After a long week, a man pulls into the neighborhood bar for "just one to relax." One turns into two, then a round for his friends. Six drinks later, he just can’t stop himself from calling his ex and shouting the very words that landed him in court the first time. Enraged, he lurches to his car, throws it in drive, runs over the curb, crosses five lanes of traffic and makes the snap decision to play hard-to-get with the wailing siren behind him.

The consequences of this string of impulsive choices are predictable: an accident, DWI, and loss of his license — for starters.

His defense: I just couldn’t help myself.

There needn’t be any reason, just an opportunity, and suddenly, a normally focused person feels compelled to drink to the point of intoxication, spend to the point of bankruptcy or provoke to the point of violence. It’s as if they can’t control themselves. More precisely, they can’t control their impulses.

Why do we behave impulsively? Even when we know we shouldn’t, instant gratification induces us to take that extra drink, reach for that third helping or go for the last word. We do it even when we know the destructive outcome. Even worse, alcohol and certain drugs have been shown to make us more impulsive. It’s not easy to beat such a vicious cycle.

Give it to me ... NOW!

Simply put, impulsivity is the inability to stop oneself from doing something. “Impulsivity is a predisposition toward rapid, unplanned reactions to internal or external stimuli without regard to the negative consequences of these reactions to the impulsive individual or to others,” explains F. Gerard Moeller, M.D., professor of psychiatry and behavioral sciences at The University of Texas Medical School at Houston and president of the International Society for Research on Impulsivity (ISRI).  In other words, the all-you-can-eat buffet might be in clear violation of your diet plan, but when the craving hits, have mercy on anyone who tries to stop you.

 Impulsivity is distinct from addiction. Though a smoker may impulsively light a cigarette after having just finished one, the smoker has become physically dependent on the addictive chemical nicotine and psychologically dependent on the act of smoking.  Addictions to certain behaviors (gambling, shopping) or substances (certain drugs, alcohol, tobacco) involve a self-reinforcing sense of psychological dependence.

Also unique from impulsivity, though often confused, are compulsive behaviors, which are ritualistic acts that someone feels they must do to ease or prevent distress.  For instance, persons may compulsively wash their hands to ward off disease or prevent some wholly unrelated and unrealistic catastrophe from happening. Some compulsive disorders are actually an attempt to control one’s environment—the opposite of impulsively reacting to one’s environment.

To understand impulsivity better, Moeller says the International Society for Research on Impulsivity focuses on the “examination of the current diagnostic criteria for disorders of impulse control.”  Moeller says that due to strides made in the past 10 years, “there is a greater understanding that impulsivity is not a [single concept], but it has a number of subcomponents. Each of these subcomponents is related to brain function in a different way.”  For instance, acting without thinking (motor impulsivity) is different from making quick decisions (cognitive impulsivity) and has different underlying causes.
 
Impulsivity often has to do with a lack—or total absence—of planning.  In the brain, the pre-frontal cortex, known to be involved in planning and decision making, is thought to play a key role in impulse control.  Damage to the pre-frontal cortex leads to impairment in our ability to suppress impulses.  In such cases, areas of the brain involved in reward, pleasure seeking or rage will dominate safer judgment.

When impulsivity can be deadly

Impulsivity has a large impact on our society, but as Moeller points out, “It is a symptom and not a disorder in and of itself.”  It can lead to common problems such as binge eating and drinking, and “it is associated with a number of psychiatric disorders including substance abuse, ADHD (Attention Deficit Hyperactivity Disorder) and bipolar disorder."

Alan Swann, MD, professor and researcher also in the Department of Psychiatry and Behavioral Sciences at UT Medical School, studies bipolar disorder and impulsivity. Impulsive behavior looks different in the manic state than it does in the depressive state. “Impulsivity in mania is associated with extreme impetuousness,” such as risky sexual behavior, he says.  On the other hand, “depressed patients have increased 'non-planning' impulsivity, related to a lack of future sense.”  They may cross a busy street without looking because they just don’t care what happens.

Swann emphasizes an important relationship between impulsivity and suicide.  “Severe suicidal behavior requires a combination of hopelessness, the wish to die and impulsivity to overcome inhibitions.  The more impulsive someone is, the less depression it takes [to commit suicide]."

Take back control

Moeller advises, “If people are having trouble with impulsivity to the point that it is causing problems with their families or their work or causing serious personal distress, they should seek help from a psychologist or psychiatrist."

For less dramatic moments of impulsivity—the ones that make you wish you could take back your words (or at least the shoes you’ve never worn)—try these:

• Reward reinforces.  Provide yourself an incentive that is fair, easy to obtain consistently, and will help you move toward your desired behavior.  And,  the sooner a reward is given after the desired behavior, the more reinforcing it is.  Reward your commitment to healthy eating choices at lunch with a square of dark chocolate at the end of the meal instead of a weekend’s worth of “reward” dessert decadence.
• Put your money where your spending was. With each frivolous purchase that you don’t make (but dearly want to) put that same purchase amount in a jar reserved for your upcoming vacation, car note or Money Market account. Make it visual: put it in cash.
• Write it down, then, sleep on it. Before you press “send” on that flaming e-mail to an infuriating co-worker, e-mail what you’d like to say to yourself, only. Then, sleep on it. Chances are that by the next day, either the issue or the impulse will have faded.
  
  The message here is to slow down.  Impulsive behaviors are done quickly, so if you give yourself a moment to consider your motives, you’ll give yourself the opportunity to prevent a regrettable action. 

• Sometimes impulsivity is helpful—in small doses. “Most definitions of impulsivity include action without forethought. This in general gets a person into trouble, but not always,” Moeller reminds. If a car comes careening into your lane, a snap decision on your part could save your life. And, a surge of courage in the face of disaster may save the life of someone else.       

If you feel you need help...

Those seeking help with these issues should contact a qualified psychologist or psychiatrist.

Information is available through the UT Medical School, Department of Psychiatry and Behavioral Sciences at 713-500-2550 or The UT Counseling and WorkLife Services, 713-500-3327 or visit their website, http://www.uthouston.edu/worklife/.

Last Updated: 10-18-2007

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