Tag Archives: Impulse Control Disorder

Psychiatric Diagnoses I’ve Been Given

I just checked out the “30 days of mental illness awareness” challenge and was inspired to write a timeline of my mental health. Then I realized I already wrote it in 2015. Another question in the 30-day challenge though is what you’re currently diagnosed with. Seriously, I don’t know what exactly my current diagnosis is. I know what the university hospital psychologist diagnosed me with, but I am not sure the psychiatrist at my current community treatment team agrees.

I’ve had a lot of diagnoses in the past. I’ve had even more suggested diagnoses that never made it into my file. Today, I will write a list of the diagnoses I’ve had. I will comment on them too.

1. Autism spectrum disorder. I was first diagnosed with this twice in 2007, then again in 2010. I lost my diagnosis in 2016 and was rediagnosed in 2017. This is the only diagnosis I’m pretty sure of that I agree with 100%. It’s the only diagnosis that I’ve been given through a proper evaluation (several, in fact).

2. Adjustment disorder. This was my diagnosis upon admission to the mental hospital in 2007. I didn’t meet the criteria for depression or any other serious mental health condition but needed care anyway. I was at the time fine with that diagnosis and think the crisis team psychiatrist who made it, did a pretty good job of assessing me.

3. Impulse control disorder NOS. I was never told why I got this diagnosis. I just found it on my treatment plan in May 2008. Probably, it was a replacement for the adjustment disorder, which you can only have for six months once the stressor that caused it goes away. I never agreed with this diagnosis and didn’t really take it all that seriously.

4. Dissociative identity disorder. This was diagnosed in November of 2010 and was probably the most controversial diagnosis I’ve ever had. I wasn’t properly assessed for it and my psychologist at the time took what I told her almost at face value. I never believed deep down that I met the full criteria for this. I mean, yes I do have alters and I do have pretty bad dissociative symptoms sometimes, but amnesia is the exception. I find this terribly hard to admit but I do have to acknowledge this diagnosis was in part based on (self-)suggestion. I do believe, like I said, that I have some dissociative symptoms.

5. Post-traumatic stress disorder. I got this diagnosis together with the DID. I don’t really know why. I mean, yes, I did (and still do) have some symptoms, but I’m not sure I have nough and I never reported more than I actually had. I did get some assessment for this. I do currently believe I definitely do have some PTSD symptoms, particularly complex PTSD symptoms. Then again, there is a lot of overlap with borderline personality disorder traits.

6. Borderline personality disorder. This was diagnosed in 2013 and replaced DID and PTSD. It was later “downgraded” to BPD traits. I do agree I have BPD traits, but I am more the quiet borderline type.

7. Dependent personality disorder. I was given this diagnosis in 2016. Never quite agreed with it, except in the sense that I could be led to believe I had every disorder that was ever suggested to me.

8. Depression. This was diagnosed in 2017 by the university hospital psychologist. I had previously been diagnosed with depressive disorder NOS, but that, according to my psychologist, was only because a diagnosis on axis I (anything other than a personality disorder) is required for treatment. I admit I was pretty badly depressed in the months that I had my assessment at the university hospital, but am not sure it was bad enough for a diagnosis. I mean, I didn’t meet the criteria in 2007, so how could I meet them in 2017? I’m assuming my current psychiatrist removed that diagnosis.


Impulse Control Disorders

In 2008, I read my treatment plan one day and saw my DSM-IV diagnostic classification. I had not only been diagnosed with Asperger’s Syndrome, which I already knew. In addition, I had been given a diagnosis of impulse control disorder not otherwise specified. This diagnosis has since been taken off my records, for which I am thankful, since my idea of the disorder was pretty negative. Since one of the writing prompts on Mama’s Losin’ It for this week is to write a post inspired by the word “impulsive”, I thought I’d educate you about impulse control disorders.

In DSM-IV, the psychiatrist’s diagnostic manual in use at the time of my diagnosis (and still in use in the Netherlands now), impulse control disorders make up their own diagnostic category distinct from disruptive behavior disorders and personality disorders that may include impulsive and/or antisocial behavior. It was in fact made very clear to me by an educated peer that impulse control disorders are quite different from antisocial behavior, because the underlying idea behind impulse control disorders is that you have little control over your impulses. Those with disruptive behavior disorders (eg. conduct disorder and oppositional defiant disorder) willfully misbehave.

The treatment, I found out, is also quite different. Whereas those with conduct disorders need to be punished for their behaviors, those with impulse control disorders need to learn what sets them off, so that they can prevent their impulsive behaviors. This is significant, because at the time of my diagnosis, I still resided on a locked unit and had seclusion used against me to “get me to take responsibility for my behavior”. Now seclusion and other restrictive behavior management techniques cannot legally be used as punishment anyway. I am, instead, all for expecting people who display aggression to make up for the damages they cause.

So what is an impulse control disorder? In DSM-IV, impulse control disorders included kleptomania, pyromania as well as pathological gambling. Pathological gambling is now, in DSM-5 (the current edition of the psychiatrist’s manual), classified as a behavioral addiction, but kleptomania and pyromania are still listed as impulse control disorders. The category in DSM-IV also includes intermittent explosive disorder (IED), the disorder which I was most close to meeting the criteria of.

IED is described in DSM-IV as characterized by several discrete episodes in which the affected person is unable to resist aggressive impulses. The aggression leads to serious assaultive acts or destruction of property. The aggression displayed during these episodes is grossly out of proportion to the psychosocial stressor(s) that may’ve led to it. The disturbance is not better explained by any other mental disorder (eg. antisocial or borderline personality disorder, conduct disorder, ADHD, psychosis or mania) and is not due to the direct physiological effects of a medication used or a substance of abuse.

In DSM-5, impulse control disorders such as kleptomania, pyromania and IED are lumped together with conduct disorder, oppositional defiant disorder and even antisocial personality disorder. The authors of the chapter on disruptive, impulse control and conduct disorders do make it clear that there is a distinction between an inability to control one’s emotions (like anger in IED) and disruptive behaviors (as in conduct disorder). They however seem to mean that in all disorders in the chapter, there is some focus on both emotional and behavioral dysregulation.

How are impulse control disorders treated? For IED and other impulse control disorders, antidepressatns have been found somewhat effective, although none have been approvd by the FDA. In one study cited on Wikipedia, people with IED responded relatively well to particularly fluoxetine (Prozac). In addition to medication, cognitive-behavioral psychotherapy is used. People with IED need to learn to relax, use alternative coping skills and resist aggressive impulses. Psychoeducation about their disorder in a group setting can also help.

IED, for clarity’s sake, does by definition lead to aggression and may lead to criminal behavior. It, therefore, does cause a disruption to other people’s lives and may lead to violations of societal norms. With my focus on an inability to control oneself rather than willful misbehavior, I did not mean to minimize the suffering others experience at the hands of someone with IED. I have not been physically aggressive towards people since adolescence, but this is one reason I was diagnosed with an impulse control disorder not otherwise specified.

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Mental Health Awareness: Living with Significant Mental Illness

Today, I’m linking up with Vicky’s mental health linky for Mental Health Awareness Week in the UK. As regular readers will know, I’ve been diagnosed with a mental illness for years. My original diagnosis was adjustment disorder, because I had landed in a psychiatric crisis when living indpendently and just didn’t meet the criteria for depression. My parents joke that I just didn’t wake up at the right time, because my doctor told me when I had sleep disturbances, that they weren’t typical of depression. I’m pretty sure I wasn’t clinically depressed.

Then came impulse control disorder NOS, which was basically an extension of the adjustment disorder I suppose, except that it reflected just my behaviors and not my moods.

In 2010, I was diagnosed wit dissociative identity disorder and PTSD. I want to tell anyone with a diagnosis of PTSD that it’s not a life sentence. I had a mild case as far as the regular symptoms were concerned (I also had symptoms of complex PTSD, and still do). EMDR treatment was suggested a few times, which can be very effective. However, because I had such a mild version of PTSD, the symptoms lessened to the point where I no longer needed the diagnosis with a lot of talking about my traumatic experiences. I later found out that talking and talking on about your trauma under a therapist’s guidance until it doesn’t hurt as much anymore may in fact be effective in people not responding ot EMDR. I don’t know the specifics of this therpay, which is called imaginary exposure, and I didn’t get any formal form of treatment for the PTSD myself.

As for the DID, I have or had a mild version of that too, probably more dissociative disorder NOS, and was able to hide the symptooms when people weren’t accepting of them anymore. There are many people, mostly peers, who believe my diagnosis of DID was incorrect. As for my therapist, she changed it to borderline personality disorder and feels this includes mild versions of DID too, so that I don’t need an additional diagnosis.

What is it like living with a mental illness? Well, for me, it is one confusing experience. I am very suggestible and have a poor sense of self. This means that I absorb many emotions from other people, and yet I do not know how to handle these emotions. I can have rapidly shifting, dramatic mood swings. One momnet, I’m fine; the next, i’m raging. Then again, my definition of “fine” is probably not the same as a currenlty mentally healthy person’s, because I’m always somewhat anxious and/or depressed.

Borderline personality disorder often co-occurs with other disorders. I have no additional diagnoses (other than autism, which I don’t consider a psychiatric disorder), but I could likely have been diagnosed with a range of disorders if this would make a difference. As I said, I have dissociative symptoms. I also have suffered from chronic, low-grade depressive moods since my teens, and likely had what is now called disruptive mood dysregulation disorder as a child. I also have some level of anxiety and used to have quite bad obsessive-compulsive symptoms in my teens and early twenties. They however went away witout treatment when I was hospitalized, so were likely a response to stress. Same with many of my somatic symptoms.

There is treatment for most of my mental health symptoms. In fact, I have improved a great deal over the years. That doesn’t mean my mental illness can be cured. I strive for recovery, which means living a meaningful life in spite of my mental illness.

Living a meaningful life, for clarity’s sake, does not necessarily mean not needing mental health support. It is a common misconception, which I fight even with my therapist, that needing less support is the ultimate measure of quality of life. I, for one, am likely to need support for the rest of my life. This doesn’t mean I can’t find joy or even happiness. I find joy in my hobbies, which include blogging, crafting and reading. I find happiness through my relationship with my husband. I do still have significant mental health problems, and I won’t say they don’t limit me. Then again, I’m more limited by the idea that needing less support is more important than feeling better.