Note: low levels serotonin assoc with impulsiveness and aggression

Impulse Control
- charec by predisposed inability to resust unplanned rapid reactions towards internal or external
stimuli without regard for negative consequences, that may cause harm to oneself or others.
Core qualities of impulse control disorders
1. repetitive or compulsive engagement in behavior despite adverse consequences
2. little control over the negative behavior
3. anxiety or craving experienced prior to engagement in impulsive behavior
4. relief or satisfaction during or after completion of the behavior

Intermittent Explosive Disorder

DSM IV
- recurrent outbursts of aggression that result in assault against people or property
- outbursts or aggression are out of proportion to triggering event or stressor
- aggression is not better explained by another psych diagnosis
- each episode remits quickly and spontaneously, often leaving patient remorseful and distressed
Epid/etio: M>F, late teens progress in severity till middle aged
- genetic, perinatal, environmental, and neurobiological factors may play a role
- may have hx of child abuse trauma or seizures
Treatment:
- SSRIs, anticonvulsants, lithium, and propranolol
- individual psychotherapy is difficult and ineffective
- group therapy and family therapy may be useful to create behavior plans to help manage episodes

Kleptomania
DSM IV
- inability to resist uncontrollable urges to steal objects that are not needed for personal use or
monentary reasons
- pleasure or relief is experienced while stealing; however intense guilt and shame often reported by
those who have this disorder
- objects stolen typically given or thrown away, returned, or hoarded
Epid/Etio: F>M, 5% of shoplifters, symp often during times of stress, chronic
- increase incidence comorbid mood disorder, eating disorder, and OCD
- bio factors and fam dysfunc during childhood may contribute
Treatment
- insight oriented psychotherapy, behavioral therapy such as systematic desensitization, adversive
conditioning and SSRIs
- some evidence for naltrexone use
note: 25% of bulimia nervosa patients have comorbid kleptomania

Pathologic Gambling
DSM IV
- persistent and recurring maladaptive gambling behavior as evidenced by 5 or more of the following
1. preoccupation with gambling
2. need to gamble with increasing amount of money to achieve pleasure
3. repeated unsuccessful attempts to cut down on gambling
4. restlessness or irritability when attempting to stop gambling
5. gambling done to escape problems or relieve dysphoria
6. returning to reclaim losses after gambling
7. lying to therapist or family members to hide level of gambling
8. committing illegal acts to finance gambling
9. jeporadizing relationships or job because of gambling
10. relying on others to financially support gambling
Epi: prev 1-3% in US, Males 66%, higher rates adolescents and young adults
- increase comorbid mood anxiety and OCD
- predisposing factos: loss of parent during childhood, inappropriate parental discipline, ADHD, lack
of family emphasis on budgeting / saving money
- genetic bio environment and neurochemical
- 1/3 recover without treatment
Treatment
- gamblers anonymous 12 step, most effective
- after 3 months abstinence, may use insight oriented psychotherapy
- treat comorbid disorders

Trichotillomania
DSM IV
- recurrent repetitive intentional pulling out of ones hair causing visible hair loss
- usually involves scalp, though can include eyebrows eyelashes facial and pubic hair
- tension is experienced immediately before pulling and relief or pleasure occurs after
- causes significant distress or impairment in daily functioning
Epi: prev 1-3%, F>M, onset during childhood or adolescence, texture of hair is trigger
- bio, genetic and environmental (rltnshp with parent, loss of imp object or figure)
- increase comorbid OCD, OCPD, mood disorders, and Borderline
- chronic and remitting course, adult onset more diffic to treat
Pyromania
DSM IV
- at least 1 episode of deliberate fire setting
- tension or arousal before act, pleasure gratification or relief when setting fires and subsequent
consequences
- fascination, interest, curiosity, attraction to fire and its consequences
- not for monetary gain, expression of anger, political statement, or due to AH VH and delusions
Epi/etio: M = F, mean age late adolescence, prognosis better in children, course can be chronic if
untreated
Treatment:
- behavior therapy, supervision, SSRIs