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Impulse control disorders include pathological gambling, repetitive hair pulling, kleptomania, pyromania, and intermittent explosive disorder. Compulsive skin picking, buying, Internet use, and sexual behavior also can be considered a problem of poor impulse control. Until recently little was known about the phenomenology, incidence, etiology, and treatment of impulse control disorders, Thankfully, that situation has changed with publication of this informative book by psychiatrist, Dr. Jon E. Grant.
Grant wrote the book to provide "an overview of impulse control disorders from a clinical perspective." He begins by describing the typical presentation of 11 impulse control disorders, referencing current diagnostic criteria for each one, and including a representative case illustration. The disorders are explained briefly and the examples give a "real world" flavor to each description.
What causes someone to have an impulse control disorder? To answer this question, Grant considers several theories. For example, some researchers have emphasized the similar urge-driven and anxiety-reduction characteristics between impulse control disorders and obsessive compulsive disorder. Impulse control disorders also share clinical features with behavioral addictions, mood disorders, and attention deficit hyperactivity disorder. Several chapters in the book address what is common among these disorders, as well as incongruent dimensions and associated psychiatric co-morbidity. The information covered in these chapters will inform mental health professionals about many diagnostic challenges and how to resolve them.
Grant explores etiology further with a lucid analysis of neurobiological influences on impulse control disorders. He details many recent advances in biochemistry, neuroanatomy, and genetics which offer intriguing theories about possible predisposing factors. Importantly, he looks at the interplay between biological determinism and social learning experiences. To illustrate, he suggests convincingly that some people who have an impulse control disorder may be more vulnerable to the reinforcing and punishing consequences of their behavior compared to non-afflicted individuals. On whole, his focus on integrating psychological theory with neurobiology is first-rate.
I was pleased to see a chapter about assessing impulse control disorders. Grant's orientation is that frequently, mental health professionals fail to diagnose the problem or they render an alternative but inaccurate diagnosis. He discusses some of the reasons contributing to diagnostic errors, emphasizing the "phenomenological similarities" between impulse control and other psychiatric disorders. To remedy potential diagnostic uncertainty, he advocates that clinicians conduct initial (baseline) and ongoing assessment through structured interviews, standardized rating scales, symptom monitoring, and self-report. His assessment recommendations are instructive and reflect considerable clinical expertise.
Surprisingly, there are few controlled treatment trials for many of the impulse control disorders. Accordingly, Grant includes a chapter that highlights those disorders with the best evidence-based outcomes, namely pathological gambling, hair pulling, compulsive buying, skin picking, intermittent explosive disorder, and kleptomania. For each disorder he first reviews the existing pharmacological treatment research, followed by psychological therapy approaches. One of the most valuable parts of the book, found in this chapter, is an easy to read table that summarizes the most rigorous pharmacotherapy and psychotherapy research currently available.
I have nothing but high praise for this book! Grant presents a complex topic with precision and remarkable insight. One reason for recommending the book is the empirical base that informs each chapter. Being an established researcher, Grant never strays from the objective evidence when he writes about diagnosis, assessment, and treatment. By doing so, he gives readers the most reasonable and scientifically validated understanding of impulse control disorders.
I also applaud Dr. Grant for writing a book free of technical jargon and arcane terminology. Certainly, he uses language fitting a professional audience of physicians, psychologists, and other mental health practitioners. However, his prose is concise, easy to comprehend, and translatable at a practical level. By giving us a goldmine of information, this book will improve clinical practice and in consequence, benefit the lives of people who have impulse control disorders.
© 2008 James K. Luiselli
James K. Luiselli, Ed.D., ABPP, BCBA is a psychologist affiliated with May Institute and a private-practice clinician. Among his publications are 6 books and over 200 journal articles. He reviews books for The New England Psychologist.