Impulsivity and accompanying disorders

Overview

The term "Impulsivity Diseases" refers to a group of mental disorders in which impulsivity is a prominent feature of the clinical presentation. Impulsivity can manifest as an inability to control one's emotions or conduct, a lack of forethought or preparation, and a failure to contemplate the repercussions of one's actions. Pyromania, ADHD, and binge-eating disorder are all examples of impulsive disorders.

 

What is Impulsivity Disorders?

Impulsivity is described here as a proclivity for quick, unplanned reactions to internal or external stimuli, regardless of the negative repercussions to the impulsive individual or others. According to Hollander et al. (2008), impulsivity is defined as "the inability to resist an impulse, desire, or temptation that is potentially detrimental to oneself or others."

Several key features of this definition should be highlighted.

• First, impulsivity is described as a tendency, part of a behavioral pattern rather than a single act. This distinction is relevant clinically because studies on the treatment of impulsive aggressiveness, which will be detailed later, reveals that people with impulsive aggression respond differently to medicine than people with largely planned violence.
• Second, it is worth noting that impulsivity is characterized by quick, unplanned activity that happens before the chance to actively consider the repercussions of an act. This distinguishes impulsivity from defective judgment or compulsive actions, in which planning precedes behavior. This difference is critical for research and therapy. Imprisoned people with planned aggressiveness (perhaps poor judgment) had distinct brain activity patterns than incarcerated people with impulsive aggression.
• Last, Impulsivity involves doing action without considering the repercussions of such action. Although impulsivity frequently includes hazards, it is not the outcome of the sorts of risks commonly associated with sensation seeking.

We believe these elements of impulsivity are significant because they may be linked to the underlying biological substrates of impulsive behavior, and therefore to impulsive therapy.

However, excessive, persistent impulsive behaviors that resist attempts to moderate them and/or result in unpleasant results and bad consequences can also be symptoms of mental illness. Ultimately, the amount of intensity, frequency, and life disruption or injury signal that there may be a mental health disorder that needs to be addressed.

 

Examples of Impulsive Behavior

While impulsive conduct is recognized as a diagnostic criterion for a number of mental illnesses including dangerous behaviors, it can also be associated with nonproblematic behaviors in everyday life.

• Positive Impulsive Behaviors

We frequently rely on impulsive, unconscious activities to get us through the day, such as driving, picking up the phone, or moving a hand away from a hot stove. However, there are certain benefits to impulsivity: Our fight or flight response, which is an instinctive reaction to possible dangers, has been one of the most effective survival weapons in our species' evolution. Thus, impulsivity can be crucial in avoiding injury.

Negative Impulsive Behaviors

While some impulsive activities may be motivated by real good intentions, such as wanting to keep safe and protect others, there are obvious distinctions between those and more damaging ones.

Some of these more negative impulsive behaviors can include:

• Excessive spending or shopping sprees
• Sudden travel
• Sudden business plans
• Sudden life decisions like quitting a job without reflection or having a plan to pay one’s bills
• Sexual indescretions
• Violent actions
• Insulting behavior toward family or friends
• Self-harm
• Suicidal ideation

When impulsive actions begin to interfere with a person's capacity to perform at job, school, or in relationships, it's a strong indication that something more serious is going on.

 

Measurement of Impulsivity

Although a wide range of measures have been linked to impulsivity and employed as "measures," there are three primary types of instruments that appear to capture essential features of impulsivity: self-report measures, behavioral laboratory measures, and event-related potentials.

• Self-Report Measures

Self-report measures, such as the Barratt Impulsiveness Scale and the Eysenck Impulsiveness Questionnaire, offer the benefit of allowing the researcher to collect data on a wide range of behaviors and whether these acts reflect long-term patterns of behavior. Items used in self-report assessments include, for example, "I act on impulse" and "I plan activities well." One disadvantage of self-report measures is that they must rely on the integrity of the person answering the questionnaire. Furthermore, these measurements are inappropriate for recurrent usage, limiting their use in therapy trials.

• Behavioral Laboratory Measures

To assess impulsivity, three main groups of laboratory paradigms have been used:

1. Punished and/or extinction paradigms,
2. Reward-choice paradigms, and
3. Response disinhibition/attentional paradigms.
   

The benefits of laboratory measures of impulsivity include their appropriateness for recurrent use, as well as their possibility for application in laboratory animals, allowing for comparative research of the fundamental biochemistry of these behaviors. Animal studies, for example, have discovered evidence for a negative association between impulsivity and serotonin function utilizing paradigms based on reward-choice models and response disinhibition/attentional models. The main drawbacks of these measures are that they do not account for the social dimensions of impulsivity and do not assess long-term patterns of behavior.

• Event-Related Potentials

Specific waveforms of electrical brain activity recorded as people complete various activities have been identified as potential markers of biological predispositions to impulsiveness. A positive waveform recorded in response to target stimuli while doing a variety of "outlandish" tasks has been linked to impulsivity and impulse control issues.

This sort of test has the benefit of being directly tied to brain function. One downside of event-related potentials is that, like behavioral laboratory tests, they do not account for the social components of impulsivity. Another problem is that event-related potentials have been linked to a range of neurologic and psychiatric diseases, making them ineffective as a marker of impulsivity. Although event-related potentials are not unique indicators, they are useful predictors when paired with other measures of impulsivity.

 

Causes and Risk Factors for Impulsive Behavior

Risky activity is not necessarily a deliberate decision. Impulsivity as a sign of a mental health disorder is frequently connected to physical changes in the brain that serve as markers that a person may be more likely to act on their impulses—however, scientists are still working to determine the exact explanation.

"Impulsivity is assumed to be caused by disturbed neurochemistry in the brain's prefrontal cortex (or prefrontal lobe), which is located below the forehead." This part of the brain is involved in planning, risk assessment, motivation, and inhibition (which is not acting). Problematic neural connections may potentially be at the root of impulsivity.

While studies continue to try to establish the specific physiological etiology of impulsive conduct, the causes for impulsive behavior might differ. Some people have a genetic component, which might be caused by mutations that disrupt the normal synthesis of neurotransmitters related in mood and cognition, such as serotonin and dopamine. Others attribute impulsivity to taught behavior, such as not being encouraged to endure irritation, uncertainty, or ambivalence.

 

Mental health conditions associated with impulsive behavior

Certain mental health conditions most commonly associated with impulsive behavior include:

Attention Deficit-Hyperactivity Disorder (ADHD)

Attention Deficit Hyperactivity Disorder (ADHD) is a psychiatric disorder characterized by developmentally inappropriate levels of inattention, hyperactivity, or impulsivity. ADHD is regarded as a malfunction of executive functioning, primarily a frontal lobe activity, and is associated with cognitive and functional issues related to brain abnormalities, despite the fact that no current standard laboratory or imaging test exists. ADHD patients struggle with attention and focus, decision making, and emotional management.

• Borderline Personality Disorder

Borderline personality disorder (BPD) is characterized by impulsivity and trouble managing emotions.

BPD-related impulsive behaviors are more inwardly focused, yet they can have an impact on relationships. She goes on to say that this conduct includes "unstable self-image, tumultuous emotions, fast mood swings (occurring within a day), and risk of self-harm.

• Bipolar Disorder

Impulsivity associated with bipolar illness, a mental health disease marked by rapid mood swings, can be episodic, which means it can occur in conjunction with other symptoms for many days at a time. Increased impulsivity or inattention is frequently accompanied by heightened mood, grandiosity, and other bipolar disorder-specific symptoms.

• Antisocial Personality Disorder

Antisocial personality disorder is characterized by a blatant disdain for consequences and the rights/feelings of others. Individuals suffering with antisocial personality disorder frequently behave impulsively, with little regard for the implications of their actions on others.

• Kleptomania

Kleptomania is classified as a disruptive, impulse-control, and behavior disorder in which a person has a "recurrent failure to resist impulses to steal goods that are not required for personal use or for their monetary worth."

• Stroke or Brain Injury

A stroke or severe brain injury can cause long-term harm to a person's brain function. This injury "may impair attention span and/or capacity to control or regulate emotions and exercise judgment.

 

Compulsive vs. Impulsive: How to Know the Difference

 

A activity is obsessive when you feel compelled to continue it until you feel relieved of tension or uncomfortable. When you do something impulsively, you do it without thinking about the implications.

• Examples of Compulsive Behaviors

Obsessive-compulsive disorder (OCD) patients frequently exhibit compulsive behaviors, commonly known as compulsions. Here are several examples:

• 1. Checking the door repeatedly to make sure it’s locked
  2. Counting the people, you walk by on the street
  3. Cleaning something that doesn’t actually need to be cleaned, typically in your home
  4. Rearranging things until they feel just right
  5. Checking the oven to make sure it’s off before leaving home
     
     
• Examples of Impulsive Behaviors

Impulsive behaviors are not so closely linked with any specific disorder. In fact, we all do them at times. Examples can include:

• • We would not engage in sexual behavior with someone if we stopped to think about it.
  • Purchasing something pricey that we do not require or cannot afford without prior planning
  • Drinking alcohol when we had not planned to or would otherwise not want to.
  • Starting today, I'll be taking a fun unplanned vacation out of state.
  • When we are enraged, we yell at someone.
  • Hugging or expressing affection to someone special
  • Giving money to a charity or to someone in need
  • Consuming junk food in place of a meal

We all act on impulses from time to time. In terms of mental health, impulsive action is not necessarily harmful unless the results are harmful. For example, if you stop for fast food on your way home impulsively, the repercussions will not have a significant influence on your life. On the other hand, if you contact your employer on the spur of the moment to tell him what you truly think of him, the ramifications may be severe.

 

Treatment for Impulsive Behavior

In most cases, disruptive impulsive behavior is treated with a combination of psychotherapy and medication. If impulsive behaviors are caused by an ongoing mental health condition, treatment will most likely focus on the larger issue at hand. Medication that may alleviate impulsive behavior, for example, will be tailored to each individual's diagnosis and the underlying reason of their symptoms.

Some of the suggested therapeutic approaches for treating impulsive conduct and the disorders that might cause it are as follows:

• Cognitive behavior therapy (CBT):
  CBT is the most widely used treatment for mental health illnesses that involve challenges with impulse control. This therapy approach focuses on the link between ideas and behaviors, with the goal of assisting a client in gaining a clear awareness of how their thinking patterns relate to certain results.
  
  
• Dialectical behavioral therapy (DBT):
  This type of therapy, which is commonly used as an effective modality in the treatment of borderline personality disorder and mood disorders, combines elements of mindfulness, such as acceptance and emotion regulation, with cognitive reordering and intentional work toward behavior chang.
  
  
• Biofeedback: 
  Biofeedback is an intervention that monitors normal bodily processes to treat impulse control problems, generally as a person learns relaxation techniques. This enables a person to learn how to better manage specific processes, such as their heartbeat, amid stressful situations.
  
  
• Mindfulness-based cognitive therapy (MBCT):
  Mindfulness treatments focuses on developing tolerance to internal sensations and impulses without responding, whereas cognitive therapies work on slowing down and more consciously processing ideas, emotions, and actions."

 

Pharmacologic Treatment of Impulsivity

A huge number of case reports and open-label trials show that a wide range of drug classes are effective for impulsive behaviors.

In controlled therapeutic studies, selective serotonin reuptake inhibitors (SSRIs) and anticonvulsants have also been used successfully to treat impulsive aggressiveness. In people with personality disorders, fluoxetine dramatically reduced impulsive aggressive behavior when compared to a placebo. Fluvoxamine, compared to placebo, reduced aggressiveness in autistic individuals, as did citalopram, compared to placebo, in patients with schizophrenia.

Anticonvulsants are effective at reducing impulsive violence, according to research from various populations. It has been discovered that phenytoin, carbamazepine, and divalproex all reduce impulsive aggressiveness. carbamazepine was not superior to placebo for aggressive behavior and was linked with several negative effects.

Most antipsychotic drugs are only useful for the treatment of acute aggressive behavior due to their lack of specificity for aggressiveness. However, there is accumulating evidence that atypical antipsychotic medicines have a more specific antiaggressive impact. Two placebo-controlled studies of risperidone in persons with dementia found that it reduced aggressiveness without causing drowsiness. A trial of risperidone in adults with autism and a short research in children with conduct disorder yielded similar results.

Another family of drugs that have been used to treat impulsive aggressiveness is -adrenergic antagonists. A few small placebo-controlled studies have found that propranolol and pindolol are effective for impulsive aggressiveness in people with organic brain damage.

Several controlled trials have demonstrated that psychostimulants increase attention and decrease impulsivity in ADHD patients when compared to placebo. Other research has found that hyperactivity or attentiveness are altered, but not impulsivity. The use of diverse measures of impulsivity may have resulted in inconsistencies in stimulant effectiveness findings. More study on the specificity of therapy for impulsivity in ADHD is required.

 

When to See a Doctor?

Anyone experiencing widespread and harmful impulse control should seek the assistance of a competent mental health professional or neurologist, who can offer a specific treatment strategy. A mental health expert can also assist in the diagnosis of underlying mental health issues that may be creating the impulsivity in the first place.

When it comes to treating possible underlying mental health disorders, persons living with impulsive behaviors may feel as if they have a long road ahead of them. However, impulsive actions, as well as the situations that may be producing them, can be alleviated with appropriate therapies.

 

Conclusion 

The propensity to act on impulse, that is, without considering the appropriateness or repercussions of the action, is referred to as impulsivity. Impulsivity as a symptom is shared by a variety of mental diseases, and impulsivity therapy is linked to the social, biological, and psychological etiologies of impulsivity. With impulsivity being a key factor in so many disorders and an important factor in treatment, it could be argued that current diagnostic categories limit biological and psychological research and that a dimensional approach may be more appropriate than the categorical approach used in psychiatric diagnosis and treatment.

More study on the measuring of impulsivity and its responsiveness to therapy will be required before such a change can occur. The majority of research in this area has been on impulsive aggressiveness. This emphasis is due in part to the fact that violent behaviors are easier to quantify than other features of impulsivity. Repeatable impulsivity measures that capture the essence of this behavior are required.