Impulse control and non-substance addictive disorders are disorders characterized by an inability in emotional and behavioural self-control. These behaviours can often cause harm to the individual and others. Such disorders include: internet addiction, pyromania, kleptomania, among others. In this article we’ll explore some explanations and treatments to impulse control and non-substance addictive disorders.
These disorders can be explained in three ways; the biochemical, behavioural and cognitive. The biochemical explanation focuses on the dopamine hypothesis. This hypothesis states that rewarding stimuli such as stealing or gambling stimulate reward centres which then release dopamine. When behaviours become compulsive, you develop a tolerance and levels of dopamine in the striatum reduce. A person will then continue to do more of this act to get the same level of dopamine which encourages continuation of compulsions and addictions.
The behavioural explanation states that when you receive a reward for doing a certain activity, you tend to repeat the activity to achieve more of the reward. This is positive reinforcement and occurs when a learnt behaviour is a result of previous trials there is also something called schedules of reinforcement. E.g. a gambler doesn’t win every time they play so they continue to play over and over again, believing that the win will overcome/ makeup for the loss this is also partial reinforcement.
The cognitive explanation, also called the Feeling State Theory, was discovered by Miller in 2010. He believed that the underlying thoughts and feeling states a person experiences during an activity create a state dependent memory, leading to impulse control disorders. Feeling states are created by an intense desire to do an activity and the positive experience associated with it and the memory of the behaviour. Another way feeling states are created is by underlying negative thoughts and beliefs. E.g. A pyromaniac who feels powerful when setting a fire may have underlying negative thoughts, such as feeling weak making the act more desirable.
In order to treat, Miller would focus on targeting patients’ rationalisations and their thinking patters. Once these had been identified, patients were to then learn to control these behaviours and change them. The destructive behaviour would be replaced by another behaviour that would still let the patient gain the same feeling they did when doing the impulse behaviour. It is shown that visualising and using eye movement desensitisation and EDMR exercises are effective.
In biochemical treatments, Grant et al had said opiates had helped to treat gambling. There was a 35 percent reduction in wanting to do gambling. Patients who were on the highest dosage of opiates were more likely to show a positive response to the drug.
Another method of treatment is to use covert sensitization. In covert sensitization an undesirable behaviour is conditioned with an unpleasant stimulus to change the addictive behaviour/compulsion. Glover had conducted a study on a Kleptomaniac female who had been shoplifting for more than 14 years. In therapy she had to imagine herself vomiting as she was shoplifting. She had to imagine other shoppers watching her as she was nauseous, but when she put the object back on the shelf, she imagined the negative feeling to go away. After the therapy, in the checkup she stated that her behaviour had decreased greatly, therefore proving to be an effective treatment.
Additionally, Imaginal desensitisation can be utilised in which muscle relaxation techniques are taught to treat the impulsive behaviour. The patient is asked to visualize themselves in a triggering situation where they feel like acting out their impulse and then are asked to leave the situation white maintaining the state of relaxation. This technique focused on reducing the anxiety and arousal they felt for the behaviour and they were to practice it outside of therapy wherever they felt as if they were going to carry out the behaviour.
Impulse control disorders tend to be chronic, however with the right treatment, and therapy, an individual can learn to manage their symptoms and live a more fulfilling life. Individuals can significantly improve their general quality of life and overcome their impulsive behaviours with commitment and persistence.
