What Is Impulsivity?

Impulsivity, or impulsive behavior, is broadly defined as actions without foresight that are poorly conceived, prematurely expressed, unnecessarily risky, and inappropriate to the situation. Impulsivity is associated with undesirable, rather than desirable, outcomes.

Impulsivity is a characteristic of a number of mental health conditions, including borderline personality disorder (BPD), bipolar disorder, and attention deficit hyperactivity disorder (ADHD).

People who experience impulsivity may make hasty decisions, get into arguments, and engage in risky behaviors. In addition to undermining relationships and a person's overall sense of well-being, impulsive behaviors can also lead to financial and legal harm if left unchecked.

Fortunately, there are treatments that can help bring impulsivity under control, including psychotherapy, mindfulness training, and pharmaceutical drugs.

Characteristics of Impulsivity

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), impulsive behaviors are a hallmark of BPD and other conditions. How it presents may vary depending on a person's specific diagnosis and the severity of their condition.

People who are impulsive are commonly described as:

• Hot-headed
• Rash
• Unpredictable
• Unstable

This instability often causes people to struggle with feelings of inadequacy that manifest with unstable emotions, unstable behaviors, and unstable relationships. In BPD, for example, people may be quick to lash out at anything considered a slight and will often fail to recognize how those emotions are unreasonable or excessive.

In psychological terms, impulsive behaviors are inherently inappropriate either in terms of scale or potential risk. In some cases, people are less likely to take into account potential consequences and will often turn to self-harm behaviors (like binge eating or excessive drinking) as a means to cope.

However, impulsive behaviors are not, in and of themselves, a diagnosis. It is only when the behavior is pervasive, detrimental, and interferes with a person's ability to function normally that mental health diagnoses such as BPD or bipolar disorder may be considered.

Identifying Impulsivity

Impulsivity is not a separate condition, but it is often a symptom of a mental health condition. No single test can confirm whether impulsive behavior is the result of BPD, bipolar disorder, or some other condition. A doctor will perform a psychological exam to determine whether the symptoms are consistent with the criteria outlined in the DSM-5.

During a psychological evaluation, a doctor will ask questions about the symptoms a person is experiencing, including questions about the severity, nature, and duration of the symptoms. In some cases, they may ask other people who have contact with the individual, such as family members, for information about symptoms and behavior.

Risk Factors for Impulsivity

There are a number of different factors that are associated with an increased risk for impulsive behavior. Some of these include:

• Age: Younger people are more prone to engaging in impulsive behaviors than older people.
• Sex: Boys and men tend to be affected by impulsivity more frequently.
• Family history: A family history of mental illness or impulsive behavior can lead to an increased risk.
• Trauma: Exposure to trauma, violence, abuse, and neglect may increase a person's risk for impulsivity.
• Substance use: Using drugs and alcohol can contribute to impulsive behavior.

Causes of Impulsivity

The exact causes of impulsivity are not fully understood, but it is believed that both environmental factors and genetic factors may play a role.

Psychological Factors

Impulsivity may sometimes stem from traumatic experiences, particularly those that occur in early childhood. A child's upbringing, including their caregiver's parenting styles, can also impact the development of self-regulation skills. Kids who do not learn to regulate their behavior effectively may experience greater impulsivity as a result.

Environmental factors can also make more people with mental health conditions such as BPD and bipolar disorder effectively manage symptoms of impulsivity.

Genetic Factors

In some conditions, impulsivity might be influenced by genetic factors. Genetic mutations that impact the production of serotonin and dopamine, the neurotransmitters associated with mood and cognition, can contribute to increased impulsivity. Some research has also shown that genetic errors may increase heritable impulsivity.

Other conditions linked to impulsivity, including bipolar disorder and ADHD, are believed to share underlying genetic factors. These genetic influences likely impact the shared symptoms such as impulsivity.

Conditions Linked to Impulsivity

Impulsive behaviors can occur in a number of different mental health conditions:

• Physical causes of impulsivity, including acquired brain injury or a neurodegenerative disease like Alzheimer's disease or Huntington's disease.
• Bipolar mania, often in tandem with grandiosity and a flight of ideas (During an acute manic episode, a person will often act impulsivity with little thought of the consequence. Spending sprees and hypersexual behaviors are two common examples of impulsivity related to bipolar disorder).
• Attention-deficit hyperactivity disorder (ADHD), known as hyperactive-impulsive ADHD, spurred by the child's inability to keep still or control inappropriate behavior (It is this lack of control, combined with a constantly shifting focus of interest, that spurs impulsivity.)
• Substance use disorders, although the impulsiveness is typically exhibited under the influence of drugs, when craving drugs, or when actively seeking drugs.
• Antisocial personality disorder (ASPD), closely aligned with BPD but differs in that there is a pervasive and persistent disregard for morals, social norms, and the rights and feelings of others
• Impulse control disorders: These include conditions such as intermittent explosive disorder, kleptomania, pyromania, and trichotillomania, which can result in risky behaviors that may harm the self or others.

Examples of Impulsivity

Impulsivity may be experessed in a variety of ways depending on the underlying cause. Every individual and situation is different. Some common examples of impulsivity include:

• Abruptly changing or canceling plans
• An inability to remain still
• Binge eating or drinking
• Clearing out belongings to "start anew"
• Constantly "turning over a new leaf"
• Destroying property
• Escalating confrontations
• Frequent emotional outbursts
• Inability to receive criticism without affront
• Joining and quitting a lot of groups
• Jumping to conclusions
• Meaningless or risky sex
• Over-apologizing
• Oversharing of emotions
• Overspending
• Physical violence
• Quitting a job suddenly
• Self-harm
• Self-mutilation
• Threatening to harm one's self or others

Treatment for Impulsivity

While impulsive behaviors can be severe and pervasive, they can often be successfully managed with treatment. Many treatments for mental health conditions have components that specifically target impulsivity.

Psychotherapy

Dialectical behavior therapy (DBT) focuses on building skills that reduce your impulsive behaviors and increase your ability to think and reflect before acting. By using coping mechanisms to handle intense emotions, a person with BPD is better equipped to face situations without confrontation.

Mindfulness, a skill taught in DBT, encourages you to stay in the moment, which can help you to remain more aware of your actions so you take the time to consider consequences. Practicing this technique can help you to take the time needed to reflect on your options, empowering you to make more rational decisions about how to respond to events around you. Mindfulness meditation is a modality often used to support the training.

Medication

Medications like selective serotonin reuptake inhibitors (SSRIs) sometimes combined with a low dose of an antipsychotic may also help. This is especially true if your behavior is extreme and poses a risk to your safety or those around you.

There are a number of drugs that specifically treat impulsivity, including:

• Atypical antipsychotics: Abilify (aripiprazole) is seen to reduce interpersonal problems and impulsivity.
• Mood stabilizers: Lamictal (lamotrigine) may help reduce impulsivity and anger, while Topamax (topiramate) may ameliorate impulsivity, anger, and anxiety.

Coping With Instability

In addition to complying with your treatment plan and seeing a therapist, there are steps you can take to better cope with impulsivity. Often, the first step is to identify the impulsive behaviors that you’d like to change. Next, you can try one of these strategies when you notice an urge to engage in one of those behaviors:

• Conduct a chain analysis, which allows you to identify the impulsive behavior, what happened prior to the behavior, evaluate your thoughts and feelings, and consider the consequences.
• Join a support group. If you lack resources like supportive friends and a family, joining a support group can be helpful in managing your impulsive behaviors. It will also allow you to talk to others about what has (and hasn't) worked for them as far as coping with impulsive behaviors.
• Replace impulsive behaviors with healthy ones. While impulsivity may cause a short-term positive effect (for example, taking away anxiety or fear), there are healthy ways to cope, including going for a walk, journaling, talking to a trusting friend, or meeting with a support group.
• Practice deep breathing. Deep breathing is one way to help manage stress, which can help you regulate your mood and reduce impulsive behavior. Focusing on your breathing can also help distract you as you move past the urge to act impulsively.