The “problem” with impulse control disorders (ICDs) is that unlike alcohol or other
substance abuse, there is no saturation point. One cannot overdose simply by gambling,
spending or having too much sex. Perhaps for this reason, ICDs are largely overlooked
and poorly understood even today despite increasing attention and research over the
last two decades. Nevertheless, anyone who has worked with patients suffering from
one or more ICD or who is a sufferer himself will know exactly just how much guilt,
shame, and functional disability there is. To support those in need, a comprehensive
source about the frequency, evolution, treatment, related public policy, public health,
forensic, and medical issues of these disorders is essential. However, to day, there
have been limited resources available on both medical and social aspects of ICDs.
Impulse control disorders attempts to fill this niche which makes this guide unique
of its kind.
What do we know about impulse control disorders? What is their impact on society?
How do cultural values facilitate and maintain the behaviour? Or, somewhat more practical
questions: What are the financial costs of violence to society? How should kleptomania
be addressed in court? This book aims to answer these, and many other exciting questions
related to the most common impulse control disorders.
Perhaps the most obviously modern culture-related ICD of all is compulsive buying.
As President Bush concluded after 9/11: “Mrs Bush and I want to encourage Americans
to go out shopping”. Nowadays growth is about having more, not being more. It is therefore
not surprising that the extent of “shopocalypse” urges attention.
The “having more” attitude may well be one of the reasons why theft is a major problem
in the United States. The impulsive form of the behaviour, kleptomania, is estimated
to account for about 5% of Americans charged with shoplifting annually. In general
criminal responsibility is reduced because of the mental illness, however, kleptomans
do not stand the cognitive test for insanity as they are very well aware of the illegal
nature of their act. The authors report a curious court case from 1997 in Tennessee
where a 47-year-old twice-divorced woman was accused of stealing $24.41 worth of merchandise
from a store. She was sentenced to 11 months and 29 days in prison. The court argued
that her lengthy history of shoplifting was a good-enough reason to protect the public
from her further criminal acts...
Did you know that today Americans spend more on gambling than on any other form of
entertainment? In the end, society pays the quantifiable costs which are estimated
to be around $5 billion annually with an additional $40 billion productivity loss
(which equals to Norway's export value in the same year, 1999!). Although gambling
has officially become a public health issue, the activity is (un?)intentionally encouraged
by many stakeholders across the world. Riverboat cruises, credit card organisations,
media and the film industry, professional sports, even fund-raising bingo in schools
send the message that it is okay to gamble.
Section II of the book describes the pellicular impulses. From the dermatologist's
view there are three types of hair pullers: child, adult with insight and adult without
insight hair pullers, all requiring different treatments. Affected hair-bearing areas
often have a bizarre pattern with irregular borders and show a decreased density of
hairs that are short but of varying length. A similar disorder, “psychodermatoses”
or skin picking affects up to 2% of patients in dermatology clinics.
Another “modern addiction”, Internet addiction is listed under Section III: Information-seeking
impulses. Does playing violent video games lead to violent behaviour? The authors
argue that not having an answer to this question may indicate that the question has
not been posed correctly in the first place.
Would you ever conduct counselling in the cyberspace? Would you ever accept an e-therapist?
Thanks to modern technology, computer programs can be “trained” by recognised experts
across a host of situations and nuances, modelling expert responses. Beyond the “perfect”
answers, is there any chance we can ever train a computer to display empathy?
The last one, Section IV is about sexual and – perhaps the most problematic of all
– aggressive impulses. Hyper-sexuality is presented from an unusual perspective: the
sex industry's hidden victims' point of view. Because of their clients' sexual desires,
sex workers are at especially high risk of violence, heroine use, STDS (higher risk
than their clients!) and mental health issues. In addition, street sex work is criminalised
in almost every part of the world (further victimisation by the authorities) which
means added pressure to their already high-risk jobs. Sex work is a dangerous business.
Almost as dangerous as men suffering from intermittent explosive disorder and their
violence against women. The United States has been classified as a rape-prone culture
that celebrates aggression and eroticizes domination. Over 4.4 million women are physically
assaulted each year by their intimate partners, 41% of which result in observable
injuries. The National Institute of Justice calculated that costs per victimization
episode for rape alone totalled more than $3 million for the year 1990, and the total
annual cost of rape has been estimated a staggering $127 billion. This amount equals
to the total US export to developing countries in the same year.
Another issue in the United States is intentional fire-setting. According to the statistics,
there is a fire somewhere in every 20 seconds. Twenty percent of these fires are intentional
fires and arson. In 2005, this resulted in 490 civilian fire deaths and 3 on-duty
firefighter fatalities. Furthermore, there is publication to report that intentional
fires and arson are likely to increase in bad economic times such as those being experienced
in the United States (and around the world) currently. The other issue around arson
is that half of all those arrested in the US are juveniles under the age of 18. Arson
arrests account for a much larger proportion of arrests for youths under the age of
10 than any other crime that the FBI tracks (3%). Unfortunately, adults who present
with fire-setting behaviour are usually directed to the criminal justice system with
minimal or no contact with the mental health systems.
With impulse control disorders, overdose and fatalities are somewhat rare. However,
their unfavourable effect on the individual's and society's level is more evident
than ever. Elias Aboujaoude and Lorrin M. Koran edited a book which is not only informative
and interesting to read, it is also eye-opening. They both have extensive experience
with these disorders: Dr. Aboujaoude is the Director of the Impulse Disorders Clinic
at Stanford University and Prof. Koran is the Director of the Obsessive–Compulsive
Disorder Clinic at the same university. Chapters of the book are written by outstanding
experts in the field of research and practice to provide first-hand information.
As a result, Impulse control disorders is not only a valuable source of information
but also a well-written, interesting guide for researchers, clinicians or anyone who
is interested in the personal and societal impact of these disorders beyond the mere