Facets of Impulsivity and Its Measurement
Impulsivity is a multifaceted personality trait. Factor analyses of self-report and behavioral measures that are used to assess this personality domain consistently demonstrate multiple distinct factors of impulsivity (Meda et al., 2009; Reynolds, Ortengren, Richards, & de Wit, 2006). For instance, Whiteside and Lynam (2001) identify four factors in common self-report measures of impulsivity. These include (1) lack of premeditation, (2) sensation seeking, (3) lack of perseverance, and (4) urgency. Lack of premeditation, reflecting a failure to think or plan before acting, is the most common conceptualization of impulsivity and is strongly captured by a majority of self-report measures of impulsivity. Sensation seeking refers to the pursuit of novel and exciting experiences (often despite or even because of the potential risks associated with those actions) (Zuckerman, Kolin, Pirce, & Zoob, 1964). Lack of perseverance reflects a failure to sustain attention or effort during tasks. Finally, urgency refers to a tendency to commit rash or regrettable actions in emotional contexts. Whiteside and Lynam's analysis explicitly describes this as occurring as a result of intense negative affect, for instance, being unable to resist a cigarette when anxious. The urgency domain is probably best broken down into two distinct domains of negative and positive urgency. The negative urgency domain, which occurs in the face of negative or aversive emotional states, is distinct from other facets of impulsivity as it is associated with the personality factor of neuroticism. Indeed, the most widely used Big 5 personality inventory, the NEO-PI-R, labels this negative urgency domain as impulsivity and includes it as one of the six facets of the neuroticism scale (Costa & MacCrae, 1992). This is strikingly different from other factors of impulsivity that show a greater relation to other personality factors including low conscientiousness or high extraversion (Whiteside & Lynam, 2001). Recent research indicates that a parallel domain labeled as positive urgency can be identified (Cyders et al., 2007), in which the person commits rash or regrettable actions when exposed to potential rewards.
Several self-report measures assess features of impulsivity. The Barratt Impulsivity Scale-11 (BIS11) is among the most widely used measures and distinguishes between attentional impulsivity, motor impulsivity, and nonplanning impulsivity (Patton, Stanford, & Barratt, 1995). The Urgency, Premeditation (lack of), Perseverance (lack of), Sensation Seeking (UPPS) Scale has been gaining in popularity due to its correspondence to factor analysis of the impulsivity domain (Whiteside & Lynam, 2001). Other frequently used measures include the Impulsiveness Scale developed by Eysenck and Eysenck (1978) and the Impulsiveness-Sensation-Seeking Scale by Zuckerman, Kuhlman, Joireman, Teta, and Kraft (1993).
Multiple behavioral paradigms also assess aspects of impulsivity. The most commonly used behavioral measures assess the ability to withhold or inhibit responses. For instance, in a go/no-go task, a prepotent ‘go’ response is established by having substantially more trials on which the subject should respond (go) than withhold their response (no-go) (Trommer, Hoeppner, Lorber, & Armstrong, 1988). The number of errors of commission (going on a no-go trial) is taken as an index of impulsivity. Alternatively, stop-signal reaction time tasks measure the time necessary to inhibit (countermand) a motor response (Logan, Cowan, & Davis, 1984).
A second class of behavioral measures of impulsivity assesses the ability (or inability) to wait for a delayed reward. This can be seen in terms of basic delay of gratification paradigms in which the individual is explicitly told that they can get a better reward if they do not consume a reward that is already present (Mischel, Shoda, & Rodriguez, 1992) or in more sophisticated temporal (delay) discounting paradigms in which the individual explicitly chooses between immediate or less delayed rewards relative to longer delayed rewards (Critchfield & Kollins, 2001). Arising in part from the behavioral economics literature, the temporal discounting paradigm allows for specific modeling of decision parameters, such as the discount rate, with impulsivity being reflected in steeper discount rates that reflect a greater valuation of immediate or quickly available rewards relative to long-term rewards.
Strikingly, these behavioral measures of impulsivity show at best modest associations with self-report measures of impulsivity (Meda et al., 2009; Reynolds et al., 2006). This likely is not a specific fault of either the self-report or the behavioral measures as much as they capture somewhat different psychological constructs. A critical advantage of behavioral measures of impulsivity is the ability to measure neural responses during performance of the task. Additionally, parallel tasks can be used in preclinical studies with animals. Indeed, go/no-go, stop-signal reaction time, and temporal discounting tasks have all been adopted for animal studies. Measures of premature responses, such as assessed by the 5-choice serial reaction time task (Robbins, 2002), have also proven particularly useful in examining the neuropharmacological substrates of impulsiveness.
Overuse of Social Networking
Enrique Echeburúa, in Principles of Addiction, 2013
Impulsivity
Impulsivity has consistently been associated with chemical and nonchemical addictions. Impulsivity means a tendency to get involved in rapid and unplanned reactions to stimuli before completing the processing of information, which means a decreased sensitivity to negative consequences of behavior. Impulsive people get involved in risky behaviors to ease tension or gain pleasure and do not pay attention to long-term consequences. An association between nonchemical addictions and attention deficit hyperactivity disorder (ADHD), a disorder related to poor psychosocial functioning in which impulsivity plays a major role, has often been reported.
Intolerance of uncertainty and addiction
Belinda Favaloro, Ahmed A. Moustafa, in Cognitive, Clinical, and Neural Aspects of Drug Addiction, 2020
IU and impulsivity in addiction
Impulsivity can be understood by a preference for immediate reward over delayed rewards, despite the delayed reward being greater or more valuable than the immediate (Xia, Gu, Zhang, & Luo, 2017). Subsequently, delay discounting is the experimental paradigm often used to examine impulsivity. Much of research has established that anxiety felt in the face of uncertainty can result in maladaptive behaviors such as impulsive decision-making. Individuals with anxiety disorders have been shown to have greater trait and state impulsivity than individuals without an anxiety disorder (Del Carlo et al., 2012).
There are two current ideas about impulsivity and its association with anxiety. Firstly, that anxiety and impulsivity are two independent biologically based dimensions of personality, which correspond to avoidance and approach motivations. Approach motivation refers to behavior that is instigated by a desirable outcome, whereas in avoidance motivation, behavior is instigated by an undesirable outcome (Elliot & Thrash, 2002). Behavioral inhibition and safety-seeking are features of anxiety that are consistent with impulsivity. The alternative concept is that impulsive behavior may be caused by increased arousal and reduced cognitive efficiency. Despite these mixed findings, many studies have reported a link between anxiety and impulsivity (Garami et al., 2017).
Many anxiety disorders involve the fear of uncertainty, which has been associated with greater psychophysiological reactivity and exaggerated startle responses in anticipation of an unpredictable negative event (Nelson et al., 2016). Therefore, anxious individuals are more likely to underestimate the value of delayed rewards. At a behavioral level, individuals with high trait anxiety are more impulsive than those with low trait anxiety. This is evident through their immediate preference for immediate rewards over delayed, as well as, the increased speed at which they choose the immediate option, in comparison to individuals with low trait anxiety (Xia et al., 2017). This positive relationship between trait anxiety and impulsivity appears to be a consequence of enhanced attentional orientation to immediate options, overevaluation of immediate rewards and greater levels of motivations linked to immediacy (Xia et al., 2017).
Overall, intolerance of uncertainty may actually promote impulsivity, especially in substance abusers. Impulsive behaviors are often found in individuals who have substance abuse disorders, and there is evidence for a link between uncertainty and increased striatal activation in the brain, specifically the left caudate, which is related to impulsivity in drug users (Garami et al., 2017). Anxiety mediates the relationship between IU and impulsivity, which indicates that negative beliefs about uncertainty may not play a unique role in impulsivity. When impulsivity was examined in opioid-dependent individuals, a significant positive relationship between impulsivity and IU was found. Therefore, there is some association between IU and impulsivity within substance abusers. Since both anxiety and impulsivity are risk factors for addiction, understanding the association is important (Garami et al., 2017).
Challenging Behavior
Chris Oliver, ... Kate Woodcock, in International Review of Research in Developmental Disabilities, 2013
4.5.3 Impulsivity
Impulsivity is reported frequently (Clarke & Boer, 1998; Dykens & Smith, 1998; Smith et al., 1998), with prevalence rates of over 80% (Dykens et al., 1997). High proportions of clinically elevated impulsivity scores are reported in children and adults (40% and 58.3%, respectively, Oliver et al., 2011) and impulsivity has been reported to be a primary problem behavior, associated with “demands being needed to be met immediately” suggesting this may be related to intolerance of delay to reward (Clarke & Boer, 1998).
Personality and Addiction Processes
Natalie Castellanos-Ryan, Patricia J. Conrod, in Principles of Addiction, 2013
Impulsivity
Impulsivity is generally associated with a deficit in reflectiveness and planning, rapid decision-making and action, and a failure to inhibit a behavior that is likely to result in negative consequences. It is clear from the literature on substance misuse in adolescent and adult samples that impulsive traits play a prominent role in addictive behavior. Impulsivity has often been associated with substance misuse, specifically, quantity and frequency of drug use, and early experimentation with drugs. Impulsivity has also been associated with the consumption of a range of different drugs, such as cannabis, ecstasy, and heroin use, and is the personality trait that has most consistently been associated with alcohol disorders in the literature.
Longitudinal studies have also identified impulsivity/disinhibited traits as risk factors for future substance misuse. For example, impulsivity in childhood, as measured by either Eysenck's psychoticism or Cloninger's novelty seeking, has been found to predict substance misuse and alcohol-related problems in adolescence and adulthood, with a study by Cloninger and colleagues showing those reporting high scores in impulsivity to be 20 times more likely to report alcoholism in adulthood compared with those who do not report high scores on this trait. Impulsivity measured by higher-order factors or super-factors like constraint (i.e. Multidimensional Personality Questionnaire or the Minnesota Multiphasic Personality Questionnaire) or by lower-order, more specific measures of impulsivity (e.g. Substance Use Risk Profile Scale) assessed in childhood or early adolescence, have also been prospectively associated with alcohol and drug use in late adolescence and young adulthood. However, it is important to highlight that some laboratory studies have shown that severe and persistent substance use can result in deficits in behavioral and/or cognitive measures of impulsivity, such as response inhibition and decision-making, and even in increased levels of self-report trait impulsivity, suggesting the possibility that the pathway from impulsivity to substance misuse is bidirectional. This highlights the importance of assessing both measures of impulsivity and substance use simultaneously across time, so that cross-lag or bidirectional effects can be evaluated. With this in mind, a recent study by Littlefield, Sher, and Wood evaluated, using latent growth models, the extent to which changes in personality and changes in drinking behavior covary across early adulthood and showed that changes in drinking behavior from 18 to 35 years of age tend to co-occur with changes in impulsivity (as well as neuroticism). While this analysis does not provide direct evidence for causal effects between these two factors, the findings suggest that the relationship between impulsivity and drinking behavior may be more complex than a simple causal relation and may be reflecting a mutually exacerbating relationship.
There is now enough evidence – provided particularly by studies on children of alcoholics as well as by studies on nonsubstance use–related addictions such as problem gambling, where the vulnerability mechanisms underlying addiction can be studied without the confounding effects of substance use – showing that impulsivity is indeed a risk factor for addiction. For example, studies on children of alcoholics, considered to be at a higher risk for future alcohol problems due to genetic vulnerability, have found that many of these children exhibit high levels of impulsive personality traits and behaviors, with some even showing that disinhibited traits mediate the relationship between family history of alcoholism and drinking behavior.
Studies on problem gambling have shown similar results than those in the substance use field, indicating that compared with nongambling controls, problem gamblers demonstrate increased scores on a range of impulsivity-related measures. Similar to findings in the alcohol, and drug use literature, impulsivity scores have also been shown to predict gambling symptom severity in clinical samples of problem gamblers, as well as community-recruited adolescents. Finally, several studies provide evidence for the hypothesis that impulsivity is a common risk factor for (or associated with shared vulnerability to) gambling and substance use problems, as well as other addictive behaviors and externalizing problems, such as antisocial behavior.
Although there is some research showing that impulsivity (or undercontrol) assessed early in childhood is associated with alcohol problems in early adulthood in men but not women, varied research has shown that men and women tend to report similar levels of impulsivity – this is not the case though if the impulsivity measure includes “aggressive tendencies” (such as the measure of constraint) on which men score higher – and similar associations between impulsivity and later substance use or other addictive behaviors.
On the Psychobiology of Impulsivity
B. af Klinteberg, ... L. Oreland, in On the Psychobiology of Personality, 2004
2.1 Impulsivity as a Personality Trait: Its Role in Different Models of Personality
Impulsivity is a prominent personality trait both in healthy subjects, psychiatric syndromes and personality disorders. According to the theoretical formulations by Eysenck and Eysenck (1975), impulsivity was originally part of the extraversion concept based on an optimal level of arousal theory. However, it was repeatedly pointed out by Schalling (1978) that Extraversion (E) in the Eysenck Personality Inventory (EPI; Eysenck & Eysenck 1964) was composed of both Sociability and Impulsiveness. Later, when the Eysenck Personality Questionnaire (EPQ; Eysenck & Eysenck 1975) was introduced, impulsiveness was included in the Psychoticism dimension, while sociability was kept in the E scale (Schalling 1978). These changes gave rise to the results that tobacco smoking, strongly related to impulsivity, correlated with E on the EPI (e.g. Eysenck et al. 1960), while in the EPQ a stronger relation was demonstrated between tobacco smoking and Psychoticism (von Knorring & Oreland 1985; McManus & Weeks 1982), indicating the importance of impulsivity as a personality trait. Additional findings suggested that the Psychoticism dimension, including impulsivity, is associated with psychopathy and lack of conformity to social norms (Robinson & Zahn 1985). Gray et al. (1983) included susceptibility to signals of reward and punishment into his model of impulsivity/anxiety in describing the dimensions of introversion-extraversion. Zuckerman (1979, 1991) also developed a psychobiological approach to impulsivity. He developed an optimal level of arousal theory of sensation seeking as a main component in disinhibitory behavior (Zuckerman 1994). In his model, impulsivity is mainly related to the Disinhibition subscale of the Sensation Seeking Scale (SSS) while Sociability and Novelty Seeking is included in the Thrill and Adventure Seeking and Experience Seeking scales. In the Karolinska Scales of Personality (KSP) constructed during the 1970s by Schalling, the dimensions of impulsivity and novelty seeking are included in the impulsiveness and monotony avoidance scales (Schalling et al. 1987). The latter scale is closely related to the SSS. The Impulsiveness scale is related to “subsolidity” in the personality dimensional system described by the Swedish psychiatrist Sjöbring (Essen-Möller 1980).
Impulsivity seems to be a very basic trait with a high genetic component (Seroczynski et al. 1999). It has been suggested that impulsivity may eventually be a more productive target for study than any of the currently available personality disorders (Ruegg & Frances 1995), and there is an ongoing discussion on impulsivity, its multidisciplinary characteristics and its psychiatric and social consequences (Barratt & Slaughter 1998; Ruegg & Frances 1995). In the present chapter, results from different research groups on the issue of impulsivity will be reviewed and related to psychosocial disturbances. However, different research groups define impulsivity differently, and impulsivity scales load on different parts of the personality spectrum. The impulsiveness scale as used in the KSP is, according to a factor analytical study reported by Zuckerman, closely related to the Psychoticism-Unsocialized Sensation Seeking factor (Figure 1).
Figure 1. Factor loadings of personality scales plotted on the neuroticism (N) emotionality, and psychcotism unsocialized sensation seeking (P-ImpUSS) dimensions.
Note: Reprinted from M. Zuckerman (1989), Personality in the third dimension: A psychobiological approach, Personality and Individual Differences, 10, p. 397 with permission from Pergamon Press Plc.Behavioral Addiction
Natalie L. Cuzen, Dan J. Stein, in Behavioral Addictions, 2014
Conclusions
Impulsivity and compulsivity are each key contributors to behavioral addiction. Specifically, impulsivity frequently plays a role in the initiation of behavioral addiction, while compulsivity supports the maintenance of the condition. Using kleptomania as a specific example of a behavioral addiction, this chapter has illustrated how impulsivity and compulsivity may overlap within the behavioral addictions as well as across other relevant conditions. A slowly growing body of research in behavioral addiction, combined with a well-established substance addiction literature, provides a foundation to manage impulsive and compulsive aspects of these conditions. An ABC model is provided, based partially on principles of substance addiction, as a framework to guide treatment of compulsive and impulsive disorders targeting key affective, behavioral addiction, and cognitive control clinical features of these conditions.
Disordered eating behaviors: anorexia, bulimia, binge eating, and obesity
Melissa T. Buelow, in Risky Decision Making in Psychological Disorders, 2020
Impulsivity
Impulsivity and the behavioral activation system (BAS) may also be a mechanism for risky decision making in this population. BAS, behavioral inhibition, and impulsivity are all associated with the development of disordered eating and eating disorders, with evidence that impulsivity is associated with increased binge/purge type behaviors and reduced BAS with restricting behaviors (Atalayer, 2018; Bodell, Joiner, & Ialongo, 2012; Burrows, Hides, Brown, Dayas, & Kay-Lambkin, 2017; Drukker et al., 2009; Fields et al., 2013; Fischer, Smith, & Cyders, 2008; Meule, de Zwaan, & Muller, 2017; Schag, Schonleber, Teufel, Zipfel, & Giel, 2013; Verdejo-Garcia et al., 2010; Waxman, 2009). Impulsivity is positively correlated with food intake and obesity (Davis, 2013; Fields et al., 2013; Jasinska et al., 2012; Meule & Platte, 2015; Murphy, Stojek, & Mackillop, 2013), as well as risky decision making within eating disorder populations (Butler & Montgomery, 2005; Gat-Lazer et al., 2017; but see Tchanturia et al., 2011). Impulsivity is also associated with the response to food cues and how rewarding they are perceived to be (Tetley, Brunstrom, & Griffiths, 2010; Volkow, Wang, & Baler, 2011), and treatments that focus on lowering impulsive responses can lead to greater outcomes (Delgado-Rico et al., 2012). Additional research is needed to determine if risky decision making is consistently linked to higher levels of impulsivity across eating disorders or is specific to certain diagnoses, as disorders such as AN-restrictive are less associated with impulsivity and more with strict behavioral control.
Brain Research in Addiction
Samantha J. Brooks, ... Dan J. Stein, in Progress in Brain Research, 2017
1.4 Interaction Between Impulsivity/Compulsivity
Impulsivity and compulsivity as described earlier commonly involve a sense of “lack of control” and share neuropsychological mechanisms underlying dysfunctional inhibition of thoughts and behaviors (Stein and Hollander, 1995). Some argue that impulsivity and compulsivity are at opposing ends of the same spectrum—a form of diathesis model (Stein et al., 1994, 1996). This model suggests that compulsivity is a hypothetical construct that is a related modification of impulsivity, and as such compulsivity is considered to be a maladaptive perseveration of behavior, which, in contrast to impulsivity, does not typically adhere to a range of normal behavior (Robbins et al., 2012). Researchers and clinicians note that initial problems in the impulsive fronto-striatal neural circuitry in those with a mental disorder diagnosis may lead to problems in the compulsive fronto-striatal neural circuitry and vice versa (e.g., Voon and Dalley, 2016). For example, PIT theory (Everitt and Robbins, 2016) posits a neurobiological switch—in those with impulsive and novelty-seeking vulnerabilities—from deliberative controlled drug use, associated with the ventral striatum (nucleus accumbens), to habitual drug use associated with the dorsal striatum (Everitt and Robbins, 2016). This supports an “impulsive–compulsive diathesis” model (Fineberg et al., 2014). Moreover, interplay between the functions of impulsivity and compulsivity that characterize various psychiatric disorders further supports the link, as opposed to separation of these constructs. In other words, compulsivity may be linked to the reduction of arousal and termination of behaviors, cognitions, and affect, whereas impulsivity corresponds to initiating them, with the differences observed in terms of varying activation of corticostriatal loops (Dalley et al., 2011). There is mounting neuroimaging and neurocognitive evidence to suggest that impulsivity significantly contributes to relapse in psychiatric disorder, whereas the role of compulsivity is less clear, with its persistent function likely aimed at reducing negative affect that might otherwise obscure the detection of more serious mental or physical illness (Everitt et al., 2008; Fineberg et al., 2014; Robbins et al., 2012). In this vein, accumulating evidence appears to suggest that the initiation of mental disorder begins with excessive arousal that is linked to impulsivity, with compulsivity regarded as a maladaptive coping strategy for such arousal, which in turn is linked to poor treatment efficacy (Blanco et al., 2009; Grant et al., 2010). However, whether impulsivity and compulsivity act concomitantly, sequentially, antagonistically, complementarily, or a combination of these at the neural level is not yet clear (Voon and Dalley, 2016)—and so considering impulsivity and compulsivity in light of the RDoC might help to better understand the two processes and how they interact.
Preface to section II: Organization of the remaining chapters
Melissa T. Buelow, in Risky Decision Making in Psychological Disorders, 2020
Impulsivity is a commonly used word without a unified, accepted meaning. In fact, defining impulsivity often relies on the use of a series of descriptors, such as disinhibition, difficulties with self-control, sensation seeking, hyperactivity, discounting future rewards, anticipatory responding, the inability to wait, and nonplanning (e.g., Barnhart & Buelow, 2017a, 2017bBarnhart & Buelow, 2017aBarnhart & Buelow, 2017b; Bechara et al., 1994; Cloninger, Svrakic, & Przybeck, 1993; Depue & Collins, 1999; Milich & Kramer, 1984; Reynolds, Ortengren, et al., 2006). Complicating the process of arriving at a unified definition of impulsivity is the strong research base suggesting not all self-report and behavioral measures of the construct relate to one another (e.g., Barnhart & Buelow, 2017a, 2017bBarnhart & Buelow, 2017aBarnhart & Buelow, 2017b; Duckworth & Kern, 2011; Reynolds, Ortengren, et al., 2006; Reynolds, Richards, et al., 2006). For the purposes of the following section, impulsivity is thought to encapsulate all of the abovementioned characteristics and can be thought of as both a failure to plan ahead and a tendency to act without thinking (or thinking sufficiently).
