120 PATHOLOGIC GAMBLING AND IMPULSE CONTROL DISORDERS

Impaired regulation of impulse is a central feature in several psychiatric disorders and behaviors, including drug use disorders, cluster B personality disorders such as borderline personality disorder, bipolar disorders, and suicide attempts. The DSM-IV’s ‘‘impulse control disorders (ICDs) not specified elsewhere’’ (1) have historically received less attention than other psychiatric conditions. This heterogeneous group of illnesses includes intermittent explosive disorder, kleptomania, pyromania, pathologic gambling (PG), trichotillomania, and ICDs not otherwise specified. We review the neurobiology and treatment of one of these ICDs, PG, and describe the nature and treatments of several other potentially related conditions that have recently received increased attention: (a) compulsive buying (CB); (b) compulsive sexual behavior (CSB); and (c) compulsive computer use (CCU). These disorders, linked by a failure to resist urges to engage in ultimately self-destructive behaviors, appear to be relatively common, frequently go unrecognized for considerable periods, and may constitute greater threats to personal health than is often appreciated.