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Impulsive Disorders

The document summarizes information about impulsive disorders with a focus on pyromania and kleptomania. It describes the key characteristics of impulsive disorders as violating social norms and bringing conflict. It then discusses specific disorders like kleptomania and pyromania in more detail, covering epidemiology, diagnostic criteria, etiology, differential diagnosis, and treatment approaches.

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Ali B. Safadi
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199 views21 pages

Impulsive Disorders

The document summarizes information about impulsive disorders with a focus on pyromania and kleptomania. It describes the key characteristics of impulsive disorders as violating social norms and bringing conflict. It then discusses specific disorders like kleptomania and pyromania in more detail, covering epidemiology, diagnostic criteria, etiology, differential diagnosis, and treatment approaches.

Uploaded by

Ali B. Safadi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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IMPULSIVE DISORDERS

With a focus on pyromania and kleptomania


Hicham Baba
Impulsive disorders
• Violate the rights of others
• Bring the individual into significant
conflict with societal norms or authority figures.

• Includes

• Oppositional defiant disorder, • Kleptomania,


• Intermittent explosive disorder • Other specified and unspecified
• Conduct disorder • Disruptive, impulse-control
• Antisocial • Pathological gambling
• Pyromania • Trichotillomania
• Skin picking
Impulsive disorders
• Two extremes:
• Conduct disorder focus largely on poorly controlled behaviors that violate the
rights of others or that violate major societal norms.
• Intermittent explosive disorder focuses largely on poorly controlled emotion,
outbursts of anger that are disproportionate to the interpersonal or other
provocation or to other psychosocial stressors.
• Intermediate in impact to these two disorders is
• Oppositional defiant disorder, in which the criteria are more evenly distributed
between emotions (anger and irritation) and behaviors (argumentativeness and
defiance).
• Pyromania and kleptomania are less commonly used diagnoses characterized by
poor impulse control related to specific behaviors (fire setting or stealing) that
relieve internal tension.
• Others do not meet the criteria for one diagnosis:
• Specified disruptive, impulse-control, and conduct disorder
• there are symptoms of conduct disorder, oppositional defiant disorder, or other disruptive,
impulse-control, and conduct disorders,
• the number of symptoms does not meet the diagnostic threshold for any of the disorders,
even though there is evidence of clinically significant impairment associated with the
symptoms
Kleptomania - Definition

• It is a recurrent failure to resist impulses

to steal objects not needed for personal use or for monetary value.

• The objects taken are often given away, returned surreptitiously, or kept

and hidden.

• Persons with kleptomania usually have the money to pay for the objects

they impulsively steal.

• The focus is not the object being stolen, rather the act of stealing itself
Kleptomania - Epidemiology
• Estimated to be about 0.6%.

• The range varies from 3.8-24% of those arrested

for shoplifting. Some reports indicate <5%.

• The male-to female ratio is 1:3 in clinical samples

• Ages 50M vs 35F

• Women go for psych eval; Men go to prison

• The frequency of stealing ranged from less than 1

to 120 episodes a month


Kleptomania - What happens?
• 1) Mounting tension before the act,

• 2) Gratification and lessening of tension


• with or without guilt, remorse, or depression after the act.

• The stealing is not planned and does not involve others.

• Less likely to occur if immediate arrest is probable

• Some people do not assess the chance of apprehension

• Repeated arrests lead to pain and humiliation


• Guilt and anxiety occur in these people,

• Anger or feelings of vengeance are not often seen


Kleptomania – Etiology
• Tend to appear in times of significant stress

• Losses, separations, and endings of important relationships

• Psychoanalytic writers stress on:

• The expression of aggressive impulses

• Libidinal aspect

• Considerations of the act, the object stolen and the victims of the theft

• Anna Freud theorizes that the first thefts from mother's purse indicate the degree to

which all stealing is rooted in the oneness between mother and child.

• Karl Abraham wrote of the central feelings of being neglected, injured, or unwanted.
Kleptomania – Etiology
• One theoretician established seven categories of stealing in chronically

acting-out children

• 1. As a means of restoring the lost mother-child relationship

• 2. As an aggressive act

• 3. As a defense against fears of being damaged

• (perhaps a search by girls for a penis or a protection against castration anxiety in boys)

• 4. As a means of seeking punishment

• 5. As a means of restoring or adding to self-esteem

• 6. In connection with, and as a reaction to, a family secret

• 7. As excitement (lust angst) and a substitute for a sexual act


Kleptomania – Biology and Family
• Brain diseases and mental retardation

• Focal neurological signs,

• Cortical atrophy, enlarged lateral ventricles

• Disturbances in monoamine metabolism

• Serotonin, dopamine , opioid

• 7% of first-degree relatives had OCD

• Higher rate of mood disorders has been reported in family members


Kleptomania – Diagnosis
• Attempt to resist the impulse to steal and know that the act it is wrong and senseless.

1. Sporadic with brief episodes and long periods of remission;

2. Episodic with protracted periods of stealing and periods of remission;

3. Chronic with some degree of fluctuation (relapse-remitting)


Kleptomania – Differential Diagnosis
• Ordinary theft.
• Ordinary theft (whether planned or impulsive) is deliberate
and is motivated by the usefulness of the object or its
monetary worth.
• Some individuals, especially adolescents, may also steal on a
dare, as an act of rebellion, or as a rite of passage.
• The diagnosis is not made unless other characteristic
features of kleptomania are also present.
• Kleptomania is exceedingly rare, whereas shoplifting is
relatively common
• most are teenagers and young adults who "boost" in pairs or small
groups for "kicks," as well as goods, and do not have a major
psychiatric disorder.
Kleptomania – Differential Diagnosis
• Malingering.
• individuals may simulate the symptoms of kleptomania to avoid
criminal prosecution. Invent stories that might seem believable
• Antisocial personality disorder and conduct disorder.
• deliberately undertaken for personal gain
• degree of premeditation and planning (often with others)
• threat of harm or actual violence, particularly to elude capture
• Guilt and remorse are lacking, or patients are patently insincere
• Manic episodes or drug intoxication
• Major depression with psychotic episodes
• Psychotic episodes
• delusions or hallucinations
• Major neurocognitive disorder.
Kleptomania – Treatment
• Insight oriented psychotherapy and psychoanalysis depend
on patients' motivations.
• Insight-oriented psychotherapy
• those who feel guilt and shame
• because of their increased motivation to change their behavior.
• Behavior therapy
• systematic desensitization, aversive conditioning,
• combination of aversive conditioning and altered social contingencies
• successful even when motivation was lacking.
• Drug therapy
• SSRIs, such as fluoxetine (Prozac) and fluvoxamine (Luvox)
• Tricyclic drugs, trazodone, lithium, valproate, naltrexone, and
electroconvulsive therapy
p
Pyromania –
Epidemiology & Comorbidities
• More common in men (8:1)
• 40% are less than 18 years old
• Associated with:
• Substance abuse (esp. alcoholism)
• Affective disorders, depressive or bipolar;
• Impulse control disorders, such as kleptomania in female fire setters;
• Inadequate and borderline personality disorders
• ADHD, adjustment and learning disabilities
• Low serotonin, hypoglycemia
• Are likely to be mildly retarded
• History of antisocial traits, such as truancy, running away from
home, and delinquency
• Enuresis
• Association between cruelty to animals and fire setting
Pyromania - Diagnosis
• Make advance preparations for starting the fire
• Indifferent or derive satisfaction from destruction
Pyromania – Differential Diagnosis

• Other causes of intentional fire setting.


• Profit, sabotage, or revenge; to conceal a crime;
• to make a political statement (e.g., an act of terrorism or protest) - arsonist
• to attract attention or recognition (e.g., setting a fire in order to discover it
and save the day).
• Fire setting may also occur as part of developmental experimentation in
childhood (e.g., playing with matches, lighters, or fire).
Pyromania – Differential Diagnosis
• Other mental disorders.
• Conduct disorder, a manic episode, or antisocial personality
disorder (deliberate)
• In response to a delusion or a hallucination (e.g., in
schizophrenia)
• Attributable to the physiological effects of another medical
condition (e.g., epilepsy).
• Major neurocognitive disorder, intellectual disability, or sub
stance intoxication. (Alzheimer's – do not appreciate the
severity)
Pyromania – Etiology
• Freud – sexuality (warmth and shape)
• Abnormal craving for power and social prestige
• Venting accumulated rage over frustration caused by a sense of social,
physical, or sexual inferiority.

• About patients
• Some patients with pyromania are volunteer firefighters who set fires to
prove themselves brave, to force other firefighters into action, or to
demonstrate their power to extinguish a blaze.
• Several studies have noted that the fathers of patients with pyromania were
absent from the home.
• it represents a wish for the absent father to return home as a rescuer, to put out
the fire, and to save the child from a difficult existence.
• Females trends: promiscuity without pleasure and petty stealing,
Pyromania – Treatment
• Children – good prognosis, complete remission possible
• Adults – not as good (deny their actions, refuse to take
responsibility, are dependent on alcohol, and lack insight)

• Behavioral approaches
• Should include supervision of patients to prevent a
repeated episode of fire setting
• Incarceration may be the only method of preventing a
recurrence
• Family therapy
References
• Kaplan & Sadock's Synopsis Of Psychiatry -11E
• DSM-V

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