Diagnosis of impulse control disorder, not elsewhere classified, begins with an evaluation by a mental health professional. This may include a medical history, and involve discussion of the nature, duration and severity of the patient’s symptoms. A physical examination may also be conducted to look for any signs of physical illness that may be contributing to the impulsive behavior.

In diagnosing impulse control disorders, it is especially important to rule out other mental health disorders, medical conditions or reasons that may be causing the behavior. Specific criteria have been developed by the American Psychiatric Association (APA) for the diagnosis of impulse control disorder, not elsewhere classified.

Criteria that must be met for a diagnosis of intermittent explosive disorder are:

• Several separate and distinct occasions of giving in to aggressive impulses that result in personal assault or the destruction of property.
  
  
• Aggressive behavior during these episodes is grossly out of proportion to whatever triggered the event.
  
  
• Aggressive behavior is not better explained by another mental health disorder (e.g., antisocial personality disorder, borderline personality disorder [BPD], psychotic disorder, manic episode, conduct disorder, attention deficit hyperactivity disorder [ADHD]), medical condition (e.g., head trauma, Alzheimer’s disease) or the effect of substances on the body (e.g., drugs or alcohol abuse, medications).

Criteria that must be met for a diagnosis of kleptomania are:

• Repeatedly giving in to an impulse to steal objects without regard for their financial value or practical use.
  
  
• Feelings of increasing tension prior to stealing.
  
  
• Feelings of pleasure or relief after stealing.
  
  
• Stealing without feelings of anger or revenge, nor in response to delusions or hallucinations.
  
  
• Stealing that is not better explained by a conduct disorder, manic episode or antisocial personality disorder.

Criteria that must be met for a diagnosis of pyromania are:

• Two or more occasions of deliberate fire-setting.
  
  
• Feelings of increasing tension prior to setting the fire.
  
  
• Feelings of pleasure or relief once the fire has been set, or when witnessing or participating in the consequences of the fire-setting.
  
  
• Fascination, interest, curiosity or attraction to fire (including fire-setting paraphernalia, use or consequences of fires).
  
  
• Fire-setting is not performed for financial gain, social or political expression, due to feelings of anger or revenge, to conceal a crime or improve one’s living circumstances. It is not performed because of impaired judgment or in response to delusions or hallucinations (e.g., dementia, mental retardation, substance abuse).
  
  
• Fire-setting is not better explained by a conduct disorder, a manic episode or antisocial personality disorder.

A patient must meet at least five or more of the following criteria for a diagnosis of pathological gambling:

• Pre-occupation with gambling.
  
  
• Increasing amounts of money are needed to achieve desired excitement.
  
  
• Continues gambling despite repeated efforts to control behavior.
  
  
• Restless or irritable when trying to stop gambling.
  
  
• Uses gambling to improve mood.
  
  
• Gambles to win back losses.
  
  
• Lies to family members, therapist or others to cover up gambling behavior.
  
  
• Steals money in order to continue gambling.
  
  
• Puts relationships, job in danger.
  
  
• Seeks money from others to pay debts related to gambling.

Criteria that must be met for a diagnosis of trichotillomania are:

• Repeated hair-pulling that results in noticeable hair loss on head and/or body.
  
  
• Feelings of increasing tension prior to pulling out hair, or when trying to resist engaging in the behavior.
  
  
• Feelings of pleasure or relief after the hair has been pulled out.
  
  
• Hair-pulling is not better explained by another mental disorder or medical condition (e.g., diseases of the skin or hair).
  
  
• Hair-pulling causes distress or impairment of personal relationships, work.