How do we distinguish compulsive vs impulsive behavior? I tell my students that compulsive behavior is repeated by the person even though that person is aware that this behavior will not result in the desired goal. This behavior can be anything from over-eating to engaging in dangerous sexual behaviors. Most people have heard of obsessive-compulsive disorder (OCD). Many of these patients are obsessed with cleaning, organization, etc.
Impulsive behavior is when the person acts quickly without considering the consequences involved. An example is if you dislike someone, you don’t just walk up to them and punch them in the face. If you did, you might get arrested for assault, or they might hit you back. On the other hand, someone who is impulsive might punch them without thinking. Both compulsive and impulsive behaviors can be associated with psychiatric disorders when they cannot be controlled and may hurt the quality of life.
This post will examine several compulsive and impulsive behaviors.
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The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has impulse control disorders listed under Disruptive, Impulse-Control, and Conduct Disorders. These include intermittent explosive disorder, pyromania, and Kleptomania. Although gambling disorder is listed under non-substance-related disorders in the DSM-5, we will include it as a conduct disorder.
This group of disorders may cause significant problems in the patient’s social and occupational functioning. They may also lead to legal and financial hardships.
Intermittent explosive disorder (IED) involves sudden aggressive, impulsive, violent episodes or angry verbal tantrums that are inappropriate given the current situation. These repetitive behaviors are a great example of poor inhibitory control. Some examples of IED include road rage, breaking or throwing objects, and domestic violence.
Pyromania: Pyromania is a condition in which the sufferer is unable to resist starting fires. These individuals know that this behavior is wrong, but this behavior is the only thing that relieves their anxiety, tension or satisfies other needs. Starting a fire does not automatically make you a pyromaniac. Pyromania is very rare. Here are symptoms that must be present for a pyromania diagnosis.
- Setting a fire on purpose on more than one occasion.
- Feeling energetic or tense before starting the fire.
- Being obsessed with anything involving fire.
- Feeling relief, gratification, or pleasure when setting fires, seeing fires, or being involved in a fires aftermath.
- Setting fires is not explained by other mental health disorders.
Kleptomania: Kleptomania is the inability to refrain from stealing unwanted or unneeded items. The items stolen are often given away or discarded soon after being obtained. Like other impulsive disorders, Kleptomania involves difficulty in controlling aggressive or antisocial impulses. This disorder is more common in women. The DSM-V outlines the following criteria for Kleptomania:
- Recurrent failure to resist impulses to steal objects that are not needed for personal use or their monetary value.
- Increasing sense of tension immediately before committing the theft.
- Pleasure, gratification, or relief at the time of committing the theft.
- The stealing is not committed to express anger or vengeance and is not in response to a delusion or hallucination.
- The stealing is not explained by conduct disorder, a manic episode, or antisocial personality disorder.
Obsessive and Compulsive Behaviors
Obsessive behaviors fall into four categories.
Hoarding- Most of us have seen the show hoarders on the television. These individuals accumulate things that they don’t need, including trash, animals, and random items. In addition, hoarders often live in unsanitary conditions. This condition is thought to be tied to a low distress tolerance and poor adjustment to anxiety. Collecting items may help the patient manage anxiety and stress.
Forbidden or harmful thoughts-These can be thoughts about sexual fantasies, aggression, or religion. They often cause the person to feel negative emotions such as shame. We all have forbidden thoughts at times, but these individuals are unable to control them. Therefore, the patient will often try to eliminate these thoughts unreasonably. They may avoid certain people or places in an attempt to rid themselves of intrusive thoughts. They may also participate in risky sexual behavior.
Cleaning-This is what many people think of when they think about OCD. However, these patients may be germaphobes or have a compulsive need to clean even when things are already spotless. These individuals are fearful of becoming sick or contaminated. Therefore, they will continue compulsive acts of cleaning until it affects their health.
Order and arrangement-Things must be in a particular order, or the person becomes distraught. This obsession can involve making sure all items are in a specific order and symmetrical. For example, they may rewrite letters to ensure they are all the same size and feel uncomfortable if their clothes are not hanging up in a particular order. These patients often suffer emotional pain if things aren’t “just right”.
Other disorders that may be mentioned here are drug addiction, compulsive buying, and compulsive eating.
Substance use disorders-This is an irresistible urge to use euphoric substances without consideration of the consequences. Unfortunately, one of the most dangerous examples of this is alcohol abuse. I have written about the dangers of alcohol abuse in the past. Those addicted to substances show a lack of impulse control. As a result, they often end up with financial and legal problems and may even die due to their addiction. Fortunately, substance abuse treatment is available.
Compulsive buying- This is often a precursor to hoarding. Current research suggests those suffering from impulse buying experience anxiety due to wanting some object of desire that they cannot identify. This “object of desire” would cause too much pain for the person to handle. Therefore, they use spending as a method of relieving this anxiety. Unfortunately, this leads to a vicious cycle of spending money on items the person does not need. Over time, credit cards are maxed out, and debt often leads the person to seek professional help.
Compulsive eating- Individuals who eat compulsively often eat even though they are full. They may eat late at night while others are asleep or eat to help combat anxiety. They may hide food to eat later. Unfortunately, many times unhealthy foods are consumed in large quantities. Some of these patients do not gain weight because they purge after eating. This may lead to bulimia and often requires professional help to resolve.
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Dopamine Dysregulation Syndrome (DDS)
Dopamine dysregulation syndrome may be caused by long-term treatment with Parkinson’s medication. We use dopamine agonists to treat Parkinson’s disease. Dopamine is a chemical messenger associated with the pleasure center of the brain. Since the drug used for Parkinson’s disease increases dopamine levels, these patients are at a higher risk of becoming addicted to and using higher doses of dopamine agonists than are necessary to treat their movement disorder. Patients with DDS often suffer from hypersexuality, compulsive eating, pathological gambling, and compulsive shopping. Hopefully, future research will help identify other groups at risk of developing DDS.
There is a common thread relating to all of these disorders, with the exception of DDS. Some need is not being met, and these behaviors help to give the patient a sense of control over their situation. Those who know me well realize that I always prefer to start with non-chemical treatments whenever possible. In the case of obsessive-compulsive spectrum disorders, I believe it is prudent, to begin with cognitive behavioral therapy. Although many people don’t have the financial ability or the time to engage in therapy sessions, books are available to help with this.
The next step is natural supplements or nutraceuticals. This is my specialty and the reason I started Sunshine Nutraceuticals.
If you or someone you know is suffering from any of these conditions affecting their quality of life, please seek professional help. Although medications aren’t necessary in all cases, they can be an effective tool in combating these disorders.
Michael J. Brown, RPh, BCPS, BCPP
Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.
Feel free to send Michael a message using this link.