- Published: November 7, 2012
Confronted with a choice between smaller, immediate rewards and larger, deferred rewards, people who lack impulse control always choose the former. Interestingly, it’s not because they don’t know the benefit of waiting for larger rewards; they usually know that their choice is not optimal. They report an abstract understanding of the wrongfulness of their choices but cannot stop making them under the pull of emotion in the moment of decision.
Modern neuroimaging has shown that those people usually suffer from prefrontal lobe damage. Impulsivity results from an imbalance between impulsive system, which involves amygdala that provides an immediate signal of pain or pleasure, and reflective system, which involves ventromedial prefrontal cortex that considers the long-term consequences of behavioral alternatives. For those who lack impulse control, their reflective system is unable to check the push for immediate action generated by impulsive system. Impulse control disorders have two treatment options: pharmacological and psychosocial.
In pharmaceutical approach, it’s shown that the use of selective serotonin reuptake inhibitor (SSRI) antidepressants has shown improvement in patients who are impulsive and aggressive. For example in pathological gambling, clomipramine, along with fluvoxamine, has shown to reduce pathological gambling in a subject by up to 90%. However, we still have inconsistent results in using fluoxetine and paroxetine. It shows that although SSRIs have shown positive results in the treatment of pathological gambling, the inconsistent results with the use of SSRIs suggest a neurological heterogeneity within the Impulse Control Disorder spectrum.
Psychosocial approach in impulse control includes Cognitive Behavioral Theraphy (CBT), which suggests that cognitive-behavioural therapies offer an effective intervention model. Aversive therapy Systematic desensitization, , covert sensitization, imaginal desensitization, and stimulus control have been proven to be successful in the treatments for pathological gambling. In another example for the treatment of sexual addiction, Eye Movement Desensitization and Reprocessing (EMDR) has been found to be effective Along with CBT. However, the psychosocial approach is far from being universal. For example, the efficiency of CBT for compulsive buying is not truly determined yet.
In the setting of law, the fact that a person can understand the wrongfulness of an act yet be powerless to refrain from committing it sheds light on reconsideration of the extent of sentencing. However, I think that we’re still not clear on how much the impulsivity acts on the person during the crime. There is no scientific measurement of the degree of difficulty which an abnormal person has in controlling his impulses. Since it’s possible that defendants who were capable of controlling their conduct will be excused from responsibility, we still need to be careful when dealing with people even with impulse control disorder. It’s also hard in the consideration of the length of sentencing because the existing treatments haven’t been proved to be consistent and efficient.