#icds

Impulse control disorder is characterized by repeated failure to resist an impulsive or an urge to perform an act that is rewarding for the person in the short term despite consequences for them and other people in the long term.

It can lead to significant impairment in important areas for functioning.

Episodes of impulse control disorder involve a rise in tension or affective arousal. It typically follows by pleasure or relief of tension, and guilt or shame after the behaviour.

The three main ICDs we are focusing on today is gambling addiction, pyromania, and kleptomania.

Pyromania

Pyromania is a type of impulse control disorder where individuals repeat a recurrent failure to resist an impulse of setting fire or the urge to perform or attempt to perform the act of setting fire.

Lack of apparent motive for the act or attempt of setting fire (revenge, rebellion, sabotage,...)

Persistent fascination with fire or related stimuli, such as watching or building fires, fascination with firefighter equipment.

Episodes of pyromania involve a rise in tension or affective arousal. It typically follows by a pleasure or relief of tension following the act of setting fire.

It feels rewarding for the person in the short term despite the consequences for them and others.

It can lead to significant impairment in important areas for functioning.

Kleptomania.

Kleptomania is a type of impulse control disorder where individuals repeat a recurrent failure to resist an impulse of stealing objects or the urge to perform the act of stealing objects.

Lack of apparent motive for the act of stealing objects (monetary gain).

Episodes of pyromania involve a rise in tension or affective arousal. It typically follows by a pleasure or relief of tension following the act of stealing objectives.

It feels rewarding for the person in the short term despite the consequences for them and others.

It can lead to significant impairment in important areas for functioning.

Gambling disorder

Gambling disorder is a type of impulse control disorder where individuals repeat a recurrent failure to resist an impulse of problematic gambling behaviour.

It is a persistent pattern of problematic behaviour that can be online or offline.

Increasing priority given to gambling behaviour to the extent it takes precedence over other life interests and daily activities.

Continuation or escalation of gambling behaviour despite negative consequences (negative impact on health, finance, relationships,...).

It can lead to significant impairment in important areas for functioning.

How do we measure them? Well, I only have to study one scale...sooo :3

THE K-SAS (Kleptomania Symptomp Assessment Scale)

It is a psychometric tool used for diagnosed kleptomania, with 11-item self-rated scale that assess severity of kleptomania. It measures the intensity, duration and frequency of the urges to steal, the thoughts, pleasure and consequences of the act. The responder was asked to consider the question in relation to the past 7 days, rated on a point-based scale from 0-4 or 0-5.

One example is If you had urges to steal during the past WEEK, on average, how strong were your urges?

Evaluation of the KSAS:

KSAS scored well for reset reliability.

It has been compared with other validated tools like Global Assessment for Functioning Scale and have good concurrent validity.

It provides quantitative data which make it easy to compare the outcomes of intervention.

It relies on self-report which means there might be response bias. Individuals may exhibit socially desirable responses, they know that the stealing object could get them in trouble and ashamed, therefore the responder might under-report the symptoms.

How do people get ICDs then? again, we have 3 explanations

Biological: Biochemical explanations of ICD is based on the dopamine deficiency syndrome (Blume and Coming), and is focuses on the dopamine neurotransmitter

It refers to a happy dopamine because its release is triggered by rewarding stimuli, such as engaging in an enjoyable activity. For example, when someone diagnosed with kleptomania steals an object, their reward centre system is stimulated and would release dopamine. 

However, when that behaviour becomes compulsive, the level of dopamine in the striatum region is reduced. The striatum refers to a brain region that is responsible for rewarding and behavioural control. A deficiency in dopamine level can lead to a perpetuation of compulsions and addictions. Therefore, the kleptomaniac would repeatedly steal objects.

There is evidence that kleptomania is a possible side effect of the administration of a synthetic form of dopamine, called L-Dopa. The drug used to treat patients of Parkinson disease, it works by increasing the dopamine level. It is reported that excessive dopamine levels caused by L-Dopamine can lead to impulse behaviour, such as kleptomania. It is also associated with gambling disorder and compulsive shopping behaviour.

Another biological explanations is due to genetics:

The reward deficiency syndrome suggest that there is a genetic predisposition to a deficiency of the reward centre in the brain. It suggest that people diagnosed with ICDs are more likely to carry the A1 allele of the DRD2 gene responsible for the coding of the D2 receptor. Around 25% of the population have the A1 allele and they develop 30% less D2 receptors, which means that there are less receptors for dopamine to bind to in their brain, leading to less communication in certain networks.

This means that they might feel less sastified by daily activities and usually resort to more extreme behavior to seek the dopamine rush (hence the behaviour)

In the study of Comings et al (sometimes i find psychologists' names very funny bc i have the humor of a 12 year old boy) the A1 allele was carried by up to 51% of people who have gambling disorder, yet only 25% of the general population carry this gene. Oh btw the likelyhood of people with severe gambling addiction carrying this gene is much higher.

We also have cognitive and psychological explanations:

Behavioral explanations (no freaky freud today sadly) The first explanation focuses on positive reinforcement, it refers to when someone’s learned behavior is a result of previous trials of that behavior. Positive reinforcement is when a certain behavior is rewarded, it is more likely to be repeated. For example, a person who wins while gambling, the winning prize is the reward, the person is more likely to gamble again. To be specific, the development of impulse control disorder can be explained through a schedule of reinforcement or partial positive reinforcement.  For gambling disorder, the individuals would not receive the reward each time, which reduce the chance they they would ever feel fully satisfied with their reward, they make them much more likely to keep playing in the mistaken belief they would make up the money they lost before, they believe that the pay out could happen if they play one more time.Research found out that fruit machine is quite addictive and can change people behaviour very fast.

Cognitive (i hate miller. it is such a simple concept and yet he make it sound so fucking foreign) Feeling - State Theory: - Miller's feeling-state theory relies on the underlying thoughts on a specific behaviour to explain obsession. Miller said that impulse control disorder is caused by the link between the intense positive feelings and a specific behaviour to form a state-dependent memory. - Feeling-state refers to the sensations, thoughts, emotions, physiological and psychological arousal in relation to a particular behavior. Impulse control disorder is composed of positive emotions and memory of that behaviour and leads to compulsive behaviour. - Miller argues that an underlying negative thought or experience is most likely to create an impulse control disorder because the individual can experience an intense feeling of euphoria and power. For example, the person with pyromania who has a feeling that I am powerful when setting fire may have underlying negative beliefs about themselves, such as weak or unimportant.

How do we treat ICDs then?

Biological

One of the biological treatments of impulse control disorder is opiate antagonist, a group of drugs that traditionally used to treat alcohol dependence patients. It works by blocking the opiate receptor in order to reduce the reinforcing of gambling behaviour. There are 2 types, nalmefene used to treat alcohol, and naltrexone used to treat opiate dependence. There are side effects such as dizziness, nausea, anxiety,...

Example case study: Grant et al (2008)

Aim and hypothesis: To investigate systematically how the individual responds to the biochemical form of treatment.

Sample

284 Ps

Approximately equal number of females and males.

All from the US.

Diagnosed with PG and gambled for the last 2 weeks.

Design

Double-blind procedure.

18 weeks of nalmefene and 16 weeks of naltrexone.

Independent group of placebo, 25, 50, 150 mg/day of nalmefene and placebo, 50, 100, 150 mg/day of naltrexone.

25% of the Ps in each condition receive placebo.

Data collection

The main measure in the study is PG-YBOCS to assess the severity of gambling disorder by assessing the symptoms over 7 days, in terms of gambling urges and behaviours. Other scales to assess anxiety, unipolar disorder and psychological function. The researchers also conduct semi-structured interviews in order to investigate the family history of alcoholism, specifically first-degree relatives.

Results, findings

The results show that at least the PG Ps had 35% reduction in the total score of PG-YBOCS for 1 month follow-up compared to the placebo group. It also states that Ps that have a family history of alcoholism and receive intense doses of opiate antagonists show the highest positive response. It is also reported that younger Ps show a more positive response to the placebo than older Ps.

Psychological

1. Cover sensitisation

It uses classical conditions, it involves an unpleasant stimulus such as nausea or an anxiety-producing image paired with an undesirable behaviour in order to reduce the likelihood of that behavior.

Example case study: Glover 

A 56-years old woman has a 14-years history of daily shoplifting.

Her behaviour started when her husband was convicted of stealing money from his workplace and she felt it difficult to forgive him. As a result, the women become isolated from their close friends, take a low-status job and become depressed. Following that the woman has compulsive thoughts of shoplifting which is repulsive and impossible to resist. Her shoplifting is without a purposeful gain. For example, the woman might steal a pair of baby shoes despite not having a baby herself or anyone to give them.

There were 4 sessions at 2-weekly intervals. The first 2 sessions involve muscle relaxation in order to enhance her ability to immerse herself in the visualization. During the treatment involved imagery of nausea and vomiting to create an unpleasant association with stealing. Increasing nausea visualisation was used, she imagined vomiting as she lifted the item to steal and attracting attention and disgust of those  around her.

The women practice these visualizations as homework.

During the last sessions, she imagined the sickness going away as she replaced the item and walked away without shoplifting. The women successfully associate the unpleasant sensations of vomiting with undesirable stealing behaviour. 

At the 19-months follow-up, she decreased the desire and avoidance of stealing, she only has a single relapse. She reported improvement in her self-esteem and social life.

2. Imaginal desensitization

This therapy relies on the use of images.

Blaszczynski and Nower

First, the therapist teaches a progressive muscle relaxation procedure. Clients must visualize themselves being exposed to a situation that triggers the drive to carry out their impulsive control disorder and then mentally leave the situation. This should be done in relaxation.

The sessions are often audio-recorded to assist with practising the technique outside therapy sessions.

It has been shown that imaginal desensitization reduces the levels of psychological and physiological arousal associated with these disorders. This would help the client to learn how to reduce arousal levels when they have the urge to perform the impulsive act and therefore less likely to repeat the behaviour. In those with gambling disorders, imaginal desensitization was found to significantly decrease arousal and anxiety levels associated with gambling impulses even at a 5-years follow-up. Clients report they feel able to control their impulses.

Mary Doe

A case of a woman named Mary Doe who was a 52 years old American divorced mother of 2 grown children. She worked as a bookkeeper and lived alone in a small condo. She was fascinated with cards while watching her grandmother play as a child. She started playing for money and to make friends with boys during high school. Her gambling disorder started when casinos were legal in the place where she lived, she would gamble everyday at the casino and lose a huge amount of money.

The therapist spoke to Mary about stressors in her life that were a trigger to her behaviour and explained that they would create a script to use in the guided imagery sessions.

जमशेदपुर : समाहरणालय सभागार में उपायुक्त कर्ण सत्यार्थी की अध्यक्षता में आंगनबाड़ी सेवाओं, महिला–बाल विकास से संबंधित योजनाओं एवं पोषण कार्यक्रमों की प्रगति की समीक्षा को लेकर समाज कल्याण विभाग की मासिक समीक्षात्मक बैठक आयोजित की गई। बैठक में जिला स्तर पर संचालित योजनाओं की विस्तृत समीक्षा करते हुए संबंधित पदाधिकारियों को समयबद्ध एवं प्रभावी क्रियान्वयन सुनिश्चित करने हेतु आवश्यक दिशा-निर्देश…