Impulse Control Disorders: Everything to Know

Impulse control disorders (ICD) are a group of mental health disorders that involve problems with self-control. 

People with ICDs fail to resist the impulse to behave in harmful ways, often without thought of the consequences. These urges typically involve disruptive behaviors—such as stealing, cheating, lying, risk-taking, rule breaking, and violence—that violate the rights, well-being, and/or safety of others. 

There are several different types of impulse control disorders. This article will discuss the five main types of impulse control disorders, as well as causes, symptoms, and how to treat them.

Types of Impulse Control Disorders

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) lists five types of impulse control disorders. They are oppositional defiant disorder, intermittent explosive disorder, conduct disorder, kleptomania, and pyromania. All five ICDs involve problems with self-control in terms of behavior and emotions. 

People with ICDs may find it difficult to resist the temptation to perform a certain action. In many cases, these urges are related to “acting out” in some way through aggressive, dishonest, rule breaking, or unsafe behavior.

Oppositional Defiant Disorder

Oppositional defiant disorder (ODD) is a condition that involves a long-lasting pattern of defiance, disobedience, and hostility toward parents, teachers, and other authority figures. It is diagnosed in children and teens, usually older than the age of 8. However, younger children and adolescents may also receive an ODD diagnosis.

Some of the most common signs and symptoms of ODD are:

• Frequent temper tantrums
• Irritability, anger, argumentativeness, and/or vindictiveness
• Refusal to obey adults’ rules or follow directions
• Difficulty making and keeping friends
• Frequently getting in trouble at school

To be diagnosed with ODD, a child must have exhibited these signs and symptoms on a consistent basis for at least six months with at least one person other than their sibling. Their disruptive behaviors must go beyond typical, developmentally appropriate rule breaking.

Some, but not all, young people with ODD later develop antisocial personality disorder (ASPD). ASPD is a mental health disorder that involves a lack of empathy (the ability to feel along with others) and a long-lasting pattern of manipulative, reckless, and/or criminal behavior.

Conduct Disorder

Conduct disorder (CD) is a condition that involves a chronic pattern of violating social norms and the rights and well-being of others. Conduct disorder is only diagnosed in children and teens up to age 18, and symptoms usually appear during early adolescence.

Common signs and symptoms of CD include:

• Frequent rule-breaking
• Angry outbursts 
• Aggression towards others, including bullying, fighting, and/or sexual assault
• Mistreating children or animals
• Dishonesty, including lying and cheating
• Excessive substance use
• Running away from home
• Truancy (skipping school)
• Criminal behavior, such as theft, vandalism, or arson

Many children with ODD eventually develop conduct disorder, which is usually considered more severe. Some people have both ODD and CD, while others meet the criteria for only one or the other. Many people with CD are diagnosed with ASPD as adults.

Intermittent Explosive Disorder

Intermittent explosive disorder (IED) is an impulse control disorder that involves repeated episodes of angry outbursts that are extremely disproportionate to the situation. 

During these impulsive episodes, a person with IED may:

• Be verbally aggressive
• Start arguments
• Physically assault others
• Destroy property or possessions
• Threaten others

To meet the DSM-5 criteria for IED, these angry outbursts can’t be related to any other mental health disorder or medical condition. They also can’t occur while someone is taking a particular medication, drinking, or using drugs.

Kleptomania

People with kleptomania, also called compulsive stealing, fail to resist the urge to steal things they don’t want or need. 

Kleptomania doesn’t involve stealing for monetary or personal gain, for revenge, or out of necessity. Instead, people with kleptomania feel an intense buildup of tension before stealing. After they steal, they feel an immediate sense of relief and/or pleasure.

Pyromania

Pyromania is an impulse control disorder that involves repeatedly and deliberately setting fires. 

Like people with kleptomania, people with pyromania don’t have political, personal, or vindictive motivations for following through with their urges. For example, someone who sets a fire to destroy an ex-partner’s property or as part of a political protest doesn’t meet the DSM-5 criteria for pyromania.

People with pyromania are often fascinated by fire and anything related to fire. They may feel “pent up” and anxious before setting a fire, followed by an intense release of tension while watching it burn.

Causes

There is no single known cause of impulse control disorders. In many cases, multiple factors interact to increase the likelihood that someone will develop an ICD. Contributing factors may include:

• Genetics: Research suggests that genetics plays a role in the development of impulse control disorders. Oppositional defiant disorder, for example, is inherited in approximately 61% of cases. Meanwhile, twin studies suggest that conduct disorder is passed down in families about 50% of the time.
• Trauma: Children with impulse control disorders like ODD or CD are significantly more likely than others to have been abused, neglected, harshly punished, or exposed to substance abuse or violence in the home. Certain environmental factors, such as childhood poverty, significantly increase the risk that someone will later be diagnosed with an impulse control disorder.
• Personality traits: Certain personality traits may make someone more likely to develop an ICD. Research indicates that people with kleptomania are more prone to novelty-seeking behaviors (pursuit of new experiences with intense emotional sensations) and are less likely to relate to others.
• Brain function: Imaging tests and cognitive assessments have revealed impairments in brain structure, thinking, and cognitive function among people with impulse control disorders. For example, studies suggest that people with pyromania may have problems with memory, executive functioning (thinking skills in planning, memory, and self-control), and attention.
• Parkinson’s disease (PD): Parkinson’s disease is a neurodegenerative disorder that causes symptoms like stiffness, slowness, balance and coordination problems, and tremors. Dopamine agonists (common medications prescribed to people with PD) can increase the risk of impulse control disorders and other disruptive, compulsive, and/or repetitive behaviors. 
• Attention deficit hyperactivity disorder (ADHD): Attention deficit hyperactivity disorder involves hyperactivity, impulsivity, and inattentiveness. ADHD is often comorbid with (exists alongside) ODD. Up to 30%–50% of people with oppositional defiant disorder also meet the criteria for ADHD. 
• Comorbid mental health conditions: Many people with impulse control disorders have comorbid mental health conditions, including personality disorders, substance use disorders, mood disorders, depression, and anxiety. For example, up to 60% of people with kleptomania also meet the criteria for obsessive-compulsive disorder (OCD). Meanwhile, people with IED have higher-than-average rates of generalized anxiety disorder (GAD) and bipolar disorder.
  

Signs and Symptoms

Impulse control disorders typically involve a severe, long-lasting pattern of disruptive, harmful, and/or risky behaviors. Common signs and symptoms of ICDs include:

• Argumentativeness
• Threatening to harm others
• Verbal or physical outbursts
• Irritability
• Vindictiveness
• Breaking rules and/or the law
• Taking unnecessary risks
• Fighting
• Bullying
• Cruel treatment of animals 
• Stealing
• Lack of empathy
• Skipping school or work
• Lying
• Vandalism
• Excessive drug or alcohol use
• Using or trying to get weapons
• Deliberately setting fires

Treatment

The first-line treatment for impulse control disorders is psychotherapy (talk therapy). Types of psychotherapy that have been found to be effective in treating people with ICDs include:

• Cognitive behavioral therapy (CBT): CBT can help people with ICDs improve their problem-solving and decision-making skills. Research suggests that CBT may help people with pyromania to identify and resist their urges. CBT is also commonly used to treat people with kleptomania. A 2018 study found that people with IED were able to control their anger more effectively after undergoing CBT in a group setting.
• Family therapy: In many cases, family therapy is the preferred treatment for children and adolescents with ODD and/or CD. Functional family therapy aims to assess how interactions between different family members may contribute to a child’s disruptive behaviors. Brief strategic family therapy, a similar short-term behavioral intervention, also works to identify repetitive patterns of thinking, relating, and interacting within the family in order to improve relationships and prevent harmful behaviors.
• Parental management training (PMT): Parental management training can help to repair the relationship between parent and child in order to reinforce positive behaviors. Typically used to treat ODD, CD, or both, PMT focuses on improving parenting skills and promoting quality time.
• Multisystemic therapy (MST): Multisystemic therapy is a holistic behavioral intervention program that addresses impulse control disorder symptoms in all areas of a child’s or adolescent’s life. Many key figures—including parents and other relatives, peers, teachers, and therapists—collaborate to promote positive behaviors and prevent harmful ones. MST may take place in foster care, juvenile detention centers, school, and home with the help of social workers and mental health professionals.
• Social skills training: Social skills training can help children and youth with ODD and/or CD to improve their relationships and everyday interactions, respond appropriately to situations, and communicate more effectively.

In some cases, a healthcare provider may prescribe psychiatric medication to manage particular symptoms of an impulse control disorder. They may also prescribe medication to help with comorbid mental health conditions like anxiety, ADHD, or depression. 

Under the supervision of their medical team, people with Parkinson’s disease may need to lower their current dose of dopamine agonists to reduce their ICD-related symptoms.

Summary

Impulse control disorders (ICDs) are a group of mental and behavioral disorders that involve a lack of self-control and a failure to resist the urge to perform harmful actions. The five main types of impulse control disorders are oppositional defiant disorder, conduct disorder, intermittent explosive disorder, pyromania, and kleptomania. 

Oppositional defiant disorder (ODD) is a condition in children and adolescents that involves a pattern of defying authority figures. Some children and adolescents with ODD are later diagnosed with conduct disorder (CD), which is characterized by a more severe pattern of violence, substance use, and/or criminal activity.

People with intermittent explosive disorder (IED) have a pattern of angry, aggressive outbursts. People with pyromania have trouble suppressing their urge to start fires, while people with kleptomania fail to resist their impulse to steal.

Researchers have not identified a single known cause of impulse control disorders. Genetics, social and environmental factors, brain structure, past trauma, and comorbid medical conditions (such as Parkinson’s disease) may all contribute to the likelihood that someone will develop an ICD.

Treatment for impulse control disorders typically involves psychotherapy, medication, or a combination of both.

A Word From Verywell

If you or your child has an impulse control disorder, you are far from alone. Fortunately, there are effective treatments available for impulse control disorders. Reach out to your healthcare provider to discuss your options.