Background

Clinicians use the term Impulsivity as an umbrella term for a group of mental illnesses where there are impulsive features or compulsive drives at the core. Conditions like gambling disorder, conduct disorder and kleptomania fall under this umbrella. 

Technological changes have in part contributed to Impulse Control Disorders being increasingly diagnosed. Thanks to the internet; betting, stock trading, and shopping are increasingly accessible. There has also been an increase in discussion within health professional and legal circles around impulsivity and how it impacts behaviour.

Impulsivity plays a core or key role in what is labelled as Impulsive Control Disorders. However, impulsivity to varying degrees is present in a far wider range of mental illnesses, such as ADHD. To take things down a step further; impulsivity is present in all of us, we can all get a little impulsive at times. 

Impulsivity - what does that mean?

In psychology, impulsivity is viewed as a tendency to act on a sudden urge. Oftentimes this behaviour is characterized by little forethought, deliberation or consideration of consequences. There is a choice of short term gains as opposed to longer-term goals. 

Breaking down impulsivity

Professor Gregory Smith, colleagues and other researchers have suggested the following traits could drive impulsivity.

  • Strong positive or negative emotions as a driver for impulsivity. An impulsive act can be viewed as a means to rid oneself of these strong emotions or feelings. 
  • A desire to try something new, to break the mould and to take on risk for the sake of new experiences. 
  • No sustained efforts to preserve despite the hard emotions or challenges faced. 
  • Lack of planning is often seen in impulsive behaviour, actions are done on a whim.

Impulsivity can also be understood from the perspective of self-control. The capacity we each have to keep our emotions and behaviour in check with our values, morals and longer-term goals. 

There is also a time component to impulsivity. A choice of taking a shorter-term gratification vs longer-term perseverance for a greater reward. We may choose to gamble or bet to calm our short term urges whilst knowing in the longer term that we will feel bad for it. 

Impulsivity may involve a lack of inhibitory control in the brain. There are complex neural pathways likely responsible. It is possible that this neural pathway inheritance has a familial or genetic component to it. 

Impulsivity vs Compulsivity

Compulsivity can be viewed as being repetitive, obsessional and restricted in behaviour. There is often little purpose in following through with these acts. Researchers have suggested that Impulsivity and Compulsivity lie on a  spectrum. One in which there is an inability to refrain or stop performing a certain behaviour. Impulsive actions can be seen as conforming to wishes that are pleasurable in the short term. Compulsive on the other hand can be seen as attempts to reduce anxiety or discomfort. 

Core Features of Impulse Control Disorders

Impulsivity is a broad term, it can contribute to a range of behaviours. When psychiatrist and psychologists think of Impulse Control Disorders they generally think of the following features:

  • Prior to the act, whether it is stealing, shopping etc., there is increased arousal, urge or tension felt. This can be either in the body and or in the mind.
  • At the time of the act, there is a sense of relief, pleasure or release of the tension. 
  • Immediately following the act there is a sense of relief, a gladness to let go of the urge.
  • In the longer term, there may be a sense of shame or guilt. This is often seen in conditions like binge eating disorder and kleptomania, both of which are associated with impulse control difficulties. This sense of shame is less likely to be felt in conduct disorder. 
  • A core feature of impulse control disorders is that there are repeated drives to perform acts which in the long term are harmful to the person.

What are Impulse - Control Disorders?

The American Psychiatric Association (APA) in their current manual lists a couple of disorders under the umbrella of Disruptive, Impulse – Control, and Conduct Disorder. It is felt that impulsivity plays a key role in the following conditions:

  • Oppositional Defiant Disorder
  • Conduct Disorder
  • Pyromania
  • Kleptomania
  • Unspecified Disruptive, Impulse – Control, and Conduct Disorder

The five conditions we have listed above are not all the conditions that the APA lists under the umbrella term. However, they go to show the breadth of conditions that fall under the category.

Impulsivity and mental health

We can all be impulsive from time to time. Most often our impulsivity has negligible or no real personal or communal consequences. However, impulsivity can be part of a mental illness. 

There is an overlap between impulsivity and the following mental health diagnosis or issues. 1) OCD and Obsessive-Compulsive Related Disorders, 2) Sexual Compulsions, 3) ADHD, 4) Cluster B personality disorders, 5) Substance use disorders. 

Assessments of Impulsivity

There is a wide range of questionnaires that can be used to determine impulsivity. Given that impulsivity is a broad concept, with various aspects, different questionnaires focus on different parts. 

For instance, the Overt-Aggression Scale Modified (OAS-M) looks at impulsivity in the context of aggression. Whereas the modified Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) can be used to explore shopping, gambling or sexual behaviours. 

Your psychologist or doctor will also want to explore how your impulsivity has impacted your behaviour and long term consequences. They are likely to want to understand impulsivity in the broader context of the person and those close to them. 

It is important to also check for other mental illnesses. Whether there is a family history. Motivation to change, address issues is also looked at as part of an assessment and initial management planning. 

Managing Impulsive Control Disorder

Treatment requires a thorough assessment and holistic understanding of the person. It also depends on the presence of other mental illnesses, life circumstance and the person’s wishes. Below we will touch on some key considerations below.

Person’s wishes and autonomy

It’s important for clinicians to educate clients on impulsivity. After that, a person can make decisions around managing the impulsivity that is right for them.

Legal Requirements

Sometimes assessments of impulsivity happen in the context of criminal activity, court assessment or part of a correctional order. For instance, someone who repeatedly shoplifts may require an assessment for kleptomania, which falls under the umbrella of Impulse Control Disorders. 

Research into Medications

There is evidence that medications, in particular, selective serotonin reuptake inhibitors (SSRIs) can help with specific conditions. For instance, there is some evidence to support the use of Paroxetine, an SSRI for the management of pathological gambling. Other classes of medications, including opioid receptor blockers and mood stabilizers have been trialled with some success in impulse control disorders.

Psychology

The general inclination is to try to address impulse control disorders first with psychology techniques or talking therapies. There are varying degrees of evidence supporting different psychological approaches.

For example, there has been a repeatedly demonstrated evidence base for family therapy and social skills training broadly speaking in managing impulsive aggressive behaviours. 

Repeated hair picking, also known as trichotillomania, has been shown to respond to cognitive behavioural therapy. In fact, the research science is in favour of therapy over medication for hair picking. 

Impulse control disorders and impulsivity more generally are complex. They have various part to them and can be expressed in costly and damaging ways. Often impulsive behaviour is long-standing. If you feel that your impulsivity is getting the way, it’s important to get help. Contact our friendly support team. You can reach us via webchat. We can put in touch with an Australian accredited psychologist or psychiatrist. 

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