167 Impulse-Control Disorder NOS (312.30)

*Associated Features

***Individuals who fall under Impulse-Control Disorder NOS do not meet any of the criteria for the above disorders or any of the other impulse control disorders in the DSM-IV-TR. (eg. substance abuse, paraphilias). Some common impulse-control disorders in this category include impulsive sexual behaviors, pathological skin picking, self-mutilation, and compulsive shopping. Those with sexual impulses often are promiscuous, show compulsive masturbation, show a compulsive use phone sex lines and/or pornography, and often show pornography dependence. Compulsive shopping problems appear more in women than men. It is often associated with the individual’s need to control his or her mood, which the person does by compulsively buying things and spending money. Pathological skin pickers may pick pimples and scabs on the face or anywhere else on the body (Spiegel & Finklea, 2009). Like trichotillomania, SSRIs are typically used as treatment for this disorder (Spiegel & Finklea, 2009).

Etiology

Impulsive behavior seems to have an underlying pre-disposition which may or may not be related to existing mental health or medical conditions, but research over the past decade has stressed the substantial co-morbidity of impulse control disorders with mood disorders, anxiety disorders, eating disorders, substance abuse, personality disorders, and with other specific impulse control disorders. In particular cases, it may be clinically difficult to disentangle from one another, with the result that the impulsivity at the core of the disorders is obscured.

Empirically supported Treatments

Although the specific category of impulse control disorders has become firmly entrenched in the DSM-IV-TR, strictly defined cases are nonetheless relatively uncommon with the result that there have not been many large scale studies of homogeneous populations. Clinicians widely appreciate, however, that these behavioral problems can cause significant stress for individuals and their families and justify further study and attempts at treatment. Findings in recent research have led some researchers to suggest that impulse control disorders form part of “the affective spectrum” linked by some common neurochemical abnormality involving low brain serotonin levels. This interest in a possible neurochemical basis for impulsive behaviors leads clinicians to hope that newer pharmacological therapies may be soon available. As well, advances in cognitive behavioral treatment suggest that a combination of pharmacotherapy and cognitive behavioral treatment may mutually enhance each other’s benefits.