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Published online by Cambridge University Press: 16 April 2020
Impulse-control disorders are characterized by the presence of irresistible urges or impulses. With regard to phenomenology and pathogenesis of these disorders two yet unsolved questions attracted researchers: do Impulse-Control Disorders represent disorders of impulses (are the urges so penetrating that the individuum is no longer able to control them) or are they primary disorders to control ubiquitary impulses, or both of them. An answer to these questions is essential for pharmacological and psychotherapeutic treatment planning. In ICD-10 and DSM-IV, however, these questions remain untouched. There, the diagnosis impulse (control) disorders should be used for kinds of persistently repeated maladaptive behaviour that are not secondary to a recognized psychiatric syndrome, and in which it appears that there is repeated failure to resist impulses to carry out the behaviour and the patients report a prodromal period of tension with a feeling of release at the time of the act. Pathological gambling, pyromania, kleptomania, and trichotillomania must be attributed to the rest-category named “Impulse Control Disorders” in DSM-IV or named “Habit and Impulse Disorders” in ICD-10. As we know from clinical praxis, patients suffering from pathological gambling show a much more complex psychopathology quite similar to substance-related disorders. Therefore we propose for DSM-V that pathological gambling should be attributed as gambling addiction (or gambling dependence syndrome) together with other substance-related and non-substance related addictions (e.g. internet addiction, buying addiction, working addiction) to a new group of dependence disorders.
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