OBJECTIVE: The authors reviewed available studies of DSM-III-R impulse
control disorders not elsewhere classified in order to determine the
relationship of these disorders to one another and to other psychiatric
disorders. METHOD: The review focused on the demographic and clinical
characteristics, phenomenology, family history, biology, and response to
treatment of individuals with intermittent explosive disorder, kleptomania,
pathological gambling, pyromania, and trichotillomania. Analysis was
restricted to reports which either indicated use of operational diagnostic
criteria or provided descriptions of the impulsive behavior detailed enough
that patients could be judged as probably meeting the DSM-III-R criteria.
RESULTS: Although different impulse control disorders have different sex
ratios, all have similar ages at onset and courses. Studies on
phenomenology, family history, and response to treatment suggest that
intermittent explosive disorder, kleptomania, pathological gambling,
pyromania, and trichotillomania may be related to mood disorders, alcohol
and psychoactive substance abuse, and anxiety disorders (especially
obsessive-compulsive disorder). Biological studies indicate that
intermittent explosive disorder and pyromania may share serotonergic
abnormalities similar to those reported in mood disorders. CONCLUSIONS: The
impulse control disorders not elsewhere classified appear to be related to
one another and to mood, anxiety, and psychoactive substance use disorders.
Thus, like major depression, obsessive-compulsive disorder, panic disorder,
bulimia nervosa, and attention deficit hyperactivity disorder, they may
represent forms of "affective spectrum disorder."