DISORDERS OF IMPULSE CONTROL

Definition

    It’s sometimes hard to draw the line between “personality” and “mental illness. Some of the things that people do are clearly self-destructive but they cannot seem to stop doing them. Disorders of impulse control cause people of all ages to engage in activities that harm themselves and often others as well. However, kids and adults with these disorders do not mean to be hurtful. They are victims of their own brains. Nonetheless, when you are living with such a “victim” or parenting one, your own life can be turned upside down.

    When a child or adult has a disorder of impulse control, he or she has tremendous difficulty resisting a specific urge. Like an alcoholic, the IDP (impulse disordered person) is overpowered by an anxious inner itch that begs for relief. Like an alcoholic, the person can rarely resist that urge without some sort of specific rehabilitation program. There are five distinct disorders of impulse control affecting both men and women in every walk of life:

•    Kleptomania: stealing for the satisfaction of taking something, not because one needs a specific item. The person is responding to an inner compulsive urge that can only be relieved by the act of stealing.

•    Intermittent Explosive Disorder: unprovoked aggressive outbursts involving property damage or assault. The person seems to lose control on specific occasions but is otherwise pleasant, functional and normal.

•    Pyromania: setting fires for pleasure and tension release.

•    Trichotillomania: involves pulling hair from one's own head, eyebrows, eyelashes, face, or body, and is more common in women than in men. There is an increased sense of tension before pulling the hair, which is relieved once it is pulled out.  There may be noticeable hair loss. Trichotillamania often begins in childhood, and can be associated with major depression or attention-deficit/hyperactivity disorder.

•    Pathological Gambling (a disorder of teens & adults): the inability to resist the urge to gamble despite serious financial loss. Five or more of the following symptoms must be present:
•    Preoccupation with gambling
•    a need to gamble with more money to achieve the thrill of winning
•    repeated unsuccessful attempts to limit gambling
•    irritability related to gambling
•    using gambling as an escape from stress
•    lying to cover up gambling
•    conducting illegal activities, such as embezzling or fraud, to finance gambling
•    borrowing money to fund gambling
•    losing a job or personal relationship as a result of gambling

Mind/Body Illness

    One might have thought that a thief, fire setter, gambler or a rage-aholic was just a bad person. As it turns out, these problems are not purely psychological. They have a physical basis in the brain centers that regulate control of impulses. It has been noted, for example, that people with serious head injuries, carcinoid syndrome (caused by carcinoid tumors) or epilepsy can be at a higher risk for developing impulse control disorders. Some people with Parkinson’s disease develop impulse control disorders as the disease progresses. Some medications have been linked to the development of impulsive disorders as well. Moreover, there may be a relationship of impulse disorders to other physically based disorders such as Obsessive Compulsive Disorder and Attention Deficit Disorder. Although it is not yet understood exactly how otherwise “normal” brains trigger disorders of impulsivity, the scientific community agrees that there is a specific, physical basis for the process.

Treatment

    As one might expect for a mind/body illness, both medication and therapy are used to this disorder. Antidepressant medications have been found to make a positive difference for some of the impulse disorders when combined with behavior therapy. Trichotillamania may wax and wane on its own (like other tic disorders), sometimes disappearing for years at a time and it seems to respond well to medication also. Some people have had success using Bach Flower Therapy (a harmless form of vibrational medicine) combined with psychotherapy. Intermittent Explosive Disorder usually requires a course of anger management therapy along with medication. Pathological gambling often requires a twelve-step addiction program in addition to any other treatment.

Disorders of Impulse Control in the Family

    When living with a spouse or child who has a disorder of impulsivity, a person experiences stress, fear, shame and anger. People with these disorders look normal; it is hard to understand why they engage in destructive behavior. It is crucial, therefore, to educate oneself about these disorders. Blaming a person for shaming the family is not a technique that is curative or positive in any way. Rather, taking the sufferer for treatment should be the goal; this is best accomplished when love and encouragement are the motivating factors. Firmness is also required however. It is often necessary to let the sufferer know that treatment is not optional. This may require rabbinical or professional assistance. However, effective treatment is worth all the trouble it might take to arrange, because it offers an individual the prospect of a healthy, happy future and it offers the family peace of mind.