IMPULSE-CONTROL DISORDERS

Impulse Control Disorders are characterised by an incapacity on the part of the patient to resist a drive or impelling temptation. The drive induces an individual to carry out actions that are dangerous for himself/herself or for others; it is preceded by a sensation of increasing tension and arousal and followed by pleasure, gratification and relief, and then, subsequently, by remorse, feelings of guilt and self-blame. The Impulse-Control Disorders are: Pathological Gambling, Pyromania, Kleptomania, Intermittent Explosive Disorder and Trichotillomania.

Pathological gambling. This disorder is characterised by the incapacity to resist a persistent temptation to indulge in gambling pursuits and betting large sums of money. The incapacity involves a situation whereby the subject cannot abandon this kind of behaviour despite frequent attempts to control himself or herself, which in turn cause a sense of restlessness. Persons affected by the disorder seek the excitement which they derive from betting increasingly large sums of money. The difficulty in interrupting such behaviour also derives from the eventual need to recover money that has been lost: a predicament which drives the subject to go on gambling. When pathological gamblers have lost all of their financial resources (on account of an enormous quantity of debts), they may engage in antisocial behaviour such as theft or counterfeiting. Other consequences that derive from the condition are the loss of close relationships, the undermining of family bonds and the jeopardising of professional, personal or scholastic activities. Persons affected by pathological gambling are generally very competitive, full of energy, restless and find that they can easily get bored. They also seem excessively preoccupied they may lose the approval of others and are particularly generous individuals. The disorder can be identified in both men and women and in adults and adolescents to the same degree.

Pyromania. Persons affected by this disorder experience an irresistible temptation to set fire to objects. Pyromaniacs do not act out of spite, revenge or anger or on the basis of any political ideology but rather to satisfy an impulse or drive they cannot resist. They are driven by an inner feeling of tension and excitement and this is placated only after having started a fire, which procures a sense of relief and gratification. These people are fascinated by, interested in and always curious about fires and everything connected with them (its various uses, related tools and equipment, its consequences etc.). Pyromaniacs often watch fires, raise false alarms and at times join in with the firemen to put them out.

Kleptomania. This is the incapacity to resist a temptation to acquire objects with no commercial value or personal usefulness. People affected by this disorder often give away the objects they steal and collect as presents or just throw them away, but they may occasionally also secretly return them to their owner. Thefts are not normally previously planned. Kleptomaniacs commit thefts alone without the aid of another person, and taking great care not to get arrested. The act is preceded by an increasing sensation of tension accompanied by pleasure, gratification and relief following the act. However, very quickly the individual realises that the gesture was entirely senseless and may feel guilty or drift into a state of depression. There are multiple consequences of the disorder, from the legal, occupational and personal points of view and also from that of the perpetrator’s own family. The onset of the disturbance is not associated with a certain age and the condition appears to be more frequent in women.

Intermittent Explosive Disorder. This disorder is characterised by the incapacity of the affected individual to resist aggressive impulses, carrying out serious aggressive actions in situations which do not justify such behaviour.

Trichotillomania. The recurrent drive to pull out one’s hair or body hair for pleasure, gratification or the alleviation of tension. Affected subjects may even occasionally swallow and eat it (tricophagia). The urgent drive to engage in this kind of behaviour is associated with an increase in psychological tension, which is then alleviated by the tearing out of hair from various parts of the body: an act that is often ritualised and performed in particular places at specific times. The most evident consequence of the disorder is represented by the appearance of extensive areas of alopecia, in some cases limited to the scalp and in others extending to the eyebrows, eyelashes or, more rarely, to the pubic area. A further consequence lies on a sense of shame which the disturbed subject feels in relation to his/her behaviour and its quite visible effects. These individuals may often present a total refusal to engage in social relations, low self-esteem and impaired social functioning.

The phenomenon may be transitory, episodic or continuous. It presents with varying degrees of intensity and may involve different areas. For example, patients may start with the hair on their head, and then go on to remove their eyebrows and eyelashes. In some individuals it is so extensive that it eventually leads to complete baldness. In other cases (more often in children) it is also directed towards other persons. In the majority of cases the disorder first appears during childhood (2-6 years of age) or adolescence. It seems to be more frequent in the female population and is often associated with anxiety disorders and depression.

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