I. Overview. Impulse Disorders (termed "Impulse- Control Disorders Not Elsewhere Classified" in the DSM-IV) involve the inability to resist an impulse or psychological drive to act in a way harmful to oneself or others. The urge causes anxiety, tension or arousal; its completion gives relief or gratification; regret or guilt may follow.
Differential diagnosis of impulse control problems includes (among others) antisocial personality disorder, conduct disorder, and mood disorders, as well as neurological conditions such as temporal lobe epilepsy. Whether the Impulse Disorders come from the same underlying etiology, or are simply a "residual group," remains unsettled. The six listed in DSM-IV (1994) are:
a. Intermittent Explosive Disorder—an inability to resist aggressive impulses that result in serious physical assaults or destruction of property
b. Kleptomania—an inability to resist recurrent impulses to steal objects not needed for personal use or monetary gain
c. Pyromania—a pattern of firesetting for pleasure, gratification, or the relief of tension
d. Pathological Gambling—recurrent, persistent and maladaptive gambling behavior
e. Trichotillomania—noticeable hair loss due to recurrent hair pulling that gives pleasure, gratification or the relief of tension
f. Impulse-Control Disorder Not Otherwise Specified—impulse control disorders not included above or elsewhere in the DSM-IV
Pathological gambling:
Pathological gambling is characterized by an impulse or urge to gamble in a persistent and maladaptive manner disrupting vital relationship and activities of daily living. It causes economic problems and disturbances in personal, social or occupational functioning.
Included maladaptive behavior: preoccupation with gambling
gamble with increasing amount of money to achieve the desired excitement
repeated unsuccessful effort to shun gambling
gambling as a way to escape problems
gambling to recoup losses
lying to conceal the extent of involvement with gambling
commission for illegal acts to finance gambling
losing personal or vocational relationships because of gambling
reliance of others for money to pay off debts
Epidemiology
Almost 3 percent from the general population may be classified as pathological
gamblers according to the DSM-IV-TR 2.8 to 8 percent in adolescents and college students belong to this disorder. Men have greater possibility to acquire this disorder and the percent is higher in location where gambling is legal. Alcohol dependence is also common among pathological gamblers.
Comorbidity
Ø rates of impulse-control disorder
Ø substance use disorders
Ø mood disorders
Ø attention-deficit
Ø hyperactive disorders
Ø antisocial
Ø borderline
Ø narcissistic personality disorder
Ø panic disorders
Ø agoraphobia
Ø obsessive-compulsive
Ø Tourette’s disorder
Etiology
(Psychosocial factors)
Ø Loss of a parent by death
Ø Separation
Ø Divorce
Ø Desertion before a child is 15 yrs old
Ø Inappropriate parental discipline
Ø Availability of gambling activities for adolescents
Ø Family emphasis on material and financial symbols
Ø Lack of family emphasize on savings, planning and budgeting
According to Sigmund Freud, the person having this disorder of compulsive gambling has deep unconscious desire to lose and gamble as a relief for unconscious feeling of guilt. Gamblers are considered narcissists whose flamboyant and unstoppable fantasies lead them to believe they can manipulate events and predict outcome. According to the learning theorist, gamblers have erroneous perception about control of impulse.
(Biological Factors)
Another explanation for gamblers compulsive and risk taking behavior is rooted in their biological aspect. Both the nergic and noradrenergic receptor system is focused in this theory. Male pathological gamblers may have subnormal MHPG concentrations in plasma, increases MHPG concentrations in the CSF, and increase urinary output of norepinephrine. Also, evidence has explained that serotonergic regulatory dysfunction in the pathological gambler. Chronic gamblers have low platelets monoamine oxidase (MAO) activity, a marker of serotonin activity, also linked to difficulties with inhibition.
Diagnosis and Clinical Features
Ø Overconfident
Ø Somewhat abrasive
Ø Energetic
Ø Free spending
Ø Lie to obtain money and continue gambling
Ø Do not budget or save money
With obvious signs of...
Ø Stress
Ø Anxiety
Ø Depression
Attitude of…
Ø Money as the cause and solution for their problems
Criminal behavior…
Ø Forgery
Ø Embezzlement
Ø Fraud
Complications…
Ø Alienation from family members
Ø Loss of life accomplishments
Ø Suicide attempts
Ø Association with fringe and illegal groups
Psychological testing and Laboratory Examination
Abnormalities in platelets MAO activity can be diagnosed among males with the disorder. Patients often have high level of impulsivity on neuropsychological tests. German studies have demonstrated that an increased cortisol levels in the saliva of gamblers while they gamble, which can account for the euphoria that occurs during the experience and its addictive potential.
Differential Diagnosis
Pathological gambling that occurs with friends or on special occasions is called social gambling. The gambling that is symptomatic of a manic episode is distinguished from pathological gambling history of a marked mood change and the loss of judgment preceding the gambling. Commonly there is a maniclike mood changes in pathological gambling, but they also follow winning and are usually succeeded by depressive episodes because of subsequent losses. Persons with antisocial personality disorder may have problems with gambling. When both disorders are present both should be diagnosed.
Course and Prognosis
Four phases in pathological gambling
The winning phase- ending with a big win, equal to about a year’s salary, which hooks patients. Women usually do not have a big win but use gambling as an escape from problems.
The progressive-loss phase- patients structured their lives around gambling and then move from excellent gamblers into stupid ones who take considerable risks, cash security, borrow money, miss work, and lose job.
The desperate phase- patients frenziedly gambling with large amounts of money, not paying debts, loan sharks involvement, writing bad checks, and possibly embezzling
The hopeless stage of accepting the losses can never be made up, but the
More abstracts about the Impulse-Control Disorder not elsewhere classified