CHAPTER 9 - PowerPoint Presentation

Slide1

CHAPTER 9 IMPULSE CONTROL DISORDERS

-A need or

desire that must be satisfied immediately regardless

of consequences

.

-Many

of

behaviors

have adverse or even destructive consequences for

individuals

, &

seldom

they

know

why

they do or why it is pleasurable

.Slide2

Essential features of impulse control disorders:-Failure to resist impulse, drive, or temptation to perform some acts that is harmful to person or others. -There may or may not be conscious resistance to impulse.

-

The

act may or may not be premeditated or planned.

-

I

ncreasing

sense of tension or arousal before committing the act.Slide3

-Experience of either pleasure, gratification, or release at, the time of committing the act. -The act is ego-syntonic: it gratifies a conscious wish of the individual’s at the moment. -Immediately after the act, there may or may not be genuine regret, self-reproach, or guilt.Slide4

1. Intermittent explosive disorder

-

L

oss

of control of

violent/aggressive

impulse that culminates in serious assaultive acts or destruction of property

.

-Some

pts.

report changes in sunroom,

as

confusion

during

episode

or amnesia for events

occurred

during

episode

.Slide5

-Sx usually appear suddenly & terminate abruptly, lasting only minutes to few hours, followed by feelings of genuine remorse & self-reproach about behavior.-Often starts in second or third decade of age.-Social r/s disturb R/T unexpected aggressive behavior.

-Disorder is rare & in males > females.Slide6

Rx-Drugs: phenothiazine sometimes anti-depression, anti-convulsant.-Psychotherapy:

Individual psychotherapy maybe

difficult,

dangerous &

mostly

unuseful

.

-Family therapy:

useful

when pt.

is adolescent

.Slide7

2. Kleptomania

-Recurrent

failure to resist impulses to steal objects not needed for personal use or their monetary

value

.

-Often stolen objects, for which individual

usually has enough

money

to pay,

are given away, discarded, returned, or

kept

hidden

.Slide8

-kleptomaniac steals purely for sake of stealing & for sense of relief & gratification that follows episode.-Rare disorder.-In females > males.-Starts in childhood then increase then decreases & become chronic & usually has judicial problems.Slide9

Rx-Insight psychotherapy psychoanalytic psychotherapy succeeds well in treating these condition especially if pt. has motivation for Rx. -Behavioral Rx

by desensitization or converted conditioning.Slide10

3. Pathological gambling

-Chronic

&

progressive failure to resist impulses to gamble, &

gambling behavior that compromises, disrupts, or

damages

personal

, family, or vocational

pursuits

.

-Impulse to gamble intensifies when individual

is under stress

.Slide11

-Many pathological gamblers exhibit characteristics associated with narcissism & grandiosity & often have difficulties with intimacy, empathy & trust.-Usually starts in adolescence (in males before females).-Fluctuates from exacerbation to remission.

-Often becomes chronic.Slide12

Rx -Rarely that pt. comes by himself to Rx but usually comes for another psychological complaints or pressure of family or judicial problems.-Admission to hospital to make him away from gambling environment &

to

insight

him

of

problem conditional by making him away of gambling for 3 months then to be treated by psychotherapy.Slide13

4. Pyromania

-Inability

to resist the impulse to set fires

.

-The

act

is

proceeded by tension or affect in arousal, &

pt.

experiences intense pleasure, gratification, or relief when

setting

fires or witnessing or participating in their aftermath

.

-Some

pyromaniacs may take precautions to avoid

fear,

many are totally indifferent to

consequences

of their behavior

.Slide14

-Usually starts in childhood & when starts in adolescence it is more destructive.-In males who are less intelligent.-Often have behavioral hx

of deviation, escaping from home, school, urine incontinence, aggressiveness against animals

.Slide15

Rx-Children: psychotherapy: behavioral or psychoanalytic to keep then from continuing this behavior.-Adults: Depends on their motivation for

Rx

so it is necessary to them as the only way to prevent their dangers.Slide16

5.Trichotillomania

-Recurrent

failure to resist impulses to pull

out

one’s

own

hair

.

-Impulse

is preceded by

increasing

sense of tension

, & then

individual experiences

sense

of release or ratification from pulling out

hair

.

-Usually in childhood but may occur at geriatric.

-In females >

males.Slide17

Rx-Anti-anxiety, anti-depression or anti-psychotic.-Behavioral therapy (Biofeedback).-

Mystification.

-

Individual

or

group

psychotherapy.