Impulse-Control Disorders;

Adjustment Disorder

Intermittent Explosive Disorder      Kleptomania      Pyromania

Pathological Gambling       Trichotillomania       Adjustment Disorder

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Impulse-Control Disorders Not Elsewhere Classified

Intermittent Explosive Disorder

• On several occasions the patient has lost control of aggressive impulses, leading to serious assault or property destruction.

• The aggression is markedly out of proportion to the seriousness of any social or psychological stressors.

• No other mental disorder or personality disorder better explains the symptoms.*

• These symptoms are not directly caused by a general medical condition or substance use, including medications and drugs of abuse.

Coding Notes

*DSM-IV specifically mentions Antisocial Personality Disorder, Borderline Personality Disorder, Attention-Deficit/Hyperactivity Disorder, Conduct Disorder, Manic Episode and psychotic disorders.

Kleptomania

• The patient repeatedly yields to the impulse to steal objects that are needed neither for personal use nor for their monetary worth.

• Just before the theft, the patient experiences increasing tension.

• At the time of theft, the patient feels gratification, pleasure or relief.

• These thefts are committed neither out of anger or revenge nor in response to delusions or hallucinations.

• The thefts are not better explained by Antisocial Personality Disorder, Conduct Disorder or a Manic Episode.

Pyromania

• More than once, the patient has deliberately and purposefully set fires.

• Before the fire-setting, the patient experiences tension or excited mood.

• The patient is interested in or attracted to fire and its circumstances and associations (such as firefighting apparatus, uses or aftermath of fire).

• The patient experiences gratification, pleasure or relief when setting fires or experiencing their consequences.

• These fires are not set:
  for profit
  to express a political agenda
  to conceal crimes
  to express anger or revenge
  to improve the patient's living circumstances
  in response to a delusion or hallucination
  as a result of impaired judgment*

• The fire-setting is not better explained by Antisocial Personality Disorder, Conduct Disorder or Manic Episode.

Coding Note

*Of course, setting any fire at all would usually be interpreted as evidence of impaired judgment. What this criterion tries to express is the faulty judgment usually associated with other Axis I disorders as dementia, Mental Retardation and Substance Intoxication.

Pathological Gambling

• Persistent, maladaptive gambling is expressed by 5 or more of the following. The patient:
  -Is preoccupied with gambling (relieves past experiences, plans new ventures or devises ways to obtain seed money)
  -Needs to put increasing amounts of money into play to get the desired excitement
  -Has repeatedly tried (and failed) to control or stop gambling
  -Feels restless or irritable when trying to control gambling
  -Uses gambling to escape from problems or to cope with dysphoric mood (such as anxiety, depression, guilt, helplessness)
  -Often tries to recoup loses ("chasing one's losses")
  -Lies to cover up the extent of gambling
  -Has stolen (embezzlement, forgery, fraud, theft) to finance gambling
  -Has jeopardized a job, important relationship or opportunity for career or education by gambling
  -Has had to rely on others for money to relieve the consequences of gambling

• A Manic Episode doesn't better explain this behavior.

Trichotillomania

• Repeated extraction of the patient's own hair causes noticeable hair loss.

• The patient feels increased tension just before hair-pulling or when trying to resist it.

• The patient feels gratification, pleasure or relief when hair-pulling.

• These symptoms cause clinically important distress or impair work, social or personal functioning.

• The behavior is not better explained by another mental disorder and is not caused by a general medical condition.

312.30 Impulse Control Disorders NOS

Adjustment Disorder

• Within 3 months of a stressor and in response to it, the patient develops emotional or behavioral symptoms.

• Either of the following demonstrates the clinical importance of the above symptoms:
  --Distress that markedly exceeds what you would normally expect from such a stressor, or
  --Materially impaired job, academic or social functioning

• These symptoms neither fulfill criteria for an Axis I disorder nor are they merely the worsening of a preexisting Axis I or Axis II disorder.

• The symptoms are not caused by Bereavement.

• They don't last longer than 6 months after the end of the stressor (or its consequences).

Depending on the predominant symptoms, code:

  309.0 With Depressed Mood. The patient is tearful, sad, hopeless.

  309.24 With Anxiety. The patient is nervous, fearful, worried.

  309.28 With Mixed Anxiety and Depressed Mood. Combination of above.

  309.3 With Disturbance of Conduct. The patient violates rules or rights of others.

  309.4 With Mixed Disturbance of Emotions and Conduct. Combinations.

  309.9 Unspecified. For example, job problems, physical complaints, social withdrawal.

Specify whether the symptoms are:

  Acute. They have lasted less than six months, or

  Chronic. They have lasted six months or more (use when stressor is chronic or has lasting effects).

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