16th November 2023

Habit and Impulse Control Disorders

Habit and impulse disorders (ICD-10) or impulse control disorders (ICD-11) are a group of disorders where the patient engages in a certain irresistible impulse that has the potential to cause harm either to the patient or to others. The behaviours may impact interpersonal relationships, education, work and general functioning and lead to distress. For a diagnosis to be made, there must be evidence of repeated inability to resist the impulse. Episodes can be prefaced by an increase in tension or emotional arousal, with these feelings easing after carrying out the act.

• Pathological fire-setting or pyromania (ICD-10/11 and DSM-5) – May present with comorbidities which should be treated; following this CBT may be useful.
• Pathological stealing or kleptomania (ICD-10/11 and DSM-5) – Possible treatment options include SSRIs and psychotherapy.
• Trichotillomania (ICD-10/11 and DSM-5) and excoriation disorder (DSM-5 and ICD-11) – These two disorders are similar and can often be seen together. Characterised by recurrent pulling of the patient’s own hair and picking of the skin, respectively. Treatments may look to treat any complications alongside psychotherapy options; there is some evidence for medication.
• Intermittent explosive disorder (DSM-5 and ICD-11) – Characterised by disproportionate aggressive or violent outbursts in response to a situation. Treatments look to minimise aggression.
• Gambling and gaming disorder is also described in DSM-5 and ICD-11. Pathological gambling was the terminology used in ICD-10.

References

• Semple D; Smyth R. (2019). Oxford Handbook of Psychiatry, fourth edition.
• International Statistical Classification of Diseases, tenth revision (ICD-10), Version:2016, https://icd.who.int/browse10/2016/en#/F60-F69
• International Statistical Classification of Diseases, eleventh revision (ICD-11), Version 01/2023, https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f826065555