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Impulse control disorders
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Impulse control disorders

Contributors: Shea A. Nagle MPH, Abhijeet Waghray MD, Richard L. Barbano MD, PhD
Other Resources UpToDate PubMed

Synopsis

Impulse control disorders are characterized by the inability to resist an action or behavior, even if it is harmful to oneself or others. The intense impulse is often preceded by increasing urges and/or internal tension, with a sense of pleasure or relief of tension after performing the resisted action. This may be followed by varying degrees of remorse or guilt. The impulse control disorders include disorders associated with specific, goal-directed activities such as kleptomania and pyromania but also include intermittent explosive disorder and pathological gambling.

Impulsivity may also be a manifestation of other psychiatric disorders, especially manic episodes, obsessive-compulsive disorder, borderline personality disorder, and antisocial personality disorder. There is a high comorbidity between impulse control disorders and these other disorders as well as affective disorders and substance abuse disorders.

Although impulse control disorders can occur at any time during childhood and adulthood, symptoms most commonly present during adolescence with a male predominance.

Impulse control disorders can be associated with other medical conditions. A case-control study on members of the US Armed Forces demonstrated an association of impulse control disorders with previous treatment with dopamine agonists, mental health disorders, and fibromyalgia. Likewise, a longitudinal study on patients with Parkinson disease showed a strong association between the prevalence of impulse control disorders and the use of dopamine agonists.

Codes

ICD10CM:
F63.0 – Pathological gambling
F63.1 – Pyromania
F63.2 – Kleptomania
F63.9 – Impulse disorder, unspecified
Z72.6 – Gambling and betting

SNOMEDCT:
66347000 – Impulse control disorder

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Psychotic disorders – Patients may display impulsivity or hallucinations that make them perform certain actions. See, eg, Drug-induced psychosis and Postpartum psychosis.
  • Bipolar disorders – Impulsivity may be a manifestation of mania.
  • Disruptive mood dysregulation disorder – Patients may be irritable or easily angered.
  • Attention deficit hyperactivity disorder – Patients may be impulsive.
  • Autism spectrum disorder – Some patients may have impulsive aggressive outbursts.
  • Conduct disorder, oppositional defiant disorder – Both characterized by aggression and rule-breaking.
  • Personality disorders, Borderline personality disorder, and Obsessive-compulsive personality disorder
  • Degenerative neurocognitive disorders – Patients with Dementia may exhibit some stealing behaviors or impaired inhibition.
  • Parkinson disease – May manifest with impulsive behaviors; associated with dopaminergic medications.
  • Intellectual developmental disorder
  • Malingering
  • Substance use disorders
  • Substance use or intoxication
  • Medication side effect – Particularly dopamine agonists.

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed:02/25/2020
Last Updated:07/20/2020
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Impulse control disorders
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A medical illustration showing key findings of Impulse control disorders : Compulsive behavior
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