Impulse control disorder Flashcards
What is the main characteristic of impulse control disorder?
The repeated inability to resist the impulse or urge to carry out a behaviour.
Describe the assessment tool for kleptomania.
Kleptomania Symptom Assessment Scale (K-SAS)
11 items rated on a point-based scale, typically 0 to 4 or 0 to 5.
Measures impulses, thoughts, feelings and behaviours related to stealing.
The greater the score, the greater the severity.
Describe the diagnostic criteria for kleptomania.
Characterised by a powerful impulse to steal.
This impulse is very hard to resist and the person will often steal things as a result.
Increasing tension before theft. Feelings of excitement after theft.
Not intended to achieve any motive such as monetary gain.
For diagnosis, there must not be another obvious explanation for the behaviours, such as any other behavioural or mental disorder, substance use or intellectual impairment.
Describe the diagnostic crietria for pyromania.
Characterised by a powerful impulse to set fires.
This impulse is very hard to resist and the person will often set fires to properties or objects.
Increasing tension before the act. Feelings of excitement after the act.
Fascination or preoccupation with fire and related stimuli, such as watching or building fires, or with firefighting equipment.
Not intended to achieve any motive such as monetary gain, sabotage or revenge.
For diagnosis, there must not be another obvious explanation for the behaviours, such as any other behavioural or mental disorder, substance use or intellectual impairment.
Describe the diagnostic criteria for gambling disorder.
Characterised by persistent gambling behaviour either online or offline.
Impaired control of the gambling. For example, in terms of time or money spent on gambling.
Prioritize gambling over other activities.
Gambling continuing despite negative consequences.
Impairment to important areas of functioning such as family life, friendships and work life.
For diagnosis, behaviour must be present over a year.
Describe the biological explanation for impulse control disorder.
When someone with impulse control disorder gives in to their impulses, their reward centres are stimulated and release dopamine.
When these behaviours become compulsive, however, levels of dopamine in the striatum are reduced. This will lead to continuation of compulsions and addictions.
This mechanism is known as “reward deficiency syndrome”
Describe the behavioural explanation for impulse control disorder.
Positive reinforcement.
In the case of gambling, partial positive reinforcement is used as an explanation because people do not receive a reward everytime.
This reduces the chance the player will ever feel fully satisfied with their reward and they are more likely to keep playing in the mistaken belief that they will earn back more than they have lost.
Describe Miller’s feeling-state theory as an explanation for impulse control disorders.
All sensations, thoughts and emotions in relation to an event is called the feeling-state.
Intense positive feeling-states when carrying out a behaviour are what causes impulse control disorders.
Positive feeling states will only appear intense and very desirable when constrasted with negative feeling states. A person who feels powerful when setting fires may have underlying negative beliefs about themselves such as being weak or unimportant. Hence, the experience of setting fires is intensely gratifying for them.
Describe the aim of Grant et al. (2008).
To identify clinical variables associated with treatment outcome in pathological gambling (PG) subjects receiving opiate antagonists.
Describe the hypothesis of Grant et al. (2008).
- Family history of alcoholism and stronger urges to gamble would be associated with stronger outcomes for those treated with opiate antagonists.
- People with less severe PG would be more likely to respond positively to a placebo than those with severe PG.
Describe the sample of Grant et al. (2008).
284 patients with PG who had gambled in the last two weeks.
From the USA.
Approximately equal numbers of men and women.
Describe the procedure of Grant et al. (2008).
In one trial, participants were randomly assigned to placebo, nalmefene doses of 25, 50 or 100 mg/day.
In the another trial, participants were assigned to placebo, naltrexone doses of 50, 100 and 150 mg/day.
Both trials were double-blind.
Yale-Brown Obsessive Compulsive Scale Modified for Pathological Gambling (PG-YBOCS) was administered.
Semi-structured interview were used to gather family history.
Describe the results for Grant et al. (2008).
A family history of alcoholism and strong gambling urges seem to predict a positive response to opiate antagonists in treatment of PG.
For those receiving a higher dose of opiate antagonists, intensity of gambling urges was associated with a positive response to treatment.
For those receiving placebo, younger age was associated with a more positive response; presumably because the behaviour is less ingrained than in older patients.
Describe the study by Glover (1985).
It is a case study.
Sample consists of a 56-year-old woman with a 14-year history of daily shoplifting.
The woman underwent four sessions at two-weekly intervals.
Muscle relaxation was used to enhance her ability to immerse herself in the visualisation.
It was decided to use imagery of nausea and vomiting paired with the act of stealing. Episodes of imagery were used involving increasing nausea as she approached an article in a supermarket which she intended to steal, leading to vomiting as she lifted the article, with other shoppers’ attention being attracted to her. The vomiting and other unpleasant sensations ceased as soon as she replaced the article, turned away and left the shop.
At a 19-month check up, she had decreased desire of stealing with only one relapse. She reported improvements in her self-esteem and social life.
Describe the study by Blaszczynski and Nower (2003).
This study describes imaginal desensitization and evidence of its effectiveness.
First, the therapist teaches a progressive muscle relaxation procedure.
Then, clients visualize themselves being exposed to a trigger that prompts their impulsive behaviour.
They are then asked to think about acting on the impulse, then to mentally leave the situation.
All of these are done in a stage of continued relaxation.
It has been shown to reduce the levels of psychological and physiological arousal associated with these disorders.
