Impulse control disorders and non-substance addictive disorder Flashcards
Definitions
I
Griffiths 2005
salience (importance)
mood modification (high)
tolerance (increases)
withdrawal (unpleasant)
conflict
relapse
Types
Kleptomania
Pyromania
Gambling disorder
Kleptomania
-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
Pyromania
-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
Gambling disorder
-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
Measures
-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)
K-SAS evaluation
+retest reliability
+concurrent validity
-response bias
+quantitative data
Causes
II
Biochemical: Dopamine
-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’
Behavioural: positive reinforcement
-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
Cognitive: Feeling state theory
-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
Treatment and management
III
Biochemical Grant et al
-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
Cognitive behavioural: Covert sensitisation
-Glover
-conditioning using a nausea or an anxiety-producing image paired with an undesirable behaviour
Glover case study
-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
Cognitive behavioural: Imaginal desensitisation
-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
Cognitive behavioural: Impulse control therapy
-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
Miller case study
-John, compulsive gambler
-after visualising the feeling state of ‘winning’ along EMDR he began to notice a reduction in the urge to gamble
Evaluation Grant et al
+double blind: reduced researcher or participant bias and increased validity
+quantitative data made easy to compare through the standardised Y-BOCS
-placebo -> ethical issues
Evaluation Glover, and John
-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
