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Impulse-control disorder
Impulse-control disorder
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Impulse control disorder or ICD is a set of psychiatric disorders including intermittent explosive disorder, kleptomania, pathological gambling, pyromania (fire-starting), and three body-focused repetitive or compulsive behaviors of trichotillomania (a compulsion to pull one's hair out), onychophagia (compulsive nail biting) and dermatillomania (compulsive skin picking). The onset of these disorders usually occurs between the ages of 7 and 15.^[1] Impulsivity, the key feature of these disorders, can be thought of as seeking a small, short term gain; in the case of these behaviours, this gain is at the expense of a large and long term loss. Those with the disorder repeatedly demonstrate failure to resist their behavioral impetuosity. Studies have suggested that the occurance of an Impulse control disorder affects marital life and causes lonliness.^[2] In a study performed by Raine et al (1994), it had been observed through the positron emission tomography (PET) scans that the glucose metabolism in the prefrontal and frontal cortex of implusive patients is lower than normal,^[3] meaning there is decreased function of both mentioned cortex in impulsive patients. Five behavioural stages characterize ICD: an impulse, growing tension, pleasure from acting, relief from the urge and finally guilt which may or may not arise.^[4]

Categorization in the DSM-IV-TR

Whereas first the ICDs were first place under the category of addictive or compulsie behaviours, Impulse Control Disorders received their own categorization in the DSM-IV-TR(American edition). There are several disorders that fall under the category of Impulse Control Disorder in the DSM-IV-TR whereas others fall under the category of ICD-Not otherwise specified. Onychophagia was also once considered an impulse control disorder in the DSM-IV-R, however is no longer included the category of the ICDs in the DSM-IV-TR.

Disorders categorized as ICD

Pathological gambling

Pathological gambling is an impulse control disorder characterized by maladaptive and re-current episodes of gambling that is significantly disruptive to the individual's familial and personal life. According to studies carried out until 2006, the prevalence of Pathological Gambling in adults was found to be between 1%-3% in the U.S., with the problem usually starting in adolescence with prevalence of about 4%-7%.^[5]

Trichotillomania

Trichotillomania is a condition where an individual has an overwhelming urge to pluck out bodily hair. Common areas include head, eyebrows, eyelashes and hands. People who suffer from Trichotillomania feel brief moments of relief after their hair plucking episodes, which triggers a greater urge to continue plucking. Estimates suggest that the prevalence of trichotillomania in females (3.4%) in the United States is about double its existence in males (1.5%). 0.6% of such cases fully meet the criteria of trichtillomania whereas the prevalence of non-clinically significant hair-pulling behaviour is about up to 15.3%.^[5]

Pyromania

Pyromania is characterized by impulsive and repetitive urges to deliberately start fires. Because of its nature, the number of studies performed for fire-setting are understandably very few. However studies done on children and adolescents suffering from pyromania have reported its prevalence to be between 2.4%-3.5% in the United States. It has also been observed that the incidence of fire-setting is more common in juvenile and teenage boys than girls of the same age.^[5]

Intermittent explosive disorder

Intermittent explosive disorder or IED is a clinical condition of experiencing recurrent aggressive episodes that are out of proportion of any given stressor. Earlier studies reported a prevalence rate between1%-2% in a clinical setting, however a study done by Coccaro and colleagues in 2004 had reported about 11.1% lifetime prevalence and 3.2% one month prevalence in a sample of a moderate number of individuals (n=253). Based on the study, Coccaro and colleagues estimated the prevalence of IED in 1.4 million individuals in the US and 10 million with lifetime IED.^[5]

Kleptomania

Kleptomania is characterized by an impulsive urge to steal purely for the sake of gratification. In the U.S. the presence of kleptomania is although unknown but has been estimated at 6 per 1000 individuals. Kleptomania is also thought to be the cause of 5% of annual shoplifting in the U.S. In case where this is true, then as much as about 100,000 arrests are made in the U.S. annually due to kleptomaniac behavior.^[5]

Disorders categorized as ICD-Not otherwise specified

This section includes disorders that are not classified as a part of any other disorder in the DSM-IV-TR. Disorders in this category also share the core features of ICD i.e. failure to resist an urge, drive to perform an action harmful to oneself or others and relief upon action.

Sexual compulsion

Sexual compulsion includes an increased urge in sexual behaviour and thoughts. This compulsion may also lead to several consequences in the individuals's life. Their has not yet been a determined estimate of its prevalence due to the secretiveness of the disorder. However a research conducted in early 1990's in the United States gave prevalence estimates between 5%-6% in the U.S. population, with male cases being higher than woman. Although it should be noted that the extent of the difference among both genders is not clear.^[5]

Skin picking

Pathologic skin picking or Dermatillomania includes an uncontrollable urge to pick one's skin in order to seek gratification.^[5] Skin picking may affect as many as 1 in 20 people, and affect more women than men. It is also linked to other psychological disorders such as anxiety or depression. People who suffer from skin picking disorder may feel relief during or after their picking episode. However, it is often followed by feeling of shame and guilt.^[6]

Internet addiction

The disorder of Internet addiction has only recently been taken into consideration and has been added as a form of ICD. It is characterized by excessive and damaging usage of internet with increased amount of time spent chatting, web-surfing, gambling, shopping or exploring pornographic web-sites. Excessive and problematic internet use has been reported across all ages, social, economical and education range. Although initially stereotyped only in males, increasing rates have been also observed in females. However, no epidemiological study has been conducted yet to understand its prevalence.^[5]

Compulsive shopping

Compulsive shopping or buying is characterized by an frequent irresistible urge to shop even if buying is not needed and\or cannot be afforded. Studies have reported the prevalence of Compulsive buying in the U.S. population to be between 2%-8% in the general adult population, with 80%-90% of these cases being females. The onset in believed to occur in late teens or early twenties and the disorder is believed to be generally chronic.^[5]

Causation

Dopaminergic agonists

Although not alone in accounting for the disorder, Dopamine agonists used for the treatment of Parkinson’s disease are known to cause Impulse control disorder. The most common Dopamine agonist are Pramipexole, pergolide, and ropirinole and these are known to cause the manifestation of Impulse Control Disorder (ICD).^[7] It has also been found out that Piribedil-which was formerly considered not to be associated with the causation-, does in fact seem to be the cause of ICD as well.^[7] Claassen and colleagues (2011) have proposed that these Dopamine agonist work by increasing the risk taking behaviour in PD patients which might be the potential cause of the development of ICD in them.^[8]

The feeling-state theory

The theory has been proposed by Robert Miller in 2010 and proposes that ICDs are formed when positive feelings get linked with specific objects or behaviours and form state-dependant memory. It is important to note that the term ‘positive feeling’ or ‘feeling state’ refers not only to emotions but to the entire psycho-physiological arousal of the body at the time. For example if a person says ‘I feel strong’, there is a complex combined emotional and physiological sensation involved behind this sentence. Therefore, when a person experiences strong positive feeling, he or she links this feeling to the specific objects that they assume is the cause of the feeling and hence this creates a link between the feeling and the object. The FST hypothesizes that the more an individual would want to re-experience the positive feeling, the more he or she would want to repeat the action that brought about the positive feeling and hence the more they would be prone to getting ICD.^[9]

Symptoms and diagnosis

Five behavioural stages can prove to be the symptoms of ICD: an impulse, growing tension, pleasure from acting, relief from the urge and finally guilt which may or may not arise.^[10] People who have an impulse control disorder cannot resist the urge to do something harmful to themselves or others around them. ICD varies from other disorders because its primary feature is the incapability to control impulses.^[11]

Treatment

Impulse control disorders have two treatment options: psychosocial and pharmacological.^[12] Treatment methodology is informed by the presence of comorbid conditions.^[13]^[5]

Pharmaceutical approach

This approach to the treatment if ICD results from the late 20th century discovery of the role of serotoninergic system in the disorders that are characterized by poor impulse control.^[14] The therapeutic treatment for ICD also stems from the fact that there is some evidence indicating the association of low cerebral serotonin function and excessive impulsiveness.^[15]

Use of anti-depressants

The researchers in support of the pharmaceutical approach have reported that the use of Selective serotonin reuptake inhibitor antidepressants has shown improvement in impulsive and aggressive patients.^[14]

In the case of Pathological Gambling, along with fluvoxamine, Clomipramine has also been shown effective in the treatment, with reducing the problems of Pathological Gambling in a subject by upto 90%. Whereas in trichollomania, the use of clomipramine has again been found to be effective, fluoxetine has not produced consistent positive results. Fluoxetine however has produced positive results in the treatment of the Pathological Skin Picking disorder,^[5]^[16] although more research is still needed to conclude this information. The use of Paroxetine has also shown to be somewhat effective although the results are inconsistent. Another medication escitalopramhas also shown to improve the condition of the subjects of Pathological Gambling with anxiety symptoms. The results suggest that although Selective serotonin re-uptake inhibitors have shown positive results in the treatment of Pathological Gambling, inconsistent results with the use of SSRI have been obtained which might suggest a neurological heterogeneity within the Impulse Control Disorder spectrum.^[16] The use of anti-depressants has also shown satisfactory results in the treatments of patients of compulsive buying and binge eating, as well as kleptomaniac patients.^[15] The use of Lithium carbonate has also been found somewhat effective in the treatment of gambling and trichotillomania.^[15]

Psychosocial approach

The psychosocial approach to the treatment of ICDs includes Cognitive behavioral therapy.

Cognitive behavioral therapy

Cognitive behavioral therapy or CBT has been found to have positive results in the case of treatment of Pathological gambling and sexual addiction.^[9] In a review of published literature on the usage of Cognitive Behaviour Therapy for the treatment of different impulse control disorders, following results were found:

For pathological gambling

Systematic desensitization, Aversive therapy, covert sensitization, imaginal desensitization, and stimulus control have been proven to be successful in the treatments to the problems of Pathological Gambling. Also "cognitive techniques such as psychoeducation, cognitive-restructuring, and relapse prevention" have proven to be effective in the treatments of such cases.^[17]

For Trichotillomania

The use of CBT has been proven to be much effective for the treatment of trichotillomania than the use of medications alone.^[18]^[19] In particular, Habit Reversal Training has shown to be the most successful in this disorder's treatment.^[19]

For Pyromania

Pyromania is harder to control in adults due to lack of co-operation, however is effective in treating child pyromaniacs. (Frey 2001)

For intermittent explosive disorder

Along with several other methods of treatments, Cognitive Behaviour therapy has also shown to be effective in the case of Intermittent Explosive Disorder as well. Cognitive Relaxation and Coping Skills Therapy (CRCST), which consists of 12 sessions staring first with the relaxation training followed by cognitive restructuring, then exposure therapy is taken. Later the focus is on resisting aggressive impulses and taking other preventative measures.^[20]

For kleptomania

In the case of kleptomania, the Cognitive Behaviour techniques used in these cases consists of covert sensitization, imaginal desensitization, systematic desensitization, aversion therapy, relaxation training, and "alternative sources of satisfaction".^[17]

For sexual addiction

Along with Cognitive Behaviour therapy, Eye movement desensitization and reprocessing (EMDR) has been found to be effective in the treatment of sexual addiction.^[9]

For compulsive buying

Although Compulsive Buying falls under the category of Impulse Control Disorder- Not Otherwise Species in the DSMIV-TR, some researchers have suggested that it consists of core features that represent impulse control disorders which includes preceding tension, difficult to resist urges and relief pr pleasure after action. The efficiency of Cognitive Behavior Therapy for Compulsive Buying is not truly determined yet however common techniques for the treatment include exposure and response prevention , relapse prevention , cognitive restructuring, covert sensitization, and stimulus control.^[17]

Co-morbidity

ICD and Parkinson's Disorder

According to research, the late complications of Parkinson's Disorder may include a range of Impulse Control Disorders, including eating, buying, compulsive gambling and sexual behavior.^[21]

ICD, OCD, And substance abuse

A relation between OCD and SUD has been proposed by Eisen and Rasmussen (1989) where 6% of their SUD patients also fell into the category of OCD. Similarly Friedman et all (2000) found a statistically significant difference in the rate of occurrence of OCD in opiate addicts compared to the rate of occurrence in general population.^[22]

Overlapping areas

There has been found an overlap between Obsessive Compulsive Disorder (OCD), Impulse Control Disorder (ICD) and Substance Abuse (SUD).^[23] Few of the overlapping areas are mentioned and described below:

Pathophysiology

In the case of Pathophysiology, it has been proposed that the dysfunction of striatum may prove to be the link between OCD, ICD and SUB. According to research, the ‘impulsiveness’ that occurs in the later stages of OCD is caused by progressive dysfunction of the ventral striatal circuit. Whereas in case of ICD and SUD, the increased dysfunction of dorsal striatal circuit increases the "ICD and SUD behaviours that are driven by the compulsive processes"^[22]

Phenomenology

OCD and ICD have traditionally been viewed as two very different disorders, the former one is generally driven by the desire to avoid harm whereas the later one driven “by reward seeking behaviour”. Still there are certain behaviours similar in both, for example the compulsiveness of skin pickings in ICD patients and the behaviour of reward seeking (for example hoarding) in OCD patients.^[22]

Treatment

It has been proposed that due to the overlap of OCD,ICD and SUD some of the medications for OCD might be able to treat ICD and SUD and vice versa.^[22]

ICD and obesity

According to a recent study done by Schmidt et all (2012), Impulse Control Disorder occurs commonly in Bariatric surgery patients. The most common ICDs observed were “pathological skin picking, compulsive buying disorder, and intermittent explosive”. However kleptomania has also been reported as one of the most common disorders for people with eating disorder.^[24] There was also an association present between depression and ICD.^[25] This relation between ICD and obesity has also been observed by Joutsa and colleagues from University of Cambridge (2012)^[26] and by Lejoveux and colleagues (2002) who reported the presence of ICD in 29% of their subjects.^[2]

ICD and anti-social or borderline personality disorder

There is a significant co-occurrence of Pathological Gambling (an ICD) and Anti-Social Personality Disorder, and is suggested to be caused partly by their common "genetic vulnerability".^[27]

ICD and substance abuse disorder

The degree of heritibality to ICD is smiliar to other psychiatric disorders including substance abuse disorder. There have also been found a genetic factor to the development of ICD just as there is for substance abuse disorder. The risk for subclinical PG in a population is accounted for by the risk of alcohol dependence by about 12-20% genetic and 3-8% environmental factors.^[27]

ICD and bipolar I disorder

An association between ICD and Bipolar I Disorder has also been found. In a study done by Karakus and Tamam (2011) the most common of the ICDs in patients with Bipolar I Disorder includes “pathologic skin picking, followed by compulsive buying, intermittent explosive disorder, and trichotillomania”. However no instances of pyromania or compulsive sexual behaviours were found in the study. Episodes of depression and alcohol abuse are found out to be significantly higher in ICD patients than in non-ICD patients. According to findings, presence of ICD causes a greater instance of alcohol abuse and suicidal attempts in Bipolar I disorder patients.^[28]

Tourette’s syndrome with ICD

Occurrence of ICD with Tourette’s syndrome has been reported to be rare but the combination produces a high degree of anger and “explosive outbursts” in children and adolescents who suffer from them. This occurs due to an underlying brain dysfunction and can prove to be very detrimental for the patient.^[3] The presence of ICD in patients with Tourette syndrome is reported to be more common than its presence in general population. Men with Tourette’s syndrome who suffer from ICD as well tend to be externally impulsive, while women who suffer from both disorders tend to be more impulsive internally. Although Attention Deficit Hyperactive Disorder (ADHD) and Obsessive Compulsive Disorder tend to be the co-morbid disorder to Tourette’s syndrome majority of the times, ICD has been suggested to be the root cause of many of the “obscure and socially inappropriate” behaviours in Tourette’s syndrome. Below is a review of Tourette’s syndrome reported with certain ICD disorders:

Tourette’s syndrome and intermittent explosive disorder (IED)

Intermittent Explosive Disorder (IED)is characterized by discrete episodes of failure to control ones rage. 23-40% of the Tourette syndrome patients report to have IED’s like symptoms as well, whereas temper tantrums are reported to be present in 64% of children by a community-based study.^[4]

References

^ Kessler RC, Amminger GP, Aguilar-Gaxiola S, Alonso J, Lee S, Ustün TB (2007). "Age of onset of mental disorders: a review of recent literature". Current opinion in psychiatry. 20 (4): 359–64. doi:10.1097/YCO.0b013e32816ebc8c. PMC 1925038. PMID 17551351.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^ ^a ^b Lejoyeux M, Arbaretaz M, Mcloughlin M and Ades J (2002). "Impulse Control Disorders and Depression". The Journal of Nervous and Mental Disease. 190 (5): 310–314.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^ ^a ^b Raj R, Sidhu BS (2011). "Tourette's disease with impulse control disorder". 53 (1): 66–68. {{cite journal}}: Cite journal requires |journal= (help); Unknown parameter |Journal= ignored (|journal= suggested) (help)
^ ^a ^b Wright; Rickards, Cavanna (2012). "Impulse-Control Disorders in Gilles de la Tourette syndrome". ''The Journal of Neuropsychiatry and Clinical Neurosciences'' 24(1): 16-27.
^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k Dell’Osso B, Altamura AC, Allen A, Marazziti D, Hollander E (2006). "Epidemiologic and clinical updates on impulse control disorders: A critical review". European Archives of Psychiatry and Clinical Neuroscience. 256 (8): 464–475. doi:10.1007/s00406-006-0668-0. PMC 1705499. PMID 16960655.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^ Fama, Jeanne (2010). Skin Picking Fact Sheet (PDF). International OCD Foundation.
^ ^a ^b Tschopp, Salazar, Gomez, Roca, Micheli(2010). "Impulse Control Disorder and Piribedil: Report of 5 Cases". ''Clinical Neuropharmacology'' 33(1) pg:11-13
^ Claassen; et all (2011). "Behavioral Neuroscience (The Risky Business of Dopamine Agonists in Parkinson Disease and Impulse Control Disorders". [[Behavioral Neuroscience 125(4):492-500
^ ^a ^b ^c Miller R (2010). "The Feeling-State Theory of Impulse-Control Disorders and the Impulse-Control Disorder Protocol". 16 (3): 2. {{cite journal}}: Cite journal requires |journal= (help); Unknown parameter |jounal= ignored (help) Cite error: The named reference "Miller" was defined multiple times with different content (see the help page).
^ Wright, Rickards, Cavanna (2012). Impulse-Control Disorders in Gilles de la Tourette syndrome. The Journal of Neuropsychiatry and Clinical Neurosciences. 24(1) pg: 16-27.
^ Ploskin, Daniel. [Ploskin, D. (2012). What Are Impulse Control Disorders?. Psych Central. Retrieved on August 9, 2012, from http://psychcentral.com/lib/2007/what-are-impulse-control-disorders/ "What are Impulse Control Disorders?"]. Retrieved 9 August 2012. {{cite web}}: Check |url= value (help)
^ Grant JE, Potenza MN, Weinstein A, Gorelick DA (2010). "Introduction to behavioral addictions". American Journal of Drug and Alcohol Abuse. 36 (5): 233–41. doi:10.3109/00952990.2010.491884. PMC 3164585. PMID 20560821. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
^ Dell'Osso B, Altamura AC, Allen A, Marazziti D, Hollander E (2006). "Epidemiologic and clinical updates on impulse control disorders: a critical review". European Archives of Psychiatry and Clinical Neuroscience. 256 (8): 464–75. doi:10.1007/s00406-006-0668-0. PMC 1705499. PMID 16960655. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
^ ^a ^b J.J. López-Ibor Jr; J. Sáiz Ruíz (1995). "Therapeutic attempts in impulse control disorder". ''European Neuropsychopharmacology'' 5(3): 178-179
^ ^a ^b ^c Carrasco JL, Sáiz-Ruiz JN (1998). "The use of serotonergic drugs in the treatment of impulse control disorders". 13: 172s. doi:10.1016/S0924-9338(99)80151-5. {{cite journal}}: Cite journal requires |journal= (help); Unknown parameter |jpurnal= ignored (help)
^ ^a ^b Grant JE, Potenza MN (2004). "Impulse Control Disorders: Clinical Characteristics and Pharmacological Management". Annals of Clinical Psychiatry. 16 (1): 27–34. doi:10.1080/10401230490281366. PMID 15147110.
^ ^a ^b ^c Hodgins; Peden (2008). "Cognitive-behavioral treatment for impulse control disorders" ''Revista brasileira de psiquiatria'' 30{1): S31-40
^ Chamberlain SR, Menzies L, Sahakian BJ, Fineberg NA (2007). "Lifting the Veil on Trichotillomania". American Journal of Psychiatry. 164 (4): 568–574. doi:10.1176/appi.ajp.164.4.568.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^ ^a ^b Mouton SG, Stanley MA (1996). "Habit reversal training for trichotillomania: A group approach". Cognitive and Behavioral Practice. 3: 159. doi:10.1016/S1077-7229(96)80036-8. Cite error: The named reference "Mouton" was defined multiple times with different content (see the help page).
^ McCloskey, M.S.; Noblett, K.L., Deffenbacher, J.L, Gollan, J.K., Coccaro, E.F. (2008). "Cognitive-Behavioral Therapy for Intermittent Explosive Disorder: A Pilot Randomized Clinical Trial". ''Journal of consulting and clinical psychology'' 76(5): 876-886
^ "S.14.04 Impulse control disorder: Prevalence and possible risk factors". European Neuropsychopharmacology. 19: S196–S197. 2009. doi:10.1016/S0924-977X(09)70247-0. {{cite journal}}: Text "author Weintraub D" ignored (help)
^ ^a ^b ^c ^d Fontenelle LF, Oostermeijer S, Harrison BJ, Pantelis C, Yücel M (2011). "Obsessive-Compulsive Disorder, Impulse Control Disorders and Drug Addiction". Drugs. 71 (7): 827–840. doi:10.2165/11591790-000000000-00000. PMID 21568361.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^ Dichter; Damiano, Allen(2012). "Reward circuitry dysfunction in psychiatric and neurodevelopmental disorders and genetic syndromes: animal models and clinical findings". [[Journal of Neurodevelopmental Disorders]] 4(19)
^ Ferbandez-Aranda; Pinheiro, Thornton, Berrettini, Crow, Fichter, Halmi, Kaplan, Keel, Mitchell, Rotondo, Strober, Woodside, Kaye, Bulik (2007). "Impulse control disorders in women with eating disorders". ''Psychiatry research'' 157(1-3):147-57.
^ Schmidt; Körber ,de Zwaan, Müller (2012). "Impulse Control Disorders in Obese Patients". ''European Eating Disorders Review'' 20(3): e144-e147
^ Joutsa; et all (2012). "Parkinsonism & Related Disorders (Impulse control disorders and depression in Finnish patients with Parkinson's disease". ''Parkinsonism & Related Disorders'' 18(2):155-160.
^ ^a ^b Brewer, Potenza(2008). "The Neurobiology and Genetics of Impulse Control Disorders: Relationships to Drug Addictions". ''Biochemical Pharmacology'' 75(1): 63–75.
^ Karakus, Tamam (2011). "Impulse control disorder comorbidity among patients with bipolar I disorder". ''Comprehensive Psychiatry'' 52(4):378-385

@@ Line 12: / Line 12: @@
  | MeshID         = D007174
 }}
-'''Impulse control disorder''' or '''ICD''' is a set of [[mental disorder|psychiatric disorders]] including [[intermittent explosive disorder]], [[kleptomania]], [[pathological gambling]], [[pyromania]] (fire-starting), and three [[body-focused repetitive behavior|body-focused repetitive]] or [[compulsive behavior]]s of [[trichotillomania]] (a compulsion to pull one's hair out), [[onychophagia]] (compulsive nail biting) and [[dermatillomania]] (compulsive skin picking). The onset of these disorders usually occurs between the ages of 7 and 15.<ref>{{cite journal |author=Kessler RC, Amminger GP, Aguilar-Gaxiola S, Alonso J, Lee S, Ustün TB |title=Age of onset of mental disorders: a review of recent literature |journal=[[Current opinion in psychiatry]]|volume=20 |issue=4 |pages=359–64 |year=2007 |pmid=17551351 |doi=10.1097/YCO.0b013e32816ebc8c |pmc=1925038}}</ref> [[Impulsivity]], the key feature of these disorders, can be thought of as seeking a small, short term gain; in the case of these behaviours, this gain is at the expense of a large and long term loss. Those with the disorder repeatedly demonstrate failure to resist their behavioral impetuosity. Studies have suggested that the occurance of an Impulse control disorder affects marital life and causes lonliness.<ref name="Lejoyeux"> {{cite journal| author= Lejoyeux M, Arbaretaz M, Mcloughlin M and Ades J |title= Impulse Control Disorders and Depression |journal=[[The Journal of Nervous and Mental Disease]]|volume= 190|issue=5|pages= 310-314|year=2002</ref> In a study performed by Raine et al (1994), it had been observed through the [[positron emission tomography]] (PET) scans that the glucose metabolism in the prefrontal and frontal cortex of implusive patients is lower than normal,<ref name=Raj> {{cite journal|author= Raj R, Sidhu BS|title= Tourette's disease with impulse control disorder|Journal=[[Indian Journal of Psychiatry]]|volume=53|issue=1|pages= 66-68|year=2011</ref> meaning there is decreased function of both mentioned cortex in impulsive patients. Five behavioural stages characterize ICD: an impulse, growing tension, pleasure from acting, relief from the urge and finally guilt which may or may not arise.<ref name= Wright>Wright; Rickards, Cavanna (2012). "Impulse-Control Disorders in Gilles de la Tourette syndrome". [[''The Journal of Neuropsychiatry and Clinical Neurosciences'']] '''24'''(1): 16-27.</ref>
+'''Impulse control disorder''' or '''ICD''' is a set of [[mental disorder|psychiatric disorders]] including [[intermittent explosive disorder]], [[kleptomania]], [[pathological gambling]], [[pyromania]] (fire-starting), and three [[body-focused repetitive behavior|body-focused repetitive]] or [[compulsive behavior]]s of [[trichotillomania]] (a compulsion to pull one's hair out), [[onychophagia]] (compulsive nail biting) and [[dermatillomania]] (compulsive skin picking). The onset of these disorders usually occurs between the ages of 7 and 15.<ref>{{cite journal |author=Kessler RC, Amminger GP, Aguilar-Gaxiola S, Alonso J, Lee S, Ustün TB |title=Age of onset of mental disorders: a review of recent literature |journal=[[Current opinion in psychiatry]]|volume=20 |issue=4 |pages=359–64 |year=2007 |pmid=17551351 |doi=10.1097/YCO.0b013e32816ebc8c |pmc=1925038}}</ref> [[Impulsivity]], the key feature of these disorders, can be thought of as seeking a small, short term gain; in the case of these behaviours, this gain is at the expense of a large and long term loss. Those with the disorder repeatedly demonstrate failure to resist their behavioral impetuosity. Studies have suggested that the occurance of an Impulse control disorder affects marital life and causes lonliness.<ref name="Lejoyeux"> {{cite journal| author= Lejoyeux M, Arbaretaz M, Mcloughlin M and Ades J |title= Impulse Control Disorders and Depression |journal=[[The Journal of Nervous and Mental Disease]]|volume= 190|issue=5|pages= 310-314|year=2002}}</ref> In a study performed by Raine et al (1994), it had been observed through the [[positron emission tomography]] (PET) scans that the glucose metabolism in the prefrontal and frontal cortex of implusive patients is lower than normal,<ref name=Raj> {{cite journal|author= Raj R, Sidhu BS|title= Tourette's disease with impulse control disorder|Journal=[[Indian Journal of Psychiatry]]|volume=53|issue=1|pages= 66-68|year=2011}}</ref> meaning there is decreased function of both mentioned cortex in impulsive patients. Five behavioural stages characterize ICD: an impulse, growing tension, pleasure from acting, relief from the urge and finally guilt which may or may not arise.<ref name= Wright>Wright; Rickards, Cavanna (2012). "Impulse-Control Disorders in Gilles de la Tourette syndrome". [[''The Journal of Neuropsychiatry and Clinical Neurosciences'']] '''24'''(1): 16-27.</ref>
 ==Categorization in the DSM-IV-TR==
@@ Line 20: / Line 20: @@
 ====Pathological gambling====
 [[Pathological gambling]] is an impulse control disorder characterized by maladaptive and re-current episodes of gambling that is significantly disruptive to the individual's familial and personal life.
-According to studies carried out until 2006, the prevalence of Pathological Gambling in adults was found to be between 1%-3% in the U.S., with the problem usually starting in adolescence with prevalence of about 4%-7%.<ref name=Bernardo> {{Cite doi |10.1007/s00406-006-0668-0}} </ref>
+According to studies carried out until 2006, the prevalence of Pathological Gambling in adults was found to be between 1%-3% in the U.S., with the problem usually starting in adolescence with prevalence of about 4%-7%.<ref name=Bernardo> {{Cite journal|author=Dell’Osso B, Altamura AC, Allen A, Marazziti D, Hollander E|year= 2006|title= Epidemiologic and clinical updates on impulse control disorders: A critical review|journal= [[European Archives of Psychiatry and Clinical Neuroscience]]|volume= 256| issue=8|pages= 464–475| doi=10.1007/s00406-006-0668-0|PMC=1705499|PMID=16960655}} </ref>
 ====Trichotillomania====