View source for Impulsivity

{{short description|Tendency to act on a whim without considering consequences}}
[[File:MRI of orbitofrontal cortex.jpg|thumb|right|200px|[[Orbitofrontal cortex]], part of the prefrontal cortex that shapes decision-making]]
In [[psychology]], '''impulsivity''' (or '''impulsiveness''') is a tendency to act on a [[Impulse (psychology)|whim]], displaying behavior characterized by little or no [[forethought]], reflection, or consideration of the consequences.<ref>{{cite book |last=VandenBos |first=G. R. |year=2007 |pages=470 |title=APA dictionary of psychology |url= https://archive.org/details/apadictionaryofp00vand |url-access=registration |location=Washington, DC |publisher=APA|isbn=9781591473800 }}</ref> Impulsive actions are typically "poorly conceived, prematurely expressed, unduly risky, or inappropriate to the situation that often result in undesirable consequences,"<ref name = "Daruna">{{cite book |last1=Daruna |first1=J. H. |last2=Barnes |first2=P. A. |year=1993 |chapter=A neurodevelopmental view of impulsivity |pages=[https://archive.org/details/impulsiveclientt0000unse/page/n23 23]–37 |doi=10.1037/10500-002 |editor1-first=William George |editor1-last=McCown |editor2-first=Judith L. |editor2-last=Johnson |editor3-first=Myrna B. |editor3-last=Shure |title=The Impulsive Client: Theory, Research, and Treatment |url=https://archive.org/details/impulsiveclientt0000unse |location= Washington, DC |publisher=American Psychological Association |isbn=978-1-55798-208-7}}</ref> which imperil long-term [[goal]]s and strategies for success.<ref name = "M&G10">{{cite book |last1=Madden |first1=Gregory J. |last2=Johnson |first2=Patrick S. |year=2010 |chapter=A Delay-Discounting Primer |editor1-first=Gregory Jude |editor1-last=Madden |editor2-first=Warren K. |editor2-last=Bickel |title=Impulsivity: The Behavioral and Neurological Science of Discounting |pages=11–37 |location= Washington, DC |publisher=American Psychological Association |isbn=978-1-4338-0477-9}}</ref> Impulsivity can be classified as a multifactorial [[Construct (philosophy of science) |construct]].<ref>{{cite journal |doi=10.1007/PL00005481 |title=Varieties of impulsivity |year=1999 |last1=Evenden |first1=J. L. |journal=Psychopharmacology |volume= 146 |issue=4 |pages=348–61 |pmid=10550486 |s2cid=5972342 }}</ref> A functional variety of impulsivity has also been suggested, which involves action without much forethought in appropriate situations that can and does result in desirable consequences. "When such actions have positive outcomes, they tend not to be seen as signs of impulsivity, but as indicators of [[boldness]], [[wiktionary:fast|quickness]], spontaneity, [[courageousness]], or unconventionality."<ref name="Daruna" /><ref name= "Dickman" /> Thus, the construct of impulsivity includes at least two independent components: first, acting without an appropriate amount of deliberation,<ref name= "Daruna"/> which may or may not be functional; and second, [[deferred gratification|choosing short-term gains over long-term ones]].<ref>{{cite book |last1=Rachlin |first1=Howard |year=2000 |chapter=Self-Control as an Abstraction of Environmental Feedback |chapter-url=https://books.google.com/books?id=KWp-EJaEAUIC&pg=PA183 |page=183 |title=The Science of Self-Control |location=Cambridge, MA |publisher=Harvard University Press |isbn=978-0-674-00093-3}}</ref>

Impulsivity is both a [[Facet (psychology)|facet]] of personality and a major component of various disorders, including [[FASD]], [[ADHD]],<ref>{{cite journal |doi= 10.1037/0033-2909.127.5.571 |title=Is ADHD a disinhibitory disorder? |year=2001 |last1=Nigg |first1=Joel T. |journal=Psychological Bulletin |volume=127 |issue=5 |pages= 571–98 |pmid=11548968}}</ref> [[substance use disorder]]s,<ref>{{cite journal |doi=10.1097/00132576-200302020-00001 |title=Relationships Among Laboratory and Psychometric Measures of Impulsivity: Implications in Substance Abuse and Dependence |year=2003 |last1=Lane |first1=Scott D. |last2=Cherek |first2=Don R. |last3=Rhoades |first3= Howard M. |last4=Pietras |first4=Cynthia J. |last5=Tcheremissine |first5=Oleg V. |journal=Addictive Disorders & Their Treatment |volume=2 |issue=2 |pages=33–40|s2cid= 143129215 }}</ref><ref>{{cite journal |doi=10.1037/1064-1297.5.3.256 |title=Impulsive and self-control choices in opioid-dependent patients and non-drug-using control patients: Drug and monetary rewards |year=1997 |last1=Madden |first1=G.J. |last2=Petry |first2=N.M. |last3=Badger |first3=G.J. | last4=Bickel |first4= W. K. |journal= [[Experimental and Clinical Psychopharmacology]] |volume=5 |issue=3 |pages=256–62 |pmid=9260073}}</ref> [[bipolar disorder]],<ref name="Henry">{{cite journal |doi= 10.1016/S0022-3956(01)00038-3 |title=Affective instability and impulsivity in borderline personality and bipolar II disorders: Similarities and differences |year=2001 |last1= Henry |first1=Chantal |last2=Mitropoulou |first2=Vivian |last3=New |first3=Antonia S |last4=Koenigsberg |first4=Harold W |last5=Silverman |first5=Jeremy |last6= Siever |first6= Larry J |journal=Journal of Psychiatric Research |volume=35 |issue=6 |pages=307–12 |pmid=11684137}}</ref> [[antisocial personality disorder]],<ref name= "Horn">{{cite journal |doi=10.1016/S0028-3932(03)00077-0 |title=Response inhibition and impulsivity: An fMRI study |url=https://archive.org/details/sim_neuropsychologia_2003_41_14/page/1959 |year=2003 |last1=Horn |first1=N.R. |last2=Dolan |first2=M. |last3=Elliott |first3=R. |last4=Deakin |first4=J.F.W. |last5=Woodruff |first5=P.W.R. |journal=Neuropsychologia |volume=41 |issue=14 |pages=1959–66 |pmid=14572528 |s2cid=31957781 }}</ref> and [[borderline personality disorder]].<ref name="Henry"/> Abnormal patterns of impulsivity have also been noted in instances of [[acquired brain injury]]<ref>{{cite journal |doi=10.1002/bin.173 |title=Impulsivity, self-control, and delay discounting in persons with acquired brain injury |url=https://archive.org/details/sim_behavioral-interventions_2005-02_20_1/page/101 |year=2005 |last1=Dixon |first1=Mark R. |last2=Jacobs |first2=Eric A. |last3=Sanders |first3=Scott |last4=Guercio |first4=John M. |last5=Soldner |first5=James |last6= Parker-Singler |first6=Susan |last7=Robinson |first7=Ashton |last8=Small |first8=Stacey |last9=Dillen |first9=Jeffrey E. |journal=Behavioral Interventions |volume=20 |issue= 1 |pages=101–20  }}</ref> and [[neurodegenerative diseases]].<ref>{{cite journal |doi=10.1038/nrneurol.2010.148 |title=Decision-making cognition in neurodegenerative diseases |year=2010 |last1=Gleichgerrcht |first1=Ezequiel |last2=Ibáñez |first2=Agustín |last3=Roca |first3=María |last4=Torralva |first4=Teresa |last5=Manes |first5=Facundo |journal=Nature Reviews Neurology |volume=6 |issue=11 |pages=611–23 |pmid=21045795 |s2cid=13333018 }}</ref> [[#Neurobiological findings|Neurobiological findings]] suggest that there are specific brain regions involved in impulsive behavior,<ref>{{cite book |last1=Corsini |first1=Raymond Joseph |year=1999 |title=The Dictionary of Psychology |publisher=Psychology Press |isbn=1-58391-028-X |page=476}}</ref><ref name="Berlin" /><ref>{{cite journal |doi=10.1089/neu.2005.22.613 |title=Deficits in Decision-Making in Head Injury Survivors |year=2005 |last1=Salmond |first1=C.H. |last2=Menon |first2=D.K. |last3=Chatfield |first3=D.A. |last4=Pickard |first4=J.D. |last5=Sahakian |first5=B.J. |journal=Journal of Neurotrauma |volume=22 |issue=6 |pages=613–22 |pmid=15941371}}</ref> although different brain networks may contribute to different manifestations of impulsivity,<ref name="Delay Discounting in the Brain">{{cite journal | vauthors = Hampton WH, Venkatraman V, Olson IR | title = Dissociable frontostriatal white matter connectivity underlies reward and motor impulsivity | language = en | journal = NeuroImage | volume = 150 | issue = 4 | pages = 336–343 | year = 2017 | doi = 10.1016/j.neuroimage.2017.02.021 | pmid = 28189592 | pmc = 5494201 }} </ref><ref>{{cite journal |doi=10.1038/nn.3092 |title=Adolescent impulsivity phenotypes characterized by distinct brain networks |year=2012 |last1=Whelan |first1=Robert |last2=Conrod |first2=Patricia J |last3=Poline |first3=Jean-Baptiste |last4=Lourdusamy |first4=Anbarasu |last5=Banaschewski |first5=Tobias |last6=Barker |first6=Gareth J |last7=Bellgrove |first7=Mark A |last8=Büchel |first8= Christian |last9=Byrne |first9=Mark |last10=Cummins |first10=Tarrant D R |last11=Fauth-Bühler |first11=Mira |last12=Flor |first12=Herta |last13=Gallinat |first13=Jürgen |last14=Heinz |first14=Andreas |last15=Ittermann |first15=Bernd |last16=Mann |first16=Karl |last17=Martinot |first17=Jean-Luc |last18=Lalor |first18=Edmund C |last19= Lathrop |first19=Mark |last20=Loth |first20=Eva |last21=Nees |first21=Frauke |last22=Paus |first22=Tomas |last23=Rietschel |first23=Marcella |last24=Smolka |first24= Michael N |last25=Spanagel |first25=Rainer |last26=Stephens |first26=David N |last27=Struve |first27=Maren |last28=Thyreau |first28=Benjamin |last29=Vollstaedt-Klein |first29=Sabine |last30=Robbins |first30=Trevor W |journal=Nature Neuroscience |volume=15 |issue=6 |pages=920–5 |pmid=22544311|s2cid=18808674 |display-authors=8 }}</ref> and that [[#Genetics|genetics]] may play a role.<ref name=":0" />

Many actions contain both impulsive and compulsive features, but impulsivity and compulsivity are functionally distinct. Impulsivity and compulsivity are interrelated in that each exhibits a tendency to act prematurely or without considered thought and often include negative outcomes.<ref name="Berlin, H. A. 2008">{{cite journal |first1=Heather A. |last1=Berlin |first2=Eric |last2=Hollander |date=July 1, 2008 |title=Understanding the Differences Between Impulsivity and Compulsivity |issue=8 |journal=Psychiatric Times |series=Psychiatric Times Vol 25 No 8 |volume=25 |url=http://www.psychiatrictimes.com/understanding-differences-between-impulsivity-and-compulsivity/page/0/1 |url-status=live |archive-url=https://web.archive.org/web/20131203001449/http://www.psychiatrictimes.com/understanding-differences-between-impulsivity-and-compulsivity/page/0/1 |archive-date=December 3, 2013 }}</ref><ref>{{cite book |last1=Oldham |first1=J.M. |last2=Hollander |first2=E.|author3-link=Andrew E. Skodol |last3=Skodol |first3=A.E. |year=1996 |title=Impulsivity and Compulsivity |location=Washington D.C. |publisher=American Psychiatric Press}}{{page needed|date=June 2013}}</ref>  Compulsivity may be on a continuum with compulsivity on one end and impulsivity on the other, but research has been contradictory on this point.<ref>{{cite journal |doi=10.1002/eat.20169 |title=Impulsivity and compulsivity in bulimia nervosa |url=https://archive.org/details/sim_international-journal-of-eating-disorders_2005-11_38_3/page/244 |year=2005 |last1=Engel |first1=Scott G. |last2=Corneliussen |first2=Stephanie J. |last3=Wonderlich |first3=Stephen A. |last4=Crosby |first4=Ross D. |last5=Le Grange |first5=Daniel |last6=Crow |first6=Scott |last7=Klein |first7=Marjorie |last8=Bardone-Cone |first8=Anna |last9=Peterson |first9=Carol |last10=Joiner |first10=Thomas |last11=Mitchell |first11=James E. |last12=Steiger |first12=Howard |journal=International Journal of Eating Disorders |volume=38 |issue=3 |pages=244–51 |pmid=16211626|display-authors=8 }}</ref> Compulsivity occurs in response to a perceived risk or threat, impulsivity occurs in response to a perceived immediate gain or benefit,<ref name="Berlin, H. A. 2008"/> and, whereas compulsivity involves repetitive actions, impulsivity involves unplanned reactions.

Impulsivity is a common feature of the conditions of [[gambling]] and [[alcohol addiction]]. Research has shown that individuals with either of these addictions discount delayed money (reduce its subjective value to them) at higher rates than those without, and that the presence of gambling and alcohol abuse lead to additive effects on discounting.<ref name="Andrade Alessi Petry 2013 pp. 241–248">{{cite journal | last1=Andrade | first1=Leonardo F. | last2=Alessi | first2=Sheila M. | last3=Petry | first3=Nancy M. | title=The Effects of Alcohol Problems and Smoking on Delay Discounting in Individuals with Gambling Problems | journal=Journal of Psychoactive Drugs | publisher=Informa UK Limited | volume=45 | issue=3 | year=2013 | issn=0279-1072 | doi=10.1080/02791072.2013.803645 | pages=241–248| pmc=3816387 | pmid=24175489}}</ref>

==Impulse==
An '''impulse''' is a wish or urge, particularly a sudden one. It can be considered as a normal and fundamental part of [[human]] [[thought]] processes, but also one that can become problematic, as in a condition like [[obsessive-compulsive disorder]],<ref>{{cite web|title=Acting on Impulse|url=https://www.psychologytoday.com/blog/short-history-mental-health/201210/acting-impulse|publisher=Psychology Today|access-date=20 February 2016}}</ref>{{ums|date=November 2017}} [[borderline personality disorder]], [[attention deficit hyperactivity disorder]], or in [[fetal alcohol spectrum disorder]]s.

The ability to control impulses, or more specifically control the desire to act on them, is an important factor in [[Personality psychology|personality]] and [[socialization]]. [[Delayed gratification|Deferred gratification]], also known as [[Impulse control disorder|impulse control]] is an example of this, concerning impulses primarily relating to things that a person wants or desires. Delayed gratification comes when one avoids acting on initial impulses. Delayed gratification has been studied in relation to childhood obesity. Resisting the urge to act on impulses is important to teach children, because it teaches the value of delayed gratification.<ref>{{Cite journal|last1=Caleza|first1=Carolina|last2=Yañez-Vico|first2=Rosa M.|last3=Mendoza|first3=Asunción|last4=Iglesias-Linares|first4=Alejandro|date=2016-02-01|title=Childhood Obesity and Delayed Gratification Behavior: A Systematic Review of Experimental Studies|url=https://www.sciencedirect.com/science/article/pii/S0022347615011671|journal=The Journal of Pediatrics|language=en|volume=169|pages=201–207.e1|doi=10.1016/j.jpeds.2015.10.008|pmid=26563536|issn=0022-3476|url-access=subscription}}</ref>
{{quote|Many psychological problems are characterized by a loss of control or a lack of control in specific situations. Usually, this lack of control is part of a pattern of behavior that also involves other [[maladaptive|maladaptive thoughts and actions]], such as [[substance abuse]] problems or sexual disorders like the [[paraphilia]]s (e.g. [[pedophilia]] and [[exhibitionism]]). When loss of control is only a component of a disorder, it usually does not have to be a part of the behavior pattern, and other symptoms must also be present for the diagnosis to be made. (Franklin<ref>{{Cite web |url=http://www.psychologyinfo.com/problems/impulse_control.html |title=Psychological Impulse Control Disorders |access-date=2022-09-07 |archive-date=2018-01-19 |archive-url=https://web.archive.org/web/20180119202343/http://psychologyinfo.com/problems/impulse_control.html |url-status=dead }}</ref>{{ums|date=November 2017}})}}

== The five traits that can lead to impulsive actions ==
For many years it was understood that impulsivity is a trait but with further analysis it can be found that there were five traits that can lead to impulsive actions:
positive urgency, 
negative urgency,
[[sensation seeking]], 
lack of planning, and
lack of perseverance.<ref>{{cite journal |last1=Smith |first1=Gregory T. |last2=Cyders |first2=Melissa A. |title=Integrating affect and impulsivity: The role of positive and negative urgency in substance use risk |journal=Drug and Alcohol Dependence |date=June 2016 |volume=163 |issue=Suppl 1 |pages=S3–S12 |doi=10.1016/j.drugalcdep.2015.08.038 |pmid=27306729 |pmc=4911536 }}</ref><ref>{{cite journal |last1=Fischer |first1=Sarah |last2=Smith |first2=Gregory T. |last3=Anderson |first3=Kristen G. |title=Clarifying the role of impulsivity in bulimia nervosa |journal=International Journal of Eating Disorders |date=May 2003 |volume=33 |issue=4 |pages=406–411 |doi=10.1002/eat.10165 |pmid=12658670 }}</ref><ref>{{cite journal |last1=Smith |first1=Gregory T. |last2=Guller |first2=Leila |last3=Zapolski |first3=Tamika C. B. |title=A Comparison of Two Models of Urgency: Urgency Predicts Both Rash Action and Depression in Youth |journal=Clinical Psychological Science |date=July 2013 |volume=1 |issue=3 |pages=266–275 |doi=10.1177/2167702612470647 |pmid=25419495 |pmc=4238932 }}</ref><ref>{{cite journal |last1=Dvorak |first1=Robert D. |last2=Pearson |first2=Matthew R. |last3=Kuvaas |first3=Nicholas J. |title=The Five-Factor Model of Impulsivity-Like Traits and Emotional Lability in Aggressive Behavior: Impulsivity, Emotional Lability, and Aggression |journal=Aggressive Behavior |date=May 2013 |volume=39 |issue=3 |pages=222–228 |doi=10.1002/ab.21474 |pmid=23471690 |pmc=4625555 }}</ref>

== Associated behavioral and societal problems ==

=== Attention-deficit hyperactivity disorder ===
[[Attention deficit-hyperactivity disorder]] (ADHD) is a multiple component disorder involving [[inattention]], impulsivity, and [[hyperactivity]].  The [[Diagnostic and Statistical Manual of Mental Disorders]] (DSM-IV-TR)<ref name="DSM IV TR">{{cite book |publisher=American Psychiatric Association |year=2000 |title=Diagnostic and statistical manual of mental disorders |volume=1 |edition=4th |doi=10.1176/appi.books.9780890423349 |doi-broken-date=2 December 2024 |isbn=978-0-89042-334-9}}{{page needed|date=June 2013}}</ref> breaks ADHD into three subtypes according to the behavioral symptoms:
Predominantly Inattentive Type,
Predominantly Hyperactive-Impulsive Type, and
Combined Type.

Predominantly hyperactive-impulsive type symptoms may include
fidgeting and squirming in seats,
talking nonstop,
dashing around and touching or playing with anything in sight,
having trouble sitting still during dinner/school/story time,
being constantly in motion, and
having difficulty doing quiet tasks or activities.

Other manifestations primarily of impulsivity include
being very impatient, 
having difficulty waiting for things they want or waiting their turns in games, 
often interrupting conversations or others' activities, or
blurting out inappropriate comments, showing their emotions without restraint, and act without regard for consequences.

Prevalence of the disorder worldwide is estimated to be between 4% and 10%, with reports as low as 2.2% and as high as 17.8%. Variation in rate of diagnoses may be attributed to differences between populations (i.e. culture), and differences in diagnostic methodologies.<ref name="Skounti">{{cite journal |last1=Skounti |first1=Maria |last2=Philalithis |first2=Anastas |last3=Galanakis |first3=Emmanouil |title=Variations in prevalence of attention deficit hyperactivity disorder worldwide |journal=European Journal of Pediatrics |date=21 December 2006 |volume=166 |issue=2 |pages=117–123 |doi=10.1007/s00431-006-0299-5 |pmid=17033803 |s2cid=20342282 }}</ref> Prevalence of ADHD among females is less than half that of males, and females more commonly fall into the inattentive subtype.<ref name="Froehlich">{{cite journal |doi=10.1001/archpedi.161.9.857 |title=Prevalence, Recognition, and Treatment of Attention-Deficit/Hyperactivity Disorder in a National Sample of US Children |year=2007 |last1=Froehlich |first1=Tanya E. |journal=Archives of Pediatrics & Adolescent Medicine |volume=161 |issue=9 |pages=857–64 |pmid=17768285 |last2=Lanphear |first2=BP |last3=Epstein |first3=JN |last4=Barbaresi |first4=WJ |last5=Katusic |first5=SK |last6=Kahn |first6=RS|author1-link=Tanya Froehlich |doi-access=free }}</ref>

Despite an upward trend in diagnoses of the inattentive subtype of ADHD, impulsivity is commonly considered to be the central feature of ADHD, and the impulsive and combined subtypes are the major contributors to the societal costs associated with ADHD.<ref name="Froehlich" /><ref name="Solanto">{{cite journal |doi=10.1023/A:1010329714819 |year=2001 |last1=Solanto |first1=Mary V. |last2=Abikoff |first2=Howard |last3=Sonuga-Barke |first3=Edmund |last4=Schachar |first4=Russell |last5=Logan |first5=Gordon D. |last6=Wigal |first6=Tim |last7=Hechtman |first7=Lily |last8=Hinshaw |first8=Stephen |last9=Turkel |first9=Elihu |journal=Journal of Abnormal Child Psychology |volume=29 |issue=3 |pages=215–28 |pmid=11411784 |title=The ecological validity of delay aversion and response inhibition as measures of impulsivity in AD/HD: A supplement to the NIMH multimodal treatment study of AD/HD  |url=https://archive.org/details/sim_journal-of-abnormal-child-psychology_2001-06_29_3/page/215 |s2cid=23953111 }}</ref> The estimated cost of illness for a child with ADHD is $14,576 (in 2005 dollars) annually.<ref name="Pelham">{{cite journal |doi=10.1093/jpepsy/jsm022 |title=The Economic Impact of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents |year=2007 |last1=Pelham |first1=William E. |last2=Foster |first2=E. Michael |last3=Robb |first3=Jessica A. |journal=Journal of Pediatric Psychology |volume=32 |issue=6 |pages=711–27 |pmid=17556402|doi-access=free }}</ref> Prevalence of ADHD among prison populations is significantly higher than that of the normal population.<ref>{{cite journal |doi=10.1007/s00406-004-0516-z |title=Prevalence of attention deficit–/hyperactivity disorder (ADHD) and comorbid disorders in young male prison inmates |year=2004 |last1=Rösler |first1=M. |last2=Retz |first2=W. |last3=Retz-Junginger |first3=P. |last4=Hengesch |first4=G. |last5=Schneider |first5=M. |last6=Supprian |first6=T. |last7=Schwitzgebel |first7=P. |last8=Pinhard |first8=K. |last9=Dovi–Akue |first9=N. |last10=Wender |first10=P. |last11=Thome |first11=J. |journal=European Archives of Psychiatry and Clinical Neuroscience |volume=254 |issue=6 |pages=365–71 |pmid=15538605 |s2cid=8737929 |display-authors=8 }}</ref>
	
In both adults<ref name="Kessler">{{cite journal |doi=10.1176/appi.ajp.163.4.716 |title=The Prevalence and Correlates of Adult ADHD in the United States: Results from the National Comorbidity Survey Replication |year=2006 |last1=Kessler |first1=R. C. |last2=Adler |first2=L. |last3=Barkley |first3=R. |last4=Biederman |first4=J. |last5=Conners |first5=C. K. |last6=Demler |first6=O. |last7=Faraone |first7=S. V. |last8=Greenhill |first8=L. L. |last9=Howes |first9=M. J. |last10=Secnik |first10=K |last11=Spencer |first11=T |last12=Ustun |first12=T. B. |last13=Walters |first13=E. E. |last14=Zaslavsky |first14=A. M. |journal=American Journal of Psychiatry |volume=163 |issue=4 |pages=716–23 |pmid=16585449 |pmc=2859678|display-authors=8 }}</ref> and children,<ref name="Wilens2002">{{cite journal |doi=10.1097/00004583-200203000-00005 |title=Psychiatric Comorbidity and Functioning in Clinically Referred Preschool Children and School-Age Youths with ADHD |year=2002 |last1=Wilens |first1=Timothy E. |last2=Biederman |first2=Joseph |last3=Brown |first3=Sarah |last4=Tanguay |first4=Sarah |last5=Monuteaux |first5=Michael C. |last6=Blake |first6=Christie |last7=Spencer |first7=Thomas J. |journal=Journal of the American Academy of Child & Adolescent Psychiatry |volume=41 |issue=3 |pages=262–8 |pmid=11886020}}</ref><ref name="Scahill">{{cite journal |pmid=10944656 |year=2000 |last1=Scahill |first1=L |last2=Schwab-Stone |first2=M |title=Epidemiology of ADHD in school-age children |volume=9 |issue=3 |pages=541–55, vii |journal=Child and Adolescent Psychiatric Clinics of North America|doi=10.1016/S1056-4993(18)30106-8 }}</ref> ADHD has a high rate of comorbidity with other mental health disorders such as [[learning disability]], [[conduct disorder]], [[anxiety disorder]], [[major depressive disorder]], [[bipolar disorder]], and [[substance abuse|substance use]] disorders.

The precise genetic and environmental factors contributing to ADHD are relatively unknown, but [[endophenotype]]s offer a potential middle ground between genes and symptoms.<ref name="Aron">{{cite journal |doi=10.1016/j.biopsych.2004.10.026 |title=The Cognitive Neuroscience of Response Inhibition: Relevance for Genetic Research in Attention-Deficit/Hyperactivity Disorder |year=2005 |last1=Aron |first1=Adam R. |last2=Poldrack |first2=Russell A. |journal=Biological Psychiatry |volume=57 |issue=11 |pages=1285–92 |pmid=15950000 |s2cid=41786909 }}</ref> ADHD is commonly linked to "core" deficits involving "[[executive function]]," "[[Hyperbolic discounting|delay aversion]]," or "activation/arousal" theories that attempt to explain ADHD through its symptomology.<ref name="Aron" /> Endophenotypes, on the other hand, purport to identify potential behavioral markers that correlate with specific genetic etiology. There is some evidence to support deficits in response inhibition as one such marker.  Problems inhibiting prepotent responses are linked with deficits in pre-frontal cortex (PFC) functioning, which is a common dysfunction associated with ADHD and other impulse-control disorders.<ref name="Ridderinkhof">{{cite journal |doi=10.1016/j.bandc.2004.09.016 |title=Neurocognitive mechanisms of cognitive control: The role of prefrontal cortex in action selection, response inhibition, performance monitoring, and reward-based learning |year=2004 |last1=Ridderinkhof |first1=K. Richard |last2=Van Den Wildenberg |first2=Wery P.M. |last3=Segalowitz |first3=Sidney J. |last4=Carter |first4=Cameron S. |journal=Brain and Cognition |volume=56 |issue=2 |pages=129–40 |pmid=15518930 |s2cid=16820592 }}</ref><ref name="Casey">{{cite journal |doi=10.1097/00004583-199703000-00016 |title=Implication of Right Frontostriatal Circuitry in Response Inhibition and Attention-Deficit/Hyperactivity Disorder |year=1997 |last1=Casey |first1=B.J. |last2=Castellanos |first2=F. Xavier |last3=Giedd |first3=Jay N. |last4=Marsh |first4=Wendy L. |last5=Hamburger |first5=Susan D. |last6=Schubert |first6=Anne B. |last7=Vauss |first7=Yolanda C. |last8=Vaituzis |first8=A. Catherine |last9=Dickstein |first9=Daniel P. |last10=Sarfatti |first10=Stacey E. |last11=Rapoport |first11=Judith L. |journal=Journal of the American Academy of Child & Adolescent Psychiatry |volume=36 |issue=3 |pages=374–83 |pmid=9055518|display-authors=8 |url=https://zenodo.org/record/1234800 }}</ref>

Evidence-based psychopharmacological and behavioral [[#Treatment of specific disorders of impulsivity|interventions]] exist for ADHD.<ref>{{Cite journal|last=DeVries|first=Melissa|date=2010-12-09|title=Book Review: Pliszka, S. R., UTHSCSA Treating ADHD and Comorbid Disorders: Psychosocial and Psychopharmacological Interventions. New York: Guilford, 2008|url=http://dx.doi.org/10.1177/1087054710362216|journal=Journal of Attention Disorders|volume=15|issue=1|pages=92–93|doi=10.1177/1087054710362216|s2cid=143753779|issn=1087-0547|url-access=subscription}}</ref>

=== Substance abuse ===

Impulsivity appears to be linked to all stages of  [[substance abuse]].<ref name="Perry">{{cite journal |doi=10.1007/s00213-008-1173-0 |title=The role of impulsive behavior in drug abuse |url=https://archive.org/details/sim_journal-of-clinical-psychopharmacology_2008-02_28_1/page/1 |year=2008 |last1=Perry |first1=Jennifer L. |last2=Carroll |first2=Marilyn E. |journal=Psychopharmacology |volume=200 |pages=1–26 |pmid=18600315 |issue=1 |s2cid=24587409 }}</ref><ref name="de Wit 2009">{{cite journal |doi=10.1111/j.1369-1600.2008.00129.x |title=Impulsivity as a determinant and consequence of drug use: A review of underlying processes |year=2009 |last1=De Wit |first1=Harriet |journal=Addiction Biology |volume=14 |pages=22–31 |pmid=18855805 |issue=1 |pmc=3640851}}</ref>

The acquisition phase of substance abuse involves the escalation from single use to regular use.<ref name="Perry" />  Impulsivity may be related to the acquisition of substance abuse because  of the potential role that instant gratification provided by the substance may offset the larger future benefits of abstaining from the substance, and because people with impaired inhibitory control may not be able to overcome motivating environmental cues, such as [[peer pressure]].<ref name="de Wit 2004">{{cite journal |pmid=15160637 |year=2004 |last1=De Wit |first1=H |last2=Richards |first2=JB |title=Dual determinants of drug use in humans: Reward and impulsivity |volume=50 |pages=19–55 |journal=Nebraska Symposium on Motivation}}</ref>  "Similarly, individuals that discount the value of delayed reinforcers begin to abuse alcohol, marijuana, and cigarettes early in life, while also abusing a wider array of illicit drugs compared to those who discounted delayed reinforcers less."<ref name="Kollins">{{cite journal |doi=10.1016/S0306-4603(02)00220-4 |title=Delay discounting is associated with substance use in college students |url=https://archive.org/details/sim_addictive-behaviors_2003-08_28_6/page/1167 |year=2003 |last1=Kollins |first1=Scott H |journal=Addictive Behaviors |volume=28 |issue=6 |pages=1167–73 |pmid=12834659}}</ref>

Escalation or dysregulation is the next and more severe phase of substance abuse.  In this phase individuals "lose control" of their addiction with large levels of drug consumption and binge drug use.  Animal studies  suggest that individuals with higher levels of impulsivity may be more prone to the escalation stage of substance abuse.<ref name="Perry" />

Impulsivity is also related to the abstinence, relapse, and treatment stages of substance abuse.  People who scored high on the [[Barratt Impulsivity Scale]] (BIS) were more likely to stop treatment for cocaine abuse.<ref name="Moeller">{{cite journal |doi=10.1016/S0740-5472(01)00202-1 |title=The impact of impulsivity on cocaine use and retention in treatment |url=https://archive.org/details/sim_journal-of-substance-abuse-treatment_2001-12_21_4/page/193 |year=2001 |last1=Moeller |first1=F.Gerard |last2=Dougherty |first2=Donald M. |last3=Barratt |first3=Ernest S. |last4=Schmitz |first4=Joy M. |last5=Swann |first5=Alan C. |last6=Grabowski |first6=John |journal=Journal of Substance Abuse Treatment |volume=21 |issue=4 |pages=193–8 |pmid=11777668}}</ref>  Additionally, they adhered to treatment for a shorter duration than people that scored low on impulsivity.<ref name="Moeller"/>  Also, impulsive people had greater cravings for drugs during withdrawal periods and were more likely to relapse.  This effect was shown in a study where smokers that test high on the BIS had increased craving in response to smoking cues, and gave into the cravings more quickly than less impulsive smokers.<ref name="Doran">{{cite journal |doi=10.1007/s00213-007-0832-x |title=Effect of impulsivity on craving and behavioral reactivity to smoking cues |url=https://archive.org/details/sim_psychopharmacology_2007-10_194_2/page/279 |year=2007 |last1=Doran |first1=Neal |last2=Spring |first2=Bonnie |last3=McChargue |first3=Dennis |journal=Psychopharmacology |volume=194 |issue=2 |pages=279–88 |pmid=17594080 |s2cid=35948752 }}</ref>  Taken as a whole the current research suggests that impulsive individuals are less likely to abstain from drugs and more likely to relapse earlier than less impulsive individuals.<ref name="Perry" />

While it is important to note the effect of impulsivity on substance abuse, the reciprocating effect whereby substance abuse can increase impulsivity has also been researched and documented.<ref name="Perry" />   The promoting effect of impulsivity on substance abuse and the effect of substance abuse on increased impulsivity creates a positive feedback loop that maintains substance seeking behaviors.  It also makes conclusions about the direction of causality difficult.  This phenomenon has been shown to be related to several substances, but not all.  For example, alcohol has been shown to increase impulsivity while amphetamines have had mixed results.<ref name="Perry" />

Substance use disorder [[#Treatment of specific disorders of impulsivity|treatments]] include prescription of medications such as [[acamprosate]], [[buprenorphine]], [[disulfiram]], [[LAAM]], [[methadone]], and [[naltrexone]],<ref name=" McGovern Carroll 2003"/> as well as effective psychotherapeutic treatment like 
[[Integrative behavioral couples therapy|behavioral couples therapy]], [[Cognitive behavioral therapy|CBT]], [[contingency management]], [[motivational interviewing|motivational enhancement therapy]], and [[relapse prevention]].<ref name=" McGovern Carroll 2003"/>

=== Eating ===

Impulsive [[overeating]] spans from an episode of indulgence by an otherwise healthy person to chronic binges by a person with an eating disorder.{{citation needed|date=June 2013}}

Consumption of a tempting food by non-clinical individuals increases when self-regulatory resources are previously depleted by another task, suggesting that it is caused by a breakdown in [[self control]].<ref name="Vohs">{{cite journal |doi=10.1111/1467-9280.00250 |title=Self-Regulatory Failure: A Resource-Depletion Approach |year=2000 |last1=Vohs |first1=K. D. |last2=Heatherton |first2=T. F. |journal=Psychological Science |volume=11 |issue=3 |pages=249–54 |pmid=11273412|s2cid=18307595 }}</ref>  Impulsive eating of unhealthy snack foods appears to be regulated by individual differences in impulsivity when self-control is weak and by attitudes towards the snack and towards healthy eating when self-control is strong.<ref>{{cite journal |doi=10.1016/j.appet.2011.11.019 |title=Reflective and impulsive influences on unhealthy snacking. The moderating effects of food related self-control |year=2012 |last1=Honkanen |first1=Pirjo |last2=Olsen |first2=Svein Ottar |last3=Verplanken |first3=Bas |last4=Tuu |first4=Ho Huy |journal=Appetite |volume=58 |issue=2 |pages=616–22 |pmid=22138115 |s2cid=39135358 }}</ref> There is also evidence that greater food consumption occurs when people are in a sad mood, although it is possible that this is due more to emotional regulation than to a lack of self-control.<ref name="Baumeister">{{cite journal |doi=10.1037/0022-3514.80.1.53 |title=Emotional distress regulation takes precedence over impulse control: If you feel bad, do it! |url=https://archive.org/details/sim_journal-of-personality-and-social-psychology_2001-01_80_1/page/53 |year=2001 |last1=Tice |first1=Dianne M. |last2=Bratslavsky |first2=Ellen |last3=Baumeister |first3=Roy F. |journal=Journal of Personality and Social Psychology |volume=80 |pages=53–67 |pmid=11195891 |issue=1 |s2cid=10596913 }}</ref> In these cases, overeating will only take place if the food is palatable to the person, and if so individual differences in impulsivity can predict the amount of consumption.<ref>{{cite journal |doi=10.1016/j.jesp.2008.09.013 |title=Three ways to resist temptation: The independent contributions of executive attention, inhibitory control, and affect regulation to the impulse control of eating behavior |year=2009 |last1=Hofmann |first1=Wilhelm |last2=Friese |first2=Malte |last3=Roefs |first3=Anne |journal=Journal of Experimental Social Psychology |volume=45 |issue=2 |pages=431–5|s2cid=51986961 |url=https://hal.archives-ouvertes.fr/hal-00686667/document }}</ref>

Chronic overeating is a behavioral component of [[binge eating disorder]], [[compulsive overeating]], and [[bulimia nervosa]]. These diseases are more common for women and may involve eating thousands of calories at a time.  Depending on which of these disorders is the underlying cause, an episode of overeating can have a variety of different motivations. Characteristics common among these three disorders include low [[self-esteem]], [[Depression (mood)|depression]], eating when not physically hungry, preoccupation with food, eating alone due to embarrassment, and feelings of regret or disgust after an episode.  In these cases, overeating is not limited to palatable foods.<ref>{{cite journal |doi=10.1037/0033-2909.110.1.86 |title=Binge eating as escape from self-awareness |url=https://archive.org/details/sim_psychological-bulletin_1991-07_110_1/page/86 |year=1991 |last1=Heatherton |first1=Todd F. |last2=Baumeister |first2=Roy F. |journal=Psychological Bulletin |volume=110 |pages=86–108 |pmid=1891520 |issue=1 |s2cid=1232881 }}</ref>

Impulsivity differentially affects disorders involving the overcontrol of food intake (such as [[anorexia nervosa]]) and disorders involving the lack of control of food intake (such as [[bulimia nervosa]]). Cognitive impulsivity, such as risk-taking, is a component of many eating disorders, including those that are restrictive.<ref name="Rosval">{{cite journal |doi=10.1002/eat.20296 |title=Impulsivity in women with eating disorders: Problem of response inhibition, planning, or attention? |url=https://archive.org/details/sim_international-journal-of-eating-disorders_2006-11_39_7/page/590 |year=2006 |last1=Rosval |first1=Lindsay |last2=Steiger |first2=Howard |last3=Bruce |first3=Kenneth |last4=Israël |first4=Mimi |last5=Richardson |first5=Jodie |last6=Aubut |first6=Melanie |journal=International Journal of Eating Disorders |volume=39 |issue=7 |pages=590–3 |pmid=16826575|doi-access=free }}</ref>  However, only people with disorders involving episodes of overeating have elevated levels of motoric impulsivity, such as reduced response inhibition capacity.<ref name="Rosval" />

One theory suggests that binging provides a short-term escape from feelings of sadness, anger, or boredom, although it may contribute to these [[negative emotion]]s in the long-term.<ref name="Vohs K.D. 2007" />  Another theory suggests that binge eating involves reward seeking, as evidenced by decreased serotonin binding receptors of binge-eating women compared to matched-weight controls<ref name="Kuikka">{{cite journal |doi=10.1007/s002130100716 |title=Reduced serotonin transporter binding in binge eating women |url=https://archive.org/details/sim_psychopharmacology_2001-05_155_3/page/310 |year=2001 |last1=Kuikka |first1=Jyrki |last2=Tammela |first2=Liisa |last3=Karhunen |first3=Leila |last4=Rissanen |first4=Aila |last5=Bergström |first5=Kim |last6=Naukkarinen |first6=Hannu |last7=Vanninen |first7=Esko |last8=Karhu |first8=Jari |last9=Lappalainen |first9=Raimo |last10=Repo-Tiihonen |first10=Eila |last11=Tiihonen |first11=Jari |last12=Uusitupa |first12=Matti |journal=Psychopharmacology |volume=155 |issue=3 |pages=310–4 |pmid=11432694|s2cid=7812191 |display-authors=8 }}</ref> and predictive value of heightened reward sensitivity/drive in dysfunctional eating.<ref name="Loxton">Loxton, N.J., Dawe, S. (2004).  Alcohol abuse and dysfunctional eating in women: The contribution of reward and punishment sensitivity and family of origin. In press.{{vs|surely not still in press nearly a decade later. was the title changed?|date=June 2013}}  As cited in: {{cite journal |doi=10.1016/j.neubiorev.2004.03.007 |title=The role of impulsivity in the development of substance use and eating disorders |year=2004 |last1=Dawe |first1=Sharon |last2=Loxton |first2=Natalie J |journal=Neuroscience & Biobehavioral Reviews |volume=28 |issue=3 |pages=343–51 |pmid=15225976 |s2cid=24435589 }}</ref>

Treatments for clinical-grade overeating include [[cognitive behavioral therapy]] to teach people how to track and change their eating habits and actions, [[interpersonal psychotherapy]] to help people analyze the contribution of their friends and family in their disorder, and pharmacological therapies including antidepressants and [[SSRIs]].<ref>{{Cite journal |last1=Agras |first1=W. Stewart |last2=Bohon |first2=Cara |date=2021-05-07 |title=Cognitive Behavioral Therapy for the Eating Disorders |journal=Annual Review of Clinical Psychology |language=en |volume=17 |issue=1 |pages=417–438 |doi=10.1146/annurev-clinpsy-081219-110907 |pmid=33962536 |s2cid=233998712 |issn=1548-5943|doi-access=free }}</ref>

=== Impulse buying ===
[[Impulse purchase|Impulse buying]] consists of purchasing a product or service without any previous intent to make that purchase.<ref>{{cite journal |doi=10.1016/S0022-4359(99)80092-X |title=Impulse buying: Modeling its precursors |url=https://archive.org/details/sim_journal-of-retailing_summer-1998_74_2/page/169 |year=1998 |last1=Beatty |first1=Sharon E. |last2=Ferrell |first2=M. Elizabeth |journal=Journal of Retailing |volume=74 |issue=2 |pages=169–91}}</ref> It has been speculated to account for as much as eighty percent of all purchases<ref>Smith, D. (1996). The joy of candy. National Petroleum News Supplement, S2.</ref> in the United States.{{Relevance inline|reason=why do we care about speculation on the percent of purchases?|date=June 2013}}

There are several theories pertaining to impulsive buying.  One theory suggests that it is exposure combining with the speed that a reward can be obtained that influences an individual to choose lesser immediate rewards over greater rewards that can be obtained later.<ref name="Mischel1972">{{cite journal |doi=10.1037/h0032198 |title=Cognitive and attentional mechanisms in delay of gratification |url=https://archive.org/details/sim_journal-of-personality-and-social-psychology_1972-02_21_2/page/204 |year=1972|author-link1=Walter Mischel |last1=Mischel |first1=Walter |last2=Ebbesen |first2=Ebbe B. |last3=Raskoff Zeiss |first3=Antonette |journal=Journal of Personality and Social Psychology |volume=21 |issue=2 |pages=204–18 |pmid=5010404}}</ref> For example, a person might choose to buy a candy bar because they are in the candy aisle even though they had decided earlier that they would not buy candy while in the store.

Another theory is one of self-regulation<ref name="Vohs K.D. 2007">{{cite journal |doi=10.1086/510228 |title=Spent Resources: Self-Regulatory Resource Availability Affects Impulse Buying |url=https://archive.org/details/sim_journal-of-consumer-research_2007-03_33_4/page/537 |year=2007 |last1=Vohs |first1=Kathleen D. |last2=Faber |first2=Ronald J. |journal=Journal of Consumer Research |volume=33 |issue=4 |pages=537–47}}</ref> which suggests that the capacity to refrain from impulsive buying is a finite resource.  As this capacity is depleted with repeated acts of restraint susceptibility to purchasing other items on impulse increases.{{citation needed|date=June 2013}}

Finally, a third theory suggests an emotional and behavioral tie between the purchaser and the product which drives both the likelihood of an impulsive purchase as well as the degree that a person will retroactively be satisfied with that purchase result.<ref>{{cite journal |doi=10.1207/s15327663jcp1603_2 |title=Reflective and Impulsive Determinants of Consumer Behavior |url=https://archive.org/details/sim_journal-of-consumer-psychology_2006_16_3/page/205 |year=2006 |last1=Strack |first1=Fritz |last2=Werth |first2=Lioba |last3=Deutsch |first3=Roland |journal=Journal of Consumer Psychology |volume=16 |issue=3 |pages=205–16}}</ref><ref name="Kwon, H. H. 2006">{{cite journal |first1=Harry H. |last1=Kwon |first2=Ketra L. |last2=Armstrong |year=2006 |title=Impulse Purchases of Sport Team Licensed Merchandise: What Matters? |journal=Journal of Sport Management |volume=20 |issue=1 |pages=101–119 |url=http://journals.humankinetics.com/jsm-back-issues/jsmvolume20issue1january/impulsepurchasesofsportteamlicensedmerchandisewhatmatters|doi=10.1123/jsm.20.1.101 |url-access=subscription }}</ref>  Some studies have shown a large number of individuals are happy with purchases made on impulse (41% in one study<ref>{{cite journal |doi=10.1086/209105 |jstor=2489410 |title=The Buying Impulse |url=https://archive.org/details/sim_journal-of-consumer-research_1987-09_14_2/page/189 |year=1987 |last1=Rook |first1=Dennis W. |journal=Journal of Consumer Research |volume=14 |issue=2 |pages=189–99}}</ref>) which is explained as a preexisting emotional attachment which has a positive relationship both with the likelihood of initiating the purchase as well as mitigating post purchase satisfaction.<ref name="Kwon, H. H. 2006"/>  As an example, when purchasing team-related college paraphernalia a large percentage of those purchases are made on impulse and are tied to the degree with which a person has positive ties to that team.<ref name="Kwon, H. H. 2006"/>

Impulsive buying is seen both as an individual trait in which each person has a preconditioned or hereditary allotment, as well as a situational construct which is mitigated by such things as emotion in the moment of the purchase and the preconditioned ties an individual has with the product.<ref name="Vohs K.D. 2007"/><ref name="Kwon, H. H. 2006"/>

Psychotherapy and pharmacological treatments have been shown to be helpful interventions for patients with impulsive-compulsive buying disorder.<ref>{{cite book |last1=Hollander |first1=E |last2=Stein |first2=D |title=Impulse-control disorders |location=Arlington |publisher=American Psychiatric Publishing |year=2006}}{{page needed|date=June 2013}}</ref>
Psychotherapy interventions include the use of desensitization techniques,<ref>{{cite journal |pmid=8591975 |year=1996 |last1=Bernik |first1=MA |last2=Akerman |first2=D |last3=Amaral |first3=JA |last4=Braun |first4=RC |title=Cue exposure in compulsive buying |url=https://archive.org/details/sim_journal-of-clinical-psychiatry_1996-02_57_2/page/90 |volume=57 |issue=2 |pages=90 |journal=The Journal of Clinical Psychiatry}}</ref> [[self-help books]]<ref name="Catalano EM 1993">{{cite book |last1=Catalano |first1=EM |last2=Sonenberg |first2=N |title=Consuming passions: help for compulsive shoppers |location=Oakland |publisher=NewHarbinger Publications |year=1993}}{{page needed|date=June 2013}}</ref> or attending a support group.<ref name="Catalano EM 1993"/>
Pharmacological interventions include the use of [[SSRIs]], such as [[fluvoxamine]],<ref>{{cite journal |pmid=9164426 |year=1997 |last1=Black |first1=DW |last2=Monahan |first2=P |last3=Gabel |first3=J |title=Fluvoxamine in the treatment of compulsive buying |volume=58 |issue=4 |pages=159–63 |journal=The Journal of Clinical Psychiatry |doi=10.4088/JCP.v58n0404}}</ref><ref>{{cite journal |doi=10.1023/A:1009030425631 |title=A Double-Blind Comparison of Fluvoxamine Versus Placebo in the Treatment of Compulsive Buying Disorder |year=2000 |last1=Black |first1=Donald |last2=Gabel |first2=Janelle |last3=Hansen |first3=Jeffrey |last4=Schlosser |first4=Steven |journal=Annals of Clinical Psychiatry |volume=12 |issue=4 |pages=205–11 |pmid=11140921 |s2cid=189937538 }}</ref> [[citalopram]],<ref>{{cite journal |doi=10.4088/JCP.v63n0808 |title=Citalopram Treatment of Compulsive Shopping |year=2002 |last1=Koran |first1=Lorrin M. |last2=Bullock |first2=Kim D. |last3=Hartston |first3=Heidi J. |last4=Elliott |first4=Michael A. |last5=d'Andrea |first5=Vincent |journal=The Journal of Clinical Psychiatry |volume=63 |issue=8 |pages=704–8 |pmid=12197451}}</ref><ref>{{cite book |last1=Guy |first1=LS |title=ECDEU assessment manual for psychopharmacology, Publication ADM 76 338 |location=Washington, DC |publisher=Department of Health, Education and Welfare |year=1976}}{{page needed|date=June 2013}}</ref> [[escitalopram]],<ref>{{cite journal |doi=10.1097/01.jcp.0000264975.79367.f4 |title=Escitalopram for Compulsive Buying Disorder |url=https://archive.org/details/sim_journal-of-clinical-psychopharmacology_2007-04_27_2/page/225 |year=2007 |last1=Koran |first1=Lorrin M. |last2=Aboujaoude |first2=Elias N. |last3=Solvason |first3=Brent |last4=Gamel |first4=Nona N. |last5=Smith |first5=Emily H. |journal=Journal of Clinical Psychopharmacology |volume=27 |issue=2 |pages=225–7 |pmid=17414257|s2cid=41883042 }}</ref> and [[naltrexone]].<ref>{{cite journal |doi=10.4088/JCP.v59n0403 |title=Opioid Antagonists in the Treatment of Impulse-Control Disorders |year=1998 |last1=Kim |first1=Suck Won |journal=The Journal of Clinical Psychiatry |volume=59 |issue=4 |pages=165–71 |pmid=9590666 |last2=Dwight |first2=MM |last3=McElroy |first3=SL |s2cid=7161577 }}</ref><ref>{{cite journal |doi=10.1080/13651500310003219 |title=Three cases of compulsive buying treated with naltrexone |year=2003 |last1=Grant |first1=Jon E. |journal=International Journal of Psychiatry in Clinical Practice |volume=7 |issue=3 |pages=223–5|doi-broken-date=1 November 2024 }}</ref>

=== Impulse control disorders not elsewhere classified ===
[[Impulse control disorder]] (ICDs) are a class of [[Diagnostic and Statistical Manual of Mental Disorders|DSM]] diagnoses that do not fall into the other diagnostic categories of the manual (e.g. substance use disorders), and that are characterized by extreme difficulty controlling impulses or urges despite negative consequences.<ref name="DSM IV TR" />  Individuals suffering from an impulse control disorder frequently experience five stages of symptoms: compelling urge or desire, failure to resist the urge, a heightened sense of arousal, succumbing to the urge (which usually yields relief from tension), and potential remorse or feelings of guilt after the behavior is completed.<ref name= "HollanderSteen2005">{{cite book |editor1-last=Hollander |editor1-first=E. |editor2-last=Stein |editor2-first=D.J. |year=2005 |title=Clinical manual of impulse-control disorders |pages=4–8 |location=Arlington, VA |publisher=American Psychiatric Press}}</ref> Specific disorders included within this category include [[intermittent explosive disorder]], [[kleptomania]], [[pathological gambling]], [[pyromania]], [[trichotillomania]] (hair-pulling disorder), and impulse control disorders not otherwise specified (ICD NOS). ICD NOS includes other significant difficulties that seem to be related to impulsivity but do not meet the criteria for a specific DSM diagnosis.<ref name="DSM IV TR" />

There has been much debate over whether or not the ICDs deserve a diagnostic category of their own, or whether they are in fact phenomenologically and epidemiologically related to other major psychiatric conditions like [[obsessive-compulsive disorder]] (OCD), [[Affective spectrum|affective disorders]], and [[Addiction|addictive disorders]].<ref name="Dell'Osso 2006">{{cite journal |doi=10.1007/s00406-006-0668-0 |title=Epidemiologic and clinical updates on impulse control disorders: A critical review |year=2006 |last1=Dell'Osso |first1=Bernardo |last2=Altamura |first2=A. Carlo |last3=Allen |first3=Andrea |last4=Marazziti |first4=Donatella |last5=Hollander |first5=Eric |journal=European Archives of Psychiatry and Clinical Neuroscience |volume=256 |issue=8 |pages=464–75 |pmid=16960655 |pmc=1705499}}</ref> In fact, the ICD classification is likely to change with the release of the [[DSM-5]] in May 2013.<ref name="DSM V Website">{{Cite web|url=http://www.dsm5.org/pages/default.aspx|archive-url=https://web.archive.org/web/20130130193514/http://www.dsm5.org/Pages/Default.aspx|url-status=dead|title=DSM-5|archive-date=January 30, 2013|website=www.dsm5.org}}</ref>  In this new revision the ICD NOS will likely be reduced or removed; proposed revisions include reclassifying trichotillomania (to be renamed hair-pulling disorder) and [[skin-picking disorder]] as obsessive-compulsive and related disorders, moving intermittent explosive disorder under the diagnostic heading of disruptive, impulse control, and conduct disorders, and gambling disorder may be included in addiction and related disorders.<ref name="DSM V Website"/>

The role of impulsivity in the ICDs varies.  Research on kleptomania and pyromania is lacking, though there is some evidence that greater kleptomania severity is tied to poor executive functioning.<ref name= "Grant et al 2007">{{cite journal |doi=10.1016/j.brat.2006.08.013 |title=Neuropsychological functioning in kleptomania☆ |url=https://archive.org/details/sim_behaviour-research-and-therapy_2007-07_45_7/page/1663 |year=2007 |last1=Grant |first1=J |last2=Odlaug |first2=B |last3=Wozniak |first3=J |journal=Behaviour Research and Therapy |volume=45 |issue=7 |pages=1663–70 |pmid=17007811}}</ref>

Trichotillomania and skin-picking disorder seem to be disorders that primarily involve motor impulsivity,<ref name= "Fineberg et al 2010">{{cite journal |doi=10.1038/npp.2009.185 |title=Probing Compulsive and Impulsive Behaviors, from Animal Models to Endophenotypes: A Narrative Review |year=2009 |last1=Fineberg |first1=Naomi A |last2=Potenza |first2=Marc N |last3=Chamberlain |first3=Samuel R |last4=Berlin |first4=Heather A |last5=Menzies |first5=Lara |last6=Bechara |first6=Antoine |last7=Sahakian |first7=Barbara J |last8=Robbins |first8=Trevor W |last9=Bullmore |first9=Edward T |last10=Hollander |first10=Eric |journal=Neuropsychopharmacology |volume=35 |issue=3 |pages=591–604 |pmid=19940844 |pmc=3055606|display-authors=8 }}</ref><ref name= "Odlaug 2010">{{cite journal |doi=10.1016/j.pnpbp.2009.11.008 |title=Motor inhibition and cognitive flexibility in pathologic skin picking |year=2010 |last1=Odlaug |first1=Brian L. |last2=Chamberlain |first2=Samuel R. |last3=Grant |first3=Jon E. |journal=Progress in Neuro-Psychopharmacology and Biological Psychiatry |volume=34 |pages=208–11 |pmid=19913592 |issue=1 |s2cid=207409063 }}</ref> and will likely be classified in the DSM-5 within the obsessive-compulsive and related disorders category.<ref name="DSM V Website"/>

Pathological gambling, in contrast, seems to involve many diverse aspects of impulsivity and abnormal [[Reward system|reward circuitry]]  (similar to substance use disorders) that has led to it being increasingly conceptualized as a non-substance or [[behavioral addiction]].<ref name="Leeman Pot 2012">{{cite journal |doi=10.1007/s00213-011-2550-7 |title=Similarities and differences between pathological gambling and substance use disorders: A focus on impulsivity and compulsivity |year=2011 |last1=Leeman |first1=Robert F. |last2=Potenza |first2=Marc N. |journal=Psychopharmacology |volume=219 |issue=2 |pages=469–90 |pmid=22057662 |pmc=3249521}}</ref> Evidence elucidating the role of impulsivity in pathological gambling is accumulating, with pathological gambling samples demonstrating greater [[#Go/no-go and stop-signal reaction time tasks|response impulsivity]], [[#5-Choice Serial Reaction Time Task (5-CSRTT) and Differential Reinforcement of Low rates (DRL)|choice impulsivity]], and reflection impulsivity than comparison control samples.<ref name="Leeman Pot 2012"/> Additionally, pathological gamblers tend to demonstrate greater response perseveration (compulsivity) and risky decisionmaking in laboratory gambling tasks compared to controls, though there is no strong evidence suggesting that attention and [[working memory]] are impaired in pathological gamblers.<ref name="Leeman Pot 2012"/> These relations between impulsivity and pathological gambling are confirmed by brain function research: pathological gamblers demonstrate less activation in the frontal cortical regions (implicated in impulsivity) compared to controls during behavioral tasks tapping response impulsivity, compulsivity, and risk/reward.<ref name="Leeman Pot 2012"/>  Preliminary, though variable, findings also suggest that striatal activation is different between gamblers and controls, and that [[neurotransmitter]] differences (e.g. [[dopamine]], [[serotonin]], [[opioids]], [[glutamate]], [[norepinephrine]]) may exist as well.<ref name="Leeman Pot 2012"/>

Individuals with intermittent explosive disorder, also known as impulsive aggression, have exhibited serotonergic abnormalities and show differential activation in response to emotional stimuli and situations.<ref name="Coccaro 2012">{{cite journal |doi=10.1176/appi.ajp.2012.11081259 |title=Intermittent Explosive Disorder as a Disorder of Impulsive Aggression for DSM-5 |url=https://archive.org/details/sim_american-journal-of-psychiatry_2012-06_169_6/page/577 |year=2012 |last1=Coccaro |first1=Emil F. |journal=American Journal of Psychiatry |pmid=22535310 |volume=169 |issue=6 |pages=577–88}}</ref>  Notably, intermittent explosive disorder is not associated with a higher likelihood of diagnosis with any of the other ICDs but is highly comorbid with disruptive behavior disorders in childhood.<ref name="Coccaro 2012"/>  Intermittent explosive disorder is likely to be re-classified in the DSM-5 under the heading of disruptive, impulse control, and conduct disorders.<ref name="DSM V Website"/>

These sorts of impulse control disorders are most often [[#Treatment of specific disorders of impulsivity|treated]] using certain types of psychopharamcological interventions (e.g. antidepressants) and behavioral treatments like [[cognitive behavioral therapy]].{{citation needed|date=June 2013}}

== Theories of impulsivity ==

=== Ego (cognitive) depletion ===
According to the ego (or cognitive) depletion theory of impulsivity, [[self-control]] refers to the capacity for altering one's own responses, especially to bring them into line with standards such as ideals, values, morals, and social expectations, and to support the pursuit of long-term goals.<ref name="Baumeister 2007">{{cite journal |doi=10.1111/j.1467-8721.2007.00534.x |title=The Strength Model of Self-Control |year=2007 |last1=Baumeister |first1=Roy F. |last2=Vohs |first2=Kathleen D. |last3=Tice |first3=Dianne M. |journal=Current Directions in Psychological Science |volume=16 |issue=6 |pages=351–5|s2cid=7414142 }}</ref> Self-control enables a person to restrain or override one response, thereby making a different response possible.<ref name="Baumeister 2007" />
A major tenet of the theory is that engaging in acts of self-control draws from a limited "reservoir" of self-control that, when depleted, results in reduced capacity for further self-regulation.<ref name="Baumeister 1998">{{cite journal |doi=10.1037/0022-3514.74.5.1252 |title=Ego depletion: Is the active self a limited resource? |url=https://archive.org/details/sim_journal-of-personality-and-social-psychology_1998-05_74_5/page/1252 |year=1998 |last1=Baumeister |first1=Roy F. |last2=Bratslavsky |first2=Ellen |last3=Muraven |first3=Mark |last4=Tice |first4=Dianne M. |journal=Journal of Personality and Social Psychology |volume=74 |issue=5 |pages=1252–65 |pmid=9599441|s2cid=14627317 }}</ref><ref name="Muraven 2000">{{cite journal |doi=10.1037/0033-2909.126.2.247 |title=Self-regulation and depletion of limited resources: Does self-control resemble a muscle? |url=https://archive.org/details/sim_psychological-bulletin_2000-03_126_2/page/247 |year=2000 |last1=Muraven |first1=Mark |last2=Baumeister |first2=Roy F. |journal=Psychological Bulletin |volume=126 |issue=2 |pages=247–59 |pmid=10748642 |s2cid=10962693 }}</ref> Self-control is viewed as analogous to a muscle: Just as a muscle requires strength and energy to exert force over a period of time, acts that have high self-control demands also require strength and energy to perform.<ref name="Hagger 2010">{{cite journal |doi=10.1037/a0019486 |title=Ego depletion and the strength model of self-control: A meta-analysis |url=https://archive.org/details/sim_psychological-bulletin_2010-07_136_4/page/495 |year=2010 |last1=Hagger |first1=Martin S. |last2=Wood |first2=Chantelle |last3=Stiff |first3=Chris |last4=Chatzisarantis |first4=Nikos L. D. |journal=Psychological Bulletin |volume=136 |issue=4 |pages=495–525 |pmid=20565167|s2cid=22705578 }}</ref> Similarly, as muscles become fatigued after a period of sustained exertion and have reduced capacity to exert further force, self-control can also become depleted when demands are made of self-control resources over a period of time. Baumeister and colleagues termed the state of diminished self-control strength [[ego depletion]] (or cognitive depletion).<ref name="Muraven 2000" />

The strength model of self-control asserts that:
*Just as exercise can make muscles stronger, there are signs that regular exertions of self-control can improve willpower strength.<ref name="Baumeister 2006">{{cite journal |doi=10.1111/j.1467-6494.2006.00428.x |title=Self-Regulation and Personality: How Interventions Increase Regulatory Success, and How Depletion Moderates the Effects of Traits on Behavior |url=https://archive.org/details/sim_journal-of-personality_2006-12_74_6/page/1773 |year=2006 |last1=Baumeister |first1=Roy F. |last2=Gailliot |first2=Matthew |last3=Dewall |first3=C. Nathan |last4=Oaten |first4=Megan |journal=Journal of Personality |volume=74 |issue=6 |pages=1773–801 |pmid=17083666}}</ref> These improvements typically take the form of resistance to depletion, in the sense that performance at self-control tasks deteriorates at a slower rate.<ref name="Baumeister 2007" /> Targeted efforts to control behavior in one area, such as spending money or exercise, lead to improvements in unrelated areas, such as studying or household chores. And daily exercises in self-control, such as improving posture, altering verbal behavior, and using one's nondominant hand for simple tasks, gradually produce improvements in self-control as measured by laboratory tasks.<ref name="Baumeister 2007" /> The finding that these improvements carry over into tasks vastly different from the daily exercises shows that the improvements are not due to simply increasing skill or acquiring [[self-efficacy]] from practice.<ref name="Baumeister 2007" />
*Just as athletes begin to conserve their remaining strength when their muscles begin to tire, so do self-controllers when some of their self-regulatory resources have been expended. The severity of behavioral impairment during depletion depends in part on whether the person expects further challenges and demands.<ref name="Baumeister 2007" /> When people expect to have to exert self-control later, they will curtail current performance more severely than if no such demands are anticipated.<ref name="Muraven 2006">{{cite journal |doi=10.1037/0022-3514.91.3.524 |title=Conserving self-control strength |url=https://archive.org/details/sim_journal-of-personality-and-social-psychology_2006-09_91_3/page/524 |year=2006 |last1=Muraven |first1=Mark |last2=Shmueli |first2=Dikla |last3=Burkley |first3=Edward |journal=Journal of Personality and Social Psychology |volume=91 |issue=3 |pages=524–37 |pmid=16938035}}</ref>
*Consistent with the conservation hypothesis, people can exert self-control despite ego depletion if the stakes are high enough. Offering cash incentives or other motives for good performance counteracts the effects of ego depletion.<ref name="Muraven 2003">{{cite journal |doi=10.1177/0146167203029007008 |title=Mechanisms of Self-Control Failure: Motivation and Limited Resources |url=https://archive.org/details/sim_personality-and-social-psychology-bulletin_2003-07_29_7/page/894 |year=2003 |last1=Muraven |first1=Mark |last2=Slessareva |first2=Elisaveta |journal=Personality and Social Psychology Bulletin |volume=29 |issue=7 |pages=894–906 |pmid=15018677 |s2cid=16961238 }}</ref> This may seem surprising but in fact it may be highly adaptive. Given the value and importance of the capacity for self-control, it would be dangerous for a person to lose that capacity completely, and so ego depletion effects may occur because people start conserving their remaining strength.<ref name="Baumeister 2007" /> When people do exert themselves on the second task, they deplete the resource even more, as reflected in severe impairments on a third task that they have not anticipated.<ref name="Muraven 2006" />

Empirical tests of the ego-depletion effect typically adopt [[dual-task paradigm]].<ref name="Baumeister 1998" /><ref>{{cite journal |doi=10.1037/0022-3514.74.3.774 |title=Self-control as a limited resource: Regulatory depletion patterns |url=https://archive.org/details/sim_journal-of-personality-and-social-psychology_1998-03_74_3/page/774 |year=1998 |last1=Muraven |first1=Mark |last2=Tice |first2=Dianne M. |last3=Baumeister |first3=Roy F. |journal=Journal of Personality and Social Psychology |volume=74 |issue=3 |pages=774–89 |pmid=9523419}}</ref><ref>{{cite journal |doi=10.1037/0022-3514.91.3.456 |title=High-maintenance interaction: Inefficient social coordination impairs self-regulation |url=https://archive.org/details/sim_journal-of-personality-and-social-psychology_2006-09_91_3/page/456 |year=2006 |last1=Finkel |first1=Eli J. |last2=Campbell |first2=W. Keith |last3=Brunell |first3=Amy B. |last4=Dalton |first4=Amy N. |last5=Scarbeck |first5=Sarah J. |last6=Chartrand |first6=Tanya L. |journal=Journal of Personality and Social Psychology |volume=91 |issue=3 |pages=456–75 |pmid=16938030}}</ref> Participants assigned to an experimental ego-depletion group are required to engage in two consecutive tasks requiring self-control.<ref name="Hagger 2010" /> Control participants are also required to engage in two consecutive tasks, but only the second task requires self-control. The strength model predicts that the performance of the experimental-group on the second self-control task will be impaired relative to that of the control group. This is because the finite self-control resources of the experimental participants will be diminished after the initial self-control task, leaving little to draw on for the second task.<ref name="Baumeister 2007" />

The effects of ego depletion do not appear to be a product of mood or arousal. In most studies, mood and arousal has not been found to differ between participants who exerted self-control and those who did not.<ref name="Baumeister 1998" /><ref name="Mark 2012">{{cite book |last=Muraven |first=Mark |chapter=Ego Depletion: Theory and Evidence |chapter-url=https://books.google.com/books?id=oqsezTrzKZEC&pg=PA111 |pages=111–26 |editor1-first=Richard M. |editor1-last=Ryan |title=The Oxford Handbook of Human Motivation |year=2012 |publisher=Oxford University Press |location=Oxford |isbn=978-0-19-539982-0}}</ref> Likewise, mood and arousal was not related to final self-control performance.<ref name="Mark 2012" /> The same is true for more specific mood items, such as frustration, irritation, annoyance, boredom, or interest as well. Feedback about success and failure of the self-control efforts does not appear to affect performance.<ref name="Wallace 2002">{{cite journal |doi=10.1080/152988602317232786 |title=The Effects of Success versus Failure Feedback on Further Self-Control |year=2002 |last1=Wallace |first1=Harry M. |last2=Baumeister |first2=Roy F. |journal=Self and Identity |volume=1 |pages=35–41|s2cid=144797743 }}</ref> In short, the decline in self-control performance after exerting self-control appears to be directly related to the amount of self-control exerted and cannot be easily explained by other, well-established psychological processes.<ref name="Mark 2012" />

=== Automatic vs. controlled processes/cognitive control ===

[[Dual process theory]] states that mental processes operate in two separate classes: automatic and controlled.  In general, automatic processes are those that are experiential in nature, occur without involving higher levels of cognition,<ref>{{cite journal |doi=10.3200/JRLP.143.3.293-317 |title=College Students' Awareness of Irrational Judgments on Gambling Tasks: A Dual-Process Account |url=https://archive.org/details/sim_journal-of-psychology_2009-05_143_3/page/293 |year=2009 |last1=Amsel |first1=Eric |last2=Close |first2=Jason |last3=Sadler |first3=Eric |last4=Klaczynski |first4=Paul A. |journal=The Journal of Psychology |volume=143 |issue=3 |pages=293–317 |pmid=19455857|s2cid=1997168 }}</ref> and are based on prior experiences or informal heuristics. Controlled decisions are effortful and largely conscious processes in which an individual weighs alternatives and makes a more deliberate decision.{{citation needed|date=June 2013}}
*''Automatic Process'':  Automatic processes have four main features.<ref name="ReferenceA">{{cite book |first1=Bertram |last1=Gawronski |first2=Laura A. |last2=Creighton |year=2013 |chapter=Dual-Process Theories |pages=218–312 |editor1-first=Donal E. |editor1-last=Carlston |title=The Oxford Handbook of Social Cognition |publisher=Oup USA |isbn=978-0-19-973001-8}}</ref> They occur unintentionally or without a conscious decision, the cost of the decision is very low in mental resources, they cannot be easily stopped, and they occur without conscious thought on the part of the individual making them.
*''Controlled Process'':  Controlled processes also have four main features<ref name="ReferenceA"/> that are very close to the opposite in spectrum from their automatic counterparts.  Controlled processes occur intentionally, they require the expenditure of cognitive resources, the individual making the decision can stop the process voluntarily, and the mental process is a conscious one.

Dual process theories at one time considered any single action/thought as either being automatic or controlled.<ref name="ReferenceA"/>  However, currently they are seen as operating more along a continuum as most impulsive actions will have both controlled and automatic attributes.<ref name="ReferenceA"/>  Automatic processes are classified according to whether they are meant to inhibit or to facilitate a thought process.<ref>{{cite journal |doi=10.1037/0033-295X.115.2.314 |title=The self-regulation of automatic associations and behavioral impulses |year=2008 |last1=Sherman |first1=Jeffrey W. |last2=Gawronski |first2=Bertram |last3=Gonsalkorale |first3=Karen |last4=Hugenberg |first4=Kurt |last5=Allen |first5=Thomas J. |last6=Groom |first6=Carla J. |journal=Psychological Review |volume=115 |issue=2 |pages=314–35 |pmid=18426292|s2cid=20186915 |url=https://escholarship.org/uc/item/4x59z6nr }}</ref> For example, in one study<ref>{{cite journal |doi=10.1037/0022-3514.63.4.534 |title=Cognitive-experiential self-theory and subjective probability: Further evidence for two conceptual systems |url=https://archive.org/details/sim_journal-of-personality-and-social-psychology_1992-10_63_4/page/534 |year=1992 |last1=Kirkpatrick |first1=Lee A. |last2=Epstein |first2=Seymour |journal=Journal of Personality and Social Psychology |volume=63 |issue=4 |pages=534–44 |pmid=1447684}}</ref> researchers offered individuals a choice between a 1 in 10 chance of winning a prize and a 10 in 100 chance. Many participants chose one of the choices over the other without identifying that the chances inherent in each were the same as they saw either only 10 chances total as more beneficial, or of having 10 chances to win as more beneficial. In effect impulsive decisions can be made as prior information and experiences dictate one of the courses of action is more beneficial when in actuality careful consideration would better enable the individual to make a more informed and improved decision.{{citation needed|date=June 2013}}

=== Intertemporal choice ===

[[Intertemporal choice]] is defined as "decisions with consequences that play out over time".<ref name="Berns">{{cite journal |doi=10.1016/j.tics.2007.08.011 |url=http://nrs.harvard.edu/urn-3:HUL.InstRepos:4554332 |title=Intertemporal choice – toward an integrative framework |year=2007 |last1=Berns |first1=Gregory S. |last2=Laibson |first2=David |last3=Loewenstein |first3=George |journal=Trends in Cognitive Sciences |volume=11 |issue=11 |pages=482–8 |pmid=17980645|s2cid=22282339 |url-access=subscription }}</ref>  This is often assessed using the relative value people assign to rewards at different points in time, either by asking experimental subjects to choose between alternatives or examining behavioral choices in a naturalistic setting.{{citation needed|date=June 2013}}

Intertemporal choice is commonly measured in the laboratory using a "delayed discounting" paradigm, which measures the process of devaluing rewards and punishments that happen in the future.<ref name="Berns" /> In this paradigm, subjects must choose between a smaller reward delivered soon and a larger reward delivered at a delay in the future.  Choosing the smaller-sooner reward is considered impulsive. By repeatedly making these choices, indifference points can be estimated. For example, if someone chose $70 now over $100 in a week, but chose the $100 in a week over $60 now, it can be inferred that they are indifferent between $100 in a week and an intermediate value between $60 and $70.  A delay discounting curve can be obtained for each participant by plotting their indifference points with different reward amounts and time delays.  Individual differences in discounting curves are affected by personality characteristics such as self-reports of impulsivity and [[locus of control]]; personal characteristics such as age, gender, IQ, race, and culture; socioeconomic characteristics such as income and education; and many other variables.<ref name=Hampton2018>{{cite journal | doi = 10.3389/fpsyg.2018.01545 | volume=9 | issue= 1545 | title=Things for Those Who Wait: Predictive Modeling Highlights Importance of Delay Discounting for Income Attainment | year=2018 | journal=Frontiers in Psychology | last1 = Hampton | first1 = W.| page=1545 | pmid=30233449 | pmc=6129952 | doi-access=free }}</ref> to drug addiction.<ref name=MacKillop2011>{{cite journal | doi = 10.1007/s00213-011-2229-0| volume=216 | issue= 3 | title=Delayed reward discounting and addictive behavior | year=2011 | journal=Psychopharmacology | last1 = MacKillop | first1 = J.| pages=305–321 | pmid=21373791 | pmc=3201846 }}</ref><ref>{{cite book |doi=10.1037/12069-002  |title= Impulsivity: The behavioral and neurological science of discounting|year=2010 |last1=Odum |first1=Amy L. |last2=Baumann |first2=Ana A. L. |isbn=978-1-4338-0477-9 |pages=39–65 |editor1-last=Madden |editor1-first=Gregory J. |editor2-last=Bickel |editor2-first=Warren K. |chapter= Delay discounting: State and trait variable}}</ref> Lesions of the [[nucleus accumbens core]] subregion<ref>{{cite journal |doi=10.1126/science.1060818 |title=Impulsive Choice Induced in Rats by Lesions of the Nucleus Accumbens Core |year=2001 |last1=Cardinal |first1=R. N. |journal=Science |volume=292 |issue=5526 |pages=2499–501 |pmid=11375482 |last2=Pennicott |first2=DR |last3=Sugathapala |first3=CL |last4=Robbins |first4=TW |last5=Everitt |first5=BJ |s2cid=18020488 |doi-access=free }}</ref> or [[basolateral amygdala]]<ref>{{cite journal |doi=10.1523/JNEUROSCI.5606-03.2004 |title=Contrasting Roles of Basolateral Amygdala and Orbitofrontal Cortex in Impulsive Choice |year=2004 |last1=Winstanley|first1=C. A. |journal=Journal of Neuroscience |volume=24 |issue=20 |pages=4718–22 |pmid=15152031 |pmc=6729470 |last2=Theobald |first2=DE |last3=Cardinal |first3=RN |last4=Robbins |first4=TW|author1-link=Catharine Winstanley }}</ref> produce shifts towards choosing the smaller-sooner reward, suggesting the involvement of these brain regions in the preference for delayed reinforcers.  There is also evidence that the orbitofrontal cortex is involved in delay discounting, although there is currently debate on whether lesions in this region result in more or less impulsivity.<ref name="dalley" />

Economic theory suggests that optimal discounting involves the [[exponential discounting]] of value over time.  This model assumes that people and institutions should discount the value of rewards and punishments at a constant rate according to how delayed they are in time.<ref name="Berns" />  While economically rational, recent evidence suggests that people and animals do not discount exponentially.  Many studies suggest that humans and animals discount future values according to a [[hyperbolic discounting]] curve where the discount factor decreases with the length of the delay (for example, waiting from today to tomorrow involves more loss of value than waiting from twenty days to twenty-one days).  Further evidence for non-constant delay discounting is suggested by the differential involvement of various brain regions in evaluating immediate versus delayed consequences.  Specifically, the prefrontal cortex is activated when choosing between rewards at a short delay or a long delay, but regions associated with the dopamine system are additionally activated when the option of an immediate reinforcer is added.<ref>{{cite journal |doi=10.1126/science.1100907 |title=Separate Neural Systems Value Immediate and Delayed Monetary Rewards |year=2004 |last1=McClure |first1=S. M. |journal=Science |volume=306 |issue=5695 |pages=503–7 |pmid=15486304 |last2=Laibson |first2=DI |last3=Loewenstein |first3=G |last4=Cohen |first4=JD |bibcode=2004Sci...306..503M |s2cid=14663380 }}</ref> Additionally, intertemporal choices differ from economic models because they involve anticipation (which may involve a neurological "reward" even if the reinforcer is delayed), self-control (and the breakdown of it when faced with temptations), and representation (how the choice is framed may influence desirability of the reinforcer),<ref name="Berns" /> none of which are accounted for by a model that assumes economic rationality.{{citation needed|date=June 2013}}

One facet of intertemporal choice is the possibility for preference reversal, when a tempting reward becomes more highly valued than abstaining only when immediately available.<ref name = "M&G10" />  For example, when sitting home alone, a person may report that they value the health benefit of not smoking a cigarette over the effect of smoking one.  However, later at night when the cigarette is immediately available, their subjective value of the cigarette may rise and they may choose to smoke it.{{citation needed|date=June 2013}}

A theory called the "primrose path" is intended to explain how preference reversal can lead to addiction in the long run.<ref>{{cite book |last1=Herrnstein |first1=Richard J. |last2=Prelec |first2=Drazen |year=1992 |chapter=A Theory of Addiction |chapter-url=https://books.google.com/books?id=3CarEZZfdkUCpg |editor1-first=George |editor1-last=Loewenstein |editor2-first=Jon |editor2-last=Elster |title=Choice Over Time |pages=331–60 |location=New York |publisher=Russell Sage Foundation |isbn=978-0-87154-558-9 }}{{Dead link|date=September 2024 |bot=InternetArchiveBot |fix-attempted=yes }}</ref> As an example, a lifetime of sobriety may be more highly valued than a lifetime of alcoholism, but, at the same time, one drink now may be more highly valued than not drinking now.  Because it is always "now," the drink is always chosen, and a paradoxical effect occurs whereby the more-valued long-term alternative is not achieved because the more-valued short-term alternative is always chosen. This is an example of complex ambivalence,<ref>{{cite book |last=Rachlin |first=Howard |chapter=Complex Ambivalence |chapter-url=https://books.google.com/books?id=KWp-EJaEAUIC&pg=PA57 |pages=57–81 |title=The Science of Self-Control |publisher=Harvard University Press |location=Cambridge, Massachusetts |year=2000 |isbn=978-0-674-00093-3}}</ref> when a choice is made not between two concrete alternatives but between one immediate and tangible alternative (i.e. having a drink) and one delayed and abstract alternative (i.e. sobriety).

Similarities between humans and non-human animals in intertemporal choice have been studied.  Pigeons<ref>{{cite journal |doi=10.3758/BF03209777 |title=Preference reversal and delayed reinforcement |year=1981 |last1=Ainslie |first1=George |last2=Herrnstein |first2=R. J. |journal=Animal Learning & Behavior |volume=9 |issue=4 |pages=476–82|s2cid=145693802 |doi-access=free }}</ref> and rats<ref>{{cite journal |doi=10.1901/jeab.2003.79-233 |title=Preference reversals with food and water reinforcers in rats |year=2003 |last1=Green |first1=Leonard |last2=Estle |first2=Sara J |journal=Journal of the Experimental Analysis of Behavior |volume=79 |issue=2 |pages=233–42 |pmid=12822689 |pmc=1284932}}</ref> also discount hyperbolically; tamarin monkeys do not wait more than eight seconds to triple the amount of a food reward.<ref>{{cite journal |doi=10.1098/rsbl.2004.0285 |title=The ecology and evolution of patience in two New World monkeys |year=2005 |last1=Hauser |first1=Marc D. |last2=Hallinan |first2=Elizabeth V. |last3=Stevens |first3=Jeffrey R. |journal=Biology Letters |volume=1 |issue=2 |pages=223–6 |pmid=17148172 |pmc=1626214}}</ref> The question arises as to whether this is a difference of homology or analogy—that is, whether the same underlying process underlies human-animal similarities or whether different processes are manifesting in similar patterns of results.{{citation needed|date=June 2013}}

=== Inhibitory control ===
{{main|inhibitory control}}

Inhibitory control, often conceptualized as an [[executive functions|executive function]], is the ability to [[cognitive inhibition|inhibit or hold back a prepotent response]].<ref name="Logan et al 1997" >{{cite journal |doi=10.1111/j.1467-9280.1997.tb00545.x |title=Impulsivity and Inhibitory Control |url=https://archive.org/details/sim_psychological-science_1997-01_8_1/page/60 |year=1997 |last1=Logan |first1=Gordon D. |last2=Schachar |first2=Russell J. |last3=Tannock |first3=Rosemary |journal=Psychological Science |volume=8 |issue=1 |pages=60–4 |jstor=40062847|s2cid=145540424 }}</ref> It is theorized that impulsive behavior reflects a deficit in this ability to inhibit a response; impulsive people may find it more difficult to inhibit action whereas non-impulsive people may find it easier to do so.<ref name="Logan et al 1997" /> There is evidence that, in normal adults, commonly used behavioral measures of inhibitory control correlate with standard self-report measures of impulsivity.<ref name="Enticott et al 2006" >{{cite journal |doi=10.1016/j.paid.2006.01.011 |title=Associations between laboratory measures of executive inhibitory control and self-reported impulsivity |url=https://archive.org/details/sim_personality-and-individual-differences_2006-07_41_2/page/n92 |year=2006 |last1=Enticott |first1=Peter G. |last2=Ogloff |first2=James R.P. |last3=Bradshaw |first3=John L. |journal=Personality and Individual Differences |volume=41 |issue=2 |pages=285–94}}</ref>

Inhibitory control may itself be multifaceted, evidenced by numerous distinct inhibition constructs that can be measured in different ways, and relate to specific types of psychopathology.<ref name="Nigg 2000" >{{cite journal |doi=10.1037/0033-2909.126.2.220 |title=On inhibition/disinhibition in developmental psychopathology: Views from cognitive and personality psychology and a working inhibition taxonomy |url=https://archive.org/details/sim_psychological-bulletin_2000-03_126_2/page/220 |year=2000 |last1=Nigg |first1=Joel T. |journal=Psychological Bulletin |volume=126 |issue=2 |pages=220–46 |pmid=10748641}}</ref> [[Joel Nigg]] developed a useful working taxonomy of these different types of inhibition, drawing heavily from the fields of cognitive and personality psychology<ref name="Nigg 2000" /> Nigg's eight proposed types of  inhibition include the following:

==== Executive Inhibition ====

===== Interference control =====
Suppression of a stimulus that elicits an interfering response, enabling a person to complete the primary response.  Interference control can also refer to suppressing distractors.<ref name="Nigg 2000" />

Interference control has been measured using cognitive tasks like the [[Stroop effect|stroop test]], [[Eriksen flanker task|flanker tasks]], [[Dual-task paradigm|dual task interference]], and [[priming (psychology)|priming]] tasks.<ref name="GrattonColesDonchin-1992" >{{cite journal |doi=10.1037/0096-3445.121.4.480 |title=Optimizing the use of information: Strategic control of activation of responses |year=1992 |last1=Gratton |first1=Gabriele |last2=Coles |first2=Michael G. H. |last3=Donchin |first3=Emanuel |journal=Journal of Experimental Psychology: General |volume=121 |issue=4 |pages=480–506|pmid=1431740 }}</ref>  Personality researchers have used the Rothbart effortful control measures and the [[conscientiousness]] scale of the [[Big Five personality traits|Big Five]] as inventory measures of interference control.  Based on imaging and neural research it is theorized that the [[Anterior cingulate cortex|anterior cingulate]], the [[Dorsolateral prefrontal cortex|dorsolateral prefrontal/premotor cortex]], and the [[basal ganglia]] are related to interference control.<ref name="Diamond1997" >{{cite conference |last=Diamond |first=A. |date=May 1997 |title=Executive functions: Developmental perspective |publisher=University of Toronto Division of Child Psychiatry |conference=Executive Function and Developmental Psychopathology |location=Toronto, Canada}}</ref><ref name="CabezaNyberg1997" >{{cite journal |doi=10.1162/jocn.1997.9.1.1 |pmid=23968177 |title=Imaging Cognition: An Empirical Review of PET Studies with Normal Subjects |url=https://archive.org/details/sim_journal-of-cognitive-neuroscience_1997-01_9_1/page/n4 |year=1997 |last1=Cabeza |first1=Roberto |last2=Nyberg |first2=Lars |journal=Journal of Cognitive Neuroscience |volume=9 |issue=1 |pages=1–26 |s2cid=33664797 }}</ref>

===== Cognitive inhibition =====
[[Cognitive inhibition]] is the suppression of unwanted or irrelevant thoughts to protect working memory and attention resources.<ref name="Nigg 2000" />

Cognitive inhibition is most often measured through tests of directed ignoring, self-report on one's intrusive thoughts, and negative priming tasks.  As with interference control, personality psychologists have measured cognitive inhibition using the Rothbart Effortful Control scale and the Big Five Conscientiousness scale. The [[anterior cingulate]], the prefrontal regions, and the association cortex seem to be involved in cognitive inhibition.<ref name="Nigg 2000" />

===== Behavioral inhibition =====
Behavioral Inhibition is the suppression of prepotent response.<ref name="Nigg 2000" />

Behavioral inhibition is usually measured using the Go/No Go task, Stop signal task, and reports of suppression of attentional orienting.  Surveys that are theoretically relevant to behavioral inhibition include the Rothbart effortful control scale, and the [[Big Five personality traits|Big Five]] Conscientiousness dimension.<ref name="Nigg 2000" /> The rationale behind the use of behavioral measures like the Stop signal task is that "go" processes and "stop processes" are independent, and that, upon "go" and "stop" cues, they "race" against each other; if the go process wins the race, the prepotent response is executed, whereas if the stop processes wins the race, the response is withheld. In this context, impulsivity is conceptualized as a relatively slow stop process.<ref name="Logan et al 1984">{{cite journal |doi=10.1037/0096-1523.10.2.276 |title=On the ability to inhibit simple and choice reaction time responses: A model and a method |year=1984 |last1=Logan |first1=Gordon D. |last2=Cowan |first2=William B. |last3=Davis |first3=Kenneth A. |journal=Journal of Experimental Psychology: Human Perception and Performance |volume=10 |issue=2 |pages=276–91|pmid=6232345 |s2cid=2595498 }}</ref> The brain regions involved in behavioral inhibition appear to be the lateral and orbital prefrontal regions along with premotor processes.

===== Oculomotor Inhibition =====
Oculomotor Inhibition is the effortful suppression of [[Saccade|reflexive saccade]].<ref name="Nigg 2000" />

Oculomotor inhibition is tested using antisaccade and oculomotor tasks. Also, the Rothbart effortful control measure and the Big Five Conscientiousness dimension are thought to tap some of the effortful processes underlying the ability to suppress saccade.  The frontal eye fields and the dorsolateral prefrontal cortex are involved in oculomotor inhibition.<ref name="Nigg 2000" />

==== Motivational inhibition ====

===== In response to punishment =====
Motivational inhibition and response in the face of punishment can be measured using tasks tapping inhibition of primary response, modified go/no go tasks, inhibition of competing response, and [[Emotional Stroop test|emotional Stroop]] tasks.<ref name="Nigg 2000" /> Personality psychologists also use the [[Gray's biopsychological theory of personality|Gray]] behavioral inhibition system measure, the [[Eysenck Personality Questionnaire|Eysenck]] scale for neurotic introversion, and the [[Alternative five model of personality|Zuckerman]] Neuroticism-Anxiety scale.<ref name="Nigg 2000" />  The  Septal-hippocampal formation, cingulate, and motor systems seem to be the brain areas most involved in response to punishment.<ref name="Nigg 2000" />

===== In response to novelty =====
Response to novelty has been measured using the Kagan behavioral inhibition system measure and scales of neurotic introversion.<ref name="Nigg 2000" />  The amygdaloid system is implicated in novelty response.<ref name="Nigg 2000" />

==== Automatic inhibition of attention ====

===== Recently inspected stimuli =====
Suppression of recently inspected stimuli for both attention and oculomotor saccade is usually measured using attentional and oculomotor inhibition of return tests. The superior colliculus and the midbrain, oculomotor pathway are involved in suppression of stimuli.<ref name="Nigg 2000" />

===== Neglected stimuli =====
Information at locations that are not presently being attended to is suppressed, while attending elsewhere.<ref name="Nigg 2000" />

This involves measures of covert attentional orienting and neglect, along with personality scales on neuroticism.<ref name="Nigg 2000" />  The posterior association cortex and subcortical pathways are implicated in this sort of inhibition.<ref name="Nigg 2000" />

=== Action/Inaction goals ===
Recent psychology research also yields out the condition of impulsivity in relation to peoples' general goal setting. It is possible these action and inaction goals are underlying people's behavioral differences in their daily lives since they can demonstrate "patterns comparable to natural variation in overall activity levels".<ref>{{cite journal | last1 = Albarracin | first1 = D. | last2 = Handley | first2 = I. M. | last3 = Noguchi | first3 = K. | last4 = McCulloch | first4 = K. C. | last5 = Li | first5 = H. | last6 = Leeper | first6 = J. | last7 = Brown | first7 = R. D. | last8 = Earl | first8 = A. | last9 = Hart | first9 = W. | year = 2008 | title = Increasing and decreasing motor and cognitive output: A model of general action and inaction goals | journal = Journal of Personality and Social Psychology | volume = 95 | issue = 3| pages = 510–523 | doi=10.1037/a0012833 | pmid=18729691 | pmc=3626413}}</ref> More specifically, the level of impulsivity and mania people have might positive correlated with favorable attitudes about and goals of general action while negatively respond to favorable attitudes about and goals of general inaction.

== Assessment of impulsivity ==

=== Personality tests and reports ===

==== Barratt Impulsiveness Scale ====
The [[Barratt Impulsiveness Scale]] (BIS) is one of the oldest and most widely used measures of impulsive personality traits. The first BIS was developed in 1959 by Dr. Ernest Barratt.<ref name="Barratt 1959">{{cite journal |doi=10.2466/pms.1959.9.3.191 |title=Anxiety and Impulsiveness Related to Psychomotor Efficiency |year=1959 |last1=Barratt |first1=Ernest S. |journal=Perceptual and Motor Skills |volume=9 |issue=3 |pages=191–8|s2cid=143118554 }}</ref> It has been revised extensively to achieve two major goals: (1) to identify a set of "impulsiveness" items that was orthogonal to a set of "anxiety" items as measured by the Taylor Manifest Anxiety Scale (MAS) or the Cattell Anxiety Scale, and (2) to define impulsiveness within the structure of related personality traits like Eysenck's Extraversion dimension or Zuckerman's Sensation-Seeking dimension, especially the disinhibition subfactor.<ref name="Barratt 1959" /> The BIS-11 with 30 items was developed in 1995.<ref name="Patton 1995">{{cite journal |doi=10.1002/1097-4679(199511)51:6<768::AID-JCLP2270510607>3.0.CO;2-1 |title=Factor structure of the barratt impulsiveness scale |url=https://archive.org/details/sim_journal-of-clinical-psychology_1995-11_51_6/page/768 |year=1995 |last1=Patton |first1=Jim H. |last2=Stanford |first2=Matthew S. |last3=Barratt |first3=Ernest S. |journal=Journal of Clinical Psychology |volume=51 |issue=6 |pages=768–74 |pmid=8778124}}</ref> According to Patton and colleagues, there are 3 subscales (Attentional Impulsiveness, Motor Impulsiveness, and Non-Planning Impulsiveness) with six factors:<ref name="Patton 1995" />
#[[Attention]]: "focusing on a task at hand".
#Motor impulsiveness: "acting on the spur of the moment".
#[[Self-control]]: "planning and thinking carefully".
#Cognitive complexity: "enjoying challenging mental tasks".
#[[Perseveration|Perseverance]]: "a consistent life style".
#Cognitive instability: "thought insertion and racing thoughts".

==== Eysenck Impulsiveness Scale ====
The Eysenck Impulsiveness Scale (EIS)<ref>{{cite journal |doi=10.1016/0191-8869(85)90011-X |title=Age norms for impulsiveness, venturesomeness and empathy in adults |year=1985 |last1=Eysenck |first1=Sybil B.G. |last2=Pearson |first2=P.R. |last3=Easting |first3=G. |last4=Allsopp |first4=J.F. |journal=Personality and Individual Differences |volume=6 |issue=5 |pages=613–9}}</ref> is a 54-item yes/no questionnaire designed to measure impulsiveness. Three subscales are computed from this measure: Impulsiveness, Venturesomeness, and Empathy. Impulsiveness is defined as "behaving without thinking and without realizing the risk involved in the behavior".<ref name="Chelsea 2006">{{cite journal |last=Dean |first=Chelsea R. |title=Assessing self-injurious behaviors on a College Campus |journal=Senior Honors Theses & Projects |year=2006 |series=Senior Honor Theses: Paper 59 |url=http://commons.emich.edu/honors/59/ |url-status=live |archive-url=https://web.archive.org/web/20131203021934/http://commons.emich.edu/honors/59/ |archive-date=2013-12-03 }}{{page needed|date=June 2013}}</ref> Venturesomeness is conceptualized as "being conscious of the risk of the behavior but acting anyway".<ref name="Chelsea 2006" /> The questionnaire was constructed through factor analysis to contain items that most highly loaded on impulsiveness and venturesomeness.<ref name="Chelsea 2006" /> The EIS is a widely used and well-validated measure.<ref name="Chelsea 2006" />

==== Dickman Impulsivity Inventory ====
The Dickman Impulsivity Inventory was first developed in 1990 by Scott J. Dickman. This scale is based on Dickman's proposal that there are two types of impulsivity that are significantly different from one another.<ref name = Burnett>{{cite journal | title=Impulsivity and Rapid Decision-Making for Reward | author=Burnett Heyes S., Adam RJ., Urner M., van der Leer L., Bahrami B., Bays PM., Husain M. | journal=Front. Psychol.|date= 22 May 2012 | pmc=3357492 | pmid=22661960 | doi=10.3389/fpsyg.2012.00153 | volume=3 | pages=153| last2=Adam | last3=Urner | last4=Van Der Leer | last5=Bahrami | last6=Bays | last7=Husain | doi-access=free }}</ref> This includes [[functional impulsivity]] which is characterized by quick decision making when it is optimal, a trait that is often considered to be a source of pride. The scale also includes [[dysfunctional impulsivity]] which is characterized by making quick decisions when it is not optimal. This type of impulsivity is most often associated with life difficulties including substance abuse problems and other negative outcomes.<ref name="Dickman">Dickman, S. J. (1990). Functional and dysfunctional impulsivity: Personality and cognitive correlates. ''Journal of Personality and Social Psychology'', 58(1), 95–102.</ref>

This scale includes 63 items of which 23 are related to dysfunctional impulsivity, 17 are related to functional impulsivity, and 23 are filler questions that relate to neither construct.<ref name="Dickman" /> This scale has been developed into a version for use with children<ref>Brunas-Wagstaff, J., Tilley, A., Verity, M., Ford, S., & Thompson, D. (1997). Functional and dysfunctional impulsivity in children and their relationship to Eysenck's impulsiveness and venturesomeness dimensions. ''Personality and Individual Differences'', 22(1), 19–35.</ref> as well as into several languages. Dickman showed there is no correlation between these two tendencies across individuals, and they also have different cognitive correlates.<ref name = Burnett/>

==== UPPS Impulsive Behavior Scale ====
The UPPS Impulsive Behavior Scale<ref name="Whiteside 2001">{{cite journal |doi=10.1016/S0191-8869(00)00064-7 |title=The Five Factor Model and impulsivity: Using a structural model of personality to understand impulsivity |url=https://archive.org/details/sim_personality-and-individual-differences_2001-03_30_4/page/669 |year=2001 |last1=Whiteside |first1=Stephen P. |last2=Lynam |first2=Donald R. |journal=Personality and Individual Differences |volume=30 |issue=4 |pages=669–89|s2cid=43839830 }}</ref> is a 45-item self-report questionnaire that was designed to measure impulsivity across dimensions of the Five Factor Model of personality. The UPPS includes 4 sub-scales: lack of premeditation, urgency, lack of perseverance, and sensation-seeking.

UPPS-P Impulsive Behavior Scale (UPPS-P)<ref>{{cite journal |doi=10.1037/1040-3590.19.1.107 |title=Integration of impulsivity and positive mood to predict risky behavior: Development and validation of a measure of positive urgency |url=https://archive.org/details/sim_psychological-assessment_2007-03_19_1/page/107 |year=2007 |last1=Cyders |first1=Melissa A. |last2=Smith |first2=Gregory T. |last3=Spillane |first3=Nichea S. |last4=Fischer |first4=Sarah |last5=Annus |first5=Agnes M. |last6=Peterson |first6=Claire |journal=Psychological Assessment |volume=19 |pages=107–18 |pmid=17371126 |issue=1}}</ref> is a revised version of the UPPS, including 59 items. It assesses an additional personality pathway to impulsive behavior, Positive Urgency, in addition to the four pathways assessed in the original version of the scale: Urgency (now Negative Urgency), (lack of) Premeditation, (lack of) Perseverance, and Sensation Seeking

UPPS-P short version (UPPS-Ps)<ref name="Billieuxa 2011">{{cite journal |doi=10.1016/j.comppsych.2011.09.001 |title=Validation of a short French version of the UPPS-P Impulsive Behavior Scale |year=2012 |last1=Billieux |first1=Joël |last2=Rochat |first2=Lucien |last3=Ceschi |first3=Grazia |last4=Carré |first4=Arnaud |last5=Offerlin-Meyer |first5=Isabelle |last6=Defeldre |first6=Anne-Catherine |last7=Khazaal |first7=Yasser |last8=Besche-Richard |first8=Chrystel |last9=Van Der Linden |first9=Martial |journal=Comprehensive Psychiatry |volume=53 |issue=5 |pages=609–15 |pmid=22036009  }}</ref> is  20-item scale that evaluates five different impulsivity facets (4 items per dimension).

UPPS-R Interview<ref name="Smith 2007">{{cite conference |last1=Smith |first1=G. T. |last2=Fischer |first2=S. |last3=Cyders |first3=M. A. |last4=Annus |first4=A. M. |last5=Spillane |first5=N. S. |year=2007 |title=Toward a comprehensive model of multiple dispositions to rash action |conference=Annual International Meeting of the Research Society on Alcoholism |location=Chicago, IL}}</ref> is a semi-structured interview that measures the degree to which individuals exhibit the various components of impulsivity assessed by the UPPS-P.

==== Lifetime History of Impulsive Behaviors ====
Lifetime History of Impulsive Behaviors (LHIB)<ref name="Schmidt 2000">{{cite book |last=Schmidt |first=Catherine A. |year=2000 |title=Development and Validation of the Lifetime History of Impulsive Behaviors Interview and Self-Report Measures |type=PhD Thesis |oclc=48501893}}{{page needed|date=June 2013}}</ref>  is a 53-item questionnaire designed to assess lifetime history of impulsive behavior (as opposed to impulsive tendencies) as well as the level of distress and impairment associated with these behaviors.<ref name="Closkey 2009">{{cite journal |doi=10.1016/j.jpsychires.2009.01.002 |title=Evaluation of behavioral impulsivity and aggression tasks as endophenotypes for borderline personality disorder |year=2009 |last1=McCloskey |first1=Michael S. |last2=New |first2=Antonia S. |last3=Siever |first3=Larry J. |last4=Goodman |first4=Marianne |last5=Koenigsberg |first5=Harold W. |last6=Flory |first6=Janine D. |last7=Coccaro |first7=Emil F. |journal=Journal of Psychiatric Research |volume=43 |issue=12 |pages=1036–48 |pmid=19232640 |pmc=2853811}}</ref> The assessment battery was designed to measure the following six dimensions: (a) impulsivity, (b) sensation seeking, (c) trait anxiety, (d) state depression, (e) empathy, and (f) social desirability. The LHIB consists of scales for clinically significant impulsivity, non-clinically significant impulsivity, and impulsivity related distress/impairment.<ref name="Closkey 2009" />

==== Behavioral Inhibition System/Behavioral Activation System ====
Behavioral Inhibition System/Behavioral Activation System (BIS/BAS)<ref name="Carver1994">{{cite journal |doi=10.1037/0022-3514.67.2.319 |title=Behavioral inhibition, behavioral activation, and affective responses to impending reward and punishment: The BIS/BAS Scales |url=https://archive.org/details/sim_journal-of-personality-and-social-psychology_1994-08_67_2/page/319 |year=1994 |last1=Carver |first1=Charles S. |last2=White |first2=Teri L. |journal=Journal of Personality and Social Psychology |volume=67 |issue=2 |pages=319–333 |s2cid=6452203 }}</ref> was developed based on the [[Gray's biopsychological theory of personality]] which suggests that there are two general motivational systems that underlie behavior and affect: BIS and BAS. This 20-item self-report questionnaire is designed to assess dispositional BIS and BAS sensitivities.

==== Impulsive/Premeditated Aggression Scale ====
Impulsive/Premeditated Aggression Scale (IPAS)<ref name="Stanford 2003">{{cite journal |doi=10.1177/1073191103010002009 |title=Characterizing Aggressive Behavior |year=2003 |last1=Stanford |first1=Matthew S. |last2=Houston |first2=Rebecca J. |last3=Mathias |first3=Charles W. |last4=Villemarette-Pittman |first4=Nicole R. |last5=Helfritz |first5=Laura E. |last6=Conklin |first6=Sarah M. |journal=Assessment |volume=10 |issue=2 |pages=183–90 |pmid=12801190|s2cid=28427132 }}</ref> is a 30-item self-report questionnaire. Half of the items describe impulsive [[aggression]] and half the items describe premeditated aggression. Aggressive [[behavior]] has traditionally been classified into two distinct subtypes, impulsive or premeditated. Impulsive aggression is defined as a hair-trigger aggressive response to provocation with loss of behavioral control.<ref name="Stanford 2003" /> Premeditated aggression is defined as a planned or conscious aggressive act, not spontaneous or related to an agitated state.<ref name="Stanford 2003" /> The IPAS is designed to characterize aggressive behavior as predominately impulsive or predominately premeditated in nature.<ref name="Stanford 2003" /> Those subjects who clustered on the impulsive factor showed a broad range of [[emotion]]al and [[cognition|cognitive]] impairments; those who clustered on the premeditated factor showed a greater inclination for aggression and [[anti-social behaviour]].<ref name="Stanford 2003" /><ref>{{cite journal |last1=Mathias |first1=Charles W. |last2=Stanford |first2=Matthew S. |last3=Marsh |first3=Dawn M. |last4=Frick |first4=Paul J. |last5=Moeller |first5=F. Gerard |last6=Swann |first6=Alan C. |last7=Dougherty |first7=Donald M. |title=Characterizing aggressive behavior with the Impulsive/Premeditated Aggression Scale among adolescents with conduct disorder |journal=Psychiatry Research |date=June 2007 |volume=151 |issue=3 |pages=231–242 |doi=10.1016/j.psychres.2006.11.001 |pmid=17383014 |pmc=1994790 }}</ref>

==== Padua Inventory ====
The Padua Inventory (PI) consists of 60 items describing common obsessional and compulsive behavior and allows investigation of such problems in normal and clinical subjects.<ref>{{cite web |last=Burns |first=G.L. |year=1995 |title=Padua Inventory-Washington State University Revision |url=http://www.commondataelements.ninds.nih.gov/CRFs/Padua%20Inventory%20-%20Washington%20State%20University%20Revision.doc?CrfId=F1268 |url-status=live |archive-url=https://web.archive.org/web/20180605032345/https://www.commondataelements.ninds.nih.gov/CRFs/Padua%20Inventory%20-%20Washington%20State%20University%20Revision.doc?CrfId=F1268 |archive-date=2018-06-05 }}</ref>

=== Behavioral paradigms ===
A wide variety of behavioral tests have been devised for the assessment of impulsivity in both clinical and experimental settings. While no single test is a perfect predictor or a sufficient replacement for an actual clinical diagnosis, when used in conjunction with parent/teacher reports, behavioral surveys, and other diagnostic criteria, the utility of behavioral paradigms lies in their ability to narrow in on specific, discrete aspects of the impulsivity umbrella. Quantifying specific deficits is of use to the clinician and the experimenter, both of whom are generally concerned with obtaining objectively measurable treatment effects.{{citation needed|date=June 2013}}

==== Marshmallow test ====
One widely recognizable test for impulsivity is the delay of gratification paradigm commonly known as the [[Stanford marshmallow experiment|'marshmallow test']].<ref name="Mischel1972" /> Developed in the 1960s to assess 'willpower' and self-control in preschoolers, the marshmallow test consists of placing a single marshmallow in front of a child and informing them that they will be left alone in the room for some duration. The child is told that if the marshmallow remains uneaten when the experimenter returns, they will be awarded a second marshmallow, both of which can then be eaten.{{citation needed|date=April 2019}}<ref>{{Cite journal|last1=Mischel|first1=Walter|last2=Ebbesen|first2=Ebbe B.|last3=Raskoff Zeiss|first3=Antonette|date=1972|title=Cognitive and attentional mechanisms in delay of gratification.|url=https://archive.org/details/sim_journal-of-personality-and-social-psychology_1972-02_21_2/page/204|journal=Journal of Personality and Social Psychology|language=en|volume=21|issue=2|pages=204–218|doi=10.1037/h0032198|issn=1939-1315|pmid=5010404}}</ref>

Despite its simplicity and ease of administration, evidence from longitudinal studies suggests that the number of seconds preschoolers wait to obtain the second marshmallow is predictive of higher SAT scores, better social and emotional coping in adolescence, higher educational achievement, and less cocaine/crack use.<ref>{{cite journal |doi=10.1037/0022-3514.54.4.687 |title=The nature of adolescent competencies predicted by preschool delay of gratification |url=https://archive.org/details/sim_journal-of-personality-and-social-psychology_1988-04_54_4/page/687 |year=1988 |last1=Mischel |first1=Walter |last2=Shoda |first2=Yuichi |last3=Peake |first3=Philip K. |journal=Journal of Personality and Social Psychology |volume=54 |issue=4 |pages=687–96 |pmid=3367285 |s2cid=42623330 }}</ref><ref>{{cite journal |doi=10.1037/0012-1649.26.6.978 |title=Predicting adolescent cognitive and self-regulatory competencies from preschool delay of gratification: Identifying diagnostic conditions |year=1990 |last1=Shoda |first1=Yuichi |last2=Mischel |first2=Walter |last3=Peake |first3=Philip K. |journal=Developmental Psychology |volume=26 |issue=6 |pages=978–86 |s2cid=4259680 |url=https://scholarworks.smith.edu/psy_facpubs/79 |url-access=subscription }}</ref><ref>{{cite journal |doi=10.1037/0022-3514.79.5.776 |title=Regulating the interpersonal self: Strategic self-regulation for coping with rejection sensitivity |url=https://archive.org/details/sim_journal-of-personality-and-social-psychology_2000-11_79_5/page/776 |year=2000 |last1=Ayduk |first1=Ozlem |author-link1=Ozlem Ayduk |last2=Mendoza-Denton |first2=Rodolfo |last3=Mischel |first3=Walter |last4=Downey |first4=Geraldine |last5=Peake |first5=Philip K. |last6=Rodriguez |first6=Monica |journal=Journal of Personality and Social Psychology |volume=79 |issue=5 |pages=776–92 |pmid=11079241|s2cid=6345213 }}</ref>

==== Delay discounting ====

Like the marshmallow test, [[Hyperbolic discounting|delay discounting]] is also a delay of gratification paradigm.<ref>{{cite book |last1=Mazur |first1=James E. |chapter=An adjusting procedure for studying delayed reinforcement |editor1-last=Commons |editor1-first=Michael L. |editor2-last=Mazur |editor2-first=James E. |editor3-last=Nevin |editor3-first=John Anthony |display-editors = 3 |editor4-last=Rachlin |editor4-first=Howard |series=Quantitative analyses of behavior: Vol. 5 |title=The effect of delay and of intervening events on reinforcement value |location=Hillsdale, NJ |publisher=Erlbaum |year=1987 |pages=55–73 |isbn=9781317838074 |chapter-url=https://books.google.com/books?id=1q5mAgAAQBAJ&pg=PA55 }}</ref> It is designed around the principle that the subjective value of a reinforcer decreases, or is 'discounted,' as the delay to reinforcement increases. Subjects are given varying choices between smaller, immediate rewards and larger, [[delayed gratification|delayed rewards]]. By manipulating reward magnitude and/or reward delay over multiple trials, 'indifference' points can be estimated whereby choosing the small, immediate reward, or the large, delayed reward are about equally likely. Subjects are labeled impulsive when their indifference points decline more steeply as a function of delay compared to the normal population (i.e. greater preference for immediate reward). Unlike the marshmallow test, delay discounting does not require verbal instruction and can be implemented on non-human animals.<ref>{{cite journal |last1=Winstanley |first1=Catharine A. |last2=Dalley |first2=Jeffrey W. |last3=Theobald |first3=David E. H. |last4=Robbins |first4=Trevor W. |title=Global 5-HT depletion attenuates the ability of amphetamine to decrease impulsive choice on a delay-discounting task in rats |url=https://archive.org/details/sim_psychopharmacology_2003-11_170_3/page/320 |journal=Psychopharmacology |date=November 2003 |volume=170 |issue=3 |pages=320–331 |doi=10.1007/s00213-003-1546-3 |pmid=12955303 |s2cid=143605377 }}</ref>

==== Go/no-go and stop-signal reaction time tasks ====

Two common tests of response inhibition used in humans are the go/no-go task, and a slight variant known as the stop-signal reaction time (SSRT) test. During a go/no-task, the participant is trained over multiple trials to make a particular response (e.g., a key-press) when presented with a 'go' signal. On some trials, a 'stop' signal is presented just prior to, or simultaneously with the 'go' signal, and the subject must inhibit the impending response.

The SSRT test is similar, except that the 'stop' signal is presented after the 'go' signal. This small modification increases the difficulty of inhibiting the 'go' response, because the participant has typically already initiated the 'go' response by the time the 'stop' signal is presented.<ref name="Winstanley" /> The participant is instructed to respond as fast as possible to the 'go' signal while maintaining the highest possible inhibition accuracy (on no-go trials). During the task, the time at which the 'stop' signal is presented (the stop signal delay or SSD) is dynamically adjusted to match the time after the 'go' signal at which the participant is just able/unable to inhibit their 'go' response. If the participant fails to inhibit their 'go' response, the 'stop' signal is moved slightly closer to the original 'go' signal, and if the participant successfully inhibits their 'go' response, the 'stop' signal is moved slightly ahead in time. The SSRT is thus measured as the average 'go' response time minus the average 'stop' signal presentation time (SSD).

==== Balloon Analogue Risk Task ====

The balloon analogue risk task (BART) was designed to assess risk-taking behavior.<ref>{{cite journal |doi=10.1037/1076-898X.8.2.75 |title=Evaluation of a behavioral measure of risk taking: The Balloon Analogue Risk Task (BART) |url=https://archive.org/details/sim_journal-of-experimental-psychology-applied_2002-06_8_2/page/75 |year=2002 |last1=Lejuez |first1=C. W. |last2=Read |first2=Jennifer P. |last3=Kahler |first3=Christopher W. |last4=Richards |first4=Jerry B. |last5=Ramsey |first5=Susan E. |last6=Stuart |first6=Gregory L. |last7=Strong |first7=David R. |last8=Brown |first8=Richard A. |journal=Journal of Experimental Psychology: Applied |volume=8 |issue=2 |pages=75–84 |pmid=12075692 |s2cid=7523498 }}</ref> Subjects are presented with a computer depiction of a balloon that can be incrementally inflated by pressing a response key. As the balloon inflates, the subject accumulates rewards with each new key-press. The balloon is programmed with a constant probability of popping. If the balloon pops, all rewards for that balloon are lost, or the subject may choose to stop inflating and 'bank' the reward for that balloon at any time. Therefore, more key-presses equate to greater reward, but also greater probability of popping and cancelling rewards for that trial. The BART assumes that those with an affinity for 'risk-taking' are more likely to pop the balloon, earning less reward overall than the typical population.{{citation needed|date=June 2013}}

==== Iowa Gambling Task ====

The [[Iowa gambling task]]  (IGT) is a test originally meant to measure decision making specifically within individuals who have ventromedial prefrontal cortex damage.<ref name="Bechara" /> The concept of impulsivity as relates to the IGT is one in which impulsive decisions are a function of an individual's lack of ability to make rational decisions over time due to an over amplification of emotional/somatic  reward.<ref name="Buelow, M. T. 2009">{{cite journal |doi=10.1007/s11065-009-9083-4 |title=Construct Validity of the Iowa Gambling Task |year=2009 |last1=Buelow |first1=Melissa T. |last2=Suhr |first2=Julie A. |journal=Neuropsychology Review |volume=19 |pages=102–14 |pmid=19194801 |issue=1 |s2cid=8248057 }}</ref> In the IGT individuals are provided four decks of cards to choose from.  Two of these decks provide much higher rewards but the deductions are also much higher while the second two decks have lower rewards per card but also much lower deductions.  Over time anyone who chooses predominantly from the high rewards decks will lose money while those who choose from the smaller rewards decks will gain money.

The IGT uses hot and cold processes in its concept of decision making.<ref name="Buelow, M. T. 2009"/>  Hot decision making involves emotional responses to the material presented based on motivation related to reward and punishment.  Cold processes occur when an individual uses rational cognitive determinations when making decisions.  Combined an individual should gain a positive emotional reaction when choices have beneficial consequences and will have [[negative emotion]]al responses tied to choices that have greater negative consequences.  In general, healthy responders to the IGT will begin to drift to the lower gain decks as they realize that they are gaining more money than they lose both through an ability to recognize that one is more consistently providing rewards as well as through the emotions related to winning consistently.  However, those who have emotional deficits will fail to recognize that they are losing money over time and will continue to be more influenced by the exhilaration of higher value rewards without being influenced by the negative emotions of the loses associated with them.{{citation needed|date=June 2013}}

For more information concerning these process refer to the '''[[Somatic marker hypothesis]]'''

==== Differential Reinforcement of Low Response Rate Task ====

Differential reinforcement of low response rate (DRL) described by Ferster and Skinner<ref>{{cite book |last1=Ferster |first1=Charles B. |last2=Skinner |first2=B. F. |title=Schedules of reinforcement |location=New York |year=1957|publisher=Appleton-Century-Crofts|lccn=57006418|oclc=4596140}}{{page needed|date=June 2013}}</ref> is used to encourage low rates of responding. It is derived from research in [[operant conditioning]] that provides an excellent opportunity to measure the hyperactive child's ability to inhibit behavioral responding. Hyperactive children were relatively unable to perform efficiently on the task, and this deficit endured regardless of age, [[IQ]], or experimental condition.<ref name="Gordon, M. 1979">{{cite journal |doi=10.1007/BF00916541 |title=The assessment of impulsivity and mediating behaviors in hyperactive and nonhyperactive boys |url=https://archive.org/details/sim_journal-of-abnormal-child-psychology_1979-09_7_3/page/317 |year=1979 |last1=Gordon |first1=Michael |journal=Journal of Abnormal Child Psychology |volume=7 |issue=3 |pages=317–26 |pmid=489853 |s2cid=31953219 }}</ref> Therefore, it can be used to discriminate accurately between teacher rated and parent rated hyperactive and nonhyperactive children. In this procedure, responses that occur before a set time interval has passed are not reinforced and reset the time required between behaviors.{{citation needed|date=June 2013}}

In a study, a child was taken to the experimental room and told that they were going to play a game in which they had a chance to win a lot of M&M's.  Every time they made the light of the reward indicator by pressing a red button, they would earn an M&M's. However, they had to wait a while (6 seconds) before they could press it to get another point. If they had pressed the button too soon, then they would have not gotten a point, and the light would not go on, and they had to wait a while before they could press it to get another point.{{citation needed|date=June 2013}}

Researchers have also observed that subjects in a time-based situation will often engage in a sequence or chain of behaviors between reinforceable responses.<ref name="Gordon, M. 1979"/> This is because this collateral behavior sequence helps the subject "wait out" the required [[Time|temporal]] delay between responses.{{citation needed|date=June 2013}}

==== Other ====
Other common impulsivity tasks include the [[Continuous Performance Task|Continuous performance task]] (CPT), [[5-Choice Serial Reaction Time Task|5-choice serial reaction time task]] (5-CSRTT), [[stroop effect|Stroop task]], and Matching Familiar Figures Task.

== Pharmacology and neurobiology ==

=== Neurobiological findings ===
Although the precise neural mechanisms underlying disorders of impulse control are not fully known, the prefrontal cortex (PFC) is the brain region most ubiquitously implicated in impulsivity.<ref name="Castellanos">{{cite journal |pmid=12154363 |year=2002 |last1=Castellanos |first1=F. Xavier |last2=Tannock |first2=Rosemary |title=Neuroscience of attention-deficit/hyperactivity disorder: The search for endophenotypes |volume=3 |issue=8 |pages=617–28 |doi=10.1038/nrn896 |journal=Nature Reviews Neuroscience |s2cid=3346437 }}</ref>  Damage to the prefrontal cortex has been associated with difficulties preparing to act, switching between response alternatives, and inhibiting inappropriate responses.<ref name="Winstanley">{{cite journal |doi=10.1016/j.cpr.2006.01.001 |title=Behavioral models of impulsivity in relation to ADHD: Translation between clinical and preclinical studies |year=2006 |last1=Winstanley |first1=Catharine A. |last2=Eagle |first2=Dawn M. |last3=Robbins |first3=Trevor W. |journal=Clinical Psychology Review |volume=26 |issue=4 |pages=379–95 |pmid=16504359 |pmc=1892795}}</ref> Recent research has uncovered additional regions of interest, as well as highlighted particular subregions of the PFC, that can be tied to performance in specific behavioral tasks.{{citation needed|date=June 2013}}

==== Delay discounting ====

Excitotoxic lesions in the nucleus accumbens core have been shown to increase preference for the smaller, immediate reward, whereas lesions to the nucleus accumbens shell have had no observable effect. Additionally, lesions of the basolateral amygdala, a region tied closely to the PFC, negatively affect impulsive choice similarly to what is observed in the nucleus accumbens core lesions.<ref name="dalley">{{cite journal |doi=10.1016/j.neuron.2011.01.020 |title=Impulsivity, Compulsivity, and Top-Down Cognitive Control |year=2011 |last1=Dalley |first1=Jeffrey W. |last2=Everitt |first2=Barry J. |last3=Robbins |first3=Trevor W. |journal=Neuron |volume=69 |issue=4 |pages=680–94 |pmid=21338879|s2cid=7952439 |doi-access=free }}</ref> Moreover, dorsal striatum may also be involved in impulsive choice in an intricate manner.<ref name="Kim">{{cite journal |doi=10.1111/nyas.13961 |title=The role of the dorsal striatum in choice impulsivity |year=2018 |last1=Kim |first1=BaekSun |last2=Im |first2=Heh-In |journal=Annals of the New York Academy of Sciences |pmid=30277562 |volume=1451 |issue=1 |pages=92–111|s2cid=52897511 }}</ref>

==== Go/No-go and Stop-signal reaction time test ====

The [[orbitofrontal cortex]] is now thought to play a role in disinhibiting,<ref name="Berlin">{{cite journal |doi=10.1093/brain/awh135 |title=Impulsivity, time perception, emotion and reinforcement sensitivity in patients with orbitofrontal cortex lesions |year=2004 |last1=Berlin |first1=H. A. |journal=Brain |volume=127 |issue=5 |pages=1108–26 |pmid=14985269 |last2=Rolls |first2=ET |last3=Kischka |first3=U|doi-access=free }}</ref> and injury to other brain structures, such as to the right inferior frontal gyrus, a specific subregion of the PFC, has been associated with deficits in stop-signal inhibition.<ref name="Aron2003">{{cite journal |doi=10.1038/nn1003 |title=Stop-signal inhibition disrupted by damage to right inferior frontal gyrus in humans |year=2003 |last1=Aron |first1=Adam R. |last2=Fletcher |first2=Paul C. |last3=Bullmore |first3=Ed T. |last4=Sahakian |first4=Barbara J. |last5=Robbins |first5=Trevor W. |journal=Nature Neuroscience |volume=6 |issue=2 |pages=115–6 |pmid=12536210 |s2cid=10096947 }}</ref>

==== 5-Choice Serial Reaction Time Task (5-CSRTT) and Differential Reinforcement of Low rates (DRL) ====
As with delay discounting, lesion studies have implicated the core region of the nucleus accumbens in response inhibition for both DRL and 5-CSRTT.  Premature responses in the 5-CSRTT may also be modulated by other systems within the ventral striatum.{{citation needed|date=June 2013}} In the 5-CSRTT, lesions of the anterior cingulate cortex have been shown to increase impulsive responding, and lesions to the prelimbic cortex impair attentional performance.<ref name="Muir">{{cite journal |doi=10.1093/cercor/6.3.470 |title=The Cerebral Cortex of the Rat and Visual Attentional Function: Dissociable Effects of Mediofrontal, Cingulate, Anterior Dorsolateral, and Parietal Cortex Lesions on a Five-Choice Serial Reaction Time Task |year=1996 |last1=Muir |first1=Janice L. |last2=Everitt |first2=Barry J. |last3=Robbins |first3=Trevor W. |journal=Cerebral Cortex |volume=6 |issue=3 |pages=470–81 |pmid=8670672|doi-access=free }}</ref>

==== Iowa Gambling Task ====
Patients with damage to the ventromedial frontal cortex exhibit poor decision-making and persist in making risky choices in the [[Iowa gambling task|Iowa Gambling Task]].<ref name="Bechara">{{cite journal |doi=10.1016/0010-0277(94)90018-3 |title=Insensitivity to future consequences following damage to human prefrontal cortex |year=1994 |last1=Bechara |first1=Antoine |last2=Damasio |first2=Antonio R. |last3=Damasio |first3=Hanna |last4=Anderson |first4=Steven W. |journal=Cognition |volume=50 |pages=7–15 |pmid=8039375 |issue=1–3 |s2cid=204981454 }}</ref><ref name="Bechara2">{{cite journal |first1=Antoine |last1=Bechara |first2=Hanna |last2=Damasio |first3=Antonio R. |last3=Damasio |first4=Gregory P. |last4=Lee |title=Different Contributions of the Human Amygdala and Ventromedial Prefrontal Cortex to Decision-Making |journal=The Journal of Neuroscience |pmid=10377356 |pmc=6782338 |year=1999 |volume=19 |issue=13 |pages=5473–81|doi=10.1523/JNEUROSCI.19-13-05473.1999 }}</ref>

=== Neurochemical and pharmacological findings ===

The primary pharmacological treatments for ADHD are methylphenidate (Ritalin) and amphetamine. Both methylphenidate and amphetamines block re-uptake of dopamine and norepinephrine into the pre-synaptic neuron, acting to increase post-synaptic levels of dopamine and norepinephrine. Of these two monoamines, increased availability of dopamine is considered the primary cause for the ameliorative effects of ADHD medications, whereas increased levels of norepinephrine may be efficacious only to the extent that it has downstream, indirect effects on dopamine.<ref name="Wilens2006">{{cite journal |first1=Timothy E. |last1=Wilens |title=Mechanism of Action of Agents Used in Attention-Deficit/Hyperactivity Disorder |journal=The Journal of Clinical Psychiatry |pmid=16961428 |url=http://article.psychiatrist.com/?ContentType=START&ID=10002653 |year=2006 |volume=67 |issue=Suppl 8 |pages=32–8 |url-status=live |archive-url=https://archive.today/20130628023108/http://article.psychiatrist.com/?ContentType=START&ID=10002653 |archive-date=2013-06-28 }}</ref>  
The effectiveness of dopamine re-uptake inhibitors in treating the symptoms of ADHD has led to the hypothesis that ADHD may arise from low tonic levels of dopamine (particularly in the fronto-limbic circuitry), but evidence in support of this theory is mixed.<ref name="Dougherty">{{cite journal |doi=10.1016/S0140-6736(99)04030-1 |title=Dopamine transporter density in patients with attention deficit hyperactivity disorder |year=1999 |last1=Dougherty |first1=Darin D |last2=Bonab |first2=Ali A |last3=Spencer |first3=Thomas J |last4=Rauch |first4=Scott L |last5=Madras |first5=Bertha K |last6=Fischman |first6=Alan J |journal=The Lancet |volume=354 |issue=9196 |pages=2132–3 |pmid=10609822 |s2cid=7420578 }}</ref><ref name="Volkow">{{cite journal |doi=10.1001/jama.2009.1308 |title=Evaluating Dopamine Reward Pathway in ADHD: Clinical Implications |year=2009 |last1=Volkow |first1=Nora D. |journal=JAMA |volume=302 |issue=10 |pages=1084–91 |pmid=19738093 |last2=Wang |first2=GJ |last3=Kollins |first3=SH |last4=Wigal |first4=TL |last5=Newcorn |first5=JH |last6=Telang |first6=F |last7=Fowler |first7=JS |last8=Zhu |first8=W |last9=Logan |first9=J |last10=Ma |first10=Yeming |last11=Pradhan |first11=Kith |last12=Wong |first12=Christopher |last13=Swanson |first13=James M. |pmc=2958516 |display-authors=8 }}</ref>

== Genetics ==

There are several difficulties when it comes to trying to identify a [[gene]] for [[complex traits]] such as impulsivity, such as [[genetic heterogeneity]].  Another difficulty is that the genes in question might sometimes show incomplete penetrance, "where a given gene variant does not always cause the phenotype".<ref name="Wallis">{{cite journal |doi=10.1093/jpepsy/jsn049 |title=Review: Genetics of Attention Deficit/Hyperactivity Disorder |year=2008 |last1=Wallis |first1=D. |last2=Russell |first2=H. F. |last3=Muenke |first3=M. |journal=Journal of Pediatric Psychology |volume=33 |issue=10 |pages=1085–99 |pmid=18522996|doi-access=free }}</ref>  Much of the research on the genetics of impulsivity-related disorders, such as ADHD, is based on family or [[Genetic linkage|linkage studies]].<ref name="Kempf">{{cite book |last1=Kempf |first1=Lucas |last2=Weinberger |first2=Daniel R |year=2009 |chapter=Molecular Genetics and Bioinformatics: An Outline for Neuropsychological Genetics |editor1-first=Terry E |editor1-last=Goldberg |editor2-first=Daniel R |editor2-last=Weinberger |title=The Genetics of Cognitive Neuroscience |url=https://archive.org/details/geneticscognitiv00gold |pages=[https://archive.org/details/geneticscognitiv00gold/page/n15 3]–26 |publisher=MIT Press |isbn=978-0-262-01307-9}}</ref> There are several genes of interest that have been studied in an attempt to find the major genetic contributors to impulsivity.  Some of these genes are:
* [[DAT1]]  is the dopamine transporter gene which is responsible for the active reuptake of dopamine from the neural synapse. DAT1 [[polymorphism (biology)|polymorphism]]s have been shown to be linked to hyperactivity and ADHD.<ref name="Brookes">{{cite journal |doi=10.1038/sj.mp.4001869 |title=The analysis of 51 genes in DSM-IV combined type attention deficit hyperactivity disorder: Association signals in DRD4, DAT1 and 16 other genes |year=2006 |last1=Brookes |first1=K |last2=Xu |first2=X |last3=Chen |first3=W |last4=Zhou |first4=K |last5=Neale |first5=B |last6=Lowe |first6=N |last7=Aneey |first7=R |last8=Franke |first8=B |last9=Gill |first9=M |last10=Ebstein |first10=R |last11=Buitelaar |first11=J |last12=Sham |first12=P |last13=Campbell |first13=D |last14=Knight |first14=J |last15=Andreou |first15=P |last16=Altink |first16=M |last17=Arnold |first17=R |last18=Boer |first18=F |last19=Buschgens |first19=C |last20=Butler |first20=L |last21=Christiansen |first21=H |last22=Feldman |first22=L |last23=Fleischman |first23=K |last24=Fliers |first24=E |last25=Howe-Forbes |first25=R |last26=Goldfarb |first26=A |last27=Heise |first27=A |last28=Gabriëls |first28=I |last29=Korn-Lubetzki |first29=I |last30=Marco |first30=R |journal=Molecular Psychiatry |volume=11 |issue=10 |pages=934–53 |pmid=16894395|s2cid=6266643 |display-authors=8 |doi-access=free }}</ref>  
* [[DRD4]] is the dopamine D4 receptor gene and is associated with ADHD and novelty seeking behaviors.<ref name="Wallis" /><ref name="Ptacek">{{cite journal |doi=10.12659/MSM.881925 |title=Dopamine D4 receptor gene DRD4 and its association with psychiatric disorders |year=2011 |last1=Ptacek |first1=Radek |last2=Kuzelova |first2=Hana |last3=Stefano |first3=George B. |journal=Medical Science Monitor |volume=17 |issue=9 |pages=RA215–20 |pmid=21873960 |pmc=3560519}}</ref> It has been proposed that novelty seeking is associated with impulsivity.  Mice deficient for DRD4 have shown less behavioral responses to novelty.<ref name="Dulawa">{{cite journal |first1=Stephanie C. |last1=Dulawa |first2=David K. |last2=Grandy |first3=Malcolm J. |last3=Low |first4=Martin P. |last4=Paulus |first5=Mark A. |last5=Geye |title=Dopamine D4 Receptor-Knock-Out Mice Exhibit Reduced Exploration of Novel Stimuli |journal=The Journal of Neuroscience |pmid=10531457 |pmc=6782928 |year=1999 |volume=19 |issue=21 |pages=9550–6|doi=10.1523/JNEUROSCI.19-21-09550.1999 }}</ref>
* [[5HT2A]] is the serotonin receptor gene.  The serotonin 2A receptor gene has been associated with both hyper locomotion, ADHD, as well as impulsivity.  Subjects with a particular polymorphism of the 5HT2A gene made more commission errors during a punishment-reward condition in a go/no-go task.<ref name="Nomura">{{cite journal |doi=10.1007/s00213-006-0398-z |title=Involvement of a polymorphism in the 5-HT2A receptor gene in impulsive behavior |url=https://archive.org/details/sim_psychopharmacology_2006-07_187_1/page/30 |year=2006 |last1=Nomura |first1=Michio |last2=Kusumi |first2=Ichiro |last3=Kaneko |first3=Masayuki |last4=Masui |first4=Takuya |last5=Daiguji |first5=Makoto |last6=Ueno |first6=Takeji |last7=Koyama |first7=Tsukasa |last8=Nomura |first8=Yasuyuki |journal=Psychopharmacology |volume=187 |pages=30–5 |pmid=16767413 |issue=1 |s2cid=12155339 }}</ref>
* [[HTR2B]] a serotonin receptor gene.<ref>{{cite journal |doi=10.1038/nature09629 |title=A population-specific HTR2B stop codon predisposes to severe impulsivity |year=2010 |last1=Bevilacqua |first1=Laura |last2=Doly |first2=Stéphane |last3=Kaprio |first3=Jaakko |last4=Yuan |first4=Qiaoping |last5=Tikkanen |first5=Roope |last6=Paunio |first6=Tiina |last7=Zhou |first7=Zhifeng |last8=Wedenoja |first8=Juho |last9=Maroteaux |first9=Luc |last10=Diaz |first10=Silvina |last11=Belmer |first11=Arnaud |last12=Hodgkinson |first12=Colin A. |last13=Dell'Osso |first13=Liliana |last14=Suvisaari |first14=Jaana |last15=Coccaro |first15=Emil |last16=Rose |first16=Richard J. |last17=Peltonen |first17=Leena |last18=Virkkunen |first18=Matti |last19=Goldman |first19=David |journal=Nature |volume=468 |issue=7327 |pages=1061–6 |pmid=21179162 |pmc=3183507|display-authors=8 |bibcode=2010Natur.468.1061B }}</ref>
* [[CTNNA2]] encodes for a brain-expressed α-catenin that has been associated with Excitement-Seeking in a [[genome-wide association study]] (GWAS) of 7860 individuals.<ref name=":0">{{cite journal |doi=10.1038/tp.2011.42 |title=Meta-analysis of genome-wide association studies identifies common variants in CTNNA2 associated with excitement-seeking |year=2011 |last1=Terracciano |first1=A |last2=Esko |first2=T |last3=Sutin |first3=A R |last4=De Moor |first4=M H M |last5=Meirelles |first5=O |last6=Zhu |first6=G |last7=Tanaka |first7=T |last8=Giegling |first8=I |last9=Nutile |first9=T |last10=Realo |first10=A |last11=Allik |first11=J |last12=Hansell |first12=N K |last13=Wright |first13=M J |last14=Montgomery |first14=G W |last15=Willemsen |first15=G |last16=Hottenga |first16=J-J |last17=Friedl |first17=M |last18=Ruggiero |first18=D |last19=Sorice |first19=R |last20=Sanna |first20=S |last21=Cannas |first21=A |last22=Räikkönen |first22=K |last23=Widen |first23=E |last24=Palotie |first24=A |last25=Eriksson |first25=J G |last26=Cucca |first26=F |last27=Krueger |first27=R F |last28=Lahti |first28=J |last29=Luciano |first29=M |last30=Smoller |first30=J W |journal=Translational Psychiatry |volume=1 |issue=10 |pages=e49– |pmid=22833195 |pmc=3309493|display-authors=8 }}</ref>

== Intervention ==

=== Interventions to impact impulsivity generally ===

While impulsivity can take on pathological forms (e.g. substance use disorder, ADHD), there are less severe, non-clinical forms of problematic impulsivity in many people's daily lives.  Research on the different facets of impulsivity can inform small interventions to change decision making and reduce impulsive behavior<ref name="Ratner et al 2008">{{cite journal |doi=10.1007/s11002-008-9044-3 |title=How behavioral decision research can enhance consumer welfare: From freedom of choice to paternalistic intervention |year=2008 |last1=Ratner |first1=Rebecca K. |last2=Soman |first2=Dilip |last3=Zauberman |first3=Gal |last4=Ariely |first4=Dan |last5=Carmon |first5=Ziv |last6=Keller |first6=Punam A. |last7=Kim |first7=B. Kyu |last8=Lin |first8=Fern |last9=Malkoc |first9=Selin |last10=Small |first10=Deborah A. |last11=Wertenbroch |first11=Klaus |journal=Marketing Letters |volume=19 |issue=3–4 |pages=383–397|s2cid=5880506 |display-authors=8 }}</ref> For example, changing cognitive representations of rewards (e.g. making long term rewards seem more concrete) and/or creating situations of "[[precommitment]]" (eliminating the option of changing one's mind later)  can reduce the preference for immediate reward seen in delay discounting.<ref name=" Ratner et al 2008" />

==== Brain training ====
Brain training interventions include laboratory-based interventions (e.g. training using tasks like go/no go) as well as community, family, and school based interventions that are ecologically valid (e.g. teaching techniques for regulating emotions or behaviors) and can be used with individuals with non-clinical levels of impulsivity.<ref name="Berkman et al 2012">{{cite journal |doi=10.1111/j.1750-8606.2012.00248.x |title=Training Self-Control: A Domain-General Translational Neuroscience Approach |year=2012 |last1=Berkman |first1=Elliot T. |last2=Graham |first2=Alice M. |last3=Fisher |first3=Philip A. |journal=Child Development Perspectives |pages=374–384|pmc=3722070 |pmid=23894251 |volume=6|issue=4 }}</ref>  Both sorts of interventions are aimed at improving executive functioning and self-control capacities, with different interventions specifically targeting different aspects of executive functioning like inhibitory control, working memory, or attention.<ref name=" Berkman et al 2012" /> Emerging evidence suggests that brain training interventions may succeed in impacting executive function, including inhibitory control.<ref name="Hoffman et al 2012">{{cite journal |doi=10.1016/j.tics.2012.01.006 |title=Executive functions and self-regulation |year=2012 |last1=Hofmann |first1=Wilhelm |last2=Schmeichel |first2=Brandon J. |last3=Baddeley |first3=Alan D. |journal=Trends in Cognitive Sciences |volume=16 |issue=3 |pages=174–80 |pmid=22336729 |s2cid=13309571 }}</ref> Inhibitory control training specifically is accumulating evidence that it can help individuals resist temptation to consume high calorie food<ref name="Houben Jansen 2011">{{cite journal |doi=10.1016/j.appet.2010.12.017 |title=Training inhibitory control. A recipe for resisting sweet temptations |year=2011 |last1=Houben |first1=Katrijn |last2=Jansen |first2=Anita |journal=Appetite |volume=56 |issue=2 |pages=345–9 |pmid=21185896|s2cid=10664026 |url=https://zenodo.org/record/894400 }}</ref> and drinking behavior.<ref name="Houben Nederkorn 2011">{{cite journal |doi=10.1016/j.drugalcdep.2010.12.011 |title=Resisting temptation: Decreasing alcohol-related affect and drinking behavior by training response inhibition |year=2011 |last1=Houben |first1=Katrijn |last2=Nederkoorn |first2=Chantal |last3=Wiers |first3=Reinout W. |last4=Jansen |first4=Anita |journal=Drug and Alcohol Dependence |volume=116 |pages=132–6 |pmid=21288663 |issue=1–3|url=https://cris.maastrichtuniversity.nl/ws/files/73261520/Jansen_2011_Resisting_temptation_decreasing_alcohol_related.pdf }}</ref> Some have voiced concerns that  the favorable results of studies testing working memory training should be interpreted with caution, claiming that conclusions regarding changes to abilities are measured using single tasks, inconsistent use of working memory tasks, no-contact control groups, and subjective measurements of change.<ref name="Shipstead et al 2012">{{cite journal |doi= 10.1037/a0027473 |title= Is working memory training effective? |url= https://archive.org/details/sim_psychological-bulletin_2012-07_138_4/page/628 |year= 2012 |last1= Shipstead |first1= Zach |last2= Redick |first2= Thomas S. |last3= Engle |first3= Randall W. |journal= Psychological Bulletin |volume= 138 |issue= 4 |pages= 628–54 |pmid=22409508 |s2cid=14152894 }}</ref>

=== Treatment of specific disorders of impulsivity ===
Behavioral, psychosocial, and psychopharmacological treatments for disorders involving impulsivity are common.

==== Psychopharmacological intervention ====
Psychopharmacological intervention in disorders of impulsivity has shown evidence of positive effects; common pharmacological interventions include the use of stimulant medication, [[selective serotonin reuptake inhibitor]]s (SSRIs) and other [[antidepressant]]s.<ref name="Dell'Osso 2006"/> ADHD has a well-established evidence base supporting the use of [[stimulant]] medication for the reduction of ADHD symptoms.<ref name="Swanson et al 2001">{{cite journal |doi=10.1097/00004583-200102000-00011 |pmid=11211365 |title=Clinical Relevance of the Primary Findings of the MTA: Success Rates Based on Severity of ADHD and ODD Symptoms at the End of Treatment |year=2001 |last1=Swanson |first1=James M. |last2=Kraemer |first2=Helena C. |last3=Hinshaw |first3=Stephen P. |last4=Arnold |first4=L. Eugene |last5=Conners |first5=C. Keith |last6=Abikoff |first6=Howard B. |last7=Clevenger |first7=Walter |last8=Davies |first8=Mark |last9=Elliott |first9=Glen R. |last10=Greenhill |first10=Laurence L. |last11=Hechtman |first11=Lily |last12=Hoza |first12=Betsy |last13=Jensen |first13=Peter S. |last14=March |first14=John S. |last15=Newcorn |first15=Jeffrey H. |last16=Owens |first16=Elizabeth B. |last17=Pelham |first17=William E. |last18=Schiller |first18=Ellen |last19=Severe |first19=Joanne B. |last20=Simpson |first20=Steve |last21=Vitiello |first21=Benedetto |last22=Wells |first22=Karen |last23=Wigal |first23=Timothy |last24=Wu |first24=MIN |journal=Journal of the American Academy of Child & Adolescent Psychiatry |volume=40 |issue=2 |pages=168–79|s2cid=4638728 |display-authors=8 }}</ref> Pathological gambling has also been studied in drug trials, and there is evidence that gambling is responsive to [[selective serotonin reuptake inhibitor|SSRI]]s and other [[antidepressant]]s.<ref name="Dell'Osso 2006"/>  Evidence based pharmacological treatment for trichotillomania is not yet available, with mixed results of studies investigating the use of SSRIs, though [[cognitive behavioral therapy]] has shown positive effects.<ref name="Dell'Osso 2006"/> Intermittent explosive disorder is most often treated with mood stabilizers, SSRIs, [[beta blocker]]s, alpha agonists, and [[anti-psychotic]]s (all of which have shown positive effects).<ref name="Dell'Osso 2006"/> There is evidence that some pharmacological interventions are efficacious in treating substance-use disorders, though their use can depend on the type of substance that is abused.<ref name="McGovern Carroll 2003">{{cite journal |doi=10.1016/S0193-953X(03)00073-X |title=Evidence-based practices for substance use disorders |year=2003 |last1=McGovern |first1=Mark P |last2=Carroll |first2=Kathleen M |journal=Psychiatric Clinics of North America |volume=26 |issue=4 |pages=991–1010 |pmid=14711132 |pmc=3678283}}</ref>  Pharmacological treatments for substance-use disorders include  [[acamprosate]], [[buprenorphine]], [[disulfiram]], [[LAAM]], [[methadone]], and [[naltrexone]].<ref name=" McGovern Carroll 2003"/>

==== Behavioral interventions ====
Behavioral interventions also have a fairly strong evidence base in impulse-control disorders.<ref name="Dell'Osso 2006"/> In ADHD, the behavioral interventions of [[Parent Management Training|behavioral parent training]], behavioral classroom management, and intensive peer-focused behavioral interventions in recreational settings meet stringent guidelines qualifying them for [[Evidence-based practice|evidence based treatment]] status.<ref name="Pelham Fabiano 2008">{{cite journal |doi=10.1080/15374410701818681 |pmid=18444058 |title=Evidence-Based Psychosocial Treatments for Attention-Deficit/Hyperactivity Disorder |year=2008 |last1=Pelham |first1=William E. |last2=Fabiano |first2=Gregory A. |journal=Journal of Clinical Child & Adolescent Psychology |volume=37 |issue=1 |pages=184–214|s2cid=829396 }}</ref> In addition, a recent meta-analysis of evidence-based ADHD treatment found organization training to be a well-established treatment method.<ref name=Evans2014>{{cite journal|last1=Evans|first1=SW|last2=Owens|first2=JS|last3=Bunford|first3=N|title=Evidence-based psychosocial treatments for children and adolescents with attention-deficit/hyperactivity disorder.|journal=Journal of Clinical Child and Adolescent Psychology|date=2014|volume=43|issue=4|pages=527–51|pmid=24245813|doi=10.1080/15374416.2013.850700|pmc=4025987}}</ref> Empirically validated behavioral treatments for substance use disorder are fairly similar across substance use disorders, and include [[Integrative behavioral couples therapy|behavioral couples therapy]], [[Cognitive behavioral therapy|CBT]], [[contingency management]], [[motivational interviewing|motivational enhancement therapy]], and [[relapse prevention]].<ref name=" McGovern Carroll 2003"/>  Pyromania and kleptomania are understudied (due in large part to the illegality of the behaviors), though there is some evidence that psychotherapeutic interventions (CBT, short term counseling, day treatment programs) are efficacious in treating pyromania, while kleptomania seems to be best addressed using SSRIs.<ref name="Dell'Osso 2006"/>  Additionally, therapies including CBT, family therapy, and [[social skills|social skill]] training have shown positive effects on explosive aggressive behaviors.<ref name="Dell'Osso 2006"/>

== See also ==
* [[Affect (psychology)|Affect]]
* [[ADHD]]
* [[Addiction]]
* [[Creativity]]
* [[Deferred gratification]]
* [[Drive theory]]
* [[Emotion]]
* [[Feeling]]
* [[Gaffe]]
* [[Instinct]]
* [[Impulse control disorder]]
* [[Sensation seeking]]
* [[Novelty seeking]]
* [[Alternative five model of personality]]

==References==
{{Reflist|3}}

==Further reading==
*{{cite journal |last1=Evenden |first1=J. L. |title=Varieties of impulsivity |journal=Psychopharmacology |date=21 October 1999 |volume=146 |issue=4 |pages=348–361 |doi=10.1007/PL00005481 |pmid=10550486 |s2cid=5972342 }}
*{{cite journal |last1=Hollander |first1=E. |last2=Rosen |first2=J. |title=Impulsivity |journal=Journal of Psychopharmacology |date=March 2000 |volume=14 |issue=2_suppl1 |pages=S39–S44 |doi=10.1177/02698811000142S106 |pmid=10888030 |s2cid=243171966 }}
*{{cite journal |last1=Moeller |first1=F. Gerard |last2=Barratt |first2=Ernest S. |last3=Dougherty |first3=Donald M. |last4=Schmitz |first4=Joy M. |last5=Swann |first5=Alan C. |title=Psychiatric Aspects of Impulsivity |url=https://archive.org/details/sim_american-journal-of-psychiatry_2001-11_158_11/page/1783 |journal=American Journal of Psychiatry |date=November 2001 |volume=158 |issue=11 |pages=1783–1793 |doi=10.1176/appi.ajp.158.11.1783 |pmid=11691682 }}
*{{cite journal |last1=Chamberlain |first1=Samuel R |last2=Sahakian |first2=Barbara J |title=The neuropsychiatry of impulsivity |journal=Current Opinion in Psychiatry |date=May 2007 |volume=20 |issue=3 |pages=255–261 |doi=10.1097/YCO.0b013e3280ba4989 |pmid=17415079 |s2cid=22198972 }}

==External links==

*{{Commons category-inline}}
*Impulsive [https://www.impulsiveinfo.com/ Info]{{dead link|date=March 2025|bot=medic}}{{cbignore|bot=medic}}

{{Borderline personality disorder}}
{{adhd}}
{{Psychopathy}}

[[Category:Symptoms and signs of mental disorders]]
[[Category:Personality traits]]
[[Category:Personality psychology]]
[[Category:Symptoms or signs related to personality features]]