Impulse Control Disorders, edited by Elias Aboujaoude, MD, and Lorrin M. Koran, MD, is an amazingly comprehensive compendium of the current information regarding the differential diagnosis, treatment, prevalence, cultural aspects, comorbidity, and references regarding what they call “Impulse Control Disorders” (ICDs). I must admit that I was initially disappointed when I received the book and saw, in the “Introduction,” only pictures of patients with scarring, excoriation, and broken hairs, patches of alopecia areola, the effects of buxism, and others. I was looking to understand some of the more interpersonal illnesses. However…do not despair. They are there and in the multitudes. Perhaps one cannot photograph them, and that is the reason the authors chose to use photos of what they could photograph!
The editors have assembled authorities from around the country and the world (New York, Washington, DC, Chicago, Texas, Iowa, New Haven, Tel Aviv, the United Kingdom, Istanbul, Germany, and France—to name a few), who, as they say in the “Introduction,” “have attempted to create a practical, authoritative guide to the ICDs that summarizes the current state of knowledge” (p. 1). They have succeeded.
The book is divided into four sections according to the “impulse” under consideration: Section I, Acquisitive Impulses; Section II, Pellicular Impulses; Section III, Information-Seeking Impulses; and Section IV, Sexual and Aggressive Impulses. Each section has several chapters devoted to different problems represented in the section. For example, Section IV includes such subjects as Hypersexuality, The Sex Industry, Intermittent Explosive Disorder, Violence Against Women, Preventing a Social Scourge, Intimate Partner Violence, Pyromania, and Arson.
Do you have a patient who, one day, reveals what you recognize as “compulsive buying”? Here, you have all the information on the subject: the history, diagnosis and classification, differential diagnosis, clinical picture, identification and assessment, prevalence, age at onset and sex, natural history and course, quality of life, etiology and pathophysiology, psychiatric comorbidity, dimensional traits, and treatment with psychotherapy and medication, as well as more than 100 references.
The chapters are written in a manner that is very readable. For example, the author (in this section, Donald Black, MD, from the University of Iowa Carver College of Medicine) writes about the “social effects,” referring to compulsive shopping as the dark underbelly of the American dream of prosperity. He lets the reader know that, despite the multitude of references, “No treatment has been well established as effective for Compulsive Buying Disorder and both psychotherapies and medication have been recommended” (p. 16). Therefore, one knows what all of those references have found, that is, that we still do not have a “proven” treatment.
Under “Information-Seeking Impulses,” the sections include a great deal of information about the questions today’s Internet use poses. The sections included are “Problematic Internet Use: Clinical Aspects,” “Virtual Violence: the Games People Play,” “Counseling in Cyberspace: Your E-Therapist is on Call.” This is a very relevant subject in today’s world when therapists are wondering how much is too much. It turns out that there are multiple assessment instruments that one can use to determine the “how much” is happening, but the question of “too much” remains an argument. However, this is one of the valuable aspects of the chapters: the authors (in this case, Timothy Lieu, MD, and Marc Potenza, MD, from the Department of Psychiatry of Yale University) let you know what is known and how much is not known. There have been no double-blind studies or controlled trials of psychopharmacology or psychotherapy. Therefore, we know that what we are guided by are case reports, and if this is an “addiction,” perhaps the medications that seem to work for Obsessive Compulsive Disorder will be effective. Personally, I believe that it is important to remember what we do not know while we assess what seems to work for our patients.
Even the appendices are filled with useful information. Appendix I contains Treatment Guidelines for Compulsive Buying Disorder, Kleptomania, Pathological Gambling, Tricotillomania, Skin Picking, Nail Biting, Problematic Internet Use, Nonparaphillic Sexual disorder, Intermittent Explosive Disorder, and Pyromania. Appendix II has a list of Scales and Assessment Instruments.
This is a highly readable book that I would recommend to all therapists.
Marcia Kraft Goin, MD, PhD
Keck School of Medicine
University of Southern California
Los Angeles, CA
The author declares no conflict of interest.