Impulse Control Disorders

Impulsivity is a trait ubiquitous with human nature. What separates humans from life forms of lower sentience is the evolution of neurocircuitry within the prefrontal cortex that allows one to practice self-governance. Self-governance, or self-control, has many monikers. Moffitt, for example, uses the sobriquet conscientiousness to express this notion of self-restraint. Moreover, whatever moniker is assigned, all encompass the foundational notion of effortful self-regulation. Those who can, for example, refrain from rising to an insult are considered to be more accomplished than their impulsive counterparts at implementing self-regulatory behavioral patterns.

Self-regulation arises from the existence of a conflict between two mutually exclusive inner psychic agencies, or more descriptively in Freudian terminology, between the impulsive id and the captious superego. One can either eat the cake, or not eat the cake, however, one cannot, both eat the cake and, at the same time, not eat the cake. Freud postulated that socialization was a process by which juveniles appreciated how best to suppress immediately satisfying urges, and instead consider what might be most beneficial for one's future self. This indelible imbroglio between our impulsive nature and self-governing consciousness is at the core of human nature.

Normative behavior encompasses both reactive and stolid patterns; however, psychopathology arises in the event of impaired self-regulation, giving rise to disinhibition. Disinhibited psychopathology has precipitated the nosologic identification of 'impulse control disorders' (ICD), in DSM 5. Those falling under the taxon of ICD experience "failure to resist an impulse, temptation, or drive to perform an act that is harmful to the other person or others." ICD, as defined in DSM 5, consists of oppositional defiant disorder (ODD), intermittent explosive disorder (IED), conduct disorder (CD), kleptomania, and pyromania. Two residual categories are available for those whose behavior does not meet the diagnostic threshold of the preceding categories.

Of note, a classification change occurred in the transition from DSM IV to 5. No longer is there the taxon' impulse-control disorders not elsewhere classified'. Instead, the disorders mentioned above fall under disruptive, impulse-control, and conduct disorders. Furthermore, attention deficit hyperactivity disorder (ADHD), trichotillomania, binge eating disorder, and pathologic gambling disorders were removed and relegated to neurodevelopmental, obsessive-compulsive, feeding, and substance-related and addictive disorders, respectively. Additionally, DSM 5 now allows for ODD and CD to coexist phenomenologically and offers a severity scale to be used in ODD. Compulsive shopping and internet addiction now fall under 'other specified disruptive, impulse control and conduct disorder,' whereas before they belonged to a category known as disruptive behavior disorder not otherwise specified (DBDNOS).