Impulsiveness (or impulsivity- the terms are used interchangeably), like most human behavioural traits, is distributed continuously in the population and becomes impairing only when expressed at extremes. It is a hallmark feature of self-regulation failures that lead to poor health decisions and outcomes, making understanding and treating impulsivity one of the most important constructs to tackle in building a culture of health.
What is impulsiveness?
Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.
Attributed to Stephen R. Covey or Viktor E. Frankl
Firstly, impulsiveness and arousal are two similar yet distinct emotional and behavioural states. In many situations, impulsiveness and arousal may conflate to enable spontaneous adaptive actions eg jumping to one side to avoid a snake.
Amongst many proposed indicators of impulsiveness are lack of planning or premeditation, sensation/novelty seeking, disinhibition, risk taking, rash action, inattention, lack of perseverance, present and future discounting, response inhibition, boldness, adventuresomeness, boredom susceptibility, unreliability, and ‘unorderliness’.
After decades of debate in the psychological literature(1.), the current consensus includes these characteristics of ‘unhealthy’ impulsiveness, where individuals fail to resist an impulse, temptation, or drive to perform an act that is ultimately harmful to themselves or others:
1) decreased sensitivity to negative consequences of behaviour;
2) preference for small, immediate rewards over larger, delayed rewards;
3) rapid, unplanned reactions to stimuli (events affecting us) before complete processing of information;
4) lack of regard for long-term consequences;
5) inability to selectively attend to a target stimulus when distractors are present; and,
6) distorted ‘urgency’ (the tendency to act rashly while in an intense negative or positive mood).
‘State’ vs ‘trait’ impulsiveness
There’s an old Talmudic belief that you build a fence around an impulse. If that’s not good enough, you build a fence around the fence.
Norman Mailer
‘State’ refers to transitory conditions at a particular time in response to a particular event, while trait refers to an enduring personality characteristic that describes or determines an individual’s behaviour across a range of situations. In other words, traits are long-term, while states are short-term.
Importantly, it appears that one’s ability to inhibit automatic emotional responses is not necessarily associated with long-term (trait) impulsivity, and, people possessing high impulsivity tendencies (trait) are no worse at controlling impulsive thinking in some situations than those with ‘non-impulsive’ personalities.
Notwithstanding this, awareness of trait impulsiveness is helpful- in trait self-compensation (slowing down responses and pausing to reflect) and targeting treatment (eg problem gambling is more trait than state-driven).
What makes us impulsive?
Our results support the hypothesis of an association between forehead inclination and impulsiveness.
Guerrero-Apolo et al, (2018). Brazilian Journal of Psychiatry, 40:270–276.
As dubious a contribution to the answer to this question the above quote is, it nevertheless serves to epitomise impulsiveness as one of the holy grails of human self-understanding.
More conventional wisdom attributes impulsiveness to a combination of environmental, genetic, and physiological factors that likely creates the perfect storm for the development of many mental health conditions that are associated with impulsivity.
Neurobiologically, numerous regions of the brain interact to affect decision-making, with the orbitofrontal cortex (OFC), and the medial prefrontal cortex (mPFC).) working together in response to serotonin to promote the ability to wait patiently and practice impulse control.
Additionally, dopamine activity in the OFC is thought(7.) to mediate reward processing and decision-making in goal-directed learning, and new research has identified Melanin-concentrating Hormone as a major contributor to impulsiveness(8.).
The Young and the Restless
Complicating matters is the way our brains (particularly the pre-frontal cortex-PFC) develop from birth. The maturational gap in development of PFC-based control (incomplete until our mid 20s) relative to more advanced motivational circuitry is said to result in an inevitable period of increased exploratory behaviour resulting in increased risk-taking.
Neurobiological models explain this increase in risk-taking behaviours in adolescence and young adulthood as arising from staggered development of subcortical dopaminergic reward networks and prefrontal control networks.
Essential for the maturation of impulse control, one particular gene (known as DCC), has been found recently(2.) to act as a “guidance cue” that determines when and precisely where brain dopamine cells form connections in the prefrontal cortex and other brain areas.
Notwithstanding the above, some findings(3.) suggest that individual variability in cognitive (thinking) control is more crucial to the relationship between risk-taking/impulsivity and outcomes than age itself.
The male and female brains
Many studies imply that men are more impulsive than women, and cite various differences in brain structure and functioning to account for the proposed link.
However, recent, more comprehensive studies(4.), suggest that gender differences in impulsive control are more complex.
For example, female smokers show greater impulsivity than male smokers, but male non-smokers in the same study showed more impulsivity.
Environmental factors
Whilst this article focusses on impulsivity as an approach behaviour, it is important to note that avoidance factors (anxiety/fear) also overarch the quality of predictions of how well we may perform a specific task.
Indeed, within-person increases in daily stress have been associated(5.) with increased daily impulsivity, both independently and as accounted for by general mood at the time.
Existing anxiety/stress and depressive disorders have also been found(6.) to modulate impulsive decision-making (negative urgency), and, in a vicious cycle, may themselves be prolonged or exacerbated by stressors generated by impulsive behaviour.
The costs of poor impulse control
Whilst not constituting a diagnosis in and of itself, impulsiveness has been linked to negative behaviours/disorders including:
| Related Behaviour/Disorder | Associations |
| Anger | Impulsive aggression and saying things ‘in the heat of the moment’ may impact relationships. |
| Binge watching | Lack of premeditation, impulse control difficulties, motivation: escapist, coping with loneliness, decisions around free-time utilisation, fixed thinking(9.) |
| Eating disorders | Irregularities in neural systems implicated in emotion regulation, reward seeking, sensory processing, and cognitive control(10.). Linked to social media. |
| Gambling | Pathological gambling is a form of behavioural addiction, underlain by high impulsivity. |
| Hypersexuality | Positive urgency: the tendency to act rashly when experiencing extremely positive affect (mood/thought state). |
| Substance use | Impulsivity is a strong predictor of substance use problems |
| Hoarding | Impulse control deficits correlate with hoarding symptoms |
| Internet addiction | Impulsivity is an indirect mediator and significantly affects Internet addiction. |
| Social Media Dependence | Linked to impulsivity, individuals are so engaged in social media that they feel distressed when they are unable to use it(11.). |
| Autism Spectrum and Attention Deficit Hyperactivity disorders | Compromises in the executive functioning of the brain can result in impulse control issues. Because of the disruption that impulsive behaviours can cause, treating impulsivity often becomes a major priority. |
| Parkinson’s disease | Impulse disorders can be precipitated in Parkinson’s disease by dopamine replacement therapy, often with detrimental consequences for patients and caregivers(7.). |
| Impulsive buying | Spontaneous, unreflective thinking; dominated by emotional attraction and proximity to product |
Tips for dealing with impulsiveness
Journaling
Keeping a diary of impulsive behaviour is a good start in addressing the issue as self-awareness is central to self-improvement.
(a) Record the behaviour or urge.
(b) Identify the triggers- these may include: people, places, situations, smells, events and times just to name a few.
(c) List both the positive consequences that reinforce the behaviour and the negative consequences of the behaviour itself.
(d) Identify patterns of triggers and responses and brainstorm how you might prevent future occurrences using planned interventions like:
- Intentionally breathe more slowly and deeply
- Apply a ‘cooling off’ period
- Exercise inner speech to acknowledge internal conflict and identify distorted thinking
- Talk to someone else about the situation
Self-control exercises
Fortunately, suppressing an impulse doesn’t always have to decrease your dopamine—it can actually feel good. The key is the prefrontal cortex, which is responsible for pursuing long-term goals and has the ability to modulate dopamine release in the nucleus accumbens. So suppressing an impulse can be rewarding, as long as it’s in service of your larger values.
Dan Siegel, 2015, The Upward Spiral: Using Neuroscience to Reverse the Course of Depression, One Small Change at a Time
Regular small exertions of self-control can reduce overall impulsiveness. Targeted efforts to control behaviour in one area, such as spending money or overeating, lead to improvements in unrelated areas, such as studying or household chores.
Daily exercises in self-control not associated with identified problem areas, such as improving posture, altering verbal behaviour, and using one’s nondominant hand for simple tasks, also spill over into general impulse control.
Create ‘precommitments’
…our impulses are too strong for our judgement sometimes
Thomas Hardy, 1891 Tess of the D’Urbervilles
In legal circles these are known as “Ulysses Contracts.” Like the Greek hero’s strategy as his ship approached the fetching but deadly Sirens, it acknowledges that we’re weak and human and likely to cave. So we create a constraint. We tie ourselves to the mast. We make a deal with ourselves in advance that can’t be overwritten later, when we’re faced with temptation or are of ‘unsound’ mind.
Impulse management apps
Whilst not endorsed in this article, you may wish to explore ‘Self-control’ Apps and Extensions. These span the gamut from impulsiveness mapping and (mainly) CBT-based resources and interventions (eg ‘Self-Awareness Log’) through apps utilising passive mobile metrics like screen time (eg MPulse app), to Apps which allow ‘Ulysses Contract’-type controls (eg ‘StayFocussed’ and ‘Cold Turkey’ Apps).
How can a psychologist help?
Psychologists may utilise several evidence-based treatment approaches to managing impulsivity, including:
Cognitive Behavioural Therapy (CBT)
… every impulse of feeling should be guided by reason.
Jane Austen, 1813, Pride and Prejudice
CBT, a widely used intervention, is based on the premise that maladaptive behaviours and thoughts can be changed by modifying underlying cognitive structures and processes. CBT for impulsivity typically involves identifying and challenging maladaptive thoughts, developing coping strategies for managing negative emotions, and practicing behavioural techniques for improving self-control.
Based on similar principles, schema therapy (ST) helps the client identify long-standing, self-defeating patterns of thinking, feeling and behaving (‘schemas’) and develop healthier alternatives to replace them.
Mindfulness-Based Interventions (MBIs)
T.S.Eliot, The Hollow Men, 1925Between the conception
And the creation
Between the emotion
And the response
Falls the Shadow
Often used in concert with CBT, MBIs have been shown to be effective in managing impulsivity by increasing self-awareness, reducing emotional reactivity, bolstering sustained attention, reinstating cognitive control, and improving self-regulation.
By addressing emotional dysregulation (i.e. difficulties in controlling emotional states and emotion-driven behaviours), MBIs are particularly effective in treating urgency-type impulsiveness (where positive or negative emotional states tend to hijack decision-making).
Dialectical Behaviour Therapy (DBT)
The DBT approach argues that executive, cognitive inhibition strategies will be most effective if preceded by boosting emotional regulation skills, acknowledging that dysregulated arousal inhibits brain centres responsible for healthy attention, decision-making, recall and learning.
Thus initially the client may work with the psychologist to examine events which arouse intense emotions, reflecting on how the emotion was handled, and progress toward goal management training and problem solving strategies.
If you are experiencing difficulties managing your impulsiveness, you may wish to consider utilising the services of a highly trained and experienced registered psychologist- please feel free to contact us for more information.
References
1. Creswell, K.G., Wright, A. et al. (2019). Multidimensional assessment of impulsivity-related measures in relation to externalizing behaviors. Psychol Med. 2019 July ; 49(10): 1678–1690.
2. Restrepo-Lozano, J.M., et al. (2022). Corticolimbic DCC gene co-expression networks as predictors of impulsivity in children. Molecular Psychiatry (2022).
3. McKewen, M., et al. (2019). Does cognitive control ability mediate the relationship between reward-related mechanisms, impulsivity, and maladaptive outcomes in adolescence and young adulthood? Cognitive, Affective, & Behavioral Neuroscience (2019) 19:653–676.
4. Vigneswaran, E. (2021). Understanding Impulsivity: Male vs Female Brain. Imperial Bioscience Review December 17, 2021.
5. Sharpe BM, Simms LJ, Wright AGC. (2021). Impulsivity, Affect, and Stress in Daily Life: Examining a Cascade Model of Urgency. J Pers Disord. 2021 Aug;35(4):494-512.
6. Hasegawaa, A., et al. (2021). Depression, Rumination, and Impulsive Action: A Latent Variable Approach to Behavioral Impulsivity. The Journal of Psychology 2021, VOL. 155, NO. 8, 717–737.
7. Kelly, M.J., Baig, F. et al. (2020). Spectrum of impulse control behaviours in Parkinson’s disease: pathophysiology and management. J Neurol Neurosurg Psychiatry 2020;91:703–711.
8. Noble, E.E., et al. (2019). Hypothalamus-hippocampus circuitry regulates impulsivity via melanin-concentrating hormone. Nature Communications volume 10, Article number: 4923 (2019).
9. Starosta J, Izydorczyk B, et al. (2021) Impulsivity and Difficulties in Emotional Regulation as Predictors ofBinge-Watching Behaviours. Front. Psychiatry 12:743870.
10. Kung, P., Soriano‑Mas, C., Steward, T. (2022). The influence of the subcortex and brain stem on overeating: How advances in functional neuroimaging can be applied to expand neurobiological models to beyond the cortex. Reviews in Endocrine and Metabolic Disorders (2022) 23:719–731.
11. He, Z., Yang, W. (2022). Impulsiveness as potential moderators of the relation between social media dependence and eating disorders risk. BMC Psychology (2022) 10:120.
12. Meikle, S., et al. (2020). Individual differences in distress, impulsivity, and coping motives for use aspredictors of problematic ecstasy use. Addictive Behaviors 108 (2020) 106397.
13. Dezhkam, N., Reza, M. et al. (2022). The Effect of Impulsivity on Addition and Addictive Tendencies: A Meta-analysis. J Health Rep Technol. 2022 July; 8(3).
14. Fariba, K.A., Gokarakonda, S.B. (2022). Impulse Control Disorders. NCBI Bookshelf. National Library of Medicine. National Institutes of Health. StatPearls Publishing.
15. Guerrero-Apolo, J.D., et al. (2018). The slant of the forehead as a craniofacial feature of impulsiveness. Brazilian Journal of Psychiatry 40:270–276.