Impulse Control Disorder and Addiction


Impulse control disorders are psychiatric disorders in which a person lacks the self-control of emotions and behaviors in ways that cause them to behave angrily or aggressively toward people or property.1 These disorders cause individuals to violate the rights of others, break the law, or are in conflict with societal norms or authority figures.1

Grouped together in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th edition, impulse control disorders include oppositional defiant disorder, conduct disorder, intermittent explosive disorder, kleptomania and pyromania.1

These disorders may commonly co-occur with substance abuse disorder and other mental health disorders.

Behavioral therapies are typically used during the treatment of impulse control disorders. Medication may also be helpful, particularly when an impulse disorder co-occurs with another mental health condition.

A Closer Look at Impulse Control Disorders

The angry, aggressive or disruptive behaviors that define impulsive control disorders are more extreme than typical behaviors that many people experience as they grow up and develop as individuals.2 They are frequent, persistent, and occur across a variety of different situations, causing significant problems.1,2

Oppositional Defiant Disorder: An individual with ODD is frequently angry, easily annoyed and often loses their temper. They are often resentful, argue with authority figures and will deliberately annoy other people. They may also be vindictive and tend to blame others for their problems. The behavior must be exhibited while interacting with at least one person who isn’t a sibling.1,2 It’s estimated that 3.3% of people suffer from oppositional defiant disorder at some point in their lifetime.1

Intermittent Explosive Disorder: This disorder is characterized by frequent impulsive and aggressive outbursts. These outbursts are grossly out of proportion to a minor issue with someone the person knows. The outbursts may involve physical aggression toward people or animals and destruction of property.1,2 Around 5% to 7% of people suffer from intermittent explosive disorder at some point in their lifetime.3

Conduct Disorder: Only diagnosed in children and youth up to 18 years of age, conduct disorder is characterized by ongoing aggressive, anti-social behavior. This includes aggression and physical cruelty toward people and animals (e.g., bullying and fighting), destroying another’s property, stealing, and lying.1,2 About 4% of people have a conduct disorder during their lifetime.1

Kleptomania: This disorder is characterized by the impulsive and unnecessary stealing of things that aren’t needed. Items may be from friends, family, or strangers, or from public places such as retail stores. The items do not need be valuable and stealing the items is not done out of anger or vindictiveness. The act of stealing provides the person with pleasure, gratification or relief from tension that builds up prior to stealing the item.1,2 Kleptomania is seen in anywhere 4% to 24% of people, but it’s prevalence rate in the general population is only about 0.3% to 0.6%.1

Pyromania: A person who repeatedly and deliberately starts fires may suffer from pyromania. They have an unusual interest or fascination with fires. Setting a fire releases built-up emotional tension from which they derive relief and/or pleasure. Pyromania is extremely rare—among those going through the criminal justice system for repeated fire setting, only 3.3% had symptoms that met the full criteria for pyromania.1

Co-Occurring Impulse Control Disorders and Substance Abuse

In general, impulse control disorders often co-occur with other disorders, including mood disorders, anxiety disorders, and substance use disorders.

Intermittent Explosive Disorder: About 35% to 48% of people with intermittent explosive disorder also have a substance use disorder.4 When an intermittent explosive disorder co-occurs with a substance use disorder, the onset of intermittent explosive disorder precedes the onset of substance use disorder about 92% of the time by an average of 8 years.5 Those with co-occurring intermittent explosive disorder and substance use disorder had significantly more severe substance use disorders.5

Kleptomania: About 22% to 50% of people with kleptomania also have a substance use disorder.4 First-degree relatives of individuals with kleptomania also have a substance use disorder at a high rate of 20%.4

Pyromania: About 33% of people with pyromania also have a substance use disorder.4

Conduct Disorder: About 42% of men and nearly 23% of women diagnosed with conduct disorder also have a SUD.6 Adolescents diagnosed with conduct disorder are also more likely to develop a substance use disorder if one or both parents have a substance use disorder.7

Oppositional Defiant Disorder: Although prevalence rates vary, children and adolescents with oppositional defiant disorder are at risk of developing a substance use disorder. Early intervention in these cases may be effective in preventing the development of substance abuse and delinquency that can cause lifelong social, occupational, and academic impairments.

In the case of co-occurring disorders, such as an impulse control disorder and substance use disorder, integrated treatment is considered superior when compared to separate treatment for each disorder.9 This type of treatment takes both disorders into account.

References

  1. Diagnostic and statistical manual of mental disorders: DSM-5. (5th ed.). (2013). Washington, D.C.: American Psychiatric Association.
  2. American Psychiatric Association. (2018). What Are Disruptive, Impulse-Control and Conduct Disorders?
  3. Harvard Health. (2019). Treating intermittent explosive disorder.
  4. Schreiber, L., Odlaug, B. L., & Grant, J. E. (2011). Impulse control disorders: Updated review of clinical characteristics and pharmacological management. Frontiers in Psychiatry, 2, 1.
  5. Coccaro, E. F., Fanning, J. R., & Lee, R. (2017). Intermittent Explosive Disorder and Substance Use Disorder: Analysis of the National Comorbidity Survey Replication Sample. The Journal of Clinical Psychiatry, 78(6), 697–702.
  6. Castellanos-Ryan, N., Struve, M., Whelan, R., Banaschewski, T., Barker, G. J., Bokde, A. L., … Conrod, P. J. (2014). Neural and Cognitive Correlates of the Common and Specific Variance Across Externalizing Problems in Young Adolescence. American Journal of Psychiatry, 171(12), 1310–1319.
  7. Connor, D. F., Ford, J. D., Albert, D. B., & Doerfler, L. A. (2007). Conduct Disorder Subtype and Comorbidity. Annals of Clinical Psychiatry, 19(3), 161–168.
  8. Riley, M., Ahmed, S., & Locke, A. (2016). Common Questions About Oppositional Defiant Disorder. American Family Physician, 93(7), 589–591.
  9. National Institute on Drug Abuse. (2018). Common Comorbidities with Substance Use Disorders.


About The Contributor

Ryan Kelley, NREMT
Ryan Kelley, NREMT

Medical Editor, American Addiction Centers

Ryan Kelley is a nationally registered Emergency Medical Technician and the former managing editor of the Journal of Emergency Medical Services (JEMS). During his time at JEMS, Ryan developed Mobile Integrated Healthcare in Action, a series... Read More


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