Impulse Control Disorders NOS generally include intermittent explosive disorder, kleptomania, pyromania, pathological gambling, and trichotillomania.
It would appear that the concept of “irresistible impulse” is troublesome because it is inherently tied to the observable behavior, thereby making it less than scientific. The test suggests that the ICD implementation of the word “habit” may be useful since there is some implicit or explicit reinforcement value of the behaviors themselves. Furthermore, NHW seem to be endorsing the use of “over-control mechanisms” since they can be investigated apart from the aggressive acts themselves.
Over and above the issues of assessment, the documentation is extremely sparse at it relates to treatment. The text did cite one particular cognitive-behavioral treatment course that I was interested in. “Self-talk is often used to dissipate anger; self-monitoring can be employed to engender greater awareness of cues that evoke aggression and associated thoughts and feelings. Modeling can be used to demonstrate effective problem solving, such as generating alternative solutions. Role playing is designed to enable the child to better empathize with others.” (Netherton, Holmes, & Walker, 1999, p. 455) The above is a great place to start. There is also some suggestion that SSRIs (antidepressants) may be of some use.
It has been suggested that Trichotillomania is a variant of obsessive-compulsive disorder (OCD). It is important to distinguish trichotillomania from other dermatological issues like alopecia araeta and tinea capitis. It is also important to access for attendant trichophaga (i.e., chewing and/or swallowing the hair) as this can lead to trichobezoars (hair casts in the digestive system). Aside from the attendant bald spots, trichobezoars are probably the most serious health risk that is presented. I don’t buy the psychosexual explanations for this disorder; they seem to be way out in left field.
Pathological gambling is an intense interest of mine, primarily because I used to deal cards at the casino. This is where I digress into a story that I can’t resist telling. I worked the graveyard shift, 10pm-6am at The Horseshoe Casino in Council Bluffs. On this particular night I was dealing a “pit game” called Caribbean Stud. It’s a “progressive” game that pays progressively larger amounts for better poker hands… and has the potential to pay huge if you get a straight flush or better (very rare). On this night, a gentleman sat down and put 4 crisp 100 dollar bills on the table. He asked for black chips, which was unusual for his level of buy in (it was only 4 chips!). He proceeded to tell me that this was his last 400 dollars on his last credit card, and that if he didn’t win this game he was going to go home and “end it.” I proceeded to put my hand up in the air, and told the manager I needed to check my schedule because I thought I worked at 2 tomorrow (code for, the guy in seat 2 is off his rocker). I proceeded to tell the shift manager what had transpired, and they advised that “we should keep an eye on him.” That’s it; I was disappointed by the apparent lack of caring on behalf of the casino to be honest. That was the last night I dealt cards, just thinking about that guy reminds me why I don’t gamble… makes me sick just thinking about it.
“A plethora of etiological speculations have been offered for pathological gambing, including unconscious needs for punishment, latent homosexual propensities, and intermittent reinforcement with a “big win” early in the reinforcement schedule.” (Netherton et al., 1999, p. 446) I was suitably surprised that adult gamblers as a group appear to be heterogeneous, with no particular personality profile found to be characteristic. I think this is an area where there is a definite lack of data… I have a “stereotypic gambling personality profile” in my head that just screams to be researched.
Netherton, S. D., Holmes, D., & Walker, C. E. (1999). Child and adolescent psychological disorders: A comprehensive textbook. Oxford, NY: Oxford University Press.