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Book and Media Reviews
December 17, 2008

Impulse Control Disorders: A Clinician’s Guide to Understanding and Treating Behavioral Addictions

JAMA. 2008;300(23):2803-2804. doi:10.1001/jama.2008.798

Impulse control disorders are common and disabling behaviors experienced by approximately 5% to 15% of the US population, or between 14 million and 42 million persons. These disorders include pathological gambling, kleptomania, intermittent explosive disorder, pathological hair pulling (trichotillomania), and pyromania. Other disorders such as compulsive Internet use, compulsive sexual behavior, pathological skin picking, and compulsive buying have been proposed as belonging to the same category. Impulsivity is defined as a predisposition toward rapid, unplanned reactions to either internal or external stimuli without regard for negative consequences. Impulse control disorders share common core qualities, including repetitive or compulsive engagement in a behavior despite adverse consequences, diminished control over the problematic behavior, an urge or craving state prior to engagement in the behavior, and a hedonic quality during the performance of the behavior in question. Subjective distress and impaired functioning are often a consequence of impulse control disorders, and their avoidance feeds the cycle of repetitive behaviors. Patients with these disorders continue to struggle with their desire to engage in the behavior and their need to stop because of mounting social, occupational, financial, or legal consequences.