Psych · General adult psychiatry — impulse-control disorders
Impulse-control disorders overview
Also known as Impulse control disorders · Disruptive impulse-control and conduct disorders · Intermittent explosive disorder overview · Kleptomania overview · Pyromania overview · Behavioural impulsivity disorders · DICCD · CSBD impulse control
Exam-exhaustive fellowship atlas on impulse-control disorders as a group — DSM-5-TR Disruptive/Impulse-Control/Conduct chapter versus ICD-11 Impulse control disorders, major reclassifications (gambling, OCRD, CSBD), shared urge phenomenology, IED epidemiology, kleptomania and pyromania, dopamine-agonist ICDs, assessment (MIDI/QUIP concepts), CBT-first care, fluoxetine and naltrexone evidence, forensic and risk interfaces. FRANZCP-primary, globally tagged.
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Target exams
Red flags
- Acute violence, arson risk, or access to weapons/fire-setting materials — prioritise safety, environment control, and legal status over nosology debates
- New-onset gambling, hypersexuality, shopping, or binge eating after dopamine-agonist start or dose rise — review the drug with neurology urgently
- Mania, stimulant intoxication, or frontal-organic disease mislabelled as a primary impulse-control disorder
- Post-arrest or post-disclosure suicidal crisis after theft, assault, or fire-setting — structured suicide assessment is mandatory
- Prescribing naltrexone without baseline LFTs or as monotherapy without psychosocial care
- Instrumental criminal theft or revenge arson misdiagnosed as kleptomania or pyromania
Meet the patient
A 63-year-old man is referred by his wife, not by himself. Over eight months he has lost forty thousand dollars on online poker, started shopping at three in the morning, and been caught taking small items from a hardware store he could easily afford. He is mortified and cannot explain any of it.[9][16]
No mania. No intoxication. No prior psychiatric history at all. What he does have, and nobody in the referral chain has mentioned, is Parkinson disease — and a dopamine agonist started fourteen months ago.[9][10][16]
The examiner's question is not "which impulse-control disorder is this?" It is "what did somebody prescribe, and when?" This topic is the map that stops you answering the first question and missing the second.[10][16]
References16ShowHide
- [1]Dell'Osso B, Altamura AC, Allen A, Marazziti D, Hollander E Epidemiologic and clinical updates on impulse control disorders: a critical review Eur Arch Psychiatry Clin Neurosci, 2006.PMID 16960655
- [2]Schreiber L, Odlaug BL, Grant JE Impulse control disorders: updated review of clinical characteristics and pharmacological management Front Psychiatry, 2011.PMID 21556272
- [3]Grant JE, Levine L, Kim D, Potenza MN Impulse control disorders in adult psychiatric inpatients Am J Psychiatry, 2005.PMID 16263865
- [4]Kessler RC, Coccaro EF, Fava M, Jaeger S, Jin R, Walters E The prevalence and correlates of DSM-IV intermittent explosive disorder in the National Comorbidity Survey Replication Arch Gen Psychiatry, 2006.PMID 16754840
- [5]Coccaro EF Intermittent explosive disorder as a disorder of impulsive aggression for DSM-5 Am J Psychiatry, 2012.PMID 22535310
- [6]Coccaro EF, Lee RJ, Kavoussi RJ A double-blind, randomized, placebo-controlled trial of fluoxetine in patients with intermittent explosive disorder J Clin Psychiatry, 2009.PMID 19389333
- [7]Grant JE, Kim SW, Odlaug BL A double-blind, placebo-controlled study of the opiate antagonist, naltrexone, in the treatment of kleptomania Biol Psychiatry, 2009.PMID 19217077
- [8]Grant JE, Won Kim S Clinical characteristics and psychiatric comorbidity of pyromania J Clin Psychiatry, 2007.PMID 18052565
- [9]Weintraub D, Koester J, Potenza MN, Siderowf AD, Stacy M, Voon V, et al. Impulse control disorders in Parkinson disease: a cross-sectional study of 3090 patients Arch Neurol, 2010.PMID 20457959
- [10]Weintraub D, Siderowf AD, Potenza MN, Goveas J, Morales KH, Duda JE, et al. Association of dopamine agonist use with impulse control disorders in Parkinson disease Arch Neurol, 2006.PMID 16831966
- [11]Kraus SW, Krueger RB, Briken P, First MB, Stein DJ, Kaplan MS, et al. Compulsive sexual behaviour disorder in the ICD-11 World Psychiatry, 2018.PMID 29352554
- [12]Potenza MN, Balodis IM, Derevensky J, Grant JE, Petry NM, Verdejo-Garcia A, et al. Gambling disorder Nat Rev Dis Primers, 2019.PMID 31346179
- [13]Grant JE, Odlaug BL, Kim SW Kleptomania: clinical characteristics and relationship to substance use disorders Am J Drug Alcohol Abuse, 2010.PMID 20575650
- [14]Chamberlain SR, Grant JE Minnesota Impulse Disorders Interview (MIDI): Validation of a structured diagnostic clinical interview for impulse control disorders Psychiatry Res, 2018.PMID 29772488
- [15]Coccaro EF, Lee R, McCloskey MS Validity of the new A1 and A2 criteria for DSM-5 intermittent explosive disorder Compr Psychiatry, 2014.PMID 24321204
- [16]Voon V, Sohr M, Lang AE, Potenza MN, Siderowf AD, Whetteckey J, et al. Impulse control disorders in Parkinson disease: a multicenter case--control study Ann Neurol, 2011.PMID 21416496