Not Otherwise Specified
This is a residual category for those impulse control disorders that do not fulfill either the criteria for the specific disorders outlined earlier or those other mental disorders with impulsive characteristics that have been covered in other sections of the DSM IV-TR (eg. substance abuse, paraphilias). Some of the more common impulse control disorders contained in this category include:
Impulsive Sexual Behaviours
"Sexual addiction", habitual promiscuity, compulsive masturbation, compulsive use of telephone sex lines and/or internet pornography, and pornography dependence are some of the sexually related behaviours classified in this section.
Repetitive Self- Mutilation
While this behaviour can be present in a wide range of psychiatric disorders, in particular associated with Borderline Personality Disorder, this impulsive behaviour is also part of the Impulse Control Disorder, NOS catchment. It refers to the actions of individuals who fail to resist impulses to episodically cut, carve or burn their skin, interfere with healing of their wounds, and so on.
The behaviour usually begins in early adolescence and becomes the individual’s habitual way of dealing with personal distress as opposed to being suicidal or in response to psychotic experiences. Between the episodes of self-harm there are periods of calm though eating disorders, alcoholism and substance abuse or kleptomania may also complicate the clinical picture.
As with other impulse control disorders, individuals experience feelings of tension immediately before hurting themselves, followed by feelings of relief or pleasure subsequently.
Compulsive Shopping
Also referred to “compulsive spending” or “oniomania”, this disorder show many similarities to kleptomania. Women appear to be more often afflicted than men. There is substantial co-morbidity with mood and anxiety disorders, and the behaviour is followed later by remorse and regret. (Ades 1997). Mood regulation is therefore a major determinant in impulse buying (Faber, 1992, O’Guinn & Faber, 1989) and these patients experience shopping or buying exciting and mood-enhancing. However, as with kleptomania. Once again, there is evidence that treatment with serotonin reuptake inhibitor type antidepressants may be helpful in alleviating the problem (McElroy, Satlin, Pope, Keck and Hudson, 1991).
Further Reading:
Christenson, G.A., Pyle, R.L., & Mitchell, J.E. (1991). Estimated lifetime prevalence of trichotillomania in college students. Journal of Clinical Psychiatry, 52, 415-417.
Faber, R.J. (1992). Money changes everything: Compulsive buying from a biopsychosocial perspective. American Behavioral Scientist, 35, 809-819.
McElroy, S.E., Satlin, A., Pope, H.G., Keck, P.E., & Hudson, J.I. (1991). Treatment of compulsive shopping with antidepressants: A report of three case studies. Annals of Clinical Psychiatry, 3, 199-204.
McElroy, S., Pope, H., Keck, P., & Hudson, J.(1995). Disorders of impulse control. In E. Hollander & D. Stein (Eds.) Impulsivity and aggression. (pp.109-136). New York: Wiley.
O’Guinn, M. & Faber, R.J. (1989). Compulsive buying: A phenomenological exploration. Journal of Consumer Research, 16, 147-157.
Other Resources:
Therapy for Sexual Impulsivity: The Paraphilias and Paraphilia-Related Disorders. Martin Kafka, MD, Psychiatric Times (on-line).
Hucker, S.J. (2004) “Disorders of Impulse Control”. In: Forensic Psychology by O’Donohue, W. and Levensky, E. (eds), Academic Press.
Hucker, S.J. (1997). “Specific Disorders of Impulse Control” In: Impulsivity: Perspectives, Principles & Practice by Webster, C.D. & Jackson, M. (eds). New York: Guilford Press.
© Stephen Hucker, MB,BS, FRCP(C), FRCPsych 2003, 2004,2005
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