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Millions of Americans wrestle with irresistible urges--to shop, steal, gamble, and more--that wreak havoc on their lives. Drs. Jon Grant and S. W. Kim, the nation's leading specialists on impulse control disorders, offer the latest research and practical help for those who engage in all types of ...
Millions of Americans wrestle with irresistible urges--to shop, steal, gamble, and more--that wreak havoc on their lives. Drs. Jon Grant and S. W. Kim, the nation's leading specialists on impulse control disorders, offer the latest research and practical help for those who engage in all types of impulse-related behaviors. Highlights include:
|1||Stories of Behavioral Addictions||9|
|2||What Are Impulse Control Disorders?||27|
|3||Who Has an Impulse Control Disorder?||39|
|4||The Impact of Impulse Control Disorders||57|
|5||Age and Gender: Influences on Impulse Control Disorders||81|
|6||Why People Behave Impulsively||99|
|7||Possible Causes of Impulse Control Disorders||115|
|8||Medication Treatment for Impulse Control Disorders||131|
|9||Psychological Treatments for Impulse Control Disorders||159|
|10||Family, Friends, and Impulse Control Disorders||173|
|Appendix A||Where to Get Help: Organizations Associated with Impulse Control Disorders||191|
|Appendix B||Selected Books and Articles Related to Impulse Control Disorders||195|
|Appendix C||Frequently Asked Questions||197|
Stories of Behavioral Addictions
Robert: The Story of a Pathological Gambler
"I've lost everything," Robert began as he took a seat in my office. "It's out of control. I can't think of anything but gambling. Even though I keep losing, I want to return to the casino and try to win back my money." Robert was noticeably upset-unable to look me in the eye, almost on the point of tears. He had called a few weeks earlier wanting to come in, but had kept finding excuses to put off the appointment. During the initial phone conversation, he refused to give me his name because of the shame and embarrassment he felt. After three phone calls, he finally made an appointment for an evening when he felt no one would see him entering a psychiatrist's office.
At first, Robert was reluctant to disclose details about his gambling. "I should be able to stop on my own. I'm not even sure why I'm here. You're a psychiatrist. I don't think I'm crazy. I just need to exercise more will power. Other people seem to be able to go to the casino, stay a little while, and leave. I don't know why I can't seem to pull myself away once I get there. It's embarrassing."
Robert went on to discuss how he had started gambling during college. He would often bet on sporting events with friends. His gambling was sporadic and apparently did not cause any problems in his life. Over the next three or four years, he started going to the local casino every couple of months with friends and playing blackjack. He would occasionally win, but even if he lost, he was able to return home without being preoccupied by the experience. Now twenty-seven years old, Robert remembers fairly distinctly when gambling started becoming a problem for him. "I guess it was some time last year when I didn't want to go to the casino with my friends. I wanted to go alone. I felt that if there were fewer distractions, I could concentrate on the cards and would have a better chance of winning. I realized at that time that gambling was no longer a game to me-it was controlling me." He fidgeted in his chair and looked uncomfortable. "It sounds like I'm an addict or something. I have never had a problem with drugs or alcohol, and here I am sounding like I'm hooked on something. The urges I have to gamble are so intense. Is this how drug addicts feel?"
Robert continued to describe how over the past year the amount of time he spent gambling had increased. He was currently going to the casino two or three nights per week. Although he intended to gamble for only a few hours and spend no more than $100 each visit, Robert usually spent most of the evening at the casino and used his credit card once the $100 in cash ran out. Robert often acquired debt of $500 to $1000 per night. The late evenings at the casino made it difficult for him to concentrate at work the next day. "I work in an accounting office. I need to be able to concentrate. After sitting up all night at the casino, I'm in no shape to work. My work has suffered, and my boss is upset." Robert's concentration at work also suffered because of the almost constant thoughts of gambling that preoccupied him. When asked to quantify the amount of time he spent thinking about gambling, Robert replied, "I probably think about my losses or about strategies to win a total of three or four hours each day. It doesn't leave a lot of room for thinking about my work."
I asked Robert why he felt he couldn't stop gambling. "I don't know if you can understand. The cravings I have to gamble are so strong. They take priority over everything else in my life. I can be driving home from work, planning on being with my wife and child for dinner. On the way home, I see a billboard for the casino, and my urges to gamble are triggered. The urges are intense, and I can't resist them. Suddenly, I'm on my way to the casino, calling my wife on the cell phone and telling her I have to stay late at work." Although Robert explained that his urges to gamble were usually triggered by billboards, he had also noticed changes in his urges during the course of his illness. He said that recently he had also urges to gamble immediately upon waking up in the morning. He used to be able to prevent the urges to gamble by taking other routes home after work so that he could avoid the billboards. Now that he was often feeling his urges spontaneously, without a known trigger, Robert felt more "out of control."
"I feel guilty about what I'm doing, but I can't stop. When I get these urges, nothing seems to relieve them except gambling. If I don't get to go to the casino when I have these urges-maybe my wife asks me to do something or a family emergency comes up-I feel incredibly anxious, and I get very irritable. The way I treat my wife and family is sometimes horrible-I leave them alone for hours, I lie to them, I cancel family plans, and it's all due to gambling."
Robert's marriage and his work had both suffered because of his gambling. Although he had been married for only three years, his wife was already talking about divorce. "I think she believes I'm having an affair. She knows nothing about the gambling. I'm ashamed that I'm so weak-I can't tell her. She also doesn't know anything about our debts. I make good money, but the credit card bills are getting bigger. I'm scared I may have to file for bankruptcy." Robert began to cry. "I just keep thinking that if I could win big one time, I would be able to get out of debt and then quit gambling."
While doing his work in the accounting office, Robert spent so much time thinking of ways to win at gambling-which tables to play, how to lay the bets, which "lucky" shirt to wear-that he couldn't complete the projects assigned to him in a timely manner. "I know I have deadlines, and I want to do the work, but I start thinking about gambling and hours just fly by. I can't concentrate on work." Robert also found it difficult to stay at work, even when he had meetings. Instead, when he felt urges to gamble, Robert would leave work early. "I know I'm ruining my career and I just can't stop my behavior."
Before coming to our clinic, Robert had never seen a psychiatrist. He had no history of drug or alcohol abuse or other psychiatric illnesses. When he first came to see me, Robert believed his problem was a lack of will power, not a psychiatric illness. He didn't really want to see a psychiatrist, but his wife insisted upon it. Although Robert had told no one about his gambling problem, his wife thought he might be suffering from depression. "She told me that I looked sad all the time and that I appeared to be losing weight. When I told her that I just had a check-up with my primary doctor, she suggested I see a psychiatrist.
"The amount of energy, time, and money I have spent gambling has me shaking my head in disgust. I look back and wonder how I have lived this way for the last year or two. It has been unbearable. I have hidden my disease from everyone. I feel like an alcoholic hiding his liquor. I have lived in fear both of the financial repercussions of my gambling and of being discovered. I have hated myself because of this illness. This disease controls you, not the reverse." Insert a blank line here Robert's story is typical of what we hear from the pathological gamblers we see in our clinic. Although the symptoms of Robert's gambling problem were severe, his description of his struggle with the illness is what many people with pathological gambling experience. Pathological gambling is an underrecognized and understudied psychiatric disorder in which people are preoccupied with gambling (planning how to win or thinking of past experiences). These people often have no history of other psychiatric problems. They function well in all other respects-holding jobs, having families-until the gambling problem overwhelms their lives. People with pathological gambling often believe that the problem is one of will power. If they were to resist the urges to gamble more strongly, they would be able to stop. But they can't stop. Unlike Robert, many people with pathological gambling do not seek psychiatric help. Instead, they tend to blame themselves for the problem. They feel extreme shame and guilt, and they suffer in silence.
In addition to the urges that they feel, pathological gamblers also think about gambling excessively. They worry about their financial problems, and they obsess about winning back their money. This combination of urges and worries causes these people extreme distress. It also interferes substantially with their lives. Pathological gambling is a complex disorder. How can a person start gambling for fun and then, over time, become unable to stop? Why does this happen to only some people who gamble and not others? How can a person lose thousands of dollars, face bankruptcy, ruin a marriage, jeopardize employment, and yet continue to believe that next time he'll win? Although it is common, pathological gambling is still a poorly understood disorder. Only recently have psychiatrists explored this problem, and the general public is just beginning to hear about pathological gambling. Until recently, the physician did not have much to offer. With recent research on medications and cognitive-behavior therapy, however, there is now hope for people who suffer from pathological gambling.
Gloria: The Story of a Compulsive Shopper
Gloria, a forty-four-year-old married woman, came to see me in the clinic, complaining of feeling depressed. She explained that she had been feeling down for the past several months. She had recently lost her job as a dental assistant and was going through a divorce. When I asked Gloria if there was anything else bothering her, she was silent for several minutes. "It's so embarrassing to talk about. It sounds ridiculous. I think my compulsion to shop is the cause of my depression.
"I don't know when everything got out of control. I've always shopped, but it's only been a problem during the past year-now I'm out of control." Gloria struggled to explain. "I used to go to stores, take my shopping list, get the items, and go home. Every now and then I would buy a few extra 'fun' things, but nothing too extravagant. My husband and I are doing well financially, but both of us are careful about our spending. About a year ago, my husband started to comment that the 'fun' things I was purchasing had increased in number, frequency, and expense. Shortly after that, I noticed that I was going to stores more often than I really needed. I would tell myself that I deserved certain things or that we had plenty of money and so I could afford them. I didn't need or even want the items I was buying-I seemed to be shopping just to shop. I had urges just to purchase something. At first I bought small items-scarves, books, shoes. As time went on, I needed to buy more expensive items to stop the urges-even items I didn't want. I started buying jewelry that I didn't wear and expensive home furnishings (drapes, appliances) that I didn't use. I also had to lie to my husband. I kept certain bills from him so he wouldn't find out. The lying tore me up inside."
Gloria explained that at first she tried to stop herself by not going to the stores. "I decided I would just stay home when I wasn't at work. Then I got addicted to Internet shopping. For instance, I decided to buy my eight-year-old nephew a birthday gift. I promised myself that I would spend only $30, no more. I found some little toy cars for sale-a few dollars each. Although I told myself I wouldn't spend more than $30, I ended up spending about $5000 on those little cars. I couldn't believe what I had done."
Although she regretted having spent so much on her nephew, Gloria told me that she was back on the Internet later that same day. "I bought four snowblowers and twenty black T-shirts. The odd thing is that we already had a snowblower and I don't wear T-shirts. Why would anyone do such a thing?" Over the next few months, Gloria began arriving late for work and then missing work. Instead, she was shopping on the Internet. "I would start shopping in the morning. After a while, I would look at the clock and realize that six or eight hours had passed and I had missed the entire workday." Even while at work, Gloria thought about items she'd like to purchase. Feeling these urges to shop also made it difficult for Gloria to concentrate-she started making mistakes. When Gloria did shop, however, she felt "peaceful": "It's not really happiness; instead, it's a relief, like some internal pressure that needs to come out. On the other hand, if something happens to keep me from shopping, I feel worse. This pressure builds up in my head, and in my whole body. I want to scream. Instead, I just become really irritable." Gloria quit spending time with her husband, choosing to shop instead. Her marriage was suffering. "I love my husband, but the urges to shop were so strong-I couldn't resist. Also, I couldn't tell him about the shopping. I thought it was a major character flaw. How could he continue to love me once he knew how weak and undisciplined I was?" Gloria lost her job, and the bills became too overwhelming to hide from her husband. "I remember the day I had to tell him about my problem. I had already spent all of our savings. I probably had $80,000 in credit card debt. I was so ashamed to tell him. I remember the look of betrayal on his face. I knew the marriage was over. I had lied to him and stolen from him. I hated myself."
Gloria's husband left her. Shortly thereafter, Gloria tried to overdose on aspirin and was admitted to a psychiatric hospital. She never told the doctors about the shopping problem; instead, she just told them she was depressed. "I never knew the shopping was an actual illness. I thought if I told the doctors, they wouldn't help me-it didn't seem like a medical problem. This is the first time I've told anyone other than my husband. This may be hard for you to believe, and it sounds silly, but shopping has ruined my family."
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Compulsive shopping is a painful and yet virtually unknown mental illness. Most people who suffer from this problem, like Gloria, tell no one. Many do not even know it's an illness. Instead, they think they have no self-control. Also, rather than telling their physician and risking embarrassment, they report feeling depressed and keep the shopping problem secret. Although many aspects of compulsive shopping remain a mystery, we do have treatments for this disorder. Gloria was successfully treated with a combination of medications, including an antidepressant [a selective serotonin reuptake inhibitor (SSRI)] and an atypical neuroleptic. Although she still occasionally has urges to shop, the urges are now mild, and she can easily resist them. Since treatments for compulsive shopping are available, physicians need to ask their patients and people need to tell their physicians when compulsive shopping is an issue.
Nancy's Story: Kleptomania (Compulsive Shoplifting)
I will never forget meeting Nancy, the first patient with kleptomania that I treated. As she walked into my office late one evening, I was struck by how nervous she was. Perspiration covered her forehead, her hands were trembling, and her voice quivered as she introduced herself. A fifty-two-year-old married woman, Nancy had gone to several psychiatrists before seeing me for what she described initially as depression and anxiety. At the interview, Nancy certainly was suffering from an anxious depression, but there also appeared to be something else she wasn't telling me.
After the initial interview, I received a letter from Nancy. In the letter, she referred to herself as the "devil's spawn." "I have been a horrible person for so long that I can't bring myself to tell you these things in person. I'm a thief. I steal something almost every day. You probably won't believe this, but I don't want the stuff I take. I don't have any idea why I take the things I do. I have plenty of money. Most of the items I steal I don't want or need. That's why I'm depressed. How can I feel good when I'm such an evil person? If you don't want to treat me any longer, I'll understand."
I called Nancy immediately upon receiving this letter to tell her that I would like to continue treating her. I stressed that she had an illness and that it wasn't a character flaw. Although she was somewhat reluctant, Nancy agreed to come for another appointment. "I was probably fourteen years old when I started stealing," she said. "I would go to stores with my mother. When I saw certain objects, I would get urges to steal them. The odd thing was that the items I stole were so ridiculous. I remember stealing key chains for several months, maybe three or four times a week. I didn't use them. I wasn't even sure why I stole them. Then I went several months where I stole batteries-hundreds of batteries. Every time I stole something, I felt a sort of 'rush.' The problem was that almost immediately after each theft, I felt guilty and ashamed. I wanted so much to tell my mother, but I couldn't. I was so afraid she'd quit loving me.
"When I got older, things got even worse. I continued to have urges to steal when I entered stores, but the items needed to be more expensive to make the urges go away. Also, I was having urges more often, and so I needed to steal more often. I couldn't steal just batteries anymore. Instead, I began to steal vacuums or lamps. One time I stole seven blenders at the same time. I remember just walking out with them in a cart. No one stopped me." Nancy admitted that as a well-dressed, attractive physician she had never been stopped by security when the alarms sounded. "By the time I reached thirty years of age, I was stealing about four to five times per week." "How has this affected your life?" I asked.
"My entire life has been torment," she replied. "Each day I worry about having the urges, and then I worry about being caught stealing. I can't relax. Also, I was raised with morals, and I know what I'm doing is wrong. I'm a common criminal. Every night I go to bed hoping, praying that tomorrow will be different, that I won't want to steal anything. My prayers are never answered. I keep telling myself, 'just stop,' but I can't. I'm married with a sixteen-year-old daughter. I haven't even told my husband. He could never understand. I don't even understand. What if my daughter knew that her mother was a thief?"
Nancy had been apprehended only once, although she had been stealing for almost forty years. She was unable to look me in the eyes as she told the story of her apprehension. "I had stolen several things from a department store, including one expensive man's tie. Sometimes after I steal, I donate the items to the Salvation Army, throw them away, or give them away as gifts. On this particular evening I decided to give the tie to my husband. I hadn't stolen it with that intent. When I got home, I gave it to him, and he loved it. In fact, he put it on immediately. He was so happy, even though looking at it flooded me with guilt. I didn't know that there were cameras in the store. Shortly after I returned home, the police came to the door. I will never forget my husband's face as they took the tie off his neck. He just looked at me in horror as the police told him I had stolen it. I lied to him yet again when I told him I didn't do it." Nancy started crying. Her pain seemed too much to bear.
Nancy had gone to two psychiatrists over the last several years. Although she had told them about the stealing, they were unable to help. "Because they were unfamiliar with kleptomania, it was hard for them to understand my problem. I think they tried, but they didn't really get it. No one knew how badly I suffered. They tried to tell me to resist my impulse to steal or just try to stop. They saw the stealing as a minor oddity. They never seemed to get the idea that the stealing was why I was coming to see a psychiatrist." Instead, Nancy was treated for depression with an SSRI, which was helpful for her depression but not for her kleptomania. "I still have urges every day and cannot stop stealing."
Nancy had also gone to several support groups for people with various mental disorders such as depression. "I talked about my depression and my difficulties with my husband, but I couldn't discuss the stealing. How could they possibly understand? I was also afraid that they would reject me for being a criminal if they knew the truth. I guess I was just wasting my time-my fears kept me from getting help."
At the time I saw Nancy, she was considering suicide. "I can't go on stealing like this, and hating myself daily for doing so." Nancy had never been without her urges to steal. She simply could not imagine a life free from this burden. I recommended a new combination of medications-an opioid antagonist in addition to her antidepressant. Four weeks after starting the medication, Nancy came to the clinic. "I can't believe what I'm about to tell you. I quit stealing. These pills are miraculous. I still have urges to steal, but they're less intense and less frequent. It's a real triumph to be able to resist them." Nancy has been able to refrain from stealing for the last nine months.
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Although it was first described in medical literature almost 200 years ago, kleptomania is one of the most poorly understood problems in psychiatry. For years there were debates about whether kleptomania was even an illness. Many thought it was merely criminal behavior. We now realize that kleptomania is a disabling illness.
Nancy's story is very typical of those we hear from people who suffer from kleptomania. These people often find it difficult to tell their families, their loved ones, or their physicians about their urges to steal. They hate themselves because of the stealing. People with kleptomania suffer the shame of engaging in criminal behavior and the frustration of being unable to stop this behavior.
Until recently, kleptomania was considered quite rare. It may, however, be more common than it has been thought to be. Stealing is mentioned in the Ten Commandments as one of the ten moral precepts of Judeo-Christian thought. The shame associated with stealing prevents many people from discussing their problem. Even though more is now known about kleptomania, it continues to be an underrecognized disorder.
Gregg's Story: Compulsive Sexual Behavior
Gregg called me shortly after seeing me on a local news show where I was interviewed about compulsive gambling. Gregg, a thirty-seven-year-old married man who worked in advertising, was quick to inform me that he did not gamble. "When I was listening to you talk about gambling, I thought it sounded a lot like my problem. You mentioned how these gamblers can't stop their behavior, that they have these urges that are so intense, and I realized it's the same for me." Gregg was obviously hesitant to discuss his problem. "I have the same problem with sex. Is that a psychiatric problem, or am I just a pervert?" Gregg began to cry and hung up. A couple of days later, Gregg called to schedule an appointment and came to the clinic. Noticeably shy and nervous, Gregg sat quietly for several minutes before he began talking. He apologized for hanging up. "I had never told that to anyone, and when I heard myself say it, I was so ashamed. Am I a sick person? I feel like some sort of degenerate." Gregg proceeded to tell his story. Although he had been married for fourteen years, Gregg often felt urges to have sex with strange women. "It's not really about seeking some thrill. Certain times I feel so tense and anxious, and then I feel these urges. The urges are uncontrollable. I know I shouldn't cheat on my wife-I love her-but I can't stop. After I have sex, I feel so calm. Of course, that quickly disappears as the guilt floods me."
Gregg's compulsive sexual behavior had started when he was about twenty-one years of age. Getting married did not dampen the urges. "I have urges three or four times per week. I only act on the urges maybe one time every couple of weeks. I try to distract myself until the urges leave. They may last for a couple of hours, and during that time I'm a real bastard-irritable, angry, tense. I would have sex more often, but it's not easy to find women during the day to have sex with.
"These urges and behavior have ruined my life. I live each day with so much guilt and shame. And yet, given the opportunity, I would continue to have sex. Why do I continue doing something even when I see that it's destroying my life, my self-respect, and my marriage? You tell me I have a psychiatric illness, but I don't believe that. I'm a bad person, and no amount of medication or therapy is going to help me."
Although we had several meetings in which we discussed his compulsive sexual behavior and possible treatment options, Gregg eventually quit coming for treatment. At that time, he was still struggling with his symptoms and with the shame. Although there is no universally accepted definition of compulsive sexual behavior, it generally refers to sexual behavior that is excessive and that leads to difficulties (work-related or personal) in a person's life or to feelings of distress. Although there are some promising treatment options for this illness, embarrassment and shame often prevent people from seeking treatment.
Impulse Control Disorders in Children and Adolescents
If adults who suffer from impulse control disorders have difficulty talking about these problems because of embarrassment and shame, consider how difficult it must be for children and adolescents. The professional literature on these illnesses suggests that most of them start during late childhood or adolescence, and yet most physicians and family members are unfamiliar with them.
Betty was thirteen years old when she started stealing. At first her parents thought that she, like many children who steal, was doing it because she wanted something or because she was upset about something. However, Betty didn't know why she was stealing. Obviously embarrassed at having been brought to a psychiatrist and ashamed of what she had been doing, Betty was hesitant to talk. "I get these feelings to take things. They scare me because I know it's wrong and I know my parents will be upset, but I can't stop myself." Betty had been stealing softballs from the school. Her mother had found about fourteen softballs in the basement where Betty had hidden them. Betty did not play softball or ever use these balls. When asked why she took the softballs, Betty started to cry. "I don't know. Help me stop."
Some impulse control disorders do not show themselves until late adolescence. Because younger children usually do not have access to unlimited amounts of money, compulsive shopping and compulsive gambling may not become problems until adolescence. Steven was seventeen years old when his parents brought him to our clinic. He had started playing cards with some adults in the neighborhood on a daily basis. He had been staying out all night gambling, was failing school, was no longer dating, and had accumulated large financial debts to the other players, debts that he could not repay. Steven discussed his gambling like any of the adult patients we treat. "I'm thinking about it all day. I keep thinking of ways I can win and get my money back." When asked if he had urges or cravings to gamble, Steven replied, "I get an intense desire to play cards. If my parents try to stop me, I'll lie, run away, or do whatever I have to so I can play." Sharon was sixteen years old when her mother brought her to an appointment. Having been raised in an affluent family, Sharon had her own credit card when she was fourteen. Her mother had become concerned about Sharon's shopping habits. Sharon often left school early to go to the mall alone to shop. She described having thoughts all day about various things she wanted to buy. Initially she went shopping with friends, but she had recently started to prefer going on her own. "I don't think of shopping as something I like to do anymore, so I don't want friends around. It's now something I have to do. If I don't buy something every day, I feel so tense." Insert a blank line here
Impulse control disorders usually start in adolescence, but children may also suffer from these disorders. Although we do not know how common these problems are in children or adolescents, people may be particularly vulnerable to the development of these disorders during adolescence. Adults whom we treat usually tell us that their behaviors began, at least to some degree, during their teen years. Also, these disorders start gradually in most people, and so they may first appear in childhood or adolescence but not become a problem until later in life.
Living with Behavioral Addicts: Stories of Family Members
Having been featured on television and in newspapers, we have received letters and emails from all over the world from people who are concerned about family members and loved ones. Sometimes the person writing us wonders if a family member has an impulse control disorder, and other times he or she is asking for treatment recommendations.
One man in Australia wrote us about his son. "My son is twenty-five years old, and I am trying to figure out if he is a kleptomaniac. He has been stealing for eight years and has been in prison twice. My wife and I had pretty much given up on him. After reading your story about kleptomania, we started to wonder if he had it. I'm not trying to make excuses for my son, but he has stolen some very peculiar items over the years. If he has an illness, I need to get help for him. If he had a heart problem, I wouldn't let that go untreated."
Many family members feel helpless as they watch a loved one continue with self-destructive behavior. The sense of isolation and shame that the patient feels is often felt by members of his or her family as well. A woman from Ireland wrote the following email about her daughter: "I watched my daughter ruin her life, the lives of her husband and children, and I could do nothing. My daughter, I believe, suffered from compulsive shopping. She was out of control-spending everything she and her husband made. They lost everything. She then went into a severe depression and took her own life. I watched this for about two years and did nothing. I didn't know it was an illness. Instead, I criticized her for being so irresponsible. I was so ashamed of what others might think of her, and of me. I never tried to get her into treatment. In fact, I quit talking to her because she always wanted to borrow money. I blame myself for her death." Another mother called to tell us about her daughter. "I just watch her gamble her life away. She's a smart young woman, and she is destroying herself. I feel that I must have done something to cause this. Or at the very least that I should be able to stop her. I'm her mother, I love her, and all I can do is sit and watch. I have never felt such pain."
The fact that these disorders can be treated effectively is highlighted by the following note we received from the wife of a pathological gambler. "My husband's illness has been so devastating for so long. He started gambling when he retired. Almost immediately he had a problem. He was never home. He spent all of his time at the casino. We lost our retirement savings. We had to ask our children for financial help. That was so humiliating. We should be helping them, not the other way around. It also hurt our relationships with our children. I didn't think they wanted us to call anymore because they feared we wanted money. My husband and I spent evenings crying, with him promising not to gamble anymore. Those moments were short-lived, however, and he would be back to the casino in a couple of days. Anyhow, once we realized that this was an illness, we looked for a psychiatrist. Finally, after a dozen attempts, we found someone who felt comfortable treating compulsive gambling. My husband is probably 75 percent better, and we are starting to rebuild our lives and our relationships with our children."
Data on impulse control disorders are incomplete. These disorders, however, may affect a substantial number of people. Estimates of the possible prevalence of these disorders in the U.S. population suggest that each impulse control disorder may be far more common than was previously thought: pathological gambling, 1 to 5 percent of the population; kleptomania, 0.5 to 1.0 percent; compulsive shopping, 1.8 to 5 percent; and compulsive sexual behavior, 5 percent. Most of these estimates, however, are derived from studies of various specific populations, such as college students or patients at certain medical clinics. Whether the illnesses are more or less common than these estimates is still unclear at this time, but the numbers suggest that these are not rare problems.
Impulse control disorders have many things in common: People are engaging in behaviors that they cannot resist; they usually have urges to perform these behaviors; the urges and behaviors cause emotional distress and interfere with their day-to-day functioning. Some people try to resist the urges, with varying degrees of success. Others are overwhelmed and may engage in the behavior almost automatically. Regardless of their degree of control over their behavior, patients suffering from impulse control disorders all feel shame because of their behavior. The shame and the secrecy the behavior engenders appear to be inherent in these disorders and are probably the first and sometimes greatest enemies to overcome.
Overcoming the secrecy and shame is an important first step in seeking treatment, and there is preliminary evidence that psychiatric treatment is often beneficial for these disorders. Several medications and certain forms of psychotherapy have shown promise in alleviating the symptoms of these illnesses. Although there is much that we still don't know about these disabling and distressing illnesses, we can offer hope to those who suffer from them.