Atypical Impulse Control Disorders Flashcards
essential features
failure to resist and impulse or drive or the temptation to perform an act that could be harmful to the person or others
Preoccupation
increasing sense of tension or arousal prior
Intoxication
pleasure, gratification, or relief duing
Wtihdrawal
regret, self-reproach, or guilt following
Intermittent Explosive Disorder
characterized by discrete episodes of failure to resist aggressive impulses resulting in serious assaults or destruction
Kleptomania-essential features
-recurrent failure to resist impulses to steal objects not need for personal use or monetary value
- hoard or return objects
- chances arrest-not likely to steal but will preplan to avoid arrest
- tension increases if resist urge; tension relief upon act completion
- no help from others
Kleptomania-associated features
- impulse to steal is ego dystonic, conflict with the ego and one’s self image
- fears capture; fell depressed or guilty
- may cause legal, family, career and personal difficulties
- a possible variant of OCD
Kleptomania-DSM Diagnostic
- sense of tension before committing act
- pleasure, gratification or relief at time of committing act
- stealing is not committed to express anger and is not in response to a delusion or a hallucination
-not better accounted for by conduct disorder, a manic disorder, or antisocial personality disorder
Kleptomania- course
- can go on for years
1. sporadic
2. episodic
3. chronic
4. may appear in childhood and continue into adulthood
Kleptomania- relationship to shoplifting
- shoplifters rate high on inner tension before and relief after stealing
- similar descriptions of impulsivity in both groups
Kleptomania- underregulation: strength
- temporary weakness-anxiety or stress
- externally-mediated weakness deficit- goods displayed to attract interest
Kleptomania- misregulation
symptoms relief from anxiety or depression
Pyromania- essential features
presence of multiple episodes of deliberate and purposeful fire setting
Pyromania- associated features
- advance preparation for starting fire
- indifferent to consequences
- lead to property damage, legal consequences, or injury/loss of life
Pyromania- DSM Diagnostic
A. deliberate and purposeful fire setting on more than one occasion
B. tension or affective arousal before the act
C. fascination with, interest in, curiosity about, or attraction to fire and its situational
D. pleasure, gratification, or relief when setting fires, or when witnessing or participating in their aftermath
E. done for monetary gain, as an expression of sociopolitical ideology, to conceal criminal activity, to express anger or vengeance, to improve one’s living circumstances, in response to a delusion or hallucination or as a result of impaired judgment
F. not better accounted for by conduct disorder, a manic disorder, or antisocial personality disorder
Pyromania- course
- episodic: fire setting incidents wax and wane in frequency
- no typical age of onset
Trichotillmania- essential features
-disorder of compulsive hair pulling that ofter results in alopecia
- pulling hair from scalp, eyebrows, eyelashes
- itch-like sensation
Trichotillmania- associated features
- Examining hair root, twirling it off, pulling strand between teeth, or eating the hairs (trichophagia)
- hair-pulling does not occur in the presence of others
- social situations avoided
- individuals deny hair pulling and conceal hair loss
- some have urges to pull hair from others
- pull hair from pets, dolls, other
- majority pull hair from more than one site
Trichotillmania- DSM Diagnostic
A. recurrent pulling out of one’s hair resulting in noticeable hair loss
B. increasing sense of tension immediately before pulling out the hair or when attempting to resist the behavior
C. pleasure, gratification, or relief when pulling out of the hair
D. disturbance is not better accounted for by another mental disorder and is not due to a general medical condition
E. disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
Trichotillmania- Types of hair pulling
- Focused (similar to OCD rituals)
- associated with mounting tension prior; relief after
- attention focused on act of pulling, which distracts
- more elaborate rituals (hair pulling symmetry) - “automatic”
- not associated with prodromal urge or sensation
- occurs during sedentary activities
Trichotillmania- physical changes
- no inflammation of follicle but evidence of damaged follicles; evidence of short/broken hairs
- patterns of hair loss are highly variable
- areas of complete hair loss
- noticeably thinned hair density
- eyebrows and eyelashes completely absent
- scarring and infection
Trichotillmania- course
- age of onset- 5-16 years
- average- 13 years
- many years or episodic
Trichotillmania- comorbidity
80%
- mood and anxiety disorders most frequent
- eating disorders and substance use less frequent
- OCD rare
Trichotillmania- underregulation: strength
Temporary weakness
- causes significant shame and weakness
- stress causes vulnerability to relapes
Trichotillmania- underregulation: monitoring
- treatment involves self-monitoring and relaxation training
- transcendence failure
Trichotillmania- underregulation: inertia
- interruption of hair pulling causes extreme anxiety
- becomes automatic behavior similar to a habit
Comorbidities
mood disorder spectrum
- depression
- antidepressants
OCD spectrum
- compulsive nature
- SSRIs
Group therapy is most commonly recommended
