Impulse control disorders (ICDs) are a class of psychiatric disorders characterized by difficulties controlling aggressive or antisocial impulses. Because they can involve physical violence, theft, or destruction of property, the disorders often have harmful effects on both the person with the disorder and on others around them.
Impulse control disorders include intermittent explosive disorder (characterized by a failure to resist aggressive or violent impulses); kleptomania (the impulse to steal things not needed for use); and pyromania (an uncontrollable impulse to set fires). In the DSM-5 , antisocial personality disorder and oppositional defiant disorder are included in the same category, which is broadly categorized as “disruptive, impulse-control, and conduct disorders.” Pathological gambling was once classified as an impulse control disorder but is now considered an addiction -related disorder in the DSM.
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Key Takeaways
- Impulse Control Disorders affects mental, emotional, and physical wellbeing
- Understanding impulse control disorders is the first step toward managing it
- Evidence-based approaches can significantly improve outcomes
- Building daily habits is more effective than one-time interventions
Understanding Impulse Control Disorders
Impulse control disorders are thought to develop through a combination of biological and environmental factors. They often co-occur with other psychiatric disorders—most notably depression , anxiety , and substance abuse —but it’s not always clear whether comorbid conditions develop independently or whether mental health challenges result from difficulty managing impulses and the consequences thereof. Regardless, many (but not all) people with impulse control disorders report significant distress or interpersonal conflict as a result of their behavior, which often feels out of their control.
The disorders themselves are rare, each affecting approximately 1 to 3 percent of the population. Combined, however, ICDs affect a significant number of children and adults.
The behaviors and emotions associated with impulse control disorders often follow a similar trajectory. Before the impulse is acted on, many with ICDs report mounting internal tension, which can become seemingly unbearable. The tension is temporarily relieved when the impulse is carried out, but afterward, there may be a rush of guilt .
Like many psychological disorders, it is not necessarily possible to permanently cure impulse control disorders. But though ICDs often feel uncontrollable, treatment is possible. While results vary depending on the disorder’s severity and on patient cooperation , the prognosis is considered to be generally positive. In most cases, children generally see greater improvement than adults, who are more likely to dismiss treatment or be uncooperative.
Cognitive behavioral therapy, or CBT, has been found to be effective for many impulse control disorders. In addition, relaxation techniques and aversion therapy have both been found to be beneficial. In cases of interpersonal conflict resulting from impulsive behavior, family therapy or couples therapy may provide additional support. Because the disorders are often comorbid with other conditions that must be factored into treatment, such as substance abuse or depression, approaches vary. Effective treatment may draw on both psychopharmacological methods, such as antidepressants , and psychotherapy .
Impulse control disorders are often treated with a combination of medication and therapy. Kleptomania, for example, is often treated with SSRIs, while intermittent explosive disorder may respond to antidepressants, anxiolytics, or anticonvulsants.
Intermittent Explosive Disorder
Intermittent explosive disorder usually begins in late childhood or adolescence , and can have a serious negative impact on sufferers' lives. Aggressive "episodes" can result in property damage or physical assault, possibly leading to trouble with the law or other long-term consequences—and in many cases, angry explosions damage relationships with others, sometimes beyond repair. For this reason, many with intermittent explosive disorder feel genuine regret after their outbursts, even if they feel relief in the moment. Luckily, treatment, while challenging, can be highly effective, particularly if it's started as early as possible.
To learn more about causes, symptoms, and treatment of intermittent explosive disorder, see our Diagnosis Dictionary.
Since intermittent explosive disorder appears to run in families, it’s likely that there is a genetic component. However, since many with intermittent explosive disorder grew up in homes where explosive behavior or violence was common, it’s highly possible that their explosive behavior is learned to some degree.
Intermittent explosive disorder is associated with differences in brain structure and function. Some research, for example, suggests that IED is linked to disruptions in serotonin pathways in the brain and limbic system. Additional research has found that the disorder is associated with lower white matter integrity and lower grey matter volume in the connections between the frontal lobe and other brain regions, which may contribute to impaired social cognition and greater difficulty regulating emotions.
Some evidence suggests that anger outbursts can increase the risk of health problems. One study, for example, found that people who had frequent “rage attacks” were more susceptible to heart attacks and stroke—especially in the hours immediately following an outburst—likely due to spikes in blood pressure and vascular resistance caused by stress . Though one instance of anger will not confer a large amount of risk, the researchers warn, frequent bouts of anger can lead to accumulated risk over time.
The primary symptom of intermittent explosive disorder is a frequent failure to control aggressive impulses. This may manifest as verbal aggression (temper tantrums, loud tirades, etc.) or physical aggression (toward other people, property, animals, etc.). Such outbursts are impulsive (not premeditated), are typically brief, and are often disproportionate to the offense that triggered them.
Frequently Asked Questions
What exactly is impulse control disorders?
Impulse control disorders (ICDs) are a class of psychiatric disorders characterized by difficulties controlling aggressive or antisocial impulses. Because they can involve physical violence, theft, or destruction of property, the disorders often have harmful effects on both the person with the disorder and on others around them.
Is impulse control disorders a serious condition?
Impulse Control Disorders exists on a spectrum. While mild forms are a normal part of life, persistent or severe impulse control disorders can significantly impact daily functioning and quality of life. It's important to seek professional support if impulse control disorders is interfering with work, relationships, or wellbeing.
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