Diagnosis

The qualification, “not classified elsewhere” in the title Impulse Control Disorders (not classified elsewhere) simply implies that the more familiar of these disorders such as alcoholism and substance use disorders are classified elsewhere and thus not included in this group. These disorders involve impulses of a wide variety, but they include some common features. The afflicted person has an irresistible urge to carry out some action; he experiences a strong tension that builds up as he approaches the moment or time period in which he is to carry out the action; and he feels an intense sense of relief after he has completed the action. Afterwards, he may or may not suffer regret over doing it. The important characteristic for this diagnosis is the presence of the tension-relief cycle.

The five most common impulse control disorders (ICD) that belong in this group are gambling, stealing (kleptomania), setting fires (pyromania), wreaking havoc and smashing things (intermittent explosive disorder), and pulling out one’s own hair (trichotillomania). All others are grouped together as Impulse Control Disorders Not Otherwise Specified or (NOS).

Treatment

Treatment for these disorders, like that for alcoholism and other substance-use disorders, is usually long and likely to include multiple relapses. Many compulsive behaviors are resistant-to-change impulses that cause problems, but are not classified as substance use disorders, even though there is consideration, debate, and disagreement over whether they should be. Examples are compulsive shopping, buying, Internet shopping and buying, social networking, exercise, lying (prevarication), sex, and inappropriate pornography use.

Most clinicians agree that the most effective treatment for these disorders is a combination of pharmacological and cognitive behavioral therapies.