Impulse control disorders: ludopathy, or gambling disorder

Impulse control disorders: what they are, how to treat them

By Cristiano Antonino On Jun 14, 2023

Impulse Control Disorders are a recently recognized diagnostic category. Disorders such as pathological gambling, pyromania, kleptomania, and intermittent explosive disorder have only been diagnosed with DSM III (American Psychiatric Association, 1980)

Only seven years later, in DSM III–R (American Psychiatric Association, 1987), trichotillomania was also recognized as a diagnostic value.

Impulse Control Disorders are generally characterized by the individual’s inability to resist an impulse or a compelling temptation

This drive induces the subject to carry out a dangerous action for themselves and/or for others and is preceded by a feeling of growing tension and excitement followed by pleasure, gratification, and relief (DSM-IV-TR, 2004 ).

Usually the action is followed by a feeling of remorse, self-blame, or guilt.

As listed above, the diagnostic group of impulse control disorders includes gambling (characterized by recurrent and persistent maladaptive gambling behavior);
pyromania (characterized by the habit of starting fires for pleasure, gratification, or relief of tension);
kleptomania (characterized by the recurring inability to resist the urge to steal objects that have no personal use or commercial value); intermittent explosive disorder (consisting of occasional episodes of inability to resist aggressive impulses and causing serious assaults or destruction of property);
trichotillomania (characterized by the recurrent plucking of hair for pleasure, gratification, or relief of tension and causing a marked loss of hair) and impulse control disorder not otherwise specified (NOS) included to code disorders of control of pulses that do not meet criteria for any of the specific disorders described above.

Although not listed in the Diagnostic Manual of Mental Disorders, there is currently a tendency to include Compulsive Shopping Disorder, Internet Addiction, and Sexual Addiction as Impulse Control Disorders.

This is due to some characteristics common to this class of disorders, such as the tension that precedes the implementation of the behavior, the search for immediate gratification, and the inability to bear the frustration deriving from avoiding such behavior.

Impulse control disorders can minimally benefit from pharmacological therapies based on SSRI antidepressants and/or mood stabilizers, which favor the control of impulsivity.

Nonetheless, the treatment of choice is cognitive behavioral psychotherapy, which usually manages to drastically reduce symptoms in a relatively short time.

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