1.7 - Impulse Control Disorders: Diagnostic Criteria
Understanding impulse control disorders
Impulse control disorders (ICDs) are a group of mental health conditions where individuals struggle to resist strong urges to perform certain behaviours, even when these actions cause harm to themselves or others.
According to the International Classification of Diseases (ICD-11), ICDs share several common characteristics:
- Build-up of tension - Individuals experience increasing internal pressure or anxiety leading up to the behaviour.
- Recurrent, irresistible urges - There are repeated, strong impulses to carry out specific actions that feel impossible to ignore.
- Short-lived euphoria or relief - Performing the behaviour brings immediate pleasure or a sense of release, but this feeling is temporary.
- Distress and dysfunction - Afterwards, people often feel shame, guilt, or regret, which can lead to problems in relationships, work, or other areas of life.
Characteristics of specific impulse control disorders
Several types of ICDs exist, each defined by a particular urge or compulsion.
Main types of impulse control disorders
| Type | Urge/compulsion | Prevalence | Age/gender differences |
|---|---|---|---|
| Kleptomania | Stealing items that are not needed or wanted | Around 0.6% of the general population | Can start at any age; more common in women |
| Pyromania | Fascination with fire, including starting fires and interest in fire-related equipment or services | Between 3% and 6% among psychiatric inpatients (based on research by Burton et al., 2012) | Often begins at a relatively young age; symptoms tend to worsen over time |
| Gambling disorder | Loss of control over gambling activities, often prioritising it over other responsibilities | Around 4% in the US population (according to Black and Shaw, 2019) | Average onset in mid-30s, but can range from 8 to 80 years; tends to start earlier in men than in women (Black et al., 2015) |
Measuring impulse control disorders
To diagnose and assess the severity of ICDs, psychologists use specialised tools that measure symptoms reliably.
The Kleptomania Symptom Assessment Scale
The Kleptomania Symptom Assessment Scale (K-SAS) is an 11-item self-report questionnaire designed to measure the severity of kleptomania symptoms. It consists of 11 items, each scored on a scale from 0 to 4, based on thoughts, feelings, and actions over the past week.
How the K-SAS works:
- Scoring system - Total scores range from 0 to 44. A score above 31 indicates severe symptoms, while above 21 suggests moderate symptoms.
- Sample item - "If you had urges to steal during the past week, on average, how strong were your urges? None (0), Mild (1), Moderate (2), Severe (3), Extreme (4)."
- Purpose - This scale helps clinicians understand the intensity of urges and related distress, aiding in diagnosis and monitoring progress.
Strengths and weaknesses of the Kleptomania Symptom Assessment Scale
Like any psychological tool, the K-SAS has advantages and limitations that affect its usefulness in research and clinical settings.
Evaluation of the K-SAS
| Strengths | Weaknesses |
|---|---|
| Practicality - It takes only about 10 minutes to complete, and no special training is needed to administer or score it. | Self-report limitations - Responses may lack validity if individuals do not answer honestly, perhaps due to shame or denial. |
| Quantitative data - The scale produces numerical scores that are objective and easy to compare, reducing bias in diagnosis. | Reliability issues - People might interpret rating labels differently; for example, one person's idea of 'moderate' could be another's 'extreme', affecting consistency. |
Idiographic and nomothetic approaches in ICD research
In psychology, approaches to studying disorders like ICDs can be broadly categorised into idiographic and nomothetic methods. The idiographic approach focuses on unique, individual experiences, while the nomothetic approach seeks general laws and patterns across groups.
Nomothetic approach
The nomothetic approach involves studying large groups to identify general principles that apply to many people.
Application to ICDs:
- Tools like the K-SAS support a nomothetic method by generating comparable data from many individuals.
- For instance, scores can be collected before and after therapy to generalise about treatment effectiveness across a population.
Idiographic approach
The idiographic approach emphasises in-depth study of individuals, considering personal contexts and unique factors.
Application to ICDs:
- Case studies, such as Glover's (1985) examination of a single person's experience with kleptomania, allow for a deeper understanding of how ICDs affect daily life, relationships, and personal circumstances.