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Impulse Control Disorders in Children

Definition: A set of disorders where each include problems with emotional and behavioral self-control including oppositional defiant disorder (ODD), conduct disorder, intermittent explosive disorder, trichotillomania, pyromania, and kleptomania. All disorders feature behavior that is acted out in an uncontrolled and impulsive manner that often has self-destructive consequences.

Symptoms: Symptoms must occur more than once per week to distinguish the diagnosis from symptoms common to normally developing children and adolescents. A child must be at least 6 years old in order to be diagnosed with one or more of these disorders.

ODD: A pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, during which four (or more) of the following are present:

ODD behavior causes clinically significant impairment in social, academic, or occupational functioning.

Conduct Disorder: Characterized by behavior that violates either the rights of others or major societal norms. Symptoms must be present for at least 3 months with one symptom being seen during the previous 6 months. Individuals will also have limited prosocial emotions such as empathy and guilt. This is usually diagnosed prior to adulthood.

Intermittent explosive disorder: Symptoms include-physical aggression, verbal aggression, non-injurious/nondestructive physical aggression.  The aggressive outbursts are impulsive and/or angry and must cause marked distress, cause impairment in occupational or interpersonal functioning, or be associated with negative financial or legal consequences.

Trichotillomania: Characterized by uncontrollable hair twisting and hair pulling often causing bald spots. The disturbance is not better accounted for by another mental disorder and is not due to a general medical condition (e.g., a dermatological condition). The disorder causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Kleptomania: Irresistible urges to steal various items from stores and homes that are not needed for personal use or their monetary value. Before stealing, there is an increasing sense of tension; afterwards, a feeling of pleasure, gratification or relief.

Pyromania: Irresistible urges to set fires on more than one occasion. The fire setting is not done for monetary gain, as an expression of sociopolitical ideology, to conceal criminal activity, to express anger or vengeance, to improve one's living circumstances, in response to a delusion or hallucination, or as a result of impaired judgment.

Causes:

Scientists don’t know what causes these disorders. But many things probably play a role, including physical or biological, psychological or emotional and cultural or societal factors. Hormones associated with violence and aggression, such as testosterone, also could play a role in the disorders. For example, researchers have suggested that women might be predisposed to less aggressive types of impulse control disorders such as kleptomania or trichotillomania, and men might be predisposed to more violent and aggressive types such as pyromania and intermittent explosive disorder. Studies have revealed that family members of people with impulse control disorders have a higher rate of addiction and mood disorders.

Treatment: Some people benefit from a type of therapy known as habit reversal. The idea here is to help the person identify the action when it is occurring, and then learn to replace that action with something else that is less harmful. If you pull your hair, you might be asked to clench your fists instead. Breathing exercises might help relax your body, soothe tense muscles and control your urges. Keeping a journal in which you write down when you felt the urge to act might help you discover that specific people or places make you feel tense and more likely to perform your compulsion. When you spot that pattern, you can figure out how to avoid it. Anti-depressants or anti-addiction medications may also help some people.