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  • Cited by 5
Cambridge University Press
Online publication date:
July 2010
Print publication year:
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Book description

In the last decade, much needed attention and research has been focused on the group of psychiatric conditions termed 'impulse control disorders' or ICDs. Pathological gambling, compulsive shopping, kleptomania, hypersexuality, Internet 'addiction', among other disorders, are characterized by a recurrent urge to perform a repetitive behavior that is gratifying in the moment but causes significant long-term distress and disability. Despite the high rate of co-morbidity with obsessive compulsive disorder, ICDs are now clearly distinguished from these disorders with a unique clinical approach for diagnosis and treatment. A wide array of psychopharmacologic and psychotherapeutic options is now available for treating these disorders. Drs Elias Aboujaoude and Lorrin M. Koran have collated the world's foremost experts in ICD research and treatment to create a comprehensive book on the frequency, evolution, treatment, and related public policy, public health, forensic, and medical issues of these disorders. This is the first book to bring together medical and social knowledge bases related to impulse control disorders.


'… a valuable guide to the DSM-IV category of impulse-control disorders not elsewhere classified. … What makes this volume so interesting is the attention placed not just on the disorders themselves, but also on the social, cultural, and legal ramifications specific to each … coherent and thorough … This book deserves a place on the bookshelves of psychiatric educators and clinicians working with individuals who have impulse-control disorders.'

Source: Journal of Clinical Psychiatry

‘… an important contribution to the clinician’s library. It is interesting and well researched … This work will be of interest to lay people and sociologists as well as clinicians.’

James Allen Wilcox Source: Annals of Clinical Psychiatry

'Impulse Control Disorders is not only a valuable source of information but also a well-written, interesting guide for researchers, clinicians or anyone who is interested in the personal and societal impact of these disorders beyond the mere symptoms.'

Source: Journal of Behavioral Addictions

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  • 9 - Trichotillomania: The View from Dermatology
    pp 111-117
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    This chapter deals with clinical aspects of compulsive buying disorder (CBD). CBD must be distinguished from normal buying behavior, although the distinction is sometimes arbitrary. Frequent shopping does not by itself constitute evidence of the presence of CBD. A distinct clinical picture of the compulsive shopper has emerged. Four distinct phases of CBD have been described, including: anticipation; preparation; shopping; and spending. CBD behaviors occur all year but can be more problematic during the Christmas holidays and others, as well as around the birthdays of family members and friends. The Compulsive Buying Scale (CBS) was developed by Faber and O'Guinn to distinguish normal from pathological buyers. Psychiatric comorbidity is the rule in individuals with CBD. Some researchers suggest that CBD is related to obsessive-compulsive disorder (OCD) and others that it is related to the substance use disorders, the mood disorders, or the disorders of impulse control.
  • 10 - How to Create a National Advocacy Organization
    pp 118-123
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    Compulsive buying is a multidetermined disorder. The pursuit of material goods, and the tendency toward compulsive buying that often accompanies it, has been accelerated by cultural wrinkle, the burgeoning of marketplaces. The culture, communities, families, and individuals - compulsive buying hurts them all. Compulsive shopping is to bankruptcy as steroids are to home runs. Relationship costs, not the least of which is an individual's relationship with himself or herself, are significant, too. Compulsive buying in children is clearly associated with family histories of compulsive/addictive behaviors. It has also been shown to be associated among adolescents with eating disorders, drinking alcohol, smoking, and early life sexual experiences. Research shows that college students and young adults are particularly vulnerable to compulsive buying. Healthier childhood is often a simpler childhood, one that puts good communication and quality time with family and friends far above engagement with the material world.
  • 11 - Skin Picking: Clinical Aspects
    pp 124-137
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    Kleptomania is classified in the International Classification of Diseases of the World Health Organization (WHO) ICD-10 (Code F63.2) under the heading of habit and impulse disorders together with pathological gambling, pyromania, and trichotillomania. Individuals with kleptomania typically suffer from emotional distress and/or impaired functioning in social and occupational areas. Kleptomania has occasionally been reported to stem from neurological disorders. The emotional distress, stress, potential marital conflict, arrests, and jail time associated with kleptomania undoubtedly diminish patients' quality of life (QOL). Kleptomania patients are highly likely to suffer from comorbid psychiatric disorders, most notably mood disorders, anxiety disorders, eating disorders, other impulse control disorders, and alcohol and other psychoactive substance abuse/dependence disorders. Clonazepam and alprazolam have been reported to produce partial success in treating kleptomania. Over the past 50 years, the treatment approach toward kleptomania has shifted away from psychodynamic therapy. Cognitive-behavioral interventions have been reported to help in individual cases.
  • 12 - SkinPicking: The View from Dermatology
    pp 138-143
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    The American Law Institute (ALI) test stated that a defendant is insane if he lacks substantial capacity to appreciate the criminality of his conduct or to conform his conduct to the requirements of the law. Courts have historically viewed the use of impulse control deficits as a defense with a degree of skepticism. Patients with kleptomania have significant impulsivity and may have high rates of comorbid mood disorders, anxiety disorders, eating disorders, and personality disorders. When using a profiling technique in an attempt to determine if a defendant accused of theft suffers from kleptomania, the expert must use caution. Not every kleptomaniac will fit the typical psychological profile, and not every shoplifter who seems to meet the profile will have kleptomania. The kleptomaniacs did rate higher than the shoplifters on the feeling of inner tension before theft.
  • 13 - Onychophagia (Nail Biting): Clinical Aspects
    pp 144-156
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    Pathological gambling (PG) is distinguished in both Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and the tenth edition of the International Classification of Mental and Behavioral Disorders (ICD-10) from gambling secondary to mania and from social gambling, which does not persist when adverse events occur. It may be associated with dopamine agonist treatments for Parkinson's disease. PG is also associated with greater health problems and increased use of medical services. Although cognitive-behavioral therapy (CBT), opioid antagonists, and sustained-release lithium carbonate appear promising for the treatment of PG, several limitations affect the current body of knowledge. PG is a common disabling psychiatric disorder associated with high rate of co-occurring disorders, particularly substance use disorders, and high rate of social and occupational dysfunction. Although psychotherapies and pharmacotherapies have shown promise, the limited data preclude making treatment recommendations with substantial degree of confidence.
  • 14 - Nail Bitingand Other Oral Habits: A Dentist’s Perspective
    pp 157-164
  • View abstract


    The majority of people who participate in gambling, view it as a social activity that does not negatively impact their lives, and, win or lose, they walk away unaffected. Numerous costs of pathological gambling cannot be quantified, such as the emotional pain associated with bankruptcy, divorce, neglect, and related difficulties experienced by gamblers and others in their lives. A national study established that problem and pathological gamblers were more than four times as likely as low-risk gamblers to have lost a job and more than three times as likely to have been fired within the past year. When a pathological gambler or loved one becomes hopeless and believes there is no way out, suicide is often considered. Federal, state, and local governments promote gambling while simultaneously providing oversight and enforcement responsibilities. The film industry glamorizes gambling and normalizes gambling behaviors across age groups.
  • 15 - Problematic Internet Use: Clinical Aspects
    pp 167-181
  • View abstract


    Indian gaming is one of the few economic development strategies that have worked in India. With regard to tribal gaming, casinos are generally built on Indian trust land, in India, where tribal territorial jurisdiction is complete and unassailable. Some casinos have been built on lands purchased by tribes, where the land has then been put into trust by the federal government. This land-into-trust generally occurs with the concurrence of the state and local governments. The right to conduct casino gaming, whether in Indian country or on land that is purchased and placed into trust, is subject to a tribal-state compact. The compacting process between the states and the tribes has been difficult at best. Funds can only be accumulated through investment and reinvestment, a process that can be accelerated by Indian gaming. For many tribes, the risk of gaming exceeds any possible benefit.
  • 17 - Counseling in Cyberspace: Your E-Therapist Is on Call
    pp 189-194
  • View abstract


    Trichotillomania (TTM) is an impulse control disorder characterized by recurrent pulling out of one's hair, resulting in noticeable hair loss. The most common hair pulling sites include the scalp, eyebrows, and eyelashes, but pulling also occurs frequently on the face, abdomen, legs, arms, armpits, or chest. Early studies of functional impairment in TTM patients suggested that concealing the physical effects of pulling from friends and family, avoiding treatment because of embarrassment, low self-esteem, decreased life satisfaction, and a negative impact on day-to-day living were all common. The TTM diagnostic interview is a standardized clinician interview designed to assess the revised third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) criteria and can be useful. However, further questioning is needed to evaluate the additional criteria described in DSM-IV-TR. Psychotherapy for individuals with TTM typically involves a variety of techniques: habit-reversal training (HRT) and stimulus control training.
  • 18 - Hypersexuality: Clinical Aspects
    pp 197-212
  • View abstract


    This chapter extends the discussion of trichotillomania (TTM) beyond the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) definition and describes the clinical approach to diagnosis and management of all hair pullers who may present in a dermatology or primary care outpatient setting. In most cases, patients with TTM present with a patchy alopecia of the scalp. The crown of the scalp is frequently involved, and significant loss in this distribution with maintenance of hair in the occiput is known as the Friar Tuck sign. In many cases, biopsy can aid in the diagnosis of TTM. Child hair pullers have a better prognosis and generally respond to more conservative measures. Adult hair pullers without insight create a unique challenge for the practitioner. Treatment for adult hair pullers includes both cognitive behavioral and pharmacologic therapy.

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