Tag Archives: Self-Control

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.

Mama’s Losin’ It

Post Comment Love

Me Want It (But Me Wait): Teaching Self-Control to Children

In the summer of 2013, Sesame Street released a fabulous video in which Cookie Monster is learning about self-control. Self-control is an important skill for children to master, as it will help them succeed at school and manage their behavior at home. Naturlly, young children have no self-control. Children with ADHD or similar issues may lack self-control up till a much older age./P>

There are many ways in which a parent can teach a child self-control. With babies, you need to begin by modeling. Remain calm yourself when your child is distressed. There may be various ways in which a baby is calmed. Some need lots of physical contact, while others need to be laid down for a bit. People vary in their opinion on self-soothing, ie. whether you need to attend to a baby when crying or ignore them. I think it depends on the baby.

Listening skills are a first requirement. Teach your child to come when you call them. Rigidly enforcing social skills like eye contact may not be appropriate for some children, like those with autism, but your child needs to learn to listen to their name and to attend to you.

When a young child cannot get what they want, cannot do what they want to do, or for another reason gets frustrated, they may tantrum. For a one-year-old, consequences don’t work, but distraction does. When your child is a little older, like from the age of two on, use brief time-outs as a consequence for tantrums. Like I’ve said before, make sure your child knows when the time-out is over. This means for a young child that you will need to call them back out of time-out. Again, this reinforces listening skills. For older children, you can ask that they come back when they’ve calmed, but this may not work for children who are still unable to understand their own emotions, like most children with autism. You can point out signs of them being calm again when you call them back out of time-out. This may help children learn about their own emotions and behaviors.

Besides giving consequences for impulsive behavior or tantrums, it’s also very important to reward self-control. If you’ve promised your child ice cream after dinner and they’ve behaved according to your reasonable expectations, give them the ice cream. That way a child learns that not only will impulsivity be punished, but also that patience and self-control are indeed going to get you farther along in life.

Motivation is not the same as self-control. If a child can focus fine on a computer game but not when tidying their room, that’s not a problem with self-control. It is more likely that they lack the motivation to tidy their room. It is however possible to change your attitude. Children will need help with this. For example, as a parent, you may turn tidying the child’s room into a game. You also need to model the right attitude. If you approach tasks like they’re nasty chores, much energy will go into motivating yourself to do the task. If you approach them with a positive attitude, you will find it’s much easier to stay motivated and thereby use your self-control skills. With children (and as adults!) who have a special interest, you can use the special interest as part of the nasty chore.

Of course, there are other skills required for completing tasks besides motivation. Your child will need to have the attention span to focus, the working memory to remember what they need to do, and the organizational skills to plan their task and get it actually finished. Until I did my research for this post, I thought this was the problem with me, but then I realized I can focus fine on this blog post, which requires reading and summarizing multiple sources. I’m now thinking that motivation may be an issue for me, and see above for solving that.

However, when someone truly has poor atttenion, working memory and/or organizational skills, these skills still can be trained at least in children. Computer-based games that reinforce memory or attention have some evidence of effecitveness behind them. Similarly, there are games that reinforce self-control directly. You know the game of stop and go, where a green light means go and a red light means stop? When the child is used to these rules, reverse them and your child will practice keeping their impulse to follow the original rules in check. I’m pretty sure there are computer-based variations to this game.