Pulse Disorders (Pulse Control Disorder) - Causes, Symptoms and Therapy

Gambling Addiction, Pyromania, Kleptomania, Trichotillomania, Dermatillomania
Impulse disorders, also known as "impulse control disorders" or "impulse control disorders", refer to an impulsive impulsive behavior, for example in the form of buying, playing, eating, nail biting, self-injuring or excessive masturbation. Although these impulsively controlled actions are consciously experienced, they are difficult to prevent on their own initiative. The victims resolve a perceived state of tension with the actions. Impulse control disorders are behavioral disorders that are common throughout society.

contents

• definition
• root cause
• symptoms
• diagnosis
• ICD classification
• Pathological play
• pyromania
• kleptomania
• trichotillomania
• Pathological hot anger
• Dermatillomanie
• Treatment of impulse disorders
• Self-help with impulse control disorders
• state of research

definition

The term impulse control disorder comes from psychiatry and clinical psychology. This refers to a certain pattern of behavior, which is triggered impulsively to dissolve a self-perceived unpleasant state of tension. The actions of those affected usually have no discernible motivation, can not or are difficult to control and often harm the patient's own interests or the interests of others.

The impulsive behavior usually follows the same schemata, which, although consciously experienced, are deliberately impossible or difficult to break. These affects can manifest themselves in numerous activities, such as excessive eating, buying, playing, nail biting, driving on the street, masturbating or self-injuring. Pulse control disorders are common in patients with borderline personality disorder.

People who suffer from a disturbance of impulse control perform compulsive acts that are consciously experienced but deliberately impossible or difficult to break. (Image: peshkova / fotolia.com)

root cause

The causes of impulse control disorders are not fully understood. Doctors suspect a complex interplay of genetic, physical and social factors such as education, environment and horizon of experience. The hormone levels of those affected are also suspected to be relevant to the problem and to significantly influence the type of disorder. For example, men are more prone to aggressive disorders such as compulsive arson, whereas women's coercive actions tend to be self-defeating, as is the case with trichotillomania (hair ripping).

In addition, a close interaction with other mental disorders is suspected, which include, for example, substance dependency and severe mental illness such as borderline. Furthermore, there are drugs that are used for example in the treatment of Parkinson's disease, which can trigger impulse control disorders.

symptoms

Typical signs of impulse control disorders are those who can not repeatedly resist their impulses. The decision to perform an impulsive action is not consciously made, but there is a compulsive urge behind it. Mostly the actions are schematic and similar to the principle, although the acts are completely different.

All impulse control disorders are preceded by nearly the same psychic process. The victims suffer from the action under an unpleasant tension, which wears off by the act performed. The unpleasant self-perception is suppressed and directed to the execution of the action. After the deed, many sufferers feel guilty and shame, which negatively affects their mental development, which in turn reinforces the inner tension and leads to repeated actions.

Despite feelings of guilt or shame, people with an impulse control disorder repeatedly perform harmful acts to get rid of a tremendous inner tension. (Image: ra2 studio / fotolia.com)

diagnosis

The diagnosis is made primarily by a psychiatrist. For the symptoms to be diagnosed as a mental disorder, the compulsive behavior must be considered unadapted or unreasonable. It also plays a role in the diagnosis of whether the person harms themselves or other people, for example, by accumulating debts or causing accidents and injuries.

ICD classification

In the WHO (World Health Organization) diagnostic classification system, "abnormal impulse control habits and impulses" has the ICD key F63, which is further subdivided, for example:

• F63.0 pathological gambling
• F63.1 pathological arson (pyromania)
• F63.2 pathological stealing (kleptomania)
• F63.3 Plucking, twisting and tearing of hair (trichotillomania)
• F63.8 Other abnormal habits and impulse control disorders (for example pathological irascibility or dermatillomania)

Pathological play

The pathological gambling refers to the abnormal habit of repeatedly engaging in intense gambling, which greatly influences or nearly controls the lives of those affected. Patients are sometimes no longer able to pursue their profession and social contacts, which has a negative impact on family, environment and ultimately on the material supply.

In colloquial language, this behavior is referred to as gambling addiction or game dependency. Again and again sufferers try to break away from playing, but this does not succeed. The addicted to gambling, often men, often try to hide their addiction from relatives and friends. They do not think of the associated possible consequences such as unemployment, debt and relationship problems while playing.

These compulsive actions are triggered by problems or negative moods, which cause unpleasant tensions for those affected, which they can only reduce by playing or betting. Frequently, sufferers lose significant sums of money, triggering a downward spiral: money is no longer enough to pursue addiction, and yet everything is being tempted to keep playing. Many gambling addicts are heavily indebted and sometimes also take criminal action in order to get the financial means to satisfy their addiction.

Excessive gambling can be a form of impulse disorder. Some gambling addicts are heavily in debt and even accept criminal acts. (Image: Kiko Jimenez / fotolia.com)

pyromania

In impulse control disorder in the form of pathological arson, sufferers repeatedly deal with the fire and everything that is connected with it. You create fires on property or on other buildings or places, whereby for third parties no real motive can be recognized. The pyromaniacs are under internal tension and excitement. Those affected feel joy or relief during the arson. They do not commit the act out of revenge or destructiveness. Even with this disorder, those affected can be prone to crime.

kleptomania

Another impulse control disorder is pathological stealing. It does not just steal things that are needed. Often the stolen goods are thrown away after the action, given away or hoarded. Sufferers feel a sense of satisfaction during or immediately after the fact. Kleptomaniacs do not steal to enrich themselves or others, but because of the inner tension of the theft and the subsequent satisfaction that comes through the act. Those affected often have a bad conscience after a theft, but commit them again and again. Since theft is a criminal offense, kleptomaniacs often come into conflict with the law.

trichotillomania

Trichotillomania describes an uncontrollable urge to pluck, twist and tear his hair. As with the disorders already described, it is also associated with inner tension and a sense of relief and satisfaction after the action. The sufferers sometimes suffer a lot of hair loss.

The causes of trichotillomania are loss situations, experiences of abuse or other serious incidents in life. However, even simpler family or interpersonal incidents may decrease self-esteem and trigger impulse control disturbances.

Most of the affected are particularly susceptible to stress. Trichotillomania is often accompanied by other mental disorders, such as massive anxiety, depression, eating disorders, obsessive-compulsive disorder or tic disorders. Many sufferers suffer as a result of this impulse disorder on skin problems. In rare cases, ruptured urine is swallowed, which can lead to intestinal obstruction in larger quantities.

People with trichotillomania suffer from an uncontrollable urge to pluck, twist and tear their hair. (Image: vladimirfloyd / fotolia.com)

Pathological hot anger

Pathological irascibility, or irritability with intermittent irritability, is an impulse control disorder characterized by explosive bursts of anger and aggression. Often the outbreaks emanate into veritable frenzy, which is out of all proportion to the situation. For example, those affected suddenly start impulsively to scream in relatively insignificant events. In most cases, these outbursts are reactions to real or supposed provocations, arguments, discussions, or the behavior of others. In some individuals, an affective behavioral change can be seen before an outbreak, for example in the form of tension or mood swings.

Dermatillomanie

Dermatillomania or Skin Picking Disorder is an impulse control disorder in which sufferers have an irresistible urge to repeatedly touch, squeeze and scratch diseased skin. This behavior can lead to considerable tissue damage. Other possible consequences are feelings of shame and guilt, which is why many sufferers increasingly isolate themselves socially.

Treatment of impulse disorders

In the treatment of impulse disorders drugs such as antidepressants are used because the impulse control disorders often occur together with depression. Non-drug therapies such as talk therapy, behavior therapy or psychoanalysis also play a crucial role. The aim of the therapy is to completely suppress the unwanted behavior or to modify the obsession so that it is reduced to a harmless level.

In addition, the social and possibly also the legal context of the act must be considered, as some victims have been criminalized, for example by compulsive stealing or arson. The success of therapy depends largely on how much affected people are willing to cooperate. Especially affected children often do not realize the seriousness of the situation here.

In most cases impulse control disorders can not be overcome alone, but require therapeutic support. (Image: Chinnapong / fotolia.com)

behavior therapy
As part of a behavioral therapy, people with impulse control disorders learn how to deal with their disorder and how they can behave when tension occurs. It tries to prevent the impulse and to learn other, alternative behavior. The therapy should always be adapted to the individual requirements of the patients and their special form of the impulse disorder.

psychoanalysis
In psychoanalysis, the personal history of those affected is worked up. The processing of traumatic events and experiences with caregivers should lead to more mental stability and self-confidence in this form of therapy.

Self-help with impulse control disorders

Pulse control disorders require holistic therapy and in most cases can not be managed alone. Decisive for a healing process is the willingness to therapy and the consistent implementation of the steps. In a therapy, self-help measures are often learned, such as the execution of non-harmful substitute actions to solve the tensions built up.

Habit reversal training
In some impulse control disorders such as trichotillomania and dermatotillomania habitual reversal training (habitual reversal) has proven itself. In this training, the problematic behavior is replaced by an alternative behavior. For example, those affected can learn to suppress the impulse by putting them on both hands.

relaxation training
Relaxation techniques for stress relief such as autogenic training, special breathing exercises and progressive muscle relaxation according to Jacobsen support the treatment.

state of research

Pulse control disorders can also be triggered by medications used in Parkinson's disease. Recently, an alternative treatment was presented in one study. Patients with Parkinson's benefit from a brain pacemaker. This allows a reduction in the required medication and can thus also reduce the impulse control disorders. (sw, vb; updated on 27.02.2018)
Specialist supervision: Barbara Schindewolf-Lensch (doctor)