adolescents. ODD is characterized by varying levels of dysfunction, argumentativeness, aggression, oppositionality, and vindictiveness within an individual.3
Children who present with ODD have symptoms that fall into three distinct categories: angry/irritable moods (losing temper, easily annoyed); vindictiveness (revenge-seeking behavior, spiteful); and argumentative/defiant behaviors (arguing with authority figures, refusing to follow rules. A child has to present with at least 4 of these symptoms from these three categories for 6 months or more to be diagnosed with ODD. This behavior can be presented in a singular setting like the home, occurs during interaction with at least one other person who is not their sibling, and ODD can not be concurrently diagnosed with disruptive mood dysregulation disorder.2,3 Those with ODD do not direct their aggression and threatening behaviors toward animals or people. They mostly direct these conflict behaviors and feelings to adults and authority figures.
Conduct disorder, or CD, is a behavioral disorder in which a child or adolescent displays severe behavior that violates the basic rights of others or societal norms. For a person to be diagnosed with CD, they must persistently and repetitively showcase at least 3 symptoms from these four categories in the last 12 months: aggression to people and animals; theft or deceit; destruction to property; and serious violations of rules and regulations.2 Symptoms that individuals with CD display comprise of bullying, manipulating others, initiating physical altercations, threats, cruelty to animals and other living things, setting fires, destroying property, forcing sexual activity onto others, stealing or breaking into others property such as a house or car, breaking curfew, truancy from school, and running away from home. The DSM-5 states that these troublesome behaviors can begin as early as pre-school, but significant symptoms manifest around middle childhood and adolescence.3 CD can only be diagnosed for children up to the age of 18. A few risk factors for developing conduct disorder include exposure to various types of physical and sexual abuse, harsh parenting styles, and unstable childhood environments.3
Intermittent Explosive Disorder
Intermittent explosive disorder, or IED, is another type of behavioral disorder that is characterized by frequent, impulsive outbursts of anger or aggression. Individuals with IED are unable to control their aggressive impulses, and their aggression can manifest in verbal aggression that occurs at least 2x per week for 3 months, or 3 behavioral outbursts/tantrums that result in damaged property within the last 12 months.2 Some other forms of aggressive behavior that people with IED display are temper tantrums, fights, and verbal arguments. Their outbursts will typically result in physical assaults upon other individuals or animals and destruction of property. Also, the aggressive outbursts that occur are out of proportion to the incident that triggered them in the first place. Individuals act out of impulse, which then creates distress for themselves and for those around them. Affected individuals with IED are more likely to have less satisfaction with their lives and have a lower quality of life. The impulses are never planned or long-lasting, but they occur spontaneously whenever the individual is triggered and last less than 30 minutes on average. Risk factors for developing IED include being young, male, single, unemployed, less educated, and being a victim of physical or sexual violence. Individuals must be at least 6 years old to be diagnosed.3
Kleptomania is a behavioral disorder that is characterized by an irresistible, recurrent urge to steal objects that either not needed for personal use or with little to no monetary value.2,3 As stated above, kleptomania is the only ICD that is more commonly diagnosed in females in comparison to males. This ICD is more rare, and it is different from shoplifting. For shoplifters, stealing is intended for some sort of monetary or personal gain and is usually planned in advance. Those with kleptomania do not need the objects they are stealing and even while they know it is wrong to steal, they cannot help themselves. They experience tension within themselves before they steal, and feel a sense of relief after the theft is completed. However, unlike shoplifters, those with kleptomania also feel levels of guilt and shame about their actions. The onset of kleptomania can occur in childhood or old age, but the disorder typically tends to appear in adolescence.3
Pyromania is a rare disorder that is characterized by the impulsive desire to set intentional fires.3 It is not to be confused with arson, which is typically motivated by alternative reasons. Those with pyromania are fascinated and even enamored by fire and its uses. Affected individuals experience emotional tension before commiting the fire and after it is done. They are not motivated by anger, curiosity, vengeance, or other external factors. They do not obtain any type of material gains; those with this disorder do it for the gratification they receive after firesetting. Some risk factors for developing pyromania include being male, being a victim of abuse, having mental illness, or being interested/fascinated by fire.3