Should we treat people with impulse-control disorders, whose behavior may be illegal and potentially harmful to others, as criminals or as people having psychological disorders?

By definition, impulse-control disorders arise from irresistible urges. Individuals with disorders such as kleptomania and pyromania engage in the illegal acts of stealing and firesetting, respectively. Those with intermittent explosive disorder may also commit illegal acts during one of their violent outbursts. When people with these disorders encounter the justice system, the, the question arises whether we should regard them as having a disorder or as practicing a form of illegal and deviant behavior similar to psychopathy.

People with kleptomania commit acts of stealing in response to a failure to resist impulses. The stealing may give them momentary relief from their anxiety-driven urge, but ultimately it leads only to significant distress and dysfunction in their everyday lives. A key difference between kleptomania and antisocial personality disorder is that people with kleptomania feel intense regret; moreover, they do not steal for any particular monetary reason. Similarly, individuals with pyromania, by definition, do not seek monetary reward from their actions. Those with intermittent explosive disorder do not seek to commit violent acts but are responding to irresistible urges. People with gambling disorder steal or cheat not for the sake of material gain, but in order to support their gambling habit.

According to one view, impulse-control disorders are not volitional disorders, which excuse an individual from moral and legal responsibility for his or her actions. A cognitive impairment that prevents knowing or remembering the negative consequences of the persons previous addictive behaviors causes the volitional disorder. Once the behavior begins, it increases the extent of the impairment.

The terminology the mental health profession uses to describe kleptomania and pyromania implies, however, that individuals with these disorders are somehow attracted to the opportunities to steal and start fires. In the case of pyromania, fire fighters, insurance investigators, law enforcement professionals, and even mental health professionals may fail to appreciate fully the diagnostic criteria for the disorder. One erroneous but popular belief is that serial arsonists are pyromaniacs. In fact, clinicians diagnose pyromania in a very small percent of chronic firesetters. We often view people with pyromania as deriving sexual pleasure from their behavior. In reality, this occurs in only a minority of cases. According to Doley (2003), the lack of accurate information about pyromania means that it is not possible to determine whether people with pyromania even exist, let alone are responsible for their behavior.

You be the judge: Should we treat people with impulse-control disorders, whose behavior may be illegal and potentially harmful to others, as criminals or as people having psychological disorders?

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