Impulse Control Disorder.

Why Can't I Stop?

Impulse Control Disorder.

Why Can’t I Stop?

Introduction

Impulse control disorder increases the risk for psychiatric disorders and substance abuse.1 Impulsivity is the tendency for a person to act without significant thought. Instead of thinking through an action, statement, or behavior, they just do it. The impulsive behavior makes their immediate reaction or needs controlling. Impulse control can be learned and can make a dramatic difference in a person’s life.

Impulsivity is a common symptom in medical conditions like bipolar disorder, borderline personality disorder, and attention-deficit hyperactivity disorder (ADHD). Those who struggle with substance abuse, especially amphetamines, are often more vulnerable to impulsivity. They desire a “quick fix” instead of thinking about what the substance could do to their body and brain.

Prevalence

It’s hard to put an exact number on how many people in the United States experience impulse control disorder. This is because doctors don’t have an exact definition or grouping of symptoms that define impulsive behavior. Until they do, most medical professionals use different surveys to decide if it’s likely a person has impulsivity concerns.

One study published in the Journal of Psychiatric Research studied results from more than 34,653 adults from administered in 2004 and 2005.2 Through reviewing these surveys, they determined an estimated 17 percent of the population was impulsive. They found men and younger people were most likely to show signs of impulsivity. They also linked impulsive behavior with a greater incidence of several medical conditions, including:

ADHD

Bipolar disorder

Drug dependence

Schizotypal personality disorders

Population that is Impulsive
17%

The study’s authors also found that impulse control disorder was connected with greater risks for suicide attempts as well as increased probability for accidents, such as driving-related accidents.

Signs of Impulse Control Disorder

A person with impulse control disorder acts quickly, makes decisions very fast, and seeks rewards quickly. These aren’t always bad traits in a person. Sometimes, a person’s quick thinking and decision making can serve them well. However, a person lacking impulse control has very little ability to stop and make a decision with careful thought.

Impulse control disorder may look different from person to person. Doctors have tests they can use to measure impulsivity. One example is the Barratt Impulsivity Scale. This is a 30-question scale that divides impulsivity into three common sets of behavior: attentional, motor, and non-planning. Some symptoms of each include:

Attentional

This presents as having a hard time focusing on a task or not being able to tolerate situations or assignments that require long-term attention.

Motor

This presents as engaging in spontaneous and unplanned actions constantly with little forethought. This may also look like asking inappropriate questions or interrupting people frequently.

Non-Planning

This presents as not thinking about or making any plans for the future. This may look like not worrying about health, who they may hurt, or the people who love them when impulsive actions occur.

This scale is just an example of some of the symptoms a person with impulsivity may experience, as well as how a doctor may evaluate a person for impulsivity.

Impulse Control in Children with ADHD

Attention-deficit hyperactivity disorder (ADHD) is a condition that makes it difficult for a person to control their behaviors and pay attention. As a result, they may act impulsively.3

Some of the ways a child with ADHD may show signs of impulsivity include:

Jump off a chair or piece of playground equipment without thinking about where they’ll land or if they could get hurt.

Blurting out an answer in class after the teacher has asked students to raise their hands.

Hyperactive-Impulsive ADHD

Doctors may further break down the ADHD subtype into a “hyperactive-impulsive” type.4 Some of the symptoms of this ADHD subtype include:

  • Always fidgeting or squirming with the seeming inability to sit still
  • Constantly running or moving from place to place with little slowing down
  • Difficulty with quiet tasks, such as reading
  • Engaging in non-stop talking
  • Interrupting a person constantly when another is speaking
  • Making comments at often inappropriate times
  • Problems waiting in line for their turn

Not all people who are impulsive have ADHD, and not all people with ADHD are impulsive. Some people have impulsivity problems but don’t have the attention problems of a person with ADHD. Impulsivity is just a known factor in some people who do have ADHD. 5

Causes

Researchers study different aspects of impulsivity, which is a topic with a growing understanding. They know that both humans and in animal (monkey) studies, impulsive people tend to have a bad memory. This makes doctors think that maybe impulsivity has something to do with the frontal portion of a person’s brain since this is the part responsible for memory.

Doctors also know that impulsivity seems to be worse the younger a person is. However, there are no signs that the overall impulsivity reduces as a person ages. Therefore, a person may be less impulsive at an older age than when they were younger, yet still have impulsive-type tendencies.

The Impulsive Gene

Doctors know that both people who are diagnosed with ADHD and chronic impulsivity are both more likely to engage in substance abuse. 6 Researchers have even identified a gene in a person’s body that may make them more likely to show ADHD-like behaviors and impulsivity known as the cAMP-response element modulator or CREM. In both rat and human studies, researchers found variations in this gene may make a person more likely to engage in substance abuse. When a person had both ADHD with signs of impulsivity as well, the risks for drug use went up even more.

Impulse Control Disorder and Addiction

According to an article in the journal Alcoholism: Clinical and Experimental Research, high levels of impulsivity and substance abuse are connected. One of the reasons this may be is because people who are impulsive are often thrill- or reward-seeking. It can be challenging delaying behavior and choices in these instances.

How Drugs Effect the Impulsive Brain

Once a person who is impulsive starts using drugs, the effects that drugs have on the brain usually only make symptoms worse. This is because drugs affect neurotransmitters in the brain. They cause a release of more chemicals that feel good, and the brain becomes addicted to the higher levels of chemicals. As a result, a person has to continually seek out these chemicals as a way to experience the same reward or high.

Impulsive Behavior and Alcohol

One laboratory study of rats found that rats who were highly reactive (made impulsive or fast choices) were more likely to drink alcohol and higher proofs of alcohol than rats who were low reactive, according to Alcoholism: Clinical and Experimental Research. Researchers have also found that high levels of impulsivity can make a person more likely to use drugs like cocaine. The fast high and immediate sensation of reward are some of the most likely reasons for this.

Impulsivity and Marijuana

Another laboratory study published in the journal Experimental and Clinical Psychopharmacology found that habitual marijuana users were more likely to have high levels of impulsivity compared to control groups who did not. 7 They also found impulsive marijuana users were more likely to show brain changes in the frontal portions of their brains. While the study is small, it does show some correlation between marijuana users and impulsivity.

Impulse Control Disorder and Recovery from Substance Abuse

Not only does impulsivity make it more likely a person may use drugs, but it also increases the difficulty a person has in staying sober when they abuse drugs. For example, a person with impulsivity concerns has difficulty delaying gratification and not getting rewards, such as the feel-good chemicals taking certain drugs produces. A person in recovery who is impulsive may struggle with sobriety due to the lack of reward and desire for a quick fix or high.

Managing Impulsivity

It’s important to note that impulsivity alone doesn’t always require medications, but most people can benefit from some kind of therapy, such as talk therapy. The following are some common treatments for impulsivity.

Medications

Doctors may prescribe medications to reduce impulsivity in those with other medical conditions, such as substance abuse or compulsive gambling. They may also prescribe medicines to control impulsivity in medical conditions such as Parkinson’s disease or ADHD.

Examples of medications prescribed include: 8

Selective Noradrenergic Reuptake Inhibitors (SNRIs)

These medications have been clinically proven to reduce impulsive behaviors because they help to reduce some of the processes in the front of the brain that can lead to impulsive behavior. An example of an SNRI medication is atomoxetine. According to Psychiatric Times, these medications have been proven to be more effective than selective serotonin reuptake inhibitors, especially when it comes to reducing impulsive behaviors.

Opioid Antagonists

While impulsivity doesn’t always go hand-in-hand with addictions such as heroin or painkillers, doctors have found the medications used to treat those addictions may also help those who struggle with impulsivity. Examples include the medications naltrexone and nalmefene. Doctors prescribe these medications to treat several impulse control disorders, including gambling addiction and kleptomania. These medications may also prove beneficial in treating those with alcohol use disorders.

Glutamatergic Agents

These medications have the power to reduce or moderate the amount of glutamate in the brain. Glutamate is an excitatory neurotransmitter, meaning it tends to get the brain revved up. Doctors have used glutamatergic agents such as N-acetylcysteine to treat conditions like marijuana dependence, gambling disorder, cocaine addiction, and nicotine dependence.

Doctors are also testing other medications and may prescribe them for different types of impulsivity. Often, it depends upon the symptoms a person has and how a person’s impulsivity is affecting their life. Other medications a doctor could prescribe are lithium and atypical antipsychotics.

Therapies

Psychotherapy from a psychiatrist or other therapy professionals may help a person who deals with chronic impulsivity learn to manage their impulses better.

Cognitive-Behavioral Therapy

While there are many therapy possibilities, one of the most common and usually most effective is cognitive-behavioral therapy. 8 This is a therapeutic approach that involves educating a person on their behaviors and how to recognize when they are acting impulsively or how their behaviors and actions affect others. Cognitive-behavioral therapy is also commonly used in treating substance abuse. A therapist helps a person focus on behaviors that can help them think through a situation or refrain from acting impulsively whenever possible.

Family Therapy

In addition to these approaches, a doctor may also recommend family-based therapies or even school-based therapies. Family therapy can help a person’s family learn how to best assist them in treating impulsivity. If a person also has aggressive behavioral outbursts, family therapy may focus on helping a family learn how to cope with and modulate these behaviors.

Treating impulsivity can require trial-and-error. Sometimes, medications take several months to work or for a doctor to say they won’t work. A person may also not respond to one therapy approach, yet work well with another.

Misconceptions About Impulsivity

Control

One of the most common misconceptions about chronic impulsivity is that a person can fully control their behavior. As scientists learn more about impulsivity and the chemical changes it causes in the brain, they have realized that impulsivity is less a learned behavior than it is a chemical and genetic one.

This doesn’t mean a person can’t learn how to deal with their condition, but it does mean that they have a challenge to overcome in terms of impulsive thoughts and behaviors.

Crystals

Using Crystals for Impulsivity has never been proven to work. One study in 2001 instructed 80 volunteers about how they would feel holding crystals; 40 volunteers were given crystals, and the other 40 volunteers were given plastic replicas of the crystals. There was no observable difference between the reactions of the two groups. However, there may be a placebo effect on people who believe crystals for impulsivity are effective.

Living with Chronic Impulsivity

Doctors have strongly linked impulsivity with many chronic conditions, including substance abuse and mental health disorders. Helping a person recognize impulsivity can be the first step towards seeking help. Therapy and medicines can help reduce harmful impulsive behaviors while also allowing the benefits that can come with impulsivity, such as being quick to make positive and beneficial judgments.