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.

REFERENCES:
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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For my research, I measured impulsive behaviour in 3-year-old children. Briefly, impulsivity is the opposite of inhibitory control. There are several forms of inhibitory control, and although there is no official categorisation of different forms of inhibitory control in young children, Anderson & Reidy (2012) defined five categories. The categories are:

  • Delay of gratification: the ability to resist direct temptation in order to receive a bigger reward after the delay.
  • Impulse control: the ability to inhibit an instinctive response.
  • Verbal inhibition: the ability to inhibit verbal responses.
  • Motoric inhibition: the ability to learn response sets that conflict with an established behaviour.
  • Go/No go: the ability to perform certain behaviour after being shown a certain stimuli but to inhibit that behaviour after being shown a different stimuli.

The Marshmallow test is a famous example of an inhibitory control task (more specifically: delay of gratification). For this task, a marshmallow is placed in front of the child. The child is told that if s/he refrains from eating the marshmallow while the examiner is gone, s/he will receive two marshmallows when the examiner returns. Another example of an inhibitory control task (more specifically: Go/No go) is the Bear/Dragon task. For this test, the child has to obey the commands (e.g. ‘hands on your head’) of the bear hand puppet, but must inhibit obeying the commands of the dragon hand puppet.

When comparing the Marshmallow task with the Bear/Dragon task, similarities and differences can be found. They are similar in the way that both tests require the child to inhibit their impulses. However, the Marshmallow task requires minimal working memory demand, while the Bear/Dragon task requires complex greater working memory demand (Petersen, Hoyniak, McQuillan, Bates, & Staples, 2016). The Bear/Dragon task is thus a complex inhibitory control task, because children are instructed to not only inhibit a prepotent response, but also to respond in a certain way to a salient, conflicting response option.

In my research, I used both behavioural tasks and parental report (both mothers and fathers) to assess inhibitory control. However, results from the behavioural tests and the parental questionnaires correlate poorly with each other; a finding which is also often reported in other studies. While behavioural tests show objective observations of the child’s behaviour, these observations are mostly only carried out at one specific time point (e.g. during a home visit). As such, the child’s performance might be prone to noise, such as that the child slept poorly the past night. Reports of behaviour, on the other hand, reflect the behaviour of the child during daily life. However, these reports can be prone to social desirable answering and parental perceptions of their child’s behaviour. By measuring inhibitory control with both behavioural tasks and parental reports, we obtain the most robust view of the child’s behaviour.

Overall, measuring inhibitory control behaviour in 3-year-olds can be challenging, but also a lot of fun! (Stay tuned for a blog on interesting anecdotes during my data collection.)

REFERENCES:

Anderson, P. J., & Reidy, N. (2012). Assessing Executive Function in Preschoolers. Neuropsychology Review, 22(4), 345–360. https://doi.org/10.1007/s11065-012-9220-3

Petersen, I. T., Hoyniak, C. P., McQuillan, M. E., Bates, J. E., & Staples, A. D. (2016). Measuring the development of inhibitory control: The challenge of heterotypic continuity. Developmental Review: DR, 40, 25–71. https://doi.org/10.1016/j.dr.2016.02.001

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In our Eat2BeNice project, we want to know how lifestyle-factors, and nutrition contribute to impulsive, compulsive, and externalizing behaviours. The best way to investigate this is to follow lifestyle and health changes in individuals for a longer period of time. This is called a prospective cohort study, as it allows us to investigate whether lifestyle and nutrition events at one point in time are associated with health effects at a later point.

Luckily we can make use of the LifeGene project for this. LifeGene is a unique project that aims to advance the knowledge about how genes, environments, and lifestyle-factors affect our health. Starting from September 2009, individuals aged 18 to 45 years, were randomly sampled from the Swedish general population. Participants were invited to include their families (partner and children). All study participants will be prompted annually to respond to an update web-based questionnaire on changes in household composition, symptoms, injuries and pregnancy.

The LifeGene project (1) consists of two parts: First, a comprehensive web-based questionnaire to collect information about the physical, mental and social well-being of the study participants. Nine themes are provided for adults: Lifestyle (including detailed dietary intake and nutrition information), Self-care, Woman’s health, Living habits, Healthy history, Asthma and allergy, Injuries, Mental health and Sociodemographic. The partners and children receive questions about two to four of these themes. For children below the age of 15 the parents are requested to answer the questions for them.

The second part is a health test: at the test centres, the study participants are examined for weight, height, waist, hip and chest circumference, heart rate and blood pressure, along with hearing. Blood and urine samples are also taken at the test centres for analysis and bio-banking.

Up until 2019, LifeGene contains information from a total of 52,107 participants. Blood, serum and urine from more than 29,500 participants are stored in Karolinska Institute (KI) biobank. From these we can analyze genetic data and biomarkers for diabetes, heart disease, kidney disease and other somatic diseases. Based on LifeGene, we aim to identify nutritional and lifestyle components that have the most harmful or protective effects on impulsive, compulsive, and externalizing behaviors across the lifespan, and further examine whether nutritional factors are important mediators to link impulsivity, compulsivity and metabolic diseases(e.g. obesity, diabetes). We will update you on our results in the near future.

For more information, please go to the LifeGene homepage www.lifegene.se. LifeGene is an open-access resource for many national and international researchers and a platform for a myriad of biomedical research projects. Several research projects are underway at LifeGene https://lifegene.se/for-scientists/ongoing-research/.

This was co-authored by Henrik Larsson, professor in the School of Medical Science, Örebro University and Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Sweden.

AUTHORS:
Lin Li, MSc, PhD student in the School of Medical Science, Örebro University, Sweden.

Henrik Larsson, PhD, professor in the School of Medical Science, Örebro University and Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Sweden.

REFERENCES:

  1. Almqvist C, Adami HO, Franks PW, Groop L, Ingelsson E, Kere J, et al. LifeGene–a large prospective population-based study of global relevance. Eur J Epidemiol. 2011;26(1):67-77.
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Yoga practice has become very popular in the last two centuries. In most western countries, yoga studios are booming. For example, Dutch practitioners are said to spent 325 million euros per year on yoga classes, clothes and events.

In scientific research, yoga and its beneficial effects on physical and mental health, have also become a serious topic of interest. In a previous post, Hannah Kurts had already outlined the positive effects of yoga for several psychiatric disorders (https://newbrainnutrition.com/how-to-help-mental-health-with-yoga/)

Recently, the effects of yoga on cognitive performance and behavioral problems in 5-year old children have been examined. A group of Tunisian researchers offered 5-year old children in kindergarten a 12-week yoga program, regular physical education, or no kind of physical activities.

They found that this kind of kindergarten-based yoga practice, had significant positive effects on visual attention, visuo-motor precision and symptoms of hyperactivity and impulsivity, in comparison to regular physical activities or no physical activities [1].

One might wonder: Quiet and peaceful yoga exercises with a bunch of energetic 5-year olds? How would that even work?

The yoga they offered in this project was a 30-minute routine, instead of a more regular 90-min session: 5 minutes of warming up, doing jogging, jumping, stretching. Next, 15 minutes of the well-known yoga postures, standing, sitting, flexing. Next, 5 minutes of breathing techniques and lastly, 5 minutes of yogic games, to train memory, awareness and creativity. And they practiced only twice a week.

It seems very promising that such a curtailed version of yoga practice can have positive effects on attention, executive functions, and behavioral control, which are all skills that are vital to good academic performance [2][3].

In some European and North-American countries, the idea of school-based yoga practice isn’t so revolutionary anymore. France, Italy, Brazil, and Canada have recognized yoga practice in its school curriculum. Italy seems to be the school-yoga champion: Classroom-based yoga is performed in all Italian schools since 2000 [4].

REFERENCES
[1] Jarraya S, Wagner M, Jarraya M and Engel FA (2019) 12 Weeks of Kindergarten-Based Yoga Practice Increases Visual Attention, Visual-Motor Precision and Decreases Behavior of Inattention and Hyperactivity in 5-Year-Old Children. Front. Psychol. 10:796. doi: 10.3389/fpsyg.2019.00796

[2] Chaya, M. S., Nagendra, H., Selvam, S., Kurpad, A., and Srinivasan, K. (2012). Effect of yoga on cognitive abilities in schoolchildren from a socioeconomically disadvantaged background: a randomized controlled study. J. Altern. Complement. Med. 18, 1161–1167. doi: 10.1089/acm. 2011.0579

[3] Verma, A., Uddhav, S., Ghanshyam Thakur, S., Devarao, D., Ranjit, K., and Bhogal, S. (2014). The effect of yoga practices on cognitive development in rural residential school children in India. Natl. J. Lab. Med. 3, 15–19.

[4] Flak, M. (2003). Recherche Sur Le Yoga Dans L’éducation. 3ème Millénaire: Spiritualité – Connaissance De Soi – Non-Dualité – Méditation, 125. Available at: http://www.rye-yoga.fr/ (accessed July 15, 2018).

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