Facets of impulsivity – Differences between patients with BPD and ADHD
It’s more than likely you have done it before, said something reckless you later regretted or sent a quick and rude response to an email with annoying content. It means that you acted impulsively, or in other words, you had a rapid and unplanned response without appropriate foresight. If your impulsivity is persistently expressed, it can be really risky and maladaptive. However, there may have been situations in which your impulsive behavior paid off and could serve a good purpose. Has it ever occurred to you that a quick response at work was a lucky move at all, or a thoughtless purchase was eventually useful?

However, is it so black and white? Do we just have to decide whether we are impulsive or not? It’s a fact now, that impulsivity is a multifaceted trait, however, there are subtle differences between researchers in how many domains do they distinguish. So the answer is: it’s more complicated than that.

High levels of impulsivity can also be the part of different psychiatric conditions, and also a diagnostic criterion. Kenézlői and colleagues emphasize the importance of impulsivity has different characteristics with respect to the condition it’s part of. Their pilot study (2019) aimed to compare the impulsivity profile, personality traits and aggression level of patients with adult Attention Deficit Hyperactivity Disorder (ADHD) and Borderline Personality Disorder (BPD) main diagnoses, and healthy control subjects. They also analyzed the role of childhood adverse events in the background of impulsive symptoms.

Comparing the aforementioned three groups, their results show that there are significant differences between the impulsivity domains: higher levels of attentional impulsivity (distractibility) and motor impulsivity (inhibition) were observed in ADHD, while non-planning impulsivity (decision-making without long consideration) was more characteristic to BPD. Besides, they found that ADHD patients reached more points on the novelty seeking, harm avoidance, reward dependency, perseverance, self-direction and the cooperation subscales than BPD patients. Regarding the aggression regulation, there was no difference in the physical aggression and hostility scores, however, BPD participants rated themselves verbally less aggressive than ADHD participants and healthy controls. Another notable outcome is that ADHD patients reached more points on anger scale and higher total scores than healthy controls, while this difference wasn’t significant with BPD patients. According to the findings, the more emotionally neglected the milieu where a person grows up, the more chance to have higher levels of impulsivity in adulthood.

Taken together, impulsivity is a heterogeneous phenomenon and more research in this field could help us to understand the etiology of different psychiatric conditions, which can result in effective and more specific therapeutic interventions.

At the time of writing, the full research article is not available online.

Kenézlői, E., Balogh, L., Fazekas, K., Bajzát, B., Kruk, E., Unoka, Zs., & Réthelyi, J. (2019). Transdiagnostic study of impulsivity dimensions. Comparative analysis of impulsivity profiles in adult Attention Deficit Hyperactivity Disorder and Borderline Personality Disorder.


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What makes some of us more likely to drive over the speed limit, participate in extreme sports or make decisions that can impact health over time? Risk-taking behavior has distinct subtypes (for example disinhibition, sensation seeking, calculated risks, impulsivity) that develop due to the complex interplay of different factors: our lifestyle and environment, our personal susceptibility (genetic and biological variants) and a wide range of psychological effects.

In the study of Strawbridge and colleagues (2018) the goal was to identify genetic determinants of this trait. This approach has the potential to improve our understanding of impulsive behavior across different psychiatric disorders. It can also help later on to explore the possible overlap between mental illnesses and physical health.

„Would you consider yourself a risk taker?” This was the question posed to 116,255 participants, aged 40 to 69, from the UK Biobank project, a large population cohort containing a wide range of sociodemographic and medical information. Roughly one-quarter answered yes, they were the ’risk takers’ group.

A subset of participants took part in a prolonged follow-up occasion as well, where the same question was asked enabling an assessment of response consistency. Reproducibility was quite good, 81% of all participants responded consistently, 13% inconsistently, while in 6% the data was missing.

Genetic loci associated with risk-taking behavior were explored using the genome-wide association study approach. The authors identified one potential locus on chromosome 3 (CADM2) consistently, which was previously implicated in cognitive and executive functions.

Considering the entire genome using the polygenic risk score approach, the authors found, that the genetic variants that make us risk-prone also make us more likely to develop mental illnesses, such as bipolar disorder, schizophrenia, attention-deficit hyperactivity disorder, and post-traumatic stress disorder.

This trait has not only significant positive genetic correlations with a range of mental health disorders, but also with smoking, lifetime cannabis use and body mass index (BMI). The latter implies the possibility that this finding could be followed up in a study exploring the nutritional aspects of impulsivity as well.

Overall, using dimensional approach for traits (from “normal” to pathological) rather than discrete diagnostic categories could be helpful for finding the common ground in the neurobiological underpinnings across psychiatric disorders. From this point of view, risk-taking behavior is also a complex and important phenotype for investigations.

You can find the full research article here.

Strawbridge, R. J., Ward, J., Cullen, B., Tunbridge, E. M., Hartz, S., Bierut, L., Horton, A., Bailey, M. E. S., Graham, N., Ferguson, A., Lyall, D. M., Mackay, D., Pidgeon, L. M., Cavanagh, J., Pell, J. P., O’Donovan, M., Escott-Price, V., Harrison, P. J., & Smith, D. J. (2018). Genome-wide analysis of self-reported risk-taking behaviour and cross-disorder genetic correlations in the UK Biobank cohort. Translational Psychiatry, 8. https://doi.org/10.1038/s41398-017-0079-1

This was co-authored by  Tünde Kilencz, a psychologist and research assistant at Semmelweis University, Department of Psychiatry and Psychotherapy in Budapest, Hungary.

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