Impulse control disorders and non-substance addictive disorder

Question 1

Definitions

Answer 1

I

Question 2

Griffiths 2005

Answer 2

salience (importance)
mood modification (high)
tolerance (increases)
withdrawal (unpleasant)
conflict
relapse

Question 3

Types

Answer 3

Kleptomania
Pyromania
Gambling disorder

Question 4

Kleptomania

Answer 4

-ongoing inability to resist the urge to steal objects not needed
-tension before, pleasure after
-more women affected
-0.3-0.6% affected
-often diagnosed with anxiety or substance misuse
-may feel guilt and shame

Question 5

Pyromania

Answer 5

-impulse to start fires
-diagnosis requires deliberate and intentional starts of fire on more than 1 occasion
-tense before, pleasure or relief afterwards
-fascinated with fire or related such as accelerates
-cannot resist the urge
-may start false fire alarms
-many report severe distress after starting fires

Question 6

Gambling disorder

Answer 6

-difficulty in controlling impulses
-stimulates the brain’s reward centre similar to substance abuse
-persistent and problematic gambling behaviour such as difficulty withdrawing from gambling, lying to conceal involvement with it, and loss of relationships due to it

Question 7

Measures

Answer 7

-Kleptomania Symptom Assessment Scale (K-SAS)
-11 item self rated scale which measures impulses, thoughts, feelings and behaviours related to stealing (all in relation to the past 7 days)
-rated from 0-4 or 0-5 (no symptom, severe)

Question 8

K-SAS evaluation

Answer 8

+retest reliability
+concurrent validity
-response bias
+quantitative data

Question 9

Causes

Answer 9

II

Question 10

Biochemical: Dopamine

Answer 10

-when behaviour is compulsive, dopamine activity is reduced
-deficiency in dopamine can lead to a perpetuation of compulsions and addictions
-this is called ‘reward deficiency syndrome’

Question 11

Behavioural: positive reinforcement

Answer 11

-idea of rewards
-someone’s learned behaviour is a result of previous trials of that behaviour
-in gambling: winning is a positive reinforcer
-even after losing they come back due to ‘schedules of reinforcement’ and partial positive reinforcement

Question 12

Cognitive: Feeling state theory

Answer 12

-underlying thoughts about particular behaviours to explain obsessions
-positive feelings can become linked with specific behaviours
-impulse disorders caused by feeling state (all the sensations, thoughts, emotions one experiences related to that behaviour)
-feeling state combined with positive emotions and physiological arousal create compulsions
-underlying negative thought creates the feeling state

Question 13

Treatment and management

Answer 13

III

Question 14

Biochemical Grant et al

Answer 14

-opiates treat gambling disorder
-284 (50%m)
-double blind
-either 16 week course nalmefene or 18 weeks naltrexone or placebo
-assessed by Y-BOCS
-opiates show significant reduction in symptoms

Question 15

Cognitive behavioural: Covert sensitisation

Answer 15

-Glover
-conditioning using a nausea or an anxiety-producing image paired with an undesirable behaviour

Question 16

Glover case study

Answer 16

-covert sensitisation to treat kleptomania
-56 yr old with 14 yrs of history in kleptomania
-imaging of nausea and vomiting to create unpleasant association with stealing
-4 sessions at 2 week intervals
-first two -> muscle relaxation for better visualisation
-19 month follow up: decreased impulse to steal, 1 single relapse

Question 17

Cognitive behavioural: Imaginal desensitisation

Answer 17

-Blaszczynski & Nower
-relies on the use of images to help individuals with: gambling, trichotillomania, kleptomania and compulsive shopping
-1st step: progressive muscle relaxation procedure
-2nd: must visualise being exposed to a situation that triggers the impulse, then thinking about acting upon it, but immediately leaving
-it has been found to decrease the strength of the impulse by reducing the level of arousal

Question 18

Cognitive behavioural: Impulse control therapy

Answer 18

-Miller
- the goal is not to eliminate the behaviour but to establish normal, healthy behaviour
- involves changing distorted thoughts a person has about their behaviour
-it links to the feeling state
-the most intense feeling and other positive feelings related to the behaviour are first identified; these are measured on the Positive Feelings Scale
-the patient is asked to recreate the feeling state in their mind
-during this time, they are to perform ‘eye movement desensitisation and reprocessing (EDMR) exercises’
-3-5 sessions

Question 19

Miller case study

Answer 19

-John, compulsive gambler
-after visualising the feeling state of ‘winning’ along EMDR he began to notice a reduction in the urge to gamble

Question 20

Evaluation Grant et al

Answer 20

+double blind: reduced researcher or participant bias and increased validity
+quantitative data made easy to compare through the standardised Y-BOCS
-placebo -> ethical issues

Question 21

Evaluation Glover, and John

Answer 21

-case study: cannot be genralised
-about kleptomania -> not sure it works on others
-could have longer follow ups than 1 year
-the therapists assessing the patients -> bias
+in depth qualitative data