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PubMed2000

[Procedural and developmental aspects of impulse-control disorders in child and adolescent schizophrenia].

200 schizophrenic patients (130 men, 70 women), which had fallen ill at the age of 4-25 years were examined in outpatient clinic. Either on the separate stages of the disease or during all its course the patients had the following impuls-control disorders: of eating--14 patients (7.0%), sexual drive--56 cases (28.0%), self-preservation--37 (18.5%), alcoholism--76 (38.0%), dromomania--38 (19.0%), pyromania--2 (1.0%), kleptomania--4 (2.0%). By the mechanisms of the disorders' development there were impulsive, obsessive and compulsive ones. The author also qualified the morbid impuls-control disorders (87 patients--43.5%) and the evolutive ones (61-30.5%). Morbid signs were considered in terms of the comorbid phenomena combined with the productive and negative symptoms of basic disease. Evolutive manifestations are deviations of ontogenesis which didn't achieve a pathologic form.

Adolescent↗

PubMed1982

Arson: a clinical study.

Psychiatric, psychosocial and medicolegal issues related to 34 arsonists and 50 controls are described. Arson was most frequently committed by males who suffered from personality disorder, mental retardation or depressive neurosis. Poor school and work records also characterized their background when compared to the control forensic psychiatric patients. The offence more frequently occurred within a one mile radius of their own home in residential property. Revenge or a "cry for help" was the most frequent motivation for the firesetting activity.

Adult↗

PubMed2000

[Impulse control and affect regulation in personality disorders].

In borderline and antisocial personality disorder there is a close interaction between affect dysregulation and impulse control disorder. Different approaches are presented that focus on affective responses to experimental stimuli in these personality disorders. Results suggest that in borderline personality disorder intense emotional responses occur in the context of specific stressors, in particular fear of being abandoned. Evidence for a general emotional hyperreactivity was not found; on the contrary, female borderline subjects rather showed reduced emotional arousal. Regarding the psychopathic subtype of antisocial personality disorder, results provided strong support for the theory of emotional detachment, which may predispose to violence through a lack of feeling of fear or also of compassion which could counteract violent impulses. Consequences for psychotherapy in BPD are considered.

Affect↗

PubMedDate not supplied

[The role of the personality in the feeding behavior disorders].

Personality disorders are common in eating disorders and preliminary reports indicate that this type of disorders implicate a poor prognosis in anorexia and bulimia nervosa. Cluster C personality disorders, particularly avoidant and dependent personality disorder are the most frequent in anorexia nervosa. In bulimia nervosa, however, cluster B personality disorders, including borderline and histrionic personality disorders, are more frequent. Furthermore, temperament could differentiate anorectic patients from bulimic patients. Eating disorders seem to be associated with high scores in neuroticism and harm avoidance. However, while anorexia nervosa patients might have higher persistence, bulimia nervosa patients seem to have an impulsive temperament. According to the character model of Cloninger, both anorexia and bulimia present lower scores in the dimension self-directedness.

Adult↗

PubMed2002

Impulsive behaviors in bulimic patients: relation to general psychopathology.

OBJECTIVE: At a general level, impulsivity is related to both bulimic and general psychopathology. However, it is a complex construct, and the specific role of different forms of impulsivity in psychopathology remains to be determined. The present study of bulimic outpatients examined the association of internally and externally directed impulsive behaviors with general and bulimic psychopathology. METHODS: Thirty female bulimic outpatients completed standardized measures of bulimic attitudes/behaviors, general psychopathology and impulsive behaviors. RESULTS: While general psychopathology was associated with internally directed impulsive behaviors (e.g., self-harm), bulimic pathology was more specifically linked with externally directed impulsivity (e.g., theft; reckless driving). DISCUSSION: The results indicate that the bulimia-impulsivity link in eating disordered patients is not simply a by-product of the broader association of impulsivity with psychopathology. Therefore, bulimic pathology does not seem to be just a manifestation of general psychological disturbance. Further research is suggested to test these results and potential clinical implications are outlined.

Adult↗

PubMed1996

Medical approaches to gambling issues--II: The medical response.

Gambling behaviors cover a spectrum from an enjoyable benign form of social entertainment to a disabling and potentially lethal medical condition. A companion paper, Medical Approaches to Gambling Issues--I: The Medical Condition, provides a literature review of gambling in its pathological and nonpathological forms. Physicians encounter patients who gamble, patients who have a treatable disorder of pathological gambling and family members of problem and pathological gamblers. This paper is intended to aid practicing physicians in their care of their patients who gamble and experience problems related to gambling, as well as in the care of those among their patient caseload who are symptomatically affected by someone else's gambling.

Behavior Therapy↗

PubMed2006

Neuropsychological performance, impulsivity, and comorbid psychiatric illness in patients with pathological gambling undergoing treatment at the CORE Inpatient Treatment Center.

INTRODUCTION: Pathologic gambling is a disorder with features that implicate abnormal functioning in brain regions involved in addiction, mood, anxiety, and impulse control disorders. Our goal was to examine brain function with neurocognitive tasks that target these brain regions in patients with pathologic gambling. METHODS: Patients were evaluated for comorbid psychiatric disorders, impulsivity, and performance on reversal-learning and reward-based decision-making cognitive tasks. RESULTS: Patients had higher impulsivity scores and significant deficits on both cognitive tasks compared with controls. All subjects also had comorbid psychiatric disorders, including mood, anxiety, psychotic, and substance abuse. CONCLUSION: The cognitive deficits and impulsivity are consistent with abnormal activity in orbitofrontal-limbic networks. The high level of comorbidity is consistent with the overall severity in these inpatients undergoing treatment, and adds weight to the concept of a fundamental abnormality in this network.

Anxiety↗

PubMed1989

Female arsonists: a clinical study.

This paper is a detailed study of a sample of 15 female arsonists. A review of the literature suggests that arson is seen more frequently in males with female firesetters usually comprising 10 to 18% of the samples of firesetters studied. As a result, female arsonists have been studied less often, and only a few authors have reported on their clinical features. This retrospective study demonstrates that female arsonists do not fall in any particular age group and are mostly either single or separated. Some psychosexual aspects of their behavior also appear to be clinically relevant. In contrast to previous studies, they were more often diagnosed as personality disordered and an association with suicidal behavior was found. Their motivations for the firesetting behavior were also considered. Finally, this paper compares some demographic, clinical, and other differences between male and female arsonists. The study also suggests that poor impulse control may be a prerequisite to this type of criminal behavior. The identification of psychopathic traits in the arsonist has important medico-legal implications.

Adolescent↗

PubMedDate not supplied

Different types of self-injurious behavior in bulimia nervosa.

In a previous study, we demonstrated the validity of the distinction, in bulimia nervosa (BN), between compulsive self-injurious behavior (SIB), such as hair pulling and onycophagia, and impulsive SIB, such as skin cutting and burning. The aim of the present study is to investigate the clinical and psychological correlates of these two categories of SIB in BN. The sample consisted of 175 consecutive patients with BN, diagnosed according to DSM-IV criteria. Subjects were assessed by means of a semistructured interview and self-reported questionnaires (Eating Disorders Inventory [EDI] and Hopkins Symptom Checklist [SCL-90]). In our sample, impulsive SIB appeared to be associated with suicide attempts, a history of sexual abuse, and depression. On the other hand, compulsive SIB seemed to be related to a lack of awareness towards emotions and body sensations, greater obsessionality, and a shorter duration of illness.

Adolescent↗

PubMed1996

The role of serotonin in the future of forensic psychiatry.

The role of serotonin in understanding suicidality, violence, impulse disorders, and paraphilias is described and the current state of our knowledge is reviewed. Clinical research in these areas will provide new understanding of behavior that leads to violations of the law. Forensic psychiatrists need to be more aware of these developments, and they must recognize that the uniqueness of their specialty lies in its clinical and research perspectives.

Aggression↗

PubMed2004

Compulsive disorders.

Compulsive disorders include a diverse group of conditions characterized by excessive thoughts or preoccupations combined with poorly controlled behaviors. They include trichotillomania, kleptomania, pathologic gambling, compulsive buying disorder, compulsive sexual behavior, and compulsive computer use. Some investigators have suggested that these conditions constitute a spectrum of disorders linked to obsessive-compulsive disorder. Others have questioned the validity of this conceptualization, and have debated the relationship between these disorders. Nevertheless, much has been learned about compulsive disorders, and there have been some successes with psychotherapeutic and psychopharmacologic treatments. Recent therapy-based interventions have moved from psychodynamic treatments toward cognitive-behavioral modalities. Serotonin reuptake inhibitors remain the best-studied pharmacologic treatment, but researchers have also explored other antidepressants, opioid agonists, mood stabilizers, and atypical antipsychotics.

Antidepressive Agents↗

PubMed2004

[Messy house syndrome].

The messy house syndrome (Diogenes syndrome) is present when, owing to a disordering of the personality structure, a person is unable to keep order, for example, in the household or his finances. Such persons are also referred to as "messies". Useless objects are hoarded in such quantities that the apartment can no longer be lived in. In many cases, the disorder is due to an underlying mental problem such as dementia, schizophrenia, ADHS or obsessive-compulsive disorders. The Prader-Willi syndrome is also associated with an unusual compulsion to hoard things or food. In the first instance, treatment is aimed at the underlying condition (neuroleptic agents, SSRI). New studies appear to suggest that the particular concomitant cognitive and emotional disturbances associated with hoarding respond to cognitive behavioral therapy.

Aged↗

PubMed2004

Dissociative symptoms in kleptomania.

Many patients with kleptomania report an altered state of consciousness during acts of theft. The purpose of this investigation was to clarify a possible link between dissociation and kleptomania, a disabling disorder whose phenomenology remains understudied. 26 adult outpatients who met DSM-IV criteria for kleptoania were administered the Dissociative Experiences Scale and compared to 22 normal controls. The patients with kleptomania had scores that differed significantly from those reported by normal controls. There were no statistically significant differences by sex. Because kleptomania patients seeking treatment with medication may differ from others with kleptomania, further studies are needed.

Adult↗

PubMed2005

The impact of comorbidity on the management of pathological gambling.

A 30-year-old woman with severe pathological gambling and cyclothymia presented to our program with no previous history of pharmacologic or psychotherapeutic treatment. Pathological gambling is an impulse -control disorder not otherwise specified (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) in which comorbidity is common, particularly with substance abuse, obsessive-compulsive disorder and mood disorders. As described in this case, pathological gamblers with bipolar comorbidity may be effectively treated with mood stabilizers such as lithium. After receiving 10 weeks of lithium treatment, the patient showed improvement in both gambling behavior and affective instability. The identification of specific subtypes among patients with pathological gambling may be relevant to the choice of pharmacologic treatment.

Adult↗

PubMed2001

Social phobia as a comorbid condition in sex offenders with paraphilia or impulse control disorder.

Studies on the prevalence of social anxiety in sex offenders show mixed results. This may be due to social anxiety being heightened only in diagnostic subgroups of sex offenders, namely in paraphiliacs. In study 1, 72 mentally disordered sexual delinquents and 30 controls were screened for social anxiety with the Social Interaction Anxiety Scale and the Social Phobia Scale by Mattick and Clarke (German versions). In study 2, 55 mentally disordered sexual delinquents were diagnosed with a structured clinical interview. In both studies, sex offenders were categorized as either paraphilic or impulse control disordered (without paraphilia) according to research criteria. Study 1 showed markedly heightened scores for social anxiety in paraphiliacs, particularly for social interaction anxiety. Study 2 found a high lifetime and point prevalence of social phobia in paraphiliacs for which corroborating evidence was again found in questionnaire results. Implications for further research, diagnostic procedures, and therapy are discussed.

Adult↗

PubMed1983

Problems in the diagnosis of intermittent explosive disorder.

The authors studied the accuracy with which intermittent explosive disorder was diagnosed in a university hospital setting. An index of diagnostic features abstracted from the description of intermittent explosive disorder in DSM-III was used for chart review. Diagnosis of the disorder was made in 20 out of 830 admissions (2.4%). In 14 cases (1.7%) it was a primary one; in another five (.6%) it was secondary; and in one case (.1%) it was tertiary. The authors discuss the varied rigorousness of the diagnosis and the importance of using an index of diagnostic features to enhance diagnostic accuracy.

Adolescent↗

PubMed2006

Dual psychiatric diagnosis and substance abuse in pathological gamblers: a preliminary gender comparison study.

BACKGROUND: Pathological Gambling (PG) is a highly prevalent and disabling impulse control disorder. Recent studies have consistently shown that PG patients have responded well to treatment with SSRI's, mood stabilizers, and opioid antagonists. These findings have supported the observation that PG is strongly associated with both mood and anxiety disorders as well as substance abuse. The aim of the study is to evaluate the comorbid psychiatric diagnoses in our sample. METHODS: Thirty-six female, and forty-two male PG's were enrolled in our study. A comprehensive psychiatric diagnostic evaluation was performed on all patients, and patients were screened for symptoms of depression and anxiety using the Hamilton Depression Rating Scale, the Hamilton Anxiety Rating Scale, the Yale-Brown Obsessive Compulsive Scale, and the Frost Multidimensional Perfectionism Scale. In addition, the patients completed self-report questionnaires about their demographic status and substance abuse. RESULTS: The majority of patients were married with full or part-time employment. The study results demonstrated that PG in males is correlated with substance and alcohol abuse. Diagnoses, which were prevalent among our cohort of female PG's included major depression, affective disorders, anxiety disorders, and eating disorders. CONCLUSION: In our sample of PGs, the men and women had different patterns of psychiatric comorbidity. The different patterns of psychiatric comorbidity seen in our male versus female PG's raises the question of whether the underlying etiopathology in PG may differ according to gender.

Adult↗

PubMed1991

Kleptomania: making sense of the nonsensical.

OBJECTIVE: Kleptomania, or the irresistible impulse to steal unneeded objects, is a poorly understood disorder. The objectives of this paper are to critically review and integrate existing data and to make suggestions for further research. DATA COLLECTION: Information was gathered by reviewing the English-language literature on kleptomania. Cases were chosen for review that approximated the diagnosis as defined in DSM-III-R. These cases were analyzed in terms of their relationship to previous theories about the disorder, and larger relevant studies were examined. Using the data organized into a table, the author explores areas of convergence and disagreement and discusses the methodological difficulties of the different studies. FINDINGS: Kleptomania is more common than previously thought. The "typical" individual with kleptomania is a 35-year-old woman who began to steal when she was 20 years old. Her thefts bring both relief and guilt. She probably has not sought treatment on her own but suffers from a necessary, pervasive, repetitive, and self-destructive act. She may have a history of sexual dysfunction or sexual preoccupation and may be unhappily married to an emotionally unsupportive husband. She has been labile and dysphoric for many years and may have a personality disorder. She has probably had a tumultuous, stressful childhood and may dissociate. CONCLUSIONS: The author proposes a biopsychosocial model of the etiology of kleptomania based on data from the literature. This model emphasizes possible childhood abuse as a precipitating factor in later development of kleptomania. More complete research is needed in the study of kleptomania.

Adolescent↗