What Is Involved in Impulse Control Disorder Treatment?

Impulse control obstacles: Also known as intentional control obstacles, it refers to the use of certain improper behaviors driven by excessively strong desires. These behaviors are not allowed by social norms or cause harm to themselves. The purpose of their behaviors is only to obtain self-psychological satisfaction or dissolution. Mental tension. Patients claim that this behavior is impulsive and cannot be controlled. Does not include deviation from normal sexual desire and sexual behavior.

Impulse control obstacle

Definition of impulse control

Impulsive control disorders, as a group of rare and recurrent mental disorders without clear and reasonable motivation, have been described by Western psychiatrists more than 100 years ago. For example, Esquirol reported in 1838 and described a kind of difficult to restrain. The theft of impulses and behaviors was first named "kleptomania"; in 1883, Marc introduced the concept of "pyromania".

Because the behaviors of impulse control patients often violate laws, regulations, or at least intolerance of most social behavior norms, they are rare in medical clinical work, and more often appear in cases of judicial mental illness identification.

Clinical characteristics of impulse control disorders

Despite impediment control obstacles, there are still many issues to be further revealed and agreed. However, as a psychiatric problem, impulse control disorders have basically the same opinions on the phenomenological characteristics of clinical manifestations.

To sum up, there are the following five:

1. The patient knew that his behavior was bad, and he tried to control it, but he always attributed it to failure, that is, it was difficult to control.

2. The act does not have any obvious external purpose, such as theft and arson. For example, the patient is not for financial income, not to cover up crimes, not to improve personal living conditions, not for political and social purposes, or to vent private anger and revenge. In short, there is no external purpose.

3 Before you act, you become more nervous or upset.

4 During the behavior process, the patient can experience the thrill of being relieved or the behavior itself can give the patient great psychological satisfaction.

5. Repeatedly, the patient had no significant mental disorder during the intermittent period of the episode.

Classification of impulse control obstacles

In China's disease diagnosis classification CCMD-3, it includes pathological gambling, pathological arson, pathological theft, epilation (pathological epilation), and other or unspecified habits and impulse control disorders.

(Kleptomania) Impulsive Control Obstacles (Kleptomania)

Repeated urges to steal items that he does not need or have value will feel considerable pressure before the action, but when acting, he will feel happy, content and relaxed. The purpose of the theft is not to express anger, revenge, but also Not because of delusions and hallucinations, but not because of conduct disorders, mania, or antisocial personality.

Incidence: The incidence of the disease is unclear. Recent reports have estimated that in the general population, there are six people per thousand, and less than 5% (4-24%) of thieves are thieves, but because of this, Most people who are sick are shy of speaking, and most thieves have not been caught, so the prevalence rate may be higher. The proportion of women is higher than that of men. It is generally believed that women are more likely to have access to psychiatric assessments, whether voluntary or forced, and that men are mostly sent directly to prison. For the first diagnosis, most men are in their 50s and women are in their 35s, often with the onset of the disease, separated by more than ten years.

Etiology: At present, there is no determined etiology. There are reports in the physiology that compulsive theft may be caused by some organic causes, such as tumors, epilepsy, dementia, or drug effects. Psychologically, most of the Studies have pointed out that most of these patients have unpleasant or abnormal childhoods, and this compulsive theft is to regain the sense of childhood loss, so such behaviors symbolically satisfy the subconscious urge, hope, or conflict, and these Impulse or hope may be about sexual or abused events, while stealing is to avoid self-fascination. In phenomenological theory, it is considered to be a variant of other known diseases. If anyone thinks that it is an unusual manifestation of an emotional disease, because antidepressants can be treated; others think it is similar to obsessive-compulsive disorder. Because they will react to this irresistible urge, ego-dsytonic (self-disagreement), and also feel relaxed when acting. It has also been found that they often have eating disorders, especially binge eating disorder. At present, some people propose the so-called affective spectrum disorder, which includes theft, obsessive-compulsive disorder, eating disorders, affective psychosis, and attention deficit syndrome. They often have common physiological and pathological reasons, possibly due to serotonin deficiency Effective for serotonin antidepressants.

Clinical manifestations: The reason for patients to see a doctor is mostly because the court found or treated other diseases and found that they would have a history of impulsive and forced theft. The reason for the theft is not for personal gain, but for the relief of their own pressure. People will feel happy when stealing. They do nt plan in advance, and they do nt think of breaking the law. It s just an impulsive behavior. But they know that such behavior is wrong. They also have guilt and shame, and rarely treat others. In order to suppress impulsive behavior, we will avoid some places that may let him steal, so later even do not shop at all, resulting in social isolation. Patients with burglars are more likely to have emotional psychiatric disorders, anxiety disorders, and eating disorders, and often have sexual dysfunction.

Course and Prognosis: Theft is a chronic disease that usually begins in late adolescence and may last for many years. The chances of automatic recovery and long-term prognosis are unclear.

Treatment: Due to the hypothesis of the same family of affective diseases in drug treatment, antidepressants are mostly used for treatment, especially for serotonin drugs, and some point out that partial or complete relief can be obtained. Psychotherapy may be effective.

(pathological gambling) Pathological gambling

It is an impulsive, continuous and repetitive gambling behavior that cannot be refused, regardless of whether it will cause serious family, personal, and professional corruption. The common performance is always thinking about gambling (always living in the past gambling experience, always counting Draw the next adventure, always want to find money to gamble); want to make money with gambling to achieve the excitement of personal expectations; repeatedly want to control gambling, quit gambling, but can not succeed; try to quit gambling or stop When gambling, there will be situations of restlessness and restlessness; using gambling to avoid stress or reduce depression (such as helplessness, sin, anxiety, and depression); usually you will find a way to get back money after losing money; often Conceal the extent of gambling involvement from family members; may be doing illegal things such as forgery, deception, theft, embezzlement or embezzlement of public funds; loss of important relationships, education, and job opportunities due to gambling; relying on others to provide money to reduce Its desperate economic pressure.

Incidence: About 3% of the general population may have pathological gambling, and the incidence is higher in men than in women. They often have parents who abuse drugs and alcohol, about 25% of cases, at least one parent, and may be pathological. Gambling patient. They are often associated with substance abuse, depression, bipolar disorder, anxiety, attention deficit syndrome, thunder's disease, and abnormal personality.

Cause: According to Freud's psychoanalytic theory, they have a subconscious desire to "lose to lose." Gambling can reduce their subconscious guilt. In behavior theory, this uncontrollable gambling behavior is considered a learned bad behavior; in cognitive theory, it is considered that these gamblers have a wrong perception, or the illusion that they can control the situation, Some people think that they have a gambling personality and are prone to risk-taking behaviors. Many studies have pointed out that this risk-taking behavior may come from physiological causes. They found that these male pathological gamblers had lower levels of MHPG in the blood and cerebrospinal fluid. MHPG is higher and more adrenaline is excreted in the urine, and the lack of this adrenaline can explain the stimulating behavior of these pathological gamblers.

Clinical manifestations: The nature of morbid gambling includes a gradual course of disease. Even if the loss is heavy, he cannot control his behavior, and does not care about the consequences of his behavior. Like drug abusers, they are often driven by a desire for pleasure, may have tolerance and withdrawal symptoms, they may increase the bet to achieve the excitement they want, if forced to reduce the frequency of gambling With the degree, they will have irritability, anxiety, low restlessness, and inattention.

Course and prognosis: The course of the disease may initially be a problem of gambling. Later, due to special psychological and social pressures and major losses, it will promote the formation of pathological gambling. The onset of men's disease is mostly in adolescents, while that of women is later. They are not well treated because they lack a sense of illness and often combine drug and alcohol dependence. The conditions for successful treatment are complete separation from gambling, improved psychological and social functions, and reduced emotional and anxiety symptoms.

Treatment: For some people, participating in a self-help group called the Anonymous Gambling Association works well, but other treatments are also important for other patients. Psychodynamic psychotherapy is an attempt to use arrogance, self-deception, and poor self-defense methods in face-to-face cases. Family therapy also has its value. Combining emotional disorders with drug abuse also requires additional treatment. In addition, behavioral therapies, such as imaginative desensitization, to relax exercises combined with visual viewing to avoid gambling videos, have also been reported successfully.

(Trichotillomania) Impulsive Control Disorder Trichotillomania

It is a chronic disease characterized by its inability to resist the urge to remove hair. It was proposed by a French dermatologist in 1889. Although most doctors agree that the disease is caused by psychological factors, most patients have never seen a psychiatrist. They will have repeated plucking behaviors, resulting in obvious lack of hair; when they feel great pressure before plucking hair, they will also have a lot of pressure to fight against this behavior; they will be happy and satisfied when plucking hair And relax.

Incidence: In the past, it was thought to be rare, but currently it is thought to have a prevalence of about 4%. There are more women and men, about 4 to 1, which often occur before the age of 17, but most of them do not receive treatment after the age of 17, But by then, this plucking behavior has become a habit, no longer caused by environmental pressure, and you will not know the purpose of this behavior clearly. At present, some people suggest to divide early and late hairstyles. Early hairstyles often occur before the age of 6, and the chances of men and women are half. The course of the disease is relatively short. Usually, simple recommendations, support and behavioral treatments are effective. Late hairstyles often occur after the age of 13, and there are more women than men. They are usually chronic and have a poor prognosis.

Etiology: The theory of psychodynamic analysis is that it is a child's response to early loss and separation. In this way, the mother of a child is often considered to be overly critical and rejected, while the father is passive and emotionally weak. It is common in children and adolescents, but if it continues, it may become a habit like biting nails and sucking fingers. The physiological explanation is that after observing their subsequent development, they find that they will have a higher chance to be combined with anxiety or affective disease. Usually they are antidepressants, especially serotonin antidepressants, and they are effective with lithium salts. It is currently believed to have multiple causes, and early or current environmental stresses may worsen its symptoms.

Clinical manifestations: Usually, parents and children will deny that this phenomenon is due to human factors at the time of consultation; all patients will admit that the disease will affect his creativity and interpersonal relationships. They often use hats, wigs, false eyelashes or make-up to cover areas without hair, and the affected area often has mixed hairs. Sections can be used to distinguish between natural baldness and skin disease.

If this continues, a referral to a psychiatrist is required for a more careful treatment assessment. These children often have ritualistic behaviors that bite or ingest their hair. They don't feel pain because they pull out their hair, they usually pull out their hair because of a strong desire, they feel relaxed when they pull out, but then they feel disappointed and guilty.

Course and prognosis: Early-onset and slight epilation behaviors are mostly reduced after clarifying things with patients and family members; late-onset and severe epilation behaviors are often chronic and last for decades. , Often combined with anxiety and emotional symptoms, may also be secondary to other diseases.

Treatment: The treatment must first let the child understand its behavior and let the child know that he is not the only patient; for the younger children, with a kind and supportive attitude, the child's behavior is informed of the harm of the behavior, and most of the time Will have effect. The treatment of chronic and severe epilation requires deep psychoanalytic psychotherapy, behavioral therapy, hypnosis therapy, and drug therapy; for children, family therapy is given to improve the family's interaction mode to reduce interpersonal stress in children . Psychoanalytic psychotherapy is to find the loss and separation experienced by early children, because it may be a driving factor for children's behavior. Behavioral therapy has a good effect on mild to moderate epilation. It allows children to understand their behavioral patterns and divert their attention. It is often used to positively feedback their non-pilling behavior and negatively inhibit their plucking. Gross behavior, punishment and relaxation exercises. Hypnosis therapy is effective for some patients with limited epilation, who have a high degree of motivation and decision-making power.

Recently, attention has been paid to the effect of drug treatment. Because it is often considered as a variant of obsessive-compulsive disorder, serotonin drugs (fluoxetine, Clomipramine,) have a good effect, but the chance of recurrence is still high. It is also best to combine psychotherapy.

(Pyromania) Impulsive Control Obstacle Pyromania

Arsonists are a kind of repeated and deliberate or purposeful arson, which has been proposed as a disease. It has also been around for a hundred years. They have the same pressure and emotional excitement as before arson. There is an indulgence in the results after fire and arson. Sense, interest, curiosity and attraction; when arson, there will be a sense of joy, contentment, and relaxation, and the same feeling for witnessing the fire scene and participating in fire fighting; they are not for money or to express their social and political Consciousness, concealment of his criminal behavior, expression of his anger and revenge, improvement of his personal life, or the result of delusions and hallucinations, nor is it caused by a lack of judgment.

Incidence: At present, it is unclear about the incidence and the proportion of men and women; but for some men who have studied this behavior, they found that their behavior can be traced back to childhood and adolescence. Most of the arson behaviors are mostly related to Money and crime are related to revenge, and there are not many opportunities to truly diagnose arsonists. In addition, these arsonists often have depression, personality disorders, alcohol and drug abuse.

Etiology: The cause of arsonism is not clear. Freud believes that the act of arson represents a kind of masturbation that is equivalent to homosexuality. Lewis et al. Believe that the motive of this repeated act of arson is revenge. People think of it as a way of communicating with people who lack social skills. Recent physiological studies have found that their 5HIAA and MHPG concentrations in the brain are low, and this represents the relationship between the serotonin and norepinephrine systems, respectively, and it also indicates that he may be a member of the family of affective diseases.

Clinical manifestations: Most arsons are not caused by arsonists, so their motivation and causes need to be carefully tracked during the assessment. Most of them have arson or some fire-related activities in childhood and adolescence. The more common defense mechanisms are It is denied that there will often be advance preparations, most of which will appear near its arson area.

Course and prognosis: It is often chronic and sudden, and it is often evaluated after being arrested. The prognosis is currently unknown.

Treatment: At present, there is no clear and effective treatment. Psychoanalytic psychotherapy often has limited effects because of denial, lack of sense of disease, and often combined with drug abuse. Behavioral therapy, such as positive feedback and punishment, has no clear effect. There is no information on the treatment of drugs.

Impulse control disorder intermittent rages

(Intermittent explosive disorder)

Its main characteristics are its sudden attack impulse, which is not commensurate with its corresponding psychological pressure, and during the period when there is no attack, it will not see obvious impulses and aggressiveness. During the attack, they cannot resist the urge to attack, thus causing severe injury and property damage; and he is not because of other mental illnesses (such as mania, schizophrenia, antisocial personality, marginal personality, attention Dyspnea syndrome, etc.), physical problems (such as head trauma or Alzheimer's disease) or drugs (amphetamine or alcoholism).

Incidence rate: The chance of occurrence is low, mostly in men. These people often have a higher chance of arson, and usually have family affiliation. People with such diseases will have a higher chance of being in the family. Depression Disease, alcohol and substance abuse.

Etiology: Before 1960, some people thought that this emotional disorder was due to abnormal function of the limbic system in the brain. In the theory of psychoanalysis, it is believed that this impulsive aggressive behavior is caused by events that hurt the narcissist in the past, and such violent events can control the distance between such people and therefore reduce The chance of being narcissistic and injured again; the typical patient's form is usually a big body, with a dependent personality, and it is easy to respond to this sense of helplessness and incompetence. Other studies have pointed out that these patients have lower platelet serotonin absorption than the general population. Therefore, if L-tryptophan, a precursor of serotonin, can be given, it can increase the concentration of sertonin between synapses, which will reduce the chance of such sudden anger. At present, whether the genetic factors or environmental factors are combined to cause this disease has not yet been determined.

Clinical manifestations: Long-term history of the disease needs to be considered, not a single episode; these people have developmental issues such as alcohol dependence, violence, emotional instability, unstable relationships, repeated job losses, and illegal behavior Wait. Of course, the diagnosis needs to rule out the possibility of other diseases, such as personality abnormalities, substance abuse or mental illness. In addition, neurological tests, neuropsychological tests or brain waves may be required to rule out the possibility of organic diseases. For some patients with epilepsy, they may There will be a change in personality, an impulsive personality, etc.

Course and prognosis: Often sudden and chronic, this kind of unpredictable aggressive behavior often causes deterioration of interpersonal relationships and social isolation.

Treatment: Contains drugs and psychosocial therapy, anti-epilepsy and type B adrenal blockers. It has been used in cases of sudden sexual violence. Some people suggest that anti-epileptic drugs are suitable for patients with sudden violent disorder. The type B adrenal blocker is suitable for patients with emotional instability due to organic factors; and anxiolytics can be used for patients who are prone to anger. In addition, supportive psychotherapy is also very useful for these patients, because this kind of relationship will allow them to seek immediate assistance before the emergence of dangerous emotional anger.