The DSM-III-R impulse control disorders not elsewhere classified: Clinical characteristics and relationship to other psychiatric disorders

Biological Psychiatry Program, University of Cincinnati College of Medicine, OH 45267-0559.
American Journal of Psychiatry (Impact Factor: 12.3). 04/1992; 149(3):318-27. DOI: 10.1176/ajp.149.3.318
Source: PubMed


The authors reviewed available studies of DSM-III-R impulse control disorders not elsewhere classified in order to determine the relationship of these disorders to one another and to other psychiatric disorders.
The review focused on the demographic and clinical characteristics, phenomenology, family history, biology, and response to treatment of individuals with intermittent explosive disorder, kleptomania, pathological gambling, pyromania, and trichotillomania. Analysis was restricted to reports which either indicated use of operational diagnostic criteria or provided descriptions of the impulsive behavior detailed enough that patients could be judged as probably meeting the DSM-III-R criteria.
Although different impulse control disorders have different sex ratios, all have similar ages at onset and courses. Studies on phenomenology, family history, and response to treatment suggest that intermittent explosive disorder, kleptomania, pathological gambling, pyromania, and trichotillomania may be related to mood disorders, alcohol and psychoactive substance abuse, and anxiety disorders (especially obsessive-compulsive disorder). Biological studies indicate that intermittent explosive disorder and pyromania may share serotonergic abnormalities similar to those reported in mood disorders.
The impulse control disorders not elsewhere classified appear to be related to one another and to mood, anxiety, and psychoactive substance use disorders. Thus, like major depression, obsessive-compulsive disorder, panic disorder, bulimia nervosa, and attention deficit hyperactivity disorder, they may represent forms of "affective spectrum disorder."

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    • "Impulse control disorders (ICDs) are characterized by impulsivity, failure to resist on impulse; the drive or temptation to harm oneself and/or others; an increasing sense of tension or excitement before acting out; and a sense of pleasure, gratification, or release at the time the act is committed or shortly thereafter [5]. DSM-IV-TR includes the category, bimpulse control disorders not elsewhere classified", which consists of kleptomania, pathological gambling, pyromania, trichotillomania , intermittent explosive disorder, and bimpulse control Available online at "
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    ABSTRACT: There is no epidemiological study on the prevalence of impulse control disorders (ICDs) in the elderly population. The studies on ICDs in elderly patients are limited and some of them are case reports about pathological gambling and kleptomania. The comorbidity of other psychiatric disorders makes diagnosis difficult and has negative effects on both treatment and the prognosis of ICDs. The aim of this study was to determine the prevalence of ICDs among elderly patients and to evaluate the related sociodemographic and clinical features. A total of 76 patients aged 60 and over who have been referred to our outpatient clinics in a one-year period were included in the study. A demographic data form was completed. The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) was used to determine axis I psychiatric disorders. The prevalence of ICDs was investigated by using the modified version of the Minnesota Impulse Disorders Interview (MIDI). Impulsivity was measured with the Barratt Impulsiveness Scale Version 11 (BIS-11). The Mini-Mental State Examination (MMSE) test was performed to evaluate the cognitive status of patients and to exclude the diagnosis of dementia. In addition, all patients completed Symptom Check List-90 (SCL-90). The prevalence rate of at least one comorbid ICD in our sample was 17%. When patients with a diagnosis of ICDs not otherwise specified (ICD-NOS) were included, the prevalence rate increased to 22.4%. The most common ICD was intermittent explosive disorder (15.8%), followed by pathological gambling (9.2%). The majority of the sample was men (54%), married (80%), had a high school education (51%), and mid-level socioeconomic status (79%). The only statistically significant difference between the sociodemographic characteristics of patients with or without ICDs was gender. The lifetime prevalence of ICDs was 34.1% in men and 8.6% in women. The prevalence of childhood conduct disorder was significantly higher in the group with ICD. There was no statistically significant difference in the number of suicide attempts, history of physical illness and family history of psychiatric disorders between the groups with or without ICDs. Comorbidity of alcohol/substance abuse was found to be 17.6% in patients with ICD whereas no cases were found in the group without ICD. The result of this study has shown that approximately one fifth of patients over 60years had at least one lifetime ICD comorbidity. The prevalence rates of ICDs seem to decrease with aging. The male gender and childhood conduct disorder are related with higher prevalence rates of ICDs in elderly.
    Comprehensive Psychiatry 05/2014; 55(4):1022-1028. DOI:10.1016/j.comppsych.2013.12.003 · 2.25 Impact Factor
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    • "A number of important questions arise such as whether having Internet addiction hampers the psychological effect of substance abuse treatment programs, or whether increased Internet use may be considered a behavioral 'substitute' that may be promoted in cases where the subject cannot control an urge to relapse to a chemical substance. These issues are common with other addictive behaviors that do not include the use of chemical substances such as gambling (Winters & Anderson, 2000), kleptomania (Sarasalo, Bergman, & Toth, 1996) and other impulse-control disorders (McElroy, Hudson, Pope Jr et al., 1992). "
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    ABSTRACT: We present results from a cross-sectional study of the entire adolescent student population aged 14 to 18 years of the island of Kos, on the correlates between personality, illicit chemical substance use, and Internet abuse. Results demonstrate that adolescents who have used illicit substances and are abusing the Internet as well appear to share some common personality characteristics, namely those that are classified under the label of "psychoticism" in the Eysenck's personality model. An increase in the severity of pathological Internet use has been linked to increased chances of having used an illicit substance. Taking into account any common personality attributes, Internet addiction can still be useful as a predictor variable for substance use experiences. Future research should attempt to verify any biological common factors between chemical substances use and Internet abuse. Targeting the adolescent population that engages in increased Internet use may be of benefit for drug abuse prevention programs.
    Journal of Addiction Medicine 03/2012; 6(1):77-84. DOI:10.1097/ADM.0b013e318233d637 · 1.76 Impact Factor
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    • "disorders. Both disorders start in adolescence or early adulthood and subsequently follow episodic and/or chronic courses [7] [13]. Similar comorbidity patterns, abnormalities of central serotonin and noradrenaline neurotransmission [7], and positive response to mood stabilizers [14] [15] [16] [17] [18] [19] [20] [21] and antidepressant drugs [22] [23] [24] [25] [26] [27] [28] [29] [30] are the other common features. "
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    ABSTRACT: Impulsivity is associated with mood instability, behavioral problems, and action without planning in patients with bipolar disorder. Increased impulsivity levels are reported at all types of mood episodes. This association suggests a high comorbidity between impulse control disorders (ICDs) and bipolar disorder. The aim of this study is to compare the prevalence of ICDs and associated clinical and sociodemographic variables in euthymic bipolar I patients. A total of 124 consecutive bipolar I patients who were recruited from regular attendees from the outpatient clinic of our Bipolar Disorder Unit were included in the study. All patients were symptomatically in remission. Diagnosis of bipolar disorder was confirmed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Impulse control disorders were investigated using the modified version of the Minnesota Impulsive Disorders Interview. Impulsivity was measured with the Barratt Impulsiveness Scale Version 11. Furthermore, all patients completed the Zuckerman Sensation-Seeking Scale Form V. The prevalence rate of all comorbid ICDs in our sample was 27.4% (n = 34). The most common ICD subtype was pathologic skin picking, followed by compulsive buying, intermittent explosive disorder, and trichotillomania. There were no instances of pyromania or compulsive sexual behavior. There was no statistically significant difference between the sociodemographic characteristics of bipolar patients with and without ICDs with regard to age, sex, education level, or marital status. Comorbidity of alcohol/substance abuse and number of suicide attempts were higher in the ICD(+) group than the ICD(-) group. Length of time between mood episodes was higher in the ICD(-) group than the ICD(+) group. There was a statistically significant difference between the total number of mood episodes between the 2 groups, but the number of depressive episodes was higher in the ICD(+) patients as compared with the ICD(-) patients. There was no statistically significant difference between the age of first episode, seasonality, presence of psychotic features, and chronicity of illness. A statistically significant difference was observed between the ICD(+) and ICD(-) groups in terms of total impulsivity, attention, nonplanning, and motor impulsivity scores as determined by the Barratt Impulsiveness Scale Version 11. The present study revealed that there is a high comorbidity rate between bipolar disorder and ICDs based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, criteria. Alcohol/substance use disorders, a high number of previous suicide attempts, and depressive episodes should alert the physician to the presence of comorbid ICDs among bipolar patients that could affect the course and treatment of the disorder.
    Comprehensive psychiatry 07/2011; 52(4):378-85. DOI:10.1016/j.comppsych.2010.08.004 · 2.25 Impact Factor
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