impulse-control disorders Flashcards
why is it important
They are problems in emotional and behavioral self-control that violate the right of others, or cause self-damage
what is the line for impulse-control disorders
- impulse, temptation
- growing internal tension
- Dificulty to resist. Discomfort when resisting
- Behavior violating the right of others or provoking selfdamage
- Momentary Relief (pleasure, in some cases)
- Guilt (in some cases)
what kind of interventions is there
- psychotherapy
- pharmacotherapy (for some cases)
what is Contingency Management
- persons earn incentives as a reward to reinforce abstinence for problematic behavior.
what is habit reversal training
- Awareness training
- Competing response training
- Contingency management
- Relaxation training
- Generalization training
what are some impulse-control disorders
- Kleptomania
- Pyromania
- Intermittent Explosive disorder
what is the main features in kleptomania
- Recurrent failure to resist impulses to steal objects that
are not needed for personal use or for their monetary
value. -
Increasing sense of tension inmediately before
committing the theft. -
Pleasure, gratification, or relief at the time of
committing the theft. - The stealing is not committed to express anger or
vengeance and is not in response to a delusion or a
hallucination.
how is kleptomaniac stealing different from other kind of stealing
- Stolen objects have little value (individual could have afforded to pay for them).
- Thefts are not preplanned (but shoplifting usually is).
- The stealing is done without assistance from others.
- Generally, stealing is avoided when immediate arrest is probable.
what is the prevalence for kleptomania
- 0.4 – 3.4 %
- But more prevalent in countries such as Australia 7%
what is the Comorbidity for kleptomania
- Other addictions (45-55%)
- Mood disorders
- Obsessive Compulsive Disorder
- ADHD
how does Wilhelm Stekel describe kleptomania
as a symbolic compensation
for a real or anticipated loss
(almost always of sexual Wilhelm nature).
how does David Fishbain describe kleptomania
as a risk-taking behavior
in response to depression.
is kleptomania learned by positive or negative reinforcement
- negative!
Rising internal tension–>
Behavior (removes tension)–>
Momentary Relief
which part of the brain does Habit learning take place
Basal ganglia
what kind of evaluation is there for kleptomania
- self-report scales
- K-SAS: Kleptomania Symptom Assessment Scale. scores:
From 8 to 20: mild
From 21 to 30: moderate
From 31 to 44: severe - structured interviews
- SCI-K: the Structured Clinical Interview for Kleptomania
what kind of interventions is there for kleptomania
- Psychotherapy
- attitude and beliefs change
- Contingency Management
- pharmacotherapy
- Opiodid Receptor Antagonists
- SSRIs
- Mood stabilizers
what are the criteria for Pyromania
- Deliberate and purposeful fire setting on more than one occasion.
- Tension or affective arousal before the act.
- Fascination with, interest in, curiosity about, or attraction to fire and its situational contexts.
- Pleasure, gratification, or relief when setting fires
or when witnessing or participating in their aftermath. - The fire setting is not 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, or as a result of
impaired judgment.
what is the prevalence for pyromania
- less than 1%
- most common in adolescence
what kind of comorbidity is there for pyromania
– Other impulse-control disorders
who invented the term pyromania?
Charles Chrétien Henri MARC
what has pyromani been related to?
- lack of social skills
- learning difficulties
what kind of intervention is there for pyromania?
- psychotherapy
- pharmacotherapy (in some cases)
what is the main features of intermittent explosive disorder?
- Recurrent outbursts that demonstrate an inability to control impulses, including either of the following:
– Verbal aggression (tantrums, verbal arguments or fights) or physical aggression that occurs twice in a week-long period for at least three months and does not lead to destruction of property or physical injury.
* These could include temper tantrums, tirades, verbal arguments/fights, or assault without damage.
–** Three** outbursts that involve injury or destruction within a year-long period
* These could be destroying an object without regard to value, assaulting an animal or individual.
* Aggressive behavior is grossly disproportionate to the magnitude of the psychosocial stressors.
* Aggressive behavior is not premeditated
what consequenses does intermittent explosive disorder have?
- Social
– Loss of friends
– Marital instability - Occupational
– Loss of employment
– Demotion - Financial
– Due to value of objects destroyed - Legal
– Civil suits
– Criminal charges
what is the prevalence for intermittent explosive disorder?
- 2,7%
- more prevalent in people younger than 35-40 years
what comorbidity is there for intermittent explosive disorder?
- bipolar disorders
- substance abuse
what risk factors is there in intermittent explosive disorder?
environmental:
* trauma
biological:
* Genetics (according to twin studies)
* Serotonergic abnormalities in:
* Anterior cingulate cortex
* Orbitofrontal cortex
* Amygdala responses to anger stimuli, are greater
what evaluation is there for intermittent explosive disorder?
STAXI: state-trait anger expression inventory
what Intervention is there for intermittent explosive disorder?
Psychotherapy:
* Relaxation
* Cognitive Behavior Therapy
* Anger Management Groups
+ pharmacotherapy
describe anger management
Awareness
**Identifying motivation for anger
**
Control
* Social skills for instigations
* Problem solving
