ConditionMental health & sleep
Impulse Control Disorders
Impulse control disorders are mental health conditions in which a person repeatedly cannot resist an urge or impulse to do something harmful to themselves or others. Often tension builds beforehand and relief or pleasure follows, then regret. In current psychiatric classification they include intermittent explosive disorder, kleptomania, pyromania, oppositional defiant disorder and conduct disorder. Related conditions include gambling disorder and impulse problems caused by some Parkinson's medicines. Cognitive behavioral therapy is the main treatment, sometimes with medicines.
Also called: ICD, disruptive, impulse-control and conduct disorders, impulsivity disorder
At a glance
- What they are
- Repeated failure to resist harmful urges, with tension before and relief after.
- Main types
- Intermittent explosive disorder, kleptomania, pyromania, oppositional defiant disorder, conduct disorder.
- Related
- Gambling disorder, trichotillomania, skin picking, compulsive buying, medicine-induced impulse problems.
- Often co-occurs with
- ADHD, depression, anxiety, bipolar disorder, substance use.
- Treatment
- Cognitive behavioral therapy, family therapy for children, sometimes medicines.
When to get help
Call 911 or go to the ER
- Thoughts of harming yourself or others, or recent violence: call or text 988 (US), or call 911 if anyone is in immediate danger
- Fire-setting that puts people or property at risk
See a doctor within a day or two
- New compulsive gambling, shopping, eating or sexual behavior after starting a Parkinson's or restless legs medicine: tell your prescriber promptly, do not stop the medicine suddenly yourself
- Repeated aggressive outbursts at home, school or work
Book a routine appointment
- Urges to steal, set fires, gamble or lash out that you struggle to control
- A child with persistent defiance, rule-breaking or aggression
- Impulsive behavior causing debt, legal problems or relationship breakdown
What impulse control disorders are
Everyone acts on impulse sometimes. In these disorders the pattern is repeated and causes significant harm or distress. Common features:
- a rising sense of tension or arousal before the act
- pleasure, gratification or relief during it
- guilt, regret or shame afterward, though not always
- repeated attempts to stop that fail
The behavior is not better explained by another condition, such as mania, psychosis or substance intoxication.
Types
| Disorder | Core behavior | Typical onset |
|---|---|---|
| Intermittent explosive disorder | Recurrent verbal or physical outbursts out of proportion to the trigger | Late childhood or teens |
| Kleptomania | Stealing items not needed for personal use or value | Teens to early adulthood |
| Pyromania | Deliberate fire-setting for fascination or relief, not for gain or revenge | Varies, rare |
| Oppositional defiant disorder | Angry, irritable mood, argumentative and defiant behavior | Childhood |
| Conduct disorder | Violating others' rights: aggression, destruction, theft, serious rule-breaking | Childhood or teens |
Related conditions with impulse features
- Gambling disorder: now classified as an addictive disorder
- trichotillomania (hair pulling) and excoriation (skin picking), classified with obsessive-compulsive disorders
- compulsive buying and compulsive sexual behavior
- binge eating
Impulse control problems from Parkinson's medicines
Dopamine agonists such as pramipexole and ropinirole, used for Parkinson's disease and restless legs syndrome, can trigger compulsive gambling, shopping, eating or sexual behavior in a significant minority of users. People may hide it out of embarrassment. Lowering the dose or changing the medicine usually resolves it, but changes should be made with the prescriber.
Causes and risk factors
- brain differences in areas controlling reward, inhibition and decision-making, including the prefrontal cortex
- brain chemistry, especially serotonin and dopamine systems
- genetics and family history of impulse disorders, mood disorders or addiction
- childhood adversity, abuse, neglect or exposure to violence
- co-occurring conditions: ADHD, depression, anxiety, bipolar disorder, substance use and personality disorders
- brain injury affecting the frontal lobes
- male sex for intermittent explosive disorder and conduct disorder. Kleptomania is reported more often in women
Effects
- injuries to self or others
- legal problems, arrests and debts
- school exclusion and job loss
- damaged relationships
- shame, depression and anxiety
- higher risk of substance use and suicidal thoughts
Diagnosis
A psychiatrist or psychologist makes the diagnosis through:
- a detailed interview about the behaviors, triggers, frequency and consequences
- screening for co-occurring conditions such as ADHD, depression, bipolar disorder and substance use
- information from family, partners or teachers, especially for children
- a medicine review
- sometimes a medical or neurological assessment if a brain injury or other medical cause is suspected
Treatment
Psychological therapies
- Cognitive behavioral therapy (CBT): identifies triggers and thoughts, builds tolerance of urges and teaches alternative responses. It is the most studied treatment.
- Anger management and relaxation training for intermittent explosive disorder.
- Habit reversal training for hair pulling and skin picking.
- Parent management training and family therapy for oppositional defiant and conduct disorders.
- Group support, such as Gamblers Anonymous.
Medicines
No medicine is specifically approved for most impulse control disorders, but some help:
- SSRIs for intermittent explosive disorder and some urges
- naltrexone for kleptomania and gambling urges in some studies
- mood stabilizers for aggression in some patients
- treating co-occurring ADHD, depression or bipolar disorder
Practical steps
- avoid triggers and high-risk situations, for example self-excluding from casinos
- involve trusted people, for example in managing money
- treat substance use, which lowers inhibition
Outlook
Impulse control disorders can be long-lasting, but many people improve substantially with therapy, treatment of co-occurring conditions and support. Early intervention in children with oppositional or conduct problems improves long-term outcomes.
Frequently asked questions
What are impulse control disorders?
They are mental health conditions in which a person repeatedly fails to resist urges to act in harmful ways. Examples include intermittent explosive disorder, kleptomania, pyromania, oppositional defiant disorder and conduct disorder. Tension often builds before the act and relief follows.
What are the types of impulse control disorders?
The main types in current classification are intermittent explosive disorder, kleptomania, pyromania, oppositional defiant disorder and conduct disorder. Related conditions with strong impulse features include gambling disorder, trichotillomania, skin picking and compulsive buying.
What causes impulse control disorders?
They result from a mix of brain differences in reward and self-control circuits, brain chemistry, genetics and life experiences such as childhood trauma. They often occur with ADHD, depression, anxiety, bipolar disorder or substance use. Some medicines can also trigger impulse problems.
Can Parkinson's medication cause impulse control disorders?
Yes. Dopamine agonists such as pramipexole and ropinirole can cause compulsive gambling, shopping, eating or sexual behavior. Tell your doctor if you or a family member notice this. Adjusting or changing the medicine usually helps, but do not stop it suddenly yourself.
How are impulse control disorders treated?
Cognitive behavioral therapy is the main treatment, teaching ways to recognize triggers and manage urges. Family therapy helps children. Medicines such as SSRIs, naltrexone or mood stabilizers may help some people, and treating co-occurring conditions is important.
Sources
This guide was written from current patient and clinical guidance, including:
- American Psychiatric Association: DSM-5-TR disruptive, impulse-control and conduct disorders
- National Institute of Mental Health: Mental health information
- Cleveland Clinic: Impulse control disorders
- Parkinson's Foundation: Impulse control disorders and dopamine agonists
- SAMHSA National Helpline