Impulsivity

The Presentation and Phenomenology of Impulsivity

File photo. [Credit: Neuroscience NewsOpens in new window] People who are high in impulsivity exhibit poor self-control and emotional instability, which manifest in behaviors that might be risky and inappropriate, and often lead to negative and undesirable consequences. Thus, these individuals often feel powerless, weak, and ashamed due to their lack of control over their impulsive behaviors.

Impulsivity, like aggressionOpens in new window and violenceOpens in new window, is diagnostically non-specific and can be a manifestation of many different disorders, both psychiatric and medical. Because it lies on the spectrum of aggression/violence, it shares many of the possible associated diagnoses for those conditions.

Impulsivity can range from inappropriate acting-out behaviors such as tantrums or unprovoked fits of rage, like those seen in patients with mental retardation, to impulsive self-mutilatory behavior, as seen in patients with borderline personality disordersOpens in new window, to paraphilias and other types of impulse-control disorders. Additionally, impulsive behaviors can be seen in patients with hypomanic or manic episodes, oppositional defiant, conduct, attention-deficit/hyperactivity, substance-related, and antisocial personality disorders.

Functional and Dysfunctional Impulsivity

The consequences of impulsive behavior are not always negative. It has been suggested that high impulsiveness when completing simple tasks under time constraints can lead to more accurate results than low impulsiveness (Dickman, 1990). Thus, impulsivity is not always associated with a negative psychological outcome.

While most of the research has been dedicated to studying the negative consequences of impulsivity, also known as negative impulsivity, it is important to note that the tendency to act quickly to achieve a positive outcome has been referred to as functional impulsivity (Winkel, Wyland, Shaffer, & Clason, 2011).

Negative impulsivity occurs despite negative consequences; however, positive impulsivity occurs due to the benefits resulting from this type of information processing style (Johnson & Kim, 2011). Thus, functional impulsivity has been associated with enthusiasm, adventurousness and extraversion, idea generation and rapid decision making (Di Milia, 2013).

An example of functional impulsivity can be considered in an individual who spontaneously offers a helping hand to their colleagues, offering to induct the new employee and show them around the office, or who volunteers to participate in a charitable event. In contrast, dysfunctional impulsivity leads to negative outcomes and is often associated with aggressionOpens in new window, violenceOpens in new window and conduct disorderOpens in new window (Winkel et al., 2011).

It is considered that enthusiastic and active people are more productive, even though they engage in risk-taking activities like individuals displaying dysfunctional impulsivity (Dickman, 1990).

It appears that an individual with dysfunctional impulsivity is more likely to disregard facts when making decisions, subsequently leading to increased negative outcomes of their impulsive behavior (Dickman, 1990).

People high in dysfunctional impulsivity are considered to be inattentive and careless, resulting in planning deficits and inability to delay gratification, which contributes to negative consequences (Johnson & Kim, 2011). Dysfunctional impulsivity is associated with fast but inaccurate decision making, high distractibility and suicidal thoughts (Di Milia, 2013).

It is considered that individuals high in dysfunctional impulsivity engage in fast and erroneous decision making due to their inability to use a slower methodical approach (Dickman, 1990). It has been suggested that stressful circumstances might interfere with the individual’s ability to engage in a slow and measured approach when making decisions (Dickman, 1990).

High dysfunctional impulsivity is associated with higher distractibility while driving and lane crossing, as well as driving while intoxicated and with high incidents of binge drinking in young males (Adan, 2012).

Dysfunctional impulsivity is also associated with the heightened tendency of individuals diagnosed with schizophrenia to display repetitive violent behavior. Dysfunctional impulsivity is considered to be at the core of many psychopathies. Individuals who scored higher on dysfunctional impulsivity demonstrated poorer responses to treatment for pathological gambling.

Furthermore, dysfunctional impulsivity was associated with higher craving as well as smoking without conscious awareness, loss of control, smoking while ill and experiencing difficulties abstaining from non-smoking areas in individuals aiming to cease smoking (Pitts & Leventhal, 2012).

Impulsivity as a Clinical Problem

Diagnosis of a psychiatric condition in an individual can have an impact on the manifestation of impulsive behaviors. Impulsivity is a prominent feature of many psychiatric and developmental disorders: personality disorders (such as Borderline Personality DisorderOpens in new window), eating disorders (such as bulimiaOpens in new window), mood disorders (such as bipolar disorderOpens in new window) and substance addictionOpens in new window (such as drug addiction) (Parry & Lindsay, 2003).

The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) addresses a number of Disruptive, Impulse-control and Conduct disordersOpens in new window. It acknowledges problems in self-control of emotions and behavior as a main problem experienced by individuals diagnosed with these disorders. Some of these disorders categorized by DSM-V are:

• Intermittent Explosive DisorderOpens in new window, characterized by “recurrent behavioral outbursts representing a failure to control aggressive impulses” and
• KleptomaniaOpens in new window, characterized by the “recurrent failure to resist impulses to steal items even though they are not needed for personal use or for their monetary value”.

The DSM-IV listed six categories of impulse control disorders characterized by a variety of uncontrolled behaviors. The categories are the following:

• failure to resist aggressive impulses,
• failure to resist impulses to steal objects not needed for personal use,
• deliberate and purposeful fire setting for personal gratification or relief,
• persistent maladaptive gambling behavior, and
• recurrent pulling out of one’s hair.

And these are the essential features of intermittent explosive disorderOpens in new window, kleptomaniaOpens in new window, pyromaniaOpens in new window, pathological gamblingOpens in new window and trichotillomaniaOpens in new window, respectively.

The sixth category of “impulse control disorder not otherwise specified” includes any other repeated failure to resist impulses to carry out a particular behavior; for example, compulsive buying, compulsive sexual behavior and repetitive self-mutilation.

Generally impulsivity has been associated with self-injurious and suicidal behaviors (Klonsky & May, 2010). It has been reported that impulsivity plays a significant role in individuals diagnosed with BPD, and it is considered an especially important factor in those who attempt self-harm and suicide (Moeller et al., 2001).

Thus, it is considered that self-destructive impulsivity is the most challenging aspect of this psychiatric condition. Similarly, individuals diagnosed with Bipolar Disorder (BD)Opens in new window tend to engage in impulsive or risky behaviors that often lead to undesired outcomes (Kathleen et al., 2009).

Impulsivity in the Nonclinical Population

Impulsivity has been associated with lower academic grades, higher aggression, interpersonal violence, impulsive shopping, and stealing in clinical and nonclinical populations (Spinella, 2004).

Some other behaviors associated with high impulsivity include maladaptive mobile phone use and pathological internet useOpens in new window. Overall, for individuals to maintain a healthy lifestyle, they need to engage in self-control to maintain exercise programs and restrain themselves in their food choices (Sutin et al., 2011).

A study investigating decision making in obese individuals indicated that poor and impulsive decision making has been shown to be prevalent in choosing high immediate gain but larger future losses. Individuals displaying high levels of impulsivity might not plan their meals or allow time for exercise, and fail to resist urges for unhealthy food choices.

Findings have shown that motor and intentional impulsivity might be contributing to young people’s impulsive choices related to their food intake (Lyke & Spinella, 2004). Additionally, it has been shown that there is a strong association between high intentional impulsivity and anxiety (Lyke & Spinella, 2004).

According to the theory of emotional eating, some individuals who have learnt that eating reduces their anxiety and fear might feel motivated to continue eating as a response to these feelings. It is interesting to note that individuals with high impulsivity demonstrate higher weight gain across their lifespan (Sutin et al., 2011).

Impulsivity, like some other personality traits, is considered to be a trait or characteristic that remains stable regardless of the individual’s situation or circumstances. Thus, if an individual tends to engage in impulsive behavior, such as buying online, this behavior can be similarly observed in an offline environment (Wells et al., 2011).

Overall, individuals who have difficulties with exercising any one particular self-control area (such as shopping) often have difficulties in other areas as well (such as gambling). In other words, some people act impulsively rarely and usually only in extreme circumstances (impulsiveness state); whereas other people act impulsively persistently — they present with an impulsivity trait (Parry & Lindsay, 2003).

Impulsivity varies across ages and gender. A study investigating deviant behaviors among adolescents has shown such behaviors displayed by boys were greater than those displayed by girls.

Related to age, younger adolescents have been shown to be more impulsive, which resulted in higher instances of disruptive behavior (Esteban & Tabernero, 2011). Overall, sensation seeking was detected to be greater in boys aged 14 – 22 than girls. Males in this age group are more likely to take risksOpens in new window, initiate drug use and engage in criminal activity (Romer, 2010).

Impulsivity in boys has been considered to place them at a higher risk for substance abuse and behavioral impulsivity. It has been found that male substance abusers demonstrate high motor impulsivity and non-planning impulsivity in individuals with substance use issues (Farnell, 2013).

Interestingly, it has been suggested that younger individuals are more prone to risk-taking activities and displaying impulsive behaviors, such as “drug abuse, unintentional injuries and unprotected sexual activities, which might be accounted by still maturing prefrontal cortex” (Romer, 2010).

At the same time, youth impulsivity is not considered a universal phenomenon and is considered to be mediated among other factors by the effects of state and peer influence. While younger people are consider to be more impulsive than adults, the decision processes that are influenced by sensation seeking are the same as in adults (Romer, 2010).