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Am J Psychiatry 1954;111:132-138.
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The Department of Psychiatry, New York University College of Medicine and the Bellevue Psychiatric Hospital.

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We have presented certain clinical pictures typified by a disorder of impulse. This disorder may express itself in a rather specific symptomatic disturbance appearing as an impulse neurosis, a perversion, or a catathymic crisis. On the other hand, the disturbance may be more diffuse and nonspecific, pervading the total personality and behavior of the individual, expressing itself in a character disorder. In the impulsive character disorder we sometimes find evidence of a relationship to organic factors. However, there is another large group belonging to the impulsive character disorders which does not show such evidence of organicity and yet is characterized by the same infantile, explosive, impulsive behavior seen in the former.In surveying the genetic and dynamic factor, it is apparent that no one factor in and of itself determines the development of an impulse disorder.Constitutional factors, early developmental experiences, present-day forces and stresses impinging upon the individual contribute to the efficacy of the control apparatus or to the strength of drive. Constitutionally, varying drive and control potentials, physiologically as well as psychologically, interweave with early developmental experiences. Among the latter are psychological ones such as oral traumata possibly leading to an intolerance of frustration with demands for immediate gratification. Interference with speech-action relationships may result in the latter persisting as the medium of communication, thus leading to a tendency toward acting out.Physiologically, illness and physical traumata may increase the strength of the drives or weaken the control apparatus. The constitutional and early developmental experiences may lend a quality of impulsivity to the character, which in the face of current forces and stresses may result in impulsive behavior. Specific early experiences may supply the clinical clothing which envelopes the impulse skeleton leading to either direct or distorted expression of a given early impulse. The result is a wide array of clinical syndromes, which have as their common denominator an impulse disorder.

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