Impulse control disorders are a type of behavioral disorder that causes someone to give into impulsive thinking. These disorders are often linked to chemical imbalances or structural changes in a region of the brain called the prefrontal cortex. The prefrontal cortex plays important roles in decision making processes.1
People with these disorders often have a criminal history or patterns of dangerous behavior. Treatment combines medication and therapy, and focuses on symptom management.
What Is an Impulse Control Disorder?
Impulse control disorder is a classification of multiple disorders that have to do with reactivity to heightened emotions and impulsive thoughts. These disorders are unique among psychological conditions in that psychological and emotional distress is focused and expressed outwardly toward the environment and other people. Most other psychological disorders focus emotional and psychological distress inward toward the self.3
People with impulse control disorders tend to have a propensity for violence and easily end up in situations where they harm others and themselves. These tendencies and behaviors are typically evident since childhood.
Impulse Control Disorders include:2
- Oppositional defiant disorder (ODD)
- Intermittent explosive disorder (IED)
- Conduct disorder (CD)
- Antisocial personality disorder (APD)
- Kleptomania
- Pyromania
Characteristics of Impulse Control Disorders
While specific disorders classified as impulse control disorders have their unique diagnostic criteria, many of the observable characteristics are shared among the various conditions. Overall, people with impulse control disorders show a pattern of outwardly destructive behavior, sometimes leading to criminal charges, and often involving others or specific objects they target with the behavior.
Characteristics that impulse control disorders may share include:4
- Engaging in risky or promiscuous behaviors and/or activities
- Explosive violent outbursts against others or property of others
- Extreme defiance
- Physical injuries as a result of acting out behaviors
- Intrusive thoughts
- Obsessions
- Uncontrollable urges
- Ongoing agitation
- Increased irritability
- Inability to concentrate
- Detached feeling from emotions and surroundings
- Feelings of guilt/regret
- Drastic shifts in mood
- Low self-esteem/self-worth
Types of Impulse Control Disorders
Impulse Control Disorders include oppositional defiant disorder (ODD), intermittent explosive disorder (IED), conduct disorder (CD), and antisocial personality disorder (APD), kleptomania, and pyromania.2 Impulse control disorder refers to the classification of these conditions, in that they have to do with acting on impulsive thoughts and uncontrolled emotions.
Oppositional Defiant Disorder (ODD)
Oppositional defiant disorder is a behavioral condition diagnosed in children and adolescents. It is identified by the child persistently exhibiting an angry or irritable mood, argumentative or defiant behavior, and vindictiveness for a period lasting longer than six months. The behaviors associated with this condition negatively affect the child’s social, family, and school functioning.5
While all children exhibit oppositional behavior from time to time, someone with ODD has markedly worse behavior when compared to others developmentally equal to them, and the behavior is prolonged and persistent.6
They will often run into trouble with authority figures, and end up in situations where their behavior has serious consequences. They are often touchy, easily annoyed, blame others for their behavior, and argue or throw temper tantrums. Largely, this is not premeditated behavior, but predicated on impulses, and the child often does not have an understanding of how to control their behavior.2
Intermittent Explosive Disorder
Intermittent explosive disorder is characterized by fits of rage or temper tantrums that last 30 minutes or more. During these fits, the person may become physically and verbally aggressive, making direct threats, throwing objects, having road rage, or striking others around them.
Afterward, there is typically a sense of relief which many times is followed by a sense of regret or embarrassment for their actions.6 The hallmark of this disorder is that there is typically remorse after the behavior is exhibited, and the person has no sense of control over their actions during explosive episodes.
This lends itself to it being classified as an impulse control disorder, as there is no control over the behavior being exhibited once triggered by an impulse or emotion. The risks of this behavior are criminal charges and guilt for the one with the disorder, and potential bodily harm to those subject to outbursts, as well as property damage.
Conduct Disorder
Conduct disorder is diagnosed primarily in adolescents and adults who display persistent patterns of behavior which violate the basic rights of others or major social norms. Such behavior includes initiating physical violence, aggression/harm toward animals, forcing sexual activity, criminal activity with confrontation such as mugging, intentional fire setting or destruction of property, deceitfulness and theft, frequently running away at a young age, or being truant from school regularly.2
There is considerable risk of harm to others when someone is diagnosed with conduct disorder. There may be a history of harm to animals like family pets, and physical altercations in the home or at school. At times, there is also no remorse for behavior shown, and behaviors are intentional. The individual will act on any impulses and desires without regard for the effects on others.
Antisocial Personality Disorder (APD)
Antisocial personality disorder is a step up in severity from conduct disorder. Only adults are diagnosed with APD, but symptoms of conduct disorder needed to be evident in their youth. Typically with the persistent violation of the basic rights of others and major social norms, there comes an indifference to, or rationalization of having hurt, mistreated, or stolen from another person.
Fisher and Hany report, “Many individuals diagnosed with antisocial personality disorder remain a burden to their families, coworkers, and closely associated peers, such as neighbors, despite becoming less troublesome with age. Mental health comorbidities and associated addictive disorders, as well as higher mortality rates due to suicides and homicides, only add to this burden.”7
Pyromania
Pyromania is diagnosed when someone has strong urges to set fires and obsesses over fire and destruction by fire. There is a presence of tension prior to setting the fire, and a sense of pleasure, gratification, or relief once the fire is set. The fires are not set for any external purpose or goal, and are not part of a set of behavioral symptoms that involve other types of property destruction or violence.8
Pyromania is a very rare disorder, and predominantly seen in males. According to the DSM-5, “individuals with this disorder are often regular ‘watchers’ at fires in their neighborhoods, may set off false alarms, and derive pleasure from institutions, equipment, and personnel associated with fire. They may spend time at the local fire department, set fires to be affiliated with the fire department, or even become firefighters”.2
Kleptomania
Kleptomania is a recurrent failure to resist impulses to steal objects that are not needed for personal use or for their monetary value. It is characterized by an anxiety-driven urge to steal, resulting in pleasure in the moment, but causing significant distress and dysfunction.2
Those who suffer from Kleptomania do have remorse for their behavior and truly act out of a need to satisfy an impulse to steal. There is obvious risk of criminal charges if caught in the act. It is estimated that 6 in 1,000 people have this condition, and it accounts for 5% of shoplifting.9
Causes of Impulse Control Disorders
The causes of impulse control disorders are largely unknown. There are likely some developmental and hereditary factors at play in the development of those with these types of disorders. It is thought that functioning of the prefrontal cortex has a lot to do with the development and manifestation of symptoms.1 There are, however, known environmental factors that can contribute to the development of impulse control disorders.
Environmental factors contributing to the development of impulse control disorders include:10
- Coming from a family with low socioeconomic status
- Coming from a place with community violence
- Lack of structure in the home and school
- Neglectful or abusive environment
- Having friends that partake in deviant or illegal activities
Impact of Impulse Control Disorders
The impacts of impulse control disorders are far-reaching and significant. For children diagnosed with an impulse control disorder, they may be unable to function well in social situations, and their behavior may lead to many consequences in school and at home. Depending on the severity of symptoms, they may also impact others’ lives through violence, theft, and property damage.
As age increases, the impact of impulse control disorders spreads to career choices and opportunities, family relationships, and societal functioning. Adults may end up with criminal charges related to their behavior, and therefore may find it difficult to obtain a job, or maintain one if symptoms are not treated. Adults with impulse control disorders also tend to be more of a risk to others they encounter, whether through fits of violence, incidents of road rage, arson, domestic violence, theft, vandalism, and other destructive and harmful behavior.
Treatment of Impulse Control Disorders
Treatment of impulse control disorders varies depending on the severity of the symptoms and the type of disorder. For example, antisocial personality disorder has no set treatment that has proven consistently effective. The best results are typically seen with those who receive treatment early in life, and learn to manage symptoms related to their impulses and heightened emotions.7 However, with other conditions within the impulse control disorder classification, there are effective treatments available.
Therapy
The most common and effective therapeutic treatment for impulse control disorders is cognitive behavioral therapy. This focuses on addressing thinking patterns and emotional behind behavior. This approach teaches techniques to manage emotional symptoms, change maladaptive cognitive patterns, and equips patients to better regulate emotions and thinking as they progress through life. When identified in younger ages, multisystemic therapy that involves the individual, family, school and other community resources can help lessen the impact of ODD and CD.
Medication
Most commonly, patients are started on selective serotonin reuptake inhibitor (SSRI) medications. These can effectively reduce impulsivity and aggression in patients by changing reactions in the prefrontal cortex.11 Other pharmaceutical approaches may be considered if SSRIs are ineffective. These may include medications used for ADHD or ones that stabilize moods. The best route to figure out what is right for you is to talk with your doctor about your condition and needs.
Final Thoughts on Impulse Control Disorders
Although living with an Impulse Control Disorder is a scary thing at times, and can lead to some hard times, you don’t have to go it alone. Talking to a therapist or reaching out to a trusted friend or family member can make a big difference in how you feel. Getting that help early has the best results, so if you’re on the fence about reaching out for help, please consider doing so.
For Further Reading
Impulse Control Disorders Infographics
