Impulse Control Disorders

What Is an Impulse Control Disorder?

Impulse control disorder (ICD) describes a group of disorders that cause difficulties in controlling aggressive behaviors, self-control, and inappropriate impulses.

These behaviors can lead to serious issues at work, school, and in some situations, to legal matters.

The actions or behaviors caused by impulse control disorders are often considered to be a threat primarily to the safety of others or to societal norms.

Examples of impulse control issues include:

• Directly defying authority figures
• Fighting
• Stealing
• Lying
• Destroying property
• Rule-breaking

Symptoms of impulse control disorders typically begin in childhood and can continue into adulthood.

In childhood, these symptoms are mostly out of the individual’s control. However, with the right therapies, adults with impulse control disorders can learn to manage these symptoms.

What Are the Risk Factors for Developing Impulse Control Disorders?

The exact cause of impulse control disorders is not fully known. However, researchers believe a mixture of genetics, biological factors, and environmental factors plays a big role in the development of impulse control disorders.

Research has shown that children whose parents have mood disorders like bipolar disorder are more likely to have oppositional defiant disorder.

Children who have parents with ADHD, substance use disorder, antisocial personality disorder, or schizophrenia are more likely to have conduct disorder.

In addition, impulse control disorders tend to affect males more than females, with the notable exception of kleptomania.

Other risk factors for developing impulse control disorders include:

• Preexisting mental illnesses such as attention deficit hyperactivity disorder (ADHD), bipolar disorder, anxiety disorders, obsessive-compulsive disorder (OCD), personality disorders, and post-traumatic stress disorder (PTSD)
• Family history of mental illness
• Repeated exposure to aggression or violence
• Prolonged physical, sexual, and/or emotional abuse and neglect from a young age
• Personal or family history of substance abuse and addiction

Types of Impulse Control Disorders

While many mental health conditions may have features similar to impulse control disorders or issues with impulsive behaviors, these five impulse control disorders differ in how they externalize distress rather than internalize it.

According to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, fifth edition), there are five recognized impulse control disorders.

There are discussions of adding other conditions, such as trichotillomania (hair-pulling), skin-picking, compulsive sexual behavior, pathological gambling, and compulsive buying, but they currently are omitted.

The five impulse control disorders include:

• Pyromania
• Kleptomania
• Conduct Disorder
• Oppositional Defiant Disorder
• Intermittent Explosive Disorder

Pyromania

Pyromania is one of the most notorious impulse control disorders, and yet it is also the most rare impulse control disorder. One study revealed that only 3% of people in prison for arson met the criteria for pyromania.

It’s not uncommon to hear people joking about being a pyromaniac, but true pyromaniacs genuinely struggle to resist the urge to start fires.

Individuals with pyromania will set objects or places alight to relieve built-up tension, anxiety, or arousal. After setting the fire, they tend to feel sated or satisfied.

Common symptoms of pyromania include:

• Being obsessed with or drawn to fire in all its forms
• Feeling energetic or tense before setting something on fire
• Purposely setting a fire on more than one occasion
• Fire-setting that can’t be explained through another mental disorder
• Feeling intense pleasure or relief when seeing fires, setting fires, or having involvement in the aftermath of a fire

Kleptomania

Kleptomania is the powerful and uncontrollable urge to steal things, most often from stores. People with kleptomania are aware that stealing is illegal and socially unacceptable, often causing them to feel guilt or shame about their compulsion.

Unlike other impulse control disorders, women are three times more likely than men to develop kleptomania. Anywhere from 0.3% to 0.6% of the US population have kleptomania, and people with kleptomania make up between 4% and 5% of people arrested for shoplifting.

Common symptoms of kleptomania include:

• Feeling anticipation or tension before stealing, followed by pleasure or relief afterward
• Unplanned episodes of stealing that are carried out alone
• Stealing items that are unneeded and could easily be afforded
• Throwing stolen items away, giving them to others, or donating them to charity out of guilt
• Feeling intense guilt, regret, or shame over stealing after the positive emotions fade

Conduct Disorder

Conduct disorder is a condition that affects children and adolescents, typically causing aggressive behaviors and actions that harm others. Conduct disorder falls within the spectrum of disruptive behavioral disorders, along with oppositional defiant disorder (ODD).

In some cases, children may begin with oppositional defiant disorder that becomes conduct disorder. Conduct disorder also tends to co-occur with other mental health conditions such as depression, learning disorders, ADHD, and antisocial personality disorder.

Conduct disorder affects 2% of children (12 and under) and 10% of adolescents (12-17) in the United States.

Because the criteria for conduct disorder and antisocial personality disorder are essentially the same, a mental health professional can change the diagnosis to antisocial personality disorder if symptoms persist into adulthood.

Common symptoms of conduct disorder include:

• Aggression and physical violence toward people and animals and violating basic rights of others
• Destroying property, stealing, or breaking into businesses or houses
• Lying to earn someone’s favor or avoid consequences
• Not showing any remorse for their negative actions
• Being easily frustrated
• Breaking the rules with no clear reason
• Running away from home or not going to school
• Issuing violent threats or engaging in verbal fights
• Blaming their own behavior on others
• Excessive alcohol drinking and/or substance use
• Difficulty making and maintaining friendships or relationships

Oppositional Defiant Disorder

Oppositional defiant disorder (ODD) is a behavior disorder that causes combative or defiant behavior in children outside of typical rebellious behavior.

Children and teens with ODD often display patterns of angry moods, vindictiveness towards people in authority, and disruption of everyday activities.

Around 2% to 16% of children and teens in the US have ODD, which typically begins around eight years old. Adolescents with ODD often have co-occurring developmental or mental disorders, such as learning disabilities, ADHD, mood disorders, and anxiety disorders.

In some cases, children with ODD will go on to develop the more severe condition of conduct disorder and, in rare cases, develop antisocial personality disorder. However, not all children with ODD will go down that path.

Common symptoms of conduct disorder include:

• Displaying vindictive or harmful behavior at least twice in the last 6 months
• Trying to annoy or upset others
• Being easily annoyed by others
• Excessively talking back to adults, especially those with authority like parents, teachers, or community leaders
• Saying mean and hateful things while upset
• Purposely refusing to comply with rules or requests
• Throwing repeated temper tantrums
• Swearing or using obscene language
• Being spiteful and revenge-seeking
• Blaming others for their mistakes
• Having frequent outbursts of rage and resentment

Intermittent Explosive Disorder

Intermittent explosive disorder describes the condition where an individual experiences sudden and repeated episodes of impulsive, violent, and explosive behavior that seems too extreme for the situation.

Common examples of this include instances of throwing or breaking objects, domestic abuse, or road rage. Intermittent explosive disorder can begin in childhood and be lifelong, although the severity of outbursts can subside with age.

Common symptoms of intermittent explosive disorder include:

• Feeling or irritability, rage, and tension before an explosion
• Physical symptoms like racing thoughts, tingling sensations, shaking, chest tightness, and pounding heartbeat before an explosion
• Intense and unpredictable temper tantrums
• Long, angry speeches or heated arguments
• Shouting or yelling
• Shoving, slapping, or pushing
• Physical fights
• Property damage
• Threatening or harming people or animals

Impulse Control Disorders and Addiction

Impulse control disorders and addiction are very closely connected. For some people with an ICD, impulsively using substances is a way to continue “feeling good.”

In other cases, the individual may already be predisposed to substance abuse, and the ICD only worsens the symptoms.

Many mental health conditions cause imbalances in certain neurotransmitters in the brain, especially related to dopamine and serotonin. These imbalances can lead to reward processing delays and impulsive behaviors that only worsen when introducing certain substances.

The most commonly abused substances among ICD patients include:

• Alcohol
• Marijuana
• Benzodiazepines
• Opioids
• Stimulants like cocaine and meth

How Are Impulse Control Disorders Treated?

Although there are no FDA-approved drugs for the treatment of ICDs, there are several methods of treating these disorders.

The most common form of treatment is psychotherapy, like cognitive behavioral therapy (CBT), which focuses on helping patients identify and address their disruptive behaviors.

Other therapies proven to help with ICDs include parent management training (PMT) and multisystemic therapy (MST).

• Parent Management Training (PMT) can be beneficial for parents who are struggling to raise children with ICDs and helps them set consistent discipline with proper rewards for positive behaviors.
• Multisystemic Therapy (MST), on the other hand, works by encouraging positive coping activities and increasing accountability and problem-solving for all family members.

In cases where patients have other mental health conditions, medications like antidepressants (SSRIs), mood stabilizers, and anti-anxiety drugs may help improve symptoms.

Treating Addiction with Impulse Control Disorder Comorbidity

Individuals with addiction and co-occurring disorders like impulse control disorder may have an even harder time quitting their substance abuse. It’s important to let healthcare providers know if you have other mental health disorders like an ICD while entering treatment.

Often, treating your ICD becomes part of addiction treatment through therapy and possible medications to help manage symptoms. With the right treatment options for both addiction and impulse control disorders, patients can successfully enter recovery and improve their quality of life.

Seek Treatment for Impulse Control Disorders

Impulse control disorders can make daily life extremely difficult for the individual and the people around them. Thankfully, there are treatments available for ICDs, as well as potentially co-occurring addiction or other mental illnesses.

Talk to your doctor or a mental healthcare professional about your symptoms and see the recommended treatment plan. If you don’t have a doctor, try using SAMHSA’s online treatment locator or call 1-800-662-4357 (HELP) to learn what mental healthcare services are available near you.