CLINICAL- Impulse Control Disorders

Question 1

Describe the diagnostic criteria for ICD

Answer 1

• Impulse control disorders are characterized by the repeated inability to resist the impulse/urge to carry out the behavior
• The behavior will feel rewarding to the person short term, but long term will lead to negative effects
  All impulse disorders have 5 unique stages:
• An impulse
• Growing tension
• Pleasure after impulse is done
• Guilt or lack of it

Question 2

The 3 impulse disorders are:

Answer 2

• 1. Kleptomania
• 2. Pyromania
• 3. Gambling disorder

Question 3

Describe kleptomania

Answer 3

• The powerful impulse to steal
• These stolen objects are not needed for personal use or monetary value
• Intrusive thoughts, affective arousal and tension characterize it and the urge to steal affects the person’s ability to concentrate and the person will feel guilt or shame.

Question 4

Describe Pyromania

Answer 4

• An impulse control disorder characterised by the impulse to start fires
• There is a strong fascination with fire. Excitement or gratification is usually felt during and immediately after the act
• For there to be a diagnosis, the individual must have deliberately set fire on more than one occasion. It also cannot be due to any other mental disorder
• There’s no real motive behind the fire such as monetary, sabotage or revenge

Question 5

Describe a gambling disorder

Answer 5

• This involves a pattern of persistent gambling behaviour, either online or offline
  It is characterized by:
• Length of time spent on the activity and how much money is spent
• Gambling being given priority over other activities
• Gambling continuing despite negative consequences
  The gambling will result in impairment in important areas of life such as family or work life

Question 6

Describe the Kleptomania Symptoms Assessment Scale (K-SAS)

Answer 6

• An 11-item self-report questionnaire
• The respondent will relate these questions to the past seven days
• Each item is rated on a scale of 0-4 or 0-5
  EXAMPLE QUESTION:
  During the past week, how many times did you experience urges to steal? Please circle the most appropriate number
  0 None — 5 Constant, near-constant

Question 7

Evaluate the K-SAS

Answer 7

• Standardised procedures make it reliable
• quantitative data for comparison of severity/ Nomothetic approach collects large amounts of data
• Good concurrent validity compared to the Global Assessment of Functioning scale
• Social desirability bias

Question 8

Describe the biological explanation

Answer 8

DOPAMINE EXPLANATION:
- This is known as the ‘happy’ chemical and is released as a trigger by reward stimuli
- The striatum is an area in the brain that is responsible for reward and behavioral control, so a deficiency in dopamine can lead to the continuation of compulsions and addiction
- e.g a kleptomaniac will steal something and their reward centers are stimulated and release dopamine, they will increase in stealing behaviour and this is known as “reward deficiency syndrome”

Question 9

Evaluate the biological explanation

Answer 9

• Comings and Blum support the explanation using brain scans which are objective, increasing validity and reliability
• Nature is supported
• Reductionist
• Deterministic, no control over chemical pathways

Question 10

What are the 2 psychological theories for ICD

Answer 10

• Behavioural: Positive reinforcement
• Cognitive: Miller’s feeling-state theory

Question 11

Describe the behavioural explanation

Answer 11

Positive reinforcement: When a behaviour results from a reward being given and so, the behaviour repeats.
- for example, the enjoyment of winning at gambling acts as a positive reinforcer
- This is explained well by use of schedules of reinforcement
- This means that for gamblers, they ill not receive a reward every time and so they will keep playing in hopes of redeeming the money they have lost and so on.

Question 12

evaluate the behavioural explanation

Answer 12

• Reductionist as it reduces several factors of rewards which could make them repeat Potenza, 2006), suggesting a neurobiological underpinning that behavioral theories overlook.
• Supports the situational side since it rewards the individual (Clark et al., 2009).
• Early experiments, such as Skinner’s work or unethical studies manipulating reinforcement in addictive behaviors, have been criticized for their artificial settings and potential harm to participants, questioning their validity and applicability to ICDs in real-life contexts.
• The behavioural model does not fit all types of addictions e.g Russian roulette which is a tactical game

Question 13

Describe the cognitive explanation

Answer 13

Miller (2010) explains that these are intense positive feelings linked with specific behaviours such as gambling or stealing.
- These links form a “state-dependent memory”
- The person with negative thoughts about themselves will experience an intense feeling of euphoria and power when they indulge in their impulsive behavior to overcome
INTENSE DESIRE + INTENSE POSITIVE EXPERIENCE = FEELING-STATE
- The feeling- state refers to all sensations, emotions and thoughts a person will experience after a particular event.
-Miller stated that an underlying negative thought/ experience is most likely to create the feeling-state that leads to ICD

Question 14

Evaluate the cognitive theory

Answer 14

• Supports both the individual and situational side. situational because the experiences reward the person. Individual because every feeling-state is different
• Holistic explanation as it considers many other aspects such as different experiences leading to different feeling-states
• Applicable to everyday life which can be treatment by placing emphasis on reducing strong associations with those feelings

Question 15

what is the biological treatment used

Answer 15

• A group of drugs called opiate antagonists

Question 16

what are the main theories and explanations in Grant et al

Answer 16

• Opiate antagonists are a group of drugs that have been traditionally used to treat substance abuse
• When an individual engages in gambling behaviour, just like addiction, the reward centers in the brain get activated
• opiate antagonists work by reducing the response of the reward centers in the brain, reducing the urge to carry out these activities

Question 17

What was the aim & Hypothesis in Grant

Answer 17

AIM:
- The research aimed to identify clinical variables associated with treatment outcome in pathological gamblers receiving opiate antagonist
HYPOTHEHSIS:
- A strong family history of alcoholism and gambling would have a positive outcome for those treated with opiate antagonist
- That people with less severe PG would be more likely to respond positively to the placebos than those with more severe PG

Question 18

Describe the features of the sample

Answer 18

• 284 participants
• equal number of male and female
• all were from USA

Question 19

How was independent measures design used

Answer 19

• participants were randomly assigned to one of 4 conditions;
• Placebo OR Nalmefene : doses were 25mg/day, 50mg/day or 100mg/day in one trial
• Placebo OR Naltrexone : doses were 50mg/day, 100mg/day or 150mg/day

Question 20

How was the double - blind technique used in Grant et al.

Answer 20

• neither the participants nor the investigators knew who was taking the placebo and who was taking the active drugs

Question 21

what was the main measure used in Grant

Answer 21

The Yale-Brown Obsessive Compulsive Scale Modified for Pathological Gambling (PG-YBOCS)

Question 22

Describe the PG-YBOCS

Answer 22

• A clinical administered scale used to assess gambling severity
• it assess the symptoms over the past 7 days
• they do this assessment by looking at their:
• behaviour
• urges
• thoughts

Question 23

What other scales were administered in Grant

Answer 23

• A scale assessing participants on psychological functioning, anxiety and depressive disorder
• a semi structured interview to question their family history particularly first degree relatives with alcoholism

Question 24

state 3 results from Grant

Answer 24

• There was a positive response to the opiate antagonists from participants with a family history of alcoholism
• there was a positive response to the higher doses of opiate antagonists to resist the strong urges of gambling
• to contradict the hypothesis, those with less severe PG had a less positive response to the placebo

Question 25

State the conclusion in Grant

Answer 25

- A family history of alcoholism and strong gambling urges seem to predict a positive response to opiate antagonists in treating PG

Question 26

Evaluate Grant et al.

Answer 26

- Used a double blind technique which eliminated participant & researcher bias increasing validity - Quantitative data was collected - applicable to everyday life through opiates as a treatment - Informed consent was taken - However there was deception as patients believed they were getting the right drug

Question 27

what are the psychological treatments

Answer 27

- Covert sensitization - imaginal desensitization

Question 28

Describe covert sensitization

Answer 28

- This involves conditioning - an unpleasant stimulus e.g nausea will be paired with an undesirable behaviour in order to change that behaviour

Question 29

Describe the sample in Glover

Answer 29

- a 56-year-old woman - with a 14-year history of daily shoplifting

Question 30

With evidence from Glover, state how impactful covert sensitization is

Answer 30

- At a 19-month check-up, she had decreased desire and avoidance to stealing behaviour.

Question 31

Describe Imaginal desensitization (ID)

Answer 31

- This therapy relies on using images to help people with ICD

Question 32

Describe ID in Blaszezynksi & Nower

Answer 32

- First the therapist will teach progressive relaxation muscle exercises - Next, clients will visualize themselves being exposed to a situation that triggers them - They will then have to mentally leave the situation through the muscle exercies learned