Impulse Control Disorders

What are impulse control disorders?

Impulse control disorders (ICDs) are a group of behavioral conditions that make it difficult to control your actions or reactions. These problematic behaviors often cause harm to others and/or yourself. They can also lead to issues with the law.

Some examples of these behaviors include:

• Angry outbursts.
• Arguing and fighting.
• Destroying property.
• Defiance and disobedience.
• Stealing.
• Breaking rules or laws.

Signs of impulse control disorders typically begin in childhood and can continue into adulthood.

Types of impulse control disorders

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists the following conditions as impulse control disorders:

• Oppositional defiant disorder (ODD): This condition involves a continuing pattern of uncooperative, defiant and sometimes hostile behavior toward people in authority.
• Conduct disorder: This condition involves an ongoing pattern of aggression toward others. Children with this condition may also show serious violations of rules and social norms at home, in school and with peers.
• Intermittent explosive disorder: This condition involves frequent impulsive anger outbursts or aggression that cause significant distress.
• Kleptomania: This is a mental health condition in which you feel an overpowering, irresistible urge to steal things. People who have this disorder know that stealing is wrong and could get them into trouble, but they can’t stop themselves.
• Pyromania: This is a mental health condition in which you can’t resist the urge to start fires. You know the fires are harmful, but you can’t control the impulse to start one. People with pyromania feel tension before setting fires and a release after. They don’t start fires for any other reason than the release.

How common are impulse control disorders?

Each impulse control disorder affects different percentages of the general U.S. population:

• Oppositional defiant disorder (ODD): 3.3% of children and adolescents.
• Conduct disorder: 4% of children and adolescents.
• Intermittent explosive disorder: 2.7%.
• Kleptomania: 0.6%.

Pyromania is the rarest type of impulse control disorder. One study showed that only 3% of people in prison for arson specifically met the criteria for pyromania.

ICDs tend to affect people assigned male at birth (AMAB) more often than people assigned female at birth (AFAB), except for kleptomania.

What are the symptoms of impulse control disorders?

Each impulse control disorder has different signs and symptoms. But they all involve a decreased ability to control your own behavior, which often negatively affects other people or breaks laws.

Most people with an impulse control disorder know their behavior is inappropriate, but they can’t stop it. People with an ICD usually feel an increasing internal tension before they act out. After the deviant behavior, they often feel a release or catharsis.

Another way to think of impulse control disorders is that the behaviors are externalizing. In other words, people with ICDs express resentment and hostility outwardly to others. This often creates conflicts with other people (or the law). This is different from other kinds of mental health conditions, like anxiety disorders and mood disorders, in which the person internalizes their distress.

It’s important to remember that most kids become defiant at times. They test their — and other people’s — boundaries to learn what’s appropriate and what’s not. But impulse control disorders involve an ongoing pattern of much more severe behaviors. These behaviors disrupt daily life and negatively affect relationships.

What causes impulse control disorders?

Researchers are still learning about the causes of impulse control disorders. So far, they think a variety of factors contribute to their development, including:

• Genetics: Studies show that children with ODD are more likely to have biological parents with mood disorders. And children with conduct disorder are more likely to have biological parents with schizophrenia, ADHD, substance use disorder (SUD) or antisocial personality disorders (ASPDs). This suggests that there may be genetic factors at play.
• Environment: Studies show several environmental factors may contribute to ICDs, like low socioeconomic status, community violence, childhood neglect, experiencing or witnessing abuse, and having deviant peers or friends.
• Biology: Some studies show abnormal changes in brain or hormone (like cortisol) activity in people with ICDs.

How are impulse control disorders diagnosed?

Mental health professionals diagnose impulse control disorders based on the criteria in the DSM-5. The signs and symptoms usually have to be apparent for at least six or 12 months. In addition, they must cause significant clinical stress that disrupts your daily life.

You or your child will likely need to see a psychologist or psychiatrist if you or they are showing signs of an impulse control disorder. These experts use specially designed interview and assessment tools to check for mental and behavioral conditions.

Psychiatrists and psychologists often rely on reports of people close to the person to get a full understanding of their behavior. This could include parents, siblings, friends and teachers.

How are impulse control disorders treated?

The U.S. Food and Drug Administration (FDA) doesn’t approve any medications for impulse control disorders. So treatment mainly involves therapy and parenting strategy adjustments.

Helpful parenting strategies for ICDs include:

• Reducing positive reinforcement of undesirable behavior.
• Encouraging behaviors that involve feeling empathy and concern for others (prosocial behaviors).
• Using nonviolent discipline.
• Making consistent, predictable parenting decisions.

Specific therapies that can help include:

• Parent management training (PMT): PMT involves teaching parents or caregivers techniques to help their child improve behaviors and learn new skills. The goal of this therapy is to set consistent discipline with proper rewarding of positive behaviors.
• Multisystemic therapy (MST): This type of therapy uses family strengths to encourage positive coping activities. A licensed therapist works with the parents or caregivers to reinforce positive behaviors and reduce negative behaviors. They help the family increase accountability and problem-solving.
• Cognitive behavioral therapy (CBT): CBT is a structured, goal-oriented type of psychotherapy (talk therapy). Therapists use it for the child with an ICD along with parent management. During CBT, a therapist helps your child take a close look at their thoughts and emotions. They’ll come to understand how their thoughts affect their actions. Through CBT, they can unlearn negative thoughts and behaviors and learn to adopt healthier thinking patterns.

Can impulse control disorders be prevented?

While they may not be entirely preventable, early diagnosis and treatment of impulse control disorders can greatly reduce the distress that your child and family experience. Additionally, it can help prevent the various issues that are commonly associated with ICDs.

What is the prognosis for impulse control disorders?

The prognosis (outlook) for impulse control disorders can vary based on the specific condition and its severity. But ICDs tend to be chronic (long-term) and can significantly impact the lives of those who have them and their loved ones.

Studies show that people with an ICD have a high likelihood of:

• Future substance use.
• Depression.
• Unemployment.
• Relationship difficulties.

However, intensive therapy can help keep problematic behaviors at bay.

A note from Cleveland Clinic

Children and teens who are aggressive or break rules or laws can be very challenging for parents. While it’s normal for young children and teens to show defiant behavior from time to time, frequent and disruptive behavior may indicate an impulse control disorder.

Starting treatment early for impulse control disorders is important, and the first step to treatment is to talk with a healthcare provider or a mental health professional. Don’t be afraid to ask your provider questions. They’re available to help.