When Al Gore ‘invented’ the internet, he can have had little understanding of the Pandora's box he was opening. Unparalleled access to sex, gambling, and shopping, according to the editors of this clinical manual, have led to a dramatic rise in all kinds of impulsive behaviour, which is why the publication of this book is timely. However, despite the claim that the impulse control disorders have only recently burst onto the scene, they do have a history and are present in DSM-IV. Intermittent explosive disorder, kleptomania, pyromania and trichotillomania form an odd assortment of diagnoses thrown together as they did not fit in elsewhere. Although linked by problems with impulsivity it is acknowledged that this is a defining characteristic of many psychiatric illnesses, and the correlation (oft-repeated here) between reduced serotonin function and measures of impulsivity seems a tenuous basis upon which to construct a new diagnostic category. Yet with DSM-V in the early stages of development, now is the time to stake a claim for the legitimacy of this rubric, and to bolster the case a number of other disorders have been added: sexual compulsions, binge eating, self-injury, compulsive shopping and, yes, internet addiction.

Each chapter reviews one disorder, providing historical background, theories of pathogenesis, and means of assessment. As a clinical manual, however, the book disappoints when it comes to approaches to management. This may of course be a reflection of the lack of evidence for interventions being of benefit; notably, the preface contains a disclaimer stating that no US Food and Drug Administration-approved medication exists for impulse control disorders. Unsurprisingly, selective serotonin reuptake inhibitors and cognitive-behavioural therapy head the list of suggested treatments.

For me this book founders particularly in its failure to address the larger question, a question hinted at by an astonishing statement: ‘Conscience is not a DSM-IV concept because it is difficult to operationalize how humans form moral judgements’ (p. 40). Many of the problems considered here would formerly have been considered vices. Is it the role of psychiatry to recast them as disease? The over-medicalisation of personal and social problems is a topical issue but such discussion is conspicuous in its absence from these pages.

So, I think it unlikely that clinical practice will be altered by use of this manual but for those keen on recommending self-help literature, with titles such as Women Who Shop Too Much - Overcoming the Urge to Splurge, the reference lists are certainly worth perusal.