ImpulsivityImpulsivity is something everyone has experienced. We have all had moments when we have said something impulsively that we regret or have gotten carried away with an idea. Sometimes the consequences of an impulsive action are minimal.  But that is not always the case.

Impulsive decision-making is more common in people with bipolar. And this increase is not just something seen during a mood episode, people with bipolar seem to have a generally increased tendency to quick or impulsive decisions.

Nevertheless, in a hypomanic or manic state, an increase in impulsive decision-making is often a key feature of the change in mood. It can result in compulsive gambling, risky sex, excessive spending, and other risky behavior.

When depressed, especially in a “mixed” state, impulsive decisions in bipolar increase the risk of suicide. I

n addition, to impulsivity being linked to mood states, Robin Flanigan in her blog post “Bipolar and Controlling Impulsivity,” notes that research suggests a link to brain differences in people with bipolar disorder regardless of mood states which makes them more prone to risk and impulsivity.

“Studies suggest that the part of the brain that plans and analyzes tends to have a weaker grip on emotional circuitry in people with bipolar—akin to worn brake pads that can’t stop a speeding car in time.

In addition, the reward system seems to be more sensitive, so that the lure of a prize wields more power.

On the one hand, the greater lure of reward can fuel goal-directed achievement. This led John Gartner to write a book arguing that hypomania is responsible for some of the success of American entrepreneurs, The Hypomanic Edge: The Link Between (A Little) Craziness and (A Lot of) Success in America.

“Why is America so rich and powerful?” asks Gartner. The answer lies in our genes, he says. “My new hypothesis became that American entrepreneurs are largely hypomanic,” writes Gartner. “Hypomanics are brimming with infectious energy, irrational confidence and really big ideas. They think, talk, move and make decisions quickly. Anyone who slows them down with questions ‘just doesn’t get it.’ Hypomanics are not crazy, but ‘normal’ is not the first word that comes to mind when describing them. Hypomanics live on the edge, between normal and abnormal.”

On the other hand, impulsivity increases susceptibility to addiction and intensifies cravings for excitement that can be profoundly self-destructive.

The Brain

What is happening in the brain to someone with bipolar disorder that may differ from someone without the diagnosis that may account for an increase in impulsivity? Robin Flanigan discusses some of the relevant research in her blog post “Impulsivity: What’s Happening in the Brain.”

“When  British researchers had a group of people with bipolar perform a roulette-style task, they showed stronger activation in the nucleus accumbens than a comparison group of people without bipolar.”

That 2014 study also found different patterns of activity within an area called the ventromedial prefrontal cortex (roughly, a “forward and middle” segment) that is active when we are weighing risk versus reward.

Those with bipolar had greater neural activity for risky bets, while those in the comparison group showed more response to “safe” bets.

The ventromedial prefrontal cortex has been implicated in other behaviors that involve deciding between future consequences and immediate pleasure, such as overeating, overspending, and substance overuse.

Meanwhile, a neighboring area called the ventrolateral prefrontal cortex (“forward and left”) may be “increasingly relevant to our understanding of impulsivity, particularly in people with bipolar disorder,” says Mary L. Phillips, MD, director of the Mood and Brain Laboratory at the University of Pittsburgh School of Medicine.

In certain situations where a big reward is possible, such as gambling, ventrolateral activity is heightened significantly more in people with bipolar disorder than in those without bipolar.

Furthermore, Phillips and her colleagues have found that the excitement associated with the possibility of a future reward increases disproportionately during mania, feeding even more juice to emotional urges and compromising the ability to regulate them—much as floodwaters may overwhelm a normally sturdy dam.

“These series of vulnerabilities often lead to risky decisions,” Phillips notes.”

Tips

Working with people with bipolar, I have learned several helpful strategies that they use to support themselves around managing risks related to impulsivity and risky decision making.

Pause and Reflect

Taking a moment to pause and observe can be incredibly helpful. A regular mindfulness practice can help people be able to take a moment to reflect before an abrupt act. The more often we practice mindfulness, the more readily able we are to use the skill during more challenging times.

Recruit a Helper

Sometimes having someone you can trust to reality test with around a possible decision you want to make can make a huge difference. This can be a therapist, friend, significant other, parent — someone you can check in with to explore if the decision could have negative consequences you are not prepared to face. They can help you weigh the pros and cons – to act, or not to act!

The 48 Hour Rule

If you are considering making an impulsive decision, try waiting 48 hours before acting. Check in with yourself after that timeline to see if anything has changed? Do you have any new information that may inform whether or not you want to act.

Know Your Triggers and Your Warning Signs

Being able to identify when you mood may be shifting can be essential to increasing your awareness around your risk to act impulsively. This may be you noticing a change in your thoughts, sleep patterns, etc. Also, know which triggers make you most vulnerable regardless of your mood state. Are there certain people or situations you are more likely to act impulsively around? Can you come up a with a plan ahead of time around how you may take time to pause before acting?

– Gina

References:

Flanigan, R. (2017, April, 7). “Impulsivity: What’s Happening in the Brain.” http://www.bphope.com/impulsivity-bipolar-brain/

Flanigan, R. (2017, April, 7). “Bipolar and Controlling Impulsivity.” http://www.bphope.com/bipolar-and-controlling-impulsivity

For More Information

Bipolar and Creativity

Early Warning Signs

Janelle Caponigro and Erica Lee