Impulsive behavior (also known as impulsivity) is a general term for a group of behaviors that occur with little or no planning or personal reflection. In childhood, one of the most common causes of impulsive behavior is attention-deficit hyperactivity disorder (ADHD). Current research indicates that impulsive tendencies can play a significant role in the onset and continuation of impulsive behavior disorders, or the clinical classification — impulse control disorders. These disorders embody a failure to resist aggressive impulses (e.g. kleptomania, pyromania, trichotillomania). However, impulsivity also plays a key role or manifests as a primary symptom in eating disorders, some personality disorders and bipolar I disorder. Eating disorders associated with the highest degree of impulsivity include classic anorexia nervosa, bulimia nervosa and a form of anorexia called binge/purge anorexia. In the U.S., an estimated 20 million females and 10 million males suffer from a clinically significant eating disorder at some point in their lifetimes.1
Types of Eating Disorders
Anorexia nervosa: This is a serious, potentially life-threatening eating disorder that is characterized by a refusal to maintain a healthy body weight, an intense fear of gaining weight and a distorted body image.2
Binge eating disorder (BED): This manifests as recurring episodes of eating significantly more food in a short period of time than most people would eat under similar circumstances. Episodes are marked by a lack of control and feeling guilty, embarrassed or disgusted. People with this disorder engage in this eating behavior an average of once per week for three months or longer.3
Binge-eating/purging anorexia: This subtype of anorexia is characterized by restricting food intake and regularly engaging in binge eating and/or purging behaviors (e.g. self-induced vomiting or the misuse of laxatives, diuretics or enemas). This type is frequently associated with additional impulse control problems and mood disorders.4
Bulimia nervosa: This is a serious, potentially life-threatening eating disorder characterized by binge eating episodes followed by behaviors such as self-induced vomiting, which are intended to undo or compensate for the effects of binge eating.5
The Impact of Impulsivity
Frequent episodes of impulsivity increase one’s risk of engaging in potentially self-destructive and damaging behaviors. Meta-analytic studies have pointed to the connection of impulsivity to antisocial behavior such as aggression and violent tendencies, risky sexual behaviors and drug and alcohol use/abuse.6 Impulsivity is characterized by a number of personality traits, including the tendency to:
- React without forethought when emotional state is strongly positive or strongly negative
- Participate in highly stimulating and/or dangerous activities
- Avoid making plans before acting
- Abandon previous plans before completion
- Fail to anticipate negative or harmful outcomes of one’s actions
Mental health professionals measure impulsive tendencies using several different questionnaires. These tools are used in conjunction with other methods to help confirm diagnoses of mental health disorders in which impulsivity plays an inherent role.
The Barratt Impulsiveness Scale (BIS-11). This is a 30-question self-reporting tool designed to assess the personality/behavioral traits of impulsiveness. Created in 1959, the BIS is one of the most commonly administered self-report measures for the assessment of impulsiveness in both research and clinical settings. It has been revised 11 times since its inception.6
UPPS-P Impulsive Behavior Scale: This is a revised version of the UPPS Impulsive Behavior scale developed by Whiteside and Lynam in 2001. It measures five distinct dimensions of impulsive behavior in adolescents and adults (ages 12 and older). There are 59 self-reporting questions that assess five subscales (urgency, premeditation, perseverance, sensation seeking and positive urgency). The scale uses a one (agree strongly) to four (disagree strongly) response format.7
The Impulsivity-Eating Disorder Connection
A 2006 study published in The International Journal of Eating Disorders used subjective and objective testing to measure the level of impulsivity in female subjects with several eating disorders. The authors concluded that females affected by classic anorexia, binge/purge anorexia or bulimia all exhibited an impulsivity-related decrease in the ability to focus attention. Those with binge/purge anorexia and bulimia also exhibited increased levels of impulsivity-related muscle activity. Furthermore, those with bulimia exhibited an increased tendency to act recklessly and/or dangerously.8
A 2015 study published in Eating Behaviors investigated the relationship between gender, impulsivity and disordered eating in healthy college students. Of the 1,223 students, 28.5% were males and 71.5% were females. Researchers utilized the BIS-11 and a four-factor version of the Eating Attitudes Test (EAT-16). Scores on all four EAT-16 factors were statistically higher for women than men. Motor impulsivity and attentional impulsivity were both associated with poorer self-perception of body shape and a greater preoccupation with food. The latter was also associated with a greater incidence of dieting. No gender differences emerged in the relationship between impulsivity and disordered eating attitudes.9
Impulsive Behavior Treatment
Treatment of many eating disorders is similar to addiction treatment, consisting of intensive group and individual therapy. Among the treatments utilized is cognitive behavioral therapy. At the core of these therapies is teaching patients a level of mindfulness, which ultimately helps stop impulsive behaviors. Being cognizant of an action the moment it occurs challenges impulsivity because it requires a level of awareness, which helps prevent spontaneous or rash behaviors.
Patients with many psychiatric disorders can exhibit impulsivity and aggressive behavior. The first approach is to treat the primary disorder such as bipolar disorder and the impulsive and aggressive behavior that may accompany it. The second methodology is to treat impulsive and aggressive behavior as a psychiatric disorder in itself, based on the fact that it involves some neurobiological mechanisms that occur independently of the primary psychiatric disorder. Medications such as mood stabilizers, antidepressants, selective serotonin reuptake inhibitors and other drugs should be prescribed on an individualized basis and in conjunction with psychotherapy that addresses the underlying issues responsible for the behavior.10
- Get The Facts on Eating Disorders. https://www.nationaleatingdisorders.org/get-facts-eating-disorders National Eating Disorders Association website. Accessed June 19, 2016.
- Anorexia Nervosa. Help Guide website http://www.helpguide.org/articles/eating-disorders/anorexia-nervosa.htm Updated May 2016. Accessed June 19, 2016.
- Understanding, Treating and Coping with Binge Eating Disorder. National Eating Disorders Association website. http://www.nationaleatingdisorders.org/blog/understanding-treating-coping-binge-eating-disorder Published March 7, 2016. Accessed June 19, 2016.
- Defining characteristics of Anorexia Nervosa. ED Referral website. http://www.edreferral.com/anorexia_nervosa.htm Accessed June 19, 2016.
- Bulimia Nervosa. National Eating Disorders Association website. https://www.nationaleatingdisorders.org/bulimia-nervosa Accessed June 19, 2016.
- Stanford MS, Mathias CW, Dougherty DM, Lake SL, Anderson NE, Patton JH. Fifty years of the Barratt Impulsiveness Scale: An update and review. Personality and Individual Differences. 2009;47:385–395.
- UPPS-P Impulsive Behavior Scale. National Kline Institute website. http://fcon_1000.projects.nitrc.org/indi/enhanced/assessments/upps-p.html Accessed June 20, 2016.
- Rosval L, Steiger H, Bruce K, Israël M, Richardson J, Aubut M. Impulsivity in women with eating disorders: problem of response inhibition, planning, or attention? Int J Eat Disord. 2006 Nov;39(7):590-3.
- Lundahl A, Wahlstrom LC, Christ CC, Stoltenberg SF. Gender differences in the relationship between impulsivity and disordered eating behaviors and attitudes. Eat Behav. 2015 Aug;18:120-4. doi: 10.1016/j.eatbeh.2015.05.004. Epub 2015 May 21.
- Prado-Lima PAS. Pharmacological treatment of impulsivity and aggressive behavior. Rev Bras Psiquiatr. 2009;31(Suppl II):S58-65.