May 2012  << Back  

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Impulse Control Disorders

James Allen Wilcox, DO, PhD

University of Arizona, Tucson, AZ, USA

Edited by Elias Aboujaoude and Lorrin M. Koran. New York, NY: Cambridge University Press; 2010; ISBN 978-0-521-89870-6; pp 324; $105 (hardcover).

Problems with poor impulse control are common in our society. From impulse shopping to poor anger control to compulsive habits, the inability to effectively control impulsive behavior has become an increasingly visible behavior in our world. Impulse Control Disorders is a book which covers a wide range of conditions where impaired impulse containment leads to distress and pathology.

This book is divided into 4 sections each dealing with a type of impulse-related pathology. The categories of dysfunction are: acquisition, pellicular, information-seeking, and sexual-aggressive impulses. Each section goes on to describe a type of problem and the related pathology of the subtype of impulse control associated with it, rather like a modern version of “the 7 deadly sins.” Brief parts regarding treatment also are included and are interesting.

The first section on disorders of acquisition is fascinating. It begins with an interesting piece on compulsive shopping. This is a common problem causing huge economic losses and suffering for many people. It includes material on why some people are pathological shoppers and how it can be differentiated from ordinary purchases. The author of the first section has done considerable research on the topic and his expertise produces a good beginning to the text. This sections goes on to issues involving gambling. Certainly, gambling has been viewed as a risky vice for millennia, but only now are clinicians and government authorities beginning to come to grips with treating it as a public health issue. The authors cover this topic nicely. The concept of risk taking and anticipation within the construct of potential reward schemes is enlightening and interesting. This section ends with a piece on kleptomania, the compulsion to steal things that are unnecessary. This is always an interesting topic and I wish that more information was provided than the relatively small number of pages in the text. Overall, the first section is well worth reading and contains valuable material.

The second section deals with pellicular impulses, the tendency to pick and pull at one’s self. This portion contains trichotillomania, skin picking, and nail biting. This is a well-written and interesting section. It has numerous photos of self-inflicted injury from these unfortunate tortures. Perspectives from dental and dermatology points of view are included, providing a unique point of view often not seen by the mental health practitioner. This is a very gripping section, but is lacking in depth and leaves the reader looking for more information.

The third section deals with the relatively new issue of information technology. This portion of the book deals with topics regarding Internet addictions and virtual reality compulsions. This is something we see to some degree every day. People surf the Internet for hours and ignore their responsibilities. Others stay up late into the night on computers or playing video games. Thirty years ago, this topic would have been moot, but now it is a real threat to the stability of some people. This kind of impulse control condition is a problem for many reasons. People with such inclinations will spend hours away from work, family, and friends. They often compound the problem with impulsive spending on the Internet. Many individuals with isolated lives spend even more time in isolation in front of a terminal or video screen, losing social contacts and sometimes social skills. This issue is common but seldom discussed in the clinical literature. It is refreshing and informative to see it included in this volume.

The final section of the book deals with issues of fundamental sexual and aggressive impulse control disorders. This portion deals with loss of impulse control over hypersexuality, pornography, explosive temper, violence, and pyromania. These are topics that could be torn from newspaper headlines. Many lives are ruined due to poor impulse control over aggression or hypersexuality. Much human suffering and considerable financial loss can be attributed to these issues. It is entirely fitting for these topics to be included in a book on impulse control problems. The authors seem knowledgeable and articulate. The issue in the case of this book is why such a small number of pages are devoted to this arena. Scarcely 100 pages are given to cover a series of topics that society has a great deal of trouble coping with. While keenly handled by the authors, one would have hoped for a more detailed review of the literature and perhaps more information regarding therapies.

This book is an important contribution to the clinician’s library. It is interesting and well researched. My main criticism is that there is not enough detail on the subjects and some potentially important topics are omitted. While each section gave a good review of the material, it seems to lack the depth of scope that one would like. The area on pellicular disorders is good in so far as it is well written and contains information from other specialists, but why was it so brief? If one has other specialists involved and even includes photos of the condition (which was a great idea), then why not spend time including more detail? Likewise, the sections on aggression and sexuality only grant a few pages to topics that have previously filled entire volumes. Because the scope of the book covers impulse control disorders, why wasn’t hoarding given a section? If one is looking for a nice, brief review of core syndromes of impulse control, this is a fine book, but it could not truly be considered a reference because of the condensed nature of the material.

How much of poor impulse control is pure habit formation to reduce anxiety vs how much is related to loss of executive function and perhaps frontal lobe disease? Some readers will be likely to claim that some of these conditions are disorders of character, while others will likely see hidden organic pathology as the cause of such problems. This potential debate must be assessed as more people look over the text and the relevant literature. This work will be of interest to laypeople and sociologists as well as clinicians. I welcome this work for its efforts and look forward to a larger, more comprehensive edition in the future.