Impulse Control Issues
Impulsivity is when a person reacts to things in a fast and unplanned way. People can react impulsively to internal events (like thoughts, feelings or memories) or external occurrences (like events or people). People with impulse control issues regularly react quickly, without considering negative consequences.
We all act on impulse from time-to-time, and it is not always problematic. But for some people, impulsivity can affect their relationships, ability to participate at work or school, or other usual daily activities. Difficulty with impulse control is a characteristic of some mental health problems, such as personality disorders, bipolar disorder and substance use problems (1). Often, impulse control issues start early on in life.
If you find that you repeatedly struggle with impulse control and notice that it is having a negative impact on your life, seek help. Effective treatments are available and therapy is one very helpful option to consider.
Types of impulse control issues
Impulsivity is a key feature of some mental health diagnoses. The manual used by mental health professionals to diagnose mental health conditions is called the DSM-5. In it, there is a category of disorders that are related to difficulty with impulse control and disruptive behavior, including:
- Kleptomania: The impulsive stealing of items that are not needed
- Pyromania: Repeatedly setting fires to release tension (but not to cause damage)
- Intermittent-explosive disorder: Repeated angry or aggressive outbursts
This category of the DSM-5 also contains other diagnoses, including:
- Oppositional defiant disorder (ODD): Characterised by angry moods, defiant behavior, being argumentative and vindictive.
- Conduct disorder: This is more severe than ODD, involving ongoing behavior that breaks societal rules, aggression, and destroying property, for example.
The DSM-5 classifies compulsive and addictive behaviors separately, although they do sound similar and are sometimes confused with impulsivity.
Impulsivity has been associated with difficulties like substance use, compulsive gambling, self-harm and aggression (2).
Prevalence of impulse control issues
Everyone acts impulsively at times, but it does not always become problematic. It’s difficult to get a good idea of how many people do face problems because of impulse control issues. This is, at least in part, because impulsivity is not a diagnosable mental health problem. Instead, it tends to be a symptom of, or associated with, other mental health problems.
However, there is data related to some of the diagnoses closely related to impulse control issues. For example:
- Kleptomania appears to be relatively uncommon. One study found that less than 1% of people met the criteria for this diagnosis (3).
- Intermittent Explosive Disorder was identified in 4-7% of the population in a review of the research (4).
- Pyromania has been estimated to occur in around 2.4-3.5% of the population (4).
Signs of impulse control issues
Impulsivity can affect people in different ways. If you are concerned about yourself or your child, look out for some of the following signs:
- Rapid, unplanned reactions to things. You might notice that you react before the opportunity to consider the consequences of the actions or before completely processing the situation.
- Appear less concerned about or less sensitive to the negative consequences of impulsive actions
- Playing with fire or showing an unusual interest in fire
- Irritability or agitation
- Low self-esteem
- Relationship problems
- Legal or financial trouble
What to do if you are struggling with impulse control
If you are struggling with impulsivity, consider a combination of the following actions:
- Therapy: Psychological talking therapies in both individual and group contexts can help you to develop strategies for improving impulse control. Individual, group or family therapy can be helpful. Types of therapy to consider are discussed further, below.
- Helplines: If you need immediate support, call 1-800-273-8255, or go the National Suicide Prevention Lifeline website.
- Checkups: See your physician for a checkup to eliminate any other medical conditions that could be associated with your symptoms.
- Medication: In some cases, medication may help to manage impulsivity and any associated symptoms of mental health problems. You might want to consider an assessment by a psychiatrist, who can prescribe the relevant medications.
- Avoid alcohol and drugs: Some substances can cause us to become disinhibited and can increase our vulnerability to impulsivity.
Therapy types to consider for impulsivity
Many types of therapy can help people learn how to have more control and address any related mental health challenges. Therapy types include:
- Cognitive Behavioral Therapy (CBT): CBT can help change unhelpful thoughts and behaviors and help people to become more aware of triggers. Additionally, it’s not uncommon to also experience mental health problems such as anxiety, depression, or substance abuse. CBT can also help with this.
- Contingency management approaches: These approaches draw on principles of learning to change impulsive behavior. Rewarding and punishing consequences are used to try to alter problematic behaviors.
- Mindfulness Practices: Mindfulness helps people to be aware more aware of their sensations, feelings and thoughts without automatically reacting.
- Acceptance and Commitment Therapy (ACT): ACT involves components of both CBT and mindfulness as well as other strategies to help people take an acceptance-based approach to impulse control.
What to look for in a therapist for impulse control issues
The best-fitting type of therapist for you will depend on individual factors, symptoms, your location and finances. When selecting a mental health professional, it can be helpful to consider the following factors:
As is the case when you are seeking therapy for any reason, it’s important to consider the potential for developing a strong working relationship with your therapist. The trusting working relationship with a therapist is called the therapeutic alliance, and it’s the number one indicator of treatment efficacy.
Qualifications and experience
It is important to look for a licensed mental health professional. This ensures that the therapist you work with has undertaken the appropriate education and training. In addition, ask your prospective therapist ahead of time whether they have specialized training and experience in treating impulse control issues.
Talk in advance
The best way to judge how you might feel about your prospective therapist is to ask for a preliminary phone call. Most therapists will be happy to oblige. This gives you the opportunity to ask about:
- Their qualifications
- Their experience working with people with impulse control issues
- Any ongoing training in impulsivity and related therapies
- What type of therapy they suggest, and what that will be like
- Their participation in insurance plans and cost of therapy
Try to speak to a few different therapists before making your mind up.
Sources and references:
- (1) Psychiatric Aspects of Impulsivity (PDF)
- (2) Altering impulsive decision making with an acceptance-based procedure
- (3) Impulse-control disorders in a college sample: results from the self-administered Minnesota Impulse Disorders Interview (MIDI)
- (4) Epidemiologic and clinical updates on impulse control disorders: a critical review
- American Psychiatric Association, “What Are Disruptive, Impulse-Control and Conduct Disorders?”
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