Impulse-Control Disorders - Diagnostic Criteria: DSM-IV

1. INTERMITTENT EXPLOSIVE DISORDER

A. Several discrete episodes of failure to resist aggressive impulses that result in serious assaultive acts or destruction of property.

B. The degree of aggressiveness expressed during the episodes is grossly out of proportion to any precipitating psychosocial stressors.

C. The aggressive episodes are not better accounted for by another mental disorder (eg, antisocial personality disorder, borderline personality disorder, a psychotic disorder, a manic episode, conduct disorder, or attention-deficit / hyperactivity disorder) and are not due to the direct physiological effects of a substance (eg, a drug of abuse, a medication) or a general medical condition (eg, head trauma, Alzheimer's disease).

2. KLEPTOMANIA

A. Recurrent failure to resist impulses to steal objects that are not needed for personal use or for their monetary value.

B. Increasing sense of tension immediately before committing the theft.

C. Pleasure, gratification or relief at the time of committing the theft.

D. The stealing is not committed to express anger or vengeance and is not in response to a delusion or a hallucination.

E. The stealing is not better accounted for by conduct disorder, a manic episode or antisocial personality disorder.

3. PYROMANIA

A. Deliberate and purposeful fire setting on more than one occasion.

B. Tension or affective arousal before the act.

C. Fascination with, interest in, curiosity about, or attraction to fire and its situational contexts (eg, paraphernalia, uses, consequences).

D. Pleasure, gratification, or relief when setting fires, or when witnessing or participating in their aftermath.

E. The fire setting is not done for monetary gain, as an expression of sociopolitical ideology, to conceal criminal activity, to express anger or vengeance, to improve one's living circumstances, in response to a delusion or hallucination, or as a result of impaired judgment (eg, in dementia, mental retardation, substance intoxication).

F. The fire setting is not better accounted for by conduct disorder, a manic episode, or antisocial personality disorder.

4. PATHOLOGIC GAMBLING [Ludopathy]

A. Persistent and recurrent maladaptive gambling behavior as indicated by five (or more) of the following:

(1) is preoccupied with gambling (eg, preoccupied with reliving past gambling experiences, handicapping or planning the next venture, or thinking of ways to get money with which to gamble) 

(2) needs to gamble with increasing amounts of money in order to achieve the desired excitement 

(3) has repeated unsuccessful efforts to control, cut back, or stop gambling 

(4) is restless or irritable when attempting to cut down or stop gambling 

(5) gambles as a way of escaping from problems or of relieving a dysphoric mood (eg, feelings of helplessness, guilt, anxiety, depression) 

(6) after losing money gambling, often returns another day to get even ("chasing" one's losses) 

(7) lies to family members, therapist, or others to conceal the extent of involvement with gambling 

(8) has committed illegal acts such as forgery, fraud, theft, or embezzlement to finance gambling 

(9) has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling 

(10) relies on others to provide money to relieve a desperate financial situation caused by gambling

B. The gambling behavior is not better accounted for by a manic episode.

5. TRICHOTILLOMANIA

A. Recurrent pulling out of one's hair resulting in noticeable hair loss.

B. An increasing sense of tension immediately before pulling out the hair or when attempting to resist the behavior.

C. Pleasure, gratification, or relief when puling out the hair.

D. The disturbance is not better accounted for by another mental disorder and is not due to a general medical condition (eg, a dermatological condition).

E. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

6. IMPULSE-CONTROL DISORDERS NOT OTHERWISE SPECIFIED

The diagnosis of impulse-control disorders not otherwise specified (NOS) is given to patients who exhibit an impulse-control problem that does not fit into one of the other five categories or is not listed elsewhere in DSM-IV (eg, substance abuse, a paraphilia). Common examples of impulse-control disorders NOS are face picking, sexual behaviors, compulsive shopping, or repetitive self-mutilation.