impulse-control disorders abnormal psychology chapter 12 (p. 445) apr 9, 2009 class #22
TRANSCRIPT
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Impulse-Control Disorders
Abnormal Psychology
Chapter 12 (p. 445)
Apr 9, 2009
Class #22
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Impulse-Control Disorders
Pathological Gambling Kleptomania Pyromania Trichotillomania Intermittent Explosive Disorder
These disorders are characterized by an inability to resist an impulse to perform behaviors that are dangerous to others or to themselves
What these disorders have in common is a tension building to irresistible levels before engaging in the behavior, and a feeling of relief or pleasure afterward
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Impulse-Control Disorders
As always, look at these five disorders with your usual critical analysis… Should DSM experts keep these here?
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Pathological Gambling
Different than other disorders in that gambling (at least to a point) is encouraged by our society… Probably at least 3% of the population
Not officially recognized by APA until 1980 (DSM-III) and is now classified as an impulse control disorder (an irresistible urge to do something)
Gender difference: M > F but this is probably an opportunity based
difference and is changing (getting closer)
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Let’s try to make a distinction…
Probably at least half of us gamble at one time or another… Poker game on Friday night Super Bowl NCAA March Madness Lottery Casino
Its not a big deal, win or lose most get on with their lives immediately
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But not for some…
Loss of control over gambling Lies about the extent of involvement with
gambling Family and job disruption Stealing money
Even from friends and family From their child’s piggybank or savings bonds is not
uncommon The game (activity) wagered on precludes all
other interests
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Personality Characteristics
Better than average intelligence Immaturity Rebellious Thrill-seeking
Gamblers habitually take chances Superstitious
In many ways, sounds like what other disorder we recently covered???
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Behavioral Characteristics
The pathological gambler is always full of optimism and never learns from defeat Sometimes there is initial caution but the
gambler will eventually risk too large sums of money
They never stop after winning Worse yet they “chase losses”
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Some interesting sex differences…
Potenza (2001) Males have more problems with sports
gambling, dog and horse racing, card games, roulette, dice, etc.
Females have more problems with slot machines, bingo, etc.
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Phases of Gambling
Gammon (1986) Reported that pathological gamblers go
through 4 major stages
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Phases of Gambling
Social Phase This is recreational gambling for fun
Winning Phase They win large amounts of money
Losing Phase Here they lose larger amounts than they won in Phase 2 and
begin using lies and deceit to cover up the amount lost
Depression Phase Everything is now out of control Can lead to loss of one’s life savings, loss of family and friends,
loss of job, ultimately in worst cases can lead to suicide
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Pathological Gambler: Typical Scenario
Many potentially severe problems will affect both the gambler and his/her family… Psychological Social Financial Medical Legal
A severe negative effect
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“The Hidden Illness”
Pathological gambling is often referred to this…
Part of the reason may have to do with cultural perspective… See short video documentary…
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Athletes seem to be particularly susceptible...
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Explanations
Not well understood by psychologists... Psychoanalytic Theory
Freud saw pathological gamblers as… does anyone want to take a guess???
Humanistic Theory These psychologists believe that gambling can
satisfy a basic need to confirm one’s worth Cognitive Theory
These psychologists believe we get false sense of power from gambling and make an otherwise dull existence existing
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Explanations
Biological Theory Arousal Theory (Hebb,1955); Hare,1968)
May apply here as we are seeing under-aroused people needing this added stimulation
Problem is they may only get what they need from losses
Possible genetic link There appears to be a heritable component to pathological
gambling and genetic overlaps between pathological gambling and alcohol dependence (Potenza, 2005)
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Treatment
Psychotherapy Can be effective but most don’t take this route. Why?
Gambler’s Anonymous Self-help group founded in 1957 Bar far the treatment of choice They hope to control their gambling tendencies by talking about
their experiences Also, allows them to bring up self-worth by helping others Unfortunately, only works for about 8% (all others are back
gambling within one year) Gam-Anon
Support system for spouses and children
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Complications
Various studies of pathological gamblers in treatment reveal that approximately 50 percent have histories of alcohol or drug abuse
Females are more likely to be depressed, and gamble as a means of escaping the depression
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Kleptomania
People with Kleptomania usually do not steal because they need the object stolen In fact, they sometimes secretly replace the
object after stealing it They steal "for the thrill of stealing," and they
don't want to get caught at it To be diagnosed, a person must have
the typical pattern: Recurrent tension leading to the behavior,
leading to relief or pleasure after performing the behavior
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Prevalence
Kleptomania is rare overall Literature is vague; social stigma discourages
patients from seeking treatment Thought to be more frequent in females
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Treatment
Not much here… Treatment is largely untested, and the
disorder often persists despite many convictions of shoplifting
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Complications
High rates of comorbid psychiatric disorders: Mood disorders
Much higher rates of depression Other impulse-control disorders Substance abuse Nicotine dependence
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Burn-out after 40…
Kleptomania tends to decrease as the individual ages
More research needed in this area
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Trichotillomania
An impulse control disorder that involves intentionally pulling out ones hair
Has all the usual features of impulse control disorders… Relief after the behavior, and
usually a buildup of tension before, at least when the individual is attempting to control the behavior
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Trichotillomania
Once, thought to be rare, but earlier estimates may have been too low because victims are usually secretive about the behavior As many as 2% of college students
have had this disorder at some time Females > Males
Hair may be pulled from any part of the body, but the scalp, eyebrows, and eyelashes are the most frequent targets
Can, in some cases, lead to baldness Must cause significant distress before it
can be diagnosed
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Trichotillomania
Sometimes seen in children, although most grow out of it
If the disorder appears in adolescence or adulthood, it is more likely to be seen in women
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They usually have other problems as well…
These people are also likely to suffer from OCD and depression… Drugs that are effective for OCD also have
shown some improvements in those with Trichotillomania
Increase serotonin levels
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Treatments
Also treated with response prevention therapy But, no established treatment that’s been very
effective More research needed here as well
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Intermittent Explosive Disorder
Several discrete episodes of failure to resist aggressive impulses that result in serious assaultive acts or destruction of property
The degree of aggressiveness expressed during the episodes is grossly out of proportion to any precipitating psychosocial stressors They usually “flip out” for little or
no reason
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Prevalence
Intermittent explosive disorder occurs most often in young men and may affect as many as one in 14 U.S. adults.
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Complications
The violent behavior that's part of intermittent explosive disorder is not always directed at others
People with this condition are also at significantly increased risk of harming themselves, either with intentional injuries or suicide attempts
Other complications of intermittent explosive disorder may include job loss, school suspension, divorce, auto accidents or incarceration
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Treatments
Many different types of drugs are used to help control intermittent explosive disorder, including: Anticonvulsants Anti-anxiety agents Mood regulators Antidepressants
Group counseling sessions focusing on rage management, also have proved helpful
Some people have found relaxation techniques useful in neutralizing anger.
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Prognosis
Since most do not seek help the prognosis is usually not good
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Pyromania
Pyromania is deliberate and purposeful fire-setting behavior
DSM criteria requires that the person set more than one deliberate fire (destructive fire)
The usual impulse disorder sequence of strong arousal before and pleasure or tension reduction after the act must be present
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Pyromania
There must not be an external motive that accounts for setting the fire People who set fires to collect insurance or
cover up crimes, do it as an expression of anger, vengeance, etc. do not qualify
The fire setting must not be accounted for by another diagnosis
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Complications
People with pyromania often have poor learning skills and emotional difficulties
High rates of mood disorders High rates of substance abuse
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Treatment
Behavioral interventions may be helpful for pyromania sufferers… Most people with pyromania in childhood get
better But untreated adults (the majority of sufferers)
don't get better
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More research needed on this one too…
Little is known about pyromania
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Any DSM-V suggestions???
Impulse Control Disorders Keep them? Move them? Eliminate them?