by Michael D. Anestis, M.S.
As I begin the final section of my Abnormal Psychology class each semester, I often ask my students a fairly simple sounding question:
What is impulsivity?
Generally speaking, I receive some well thought-out responses that center on the idea of acting without thinking. After complimenting my students' responses, which are invariably strong, I ask a follow-up question:
What are some examples of impulsive behaviors?
What are some examples of impulsive behaviors?
Here's where things get tricky. Typical answers include substance use, self-injury, sky diving, gambling, physical aggression, yelling, shopping, extreme sports, and binge eating. That list is quite broad, I point out, and my students nod in agreement, as we all recognize two basic facts: these behaviors are not all the same and not every individual utilizes a behavior for the same reason. For example, while some individuals drink alcohol for social reasons, others drink to cope with negative emotions. Although drinking for social reasons can be problematic, those who drink to reduce negative emotions have, by far, the worst outcome (Cooper, 1992). So, we all know impulsivity when we see it, but it appears that defining it might be somewhat complicated.
The vague nature of the above list of behaviors is a prime example of the problems inherent in the concept of impulsivity. In fact, Lynam and Miller (2004) concluded that impulsivity is defined differently across so many different studies that it nearly impossible to provide a single, universally accepted definition. Gray (1970) defined impulsivity as an individual's sensitivity to and tendency to act upon reward cues. In other words, the degree to which an individual notices potentially rewarding stimuli and acts in a way to attain them determines the degree to which he is impulsive. The highly influential concepts of the Behavioral Activation System (BAS) and Behavioral Inhibition System (BIS) were formed on the basis of this definition.
Eysenck and Eysenck (1977) decided that impulsivity was slightly broader than Gray's conceptualization and defined it instead as a combination of taking risks, making swift decisions, and forsaking planning. This definition did not specify that individuals were highly sensitive to rewards, but rather focused on a behavioral tendency to act without considering consequences.
In another influential definition of impulsivity, Patton, Stanford, and Barratt (1995) indicated that the construct is comprised of three components: lack of planning, lack of focus on the task at hand, and the tendency to act without delay. This definition is fairly consistent with that of Eysenck and Eysenck (1977), but includes consideration of a difficulty in focusing on the current task.
Each of these definitions has been utilized in highly influential research and has helped us to better understand maladaptive behavioral patterns. The problem, however, is that these definitions still do not address the problems my students and I come across each semester when we look at our list of impulsive behaviors. For one thing, none of these definitions makes any mention of emotions as a component of impulsivity despite mountains of research indicating that affect plays a pivotal role in dysregulated behavior. Such weaknesses were the motivation for the creation of the UPPS Impulsive Behavior Scale (Whiteside & Lynam, 2001), which has since been revised and is now referred to as the UPPS-P Impulsive Behavior Scale (Cyders, Smith, Spillane, Fischer, Annus, & Peterson, 2007). The UPPS-P breaks the concept of impulsivity into five distinct subscales:
So why was it important to create this new assessment tool and to parse the construct of impulsivity into so many different components? Quite simply, because each of these subscales predicts different behavioral outcomes. In other words, by determining whether an individual exhibits high levels of one of these variables, we can have a better sense of her vulnerabilities to particular behaviors and mental illnesses. In this sense, the UPPS-P has similar utility to the functional model of non-suicidal self-injury, which was discussed in an earlier PBB post.
Sarah Fischer, one of the most influential researchers on this topic, will be providing an upcoming PBB featured article and we intend to write in depth on these variables in the coming weeks, but I want to provide a brief overview of the research on the UPPS-P in order to clarify the importance of thinking about a broad topic such as impulsivity in a more specific manner.
Negative urgency, the most heavily researched of these variables, has been shown to predict a variety of problematic outcomes. In particular, high levels of negative urgency have been shown to predict elevations in aggression, drinking alcohol to reduce negative affect, compulsive buying behaviors, hostile attribution style, substance use disorders, and early marijuana use in men (Billieux, Rochat, My Lien Rebetez, & Van der Linden, 2008; Fischer, Anderson, & Smith, 2004; Fischer, Smith, & Anderson, 2003; Lynam & Miller, 2004; Miller, Flory, Lynam, & Leukefeld, 2003; Verdejo-Garcia, Bechara, Recknor, & Perez-Garcia, 2007). Fischer and Smith (2008) found that negative urgency interacts with expectancies, such that high levels of negative urgency in combination with the expectation that a behavior will reduce negative emotions is highly predictive of the likelihood of using that behavior. The authors demonstrated this in a variety of dysregulated behaviors, including binge eating, problematic drinking, and gambling. Additionally, Anestis, Selby, and Joiner (2007) found that increases in levels of negative urgency predicted increases in drinking to reduce negative emotions, binge eating, and excessive reassurance seeking over a six-week period. Anestis, Selby, Fink, & Joiner (2007) found that negative urgency interacts with distress tolerance such that high levels of negative urgency and low levels of distress tolerance resulted in the greatest level of binge eating behaviors.
So what do all these findings tell us? Individuals with high levels of negative urgency are likely to engage in a variety of problematic behaviors when they are upset. Their use of such behaviors is driven in large part by their emotional experiences, indicating that such individuals are in need of training in emotion regulation skills. If negative urgency is, in fact, driving a behavior, it is thus imperative for a clinician to identify this fact, as the drive to reduce negative affect is often predictive of the worst outcome in behaviors such as alcohol consumption (Cooper, 1992).
What about the other scales? Although there is not as much research on the other scales as of yet, there is enough to demonstrate that, while they are all related to the broad idea of impulsivity, they are also quite distinct from one another. Sensation seeking, for instance, does not predict a similar list of behaviors. In fact, whereas negative urgency is negatively correlated with distress tolerance, sensation seeking is positively correlated with distress tolerance. In other words, individuals high in negative urgency typically can not tolerate much negative emotion whereas individuals high in sensation seeking are typically capable of tolerating significant negative emotional experiences. Additionally, whereas negative urgency is not significantly correlated with the acquired capability for suicide, sensation seeking is positively correlated with the acquired capability (Bender, Anestis, Anestis, & Joiner, 2009). Because individuals high in sensation seeking tend to engage in thrilling, dangerous behaviors, they habituate to fear and physiological pain and, over time, become capable of enacting lethal self-harm. Remember, the desire for suicide and the capability for suicide are distinct from one another, but this finding nonetheless is important as it means that, if an individual high in sensation seeking desires suicide, they are much more likely to utilize a lethal attempt method than is an individual low in sensation seeking.
The vague nature of the above list of behaviors is a prime example of the problems inherent in the concept of impulsivity. In fact, Lynam and Miller (2004) concluded that impulsivity is defined differently across so many different studies that it nearly impossible to provide a single, universally accepted definition. Gray (1970) defined impulsivity as an individual's sensitivity to and tendency to act upon reward cues. In other words, the degree to which an individual notices potentially rewarding stimuli and acts in a way to attain them determines the degree to which he is impulsive. The highly influential concepts of the Behavioral Activation System (BAS) and Behavioral Inhibition System (BIS) were formed on the basis of this definition.
Eysenck and Eysenck (1977) decided that impulsivity was slightly broader than Gray's conceptualization and defined it instead as a combination of taking risks, making swift decisions, and forsaking planning. This definition did not specify that individuals were highly sensitive to rewards, but rather focused on a behavioral tendency to act without considering consequences.
In another influential definition of impulsivity, Patton, Stanford, and Barratt (1995) indicated that the construct is comprised of three components: lack of planning, lack of focus on the task at hand, and the tendency to act without delay. This definition is fairly consistent with that of Eysenck and Eysenck (1977), but includes consideration of a difficulty in focusing on the current task.Each of these definitions has been utilized in highly influential research and has helped us to better understand maladaptive behavioral patterns. The problem, however, is that these definitions still do not address the problems my students and I come across each semester when we look at our list of impulsive behaviors. For one thing, none of these definitions makes any mention of emotions as a component of impulsivity despite mountains of research indicating that affect plays a pivotal role in dysregulated behavior. Such weaknesses were the motivation for the creation of the UPPS Impulsive Behavior Scale (Whiteside & Lynam, 2001), which has since been revised and is now referred to as the UPPS-P Impulsive Behavior Scale (Cyders, Smith, Spillane, Fischer, Annus, & Peterson, 2007). The UPPS-P breaks the concept of impulsivity into five distinct subscales:
Positive Urgency
The tendency to act rashly when experiencing positive emotions.
Negative Urgency
The tendency to act rashly when experiencing negative emotions.
Sensation Seeking
The tendency to seek out activities involving an element of risk or thrill.
(lack of) Premeditation
The tendency to act without deliberation
(lack of) Perseverance
The tendency to give up when activities become difficult or boring
The tendency to act rashly when experiencing positive emotions.
Negative Urgency
The tendency to act rashly when experiencing negative emotions.
Sensation Seeking
The tendency to seek out activities involving an element of risk or thrill.
(lack of) Premeditation
The tendency to act without deliberation
(lack of) Perseverance
The tendency to give up when activities become difficult or boring
So why was it important to create this new assessment tool and to parse the construct of impulsivity into so many different components? Quite simply, because each of these subscales predicts different behavioral outcomes. In other words, by determining whether an individual exhibits high levels of one of these variables, we can have a better sense of her vulnerabilities to particular behaviors and mental illnesses. In this sense, the UPPS-P has similar utility to the functional model of non-suicidal self-injury, which was discussed in an earlier PBB post.
Sarah Fischer, one of the most influential researchers on this topic, will be providing an upcoming PBB featured article and we intend to write in depth on these variables in the coming weeks, but I want to provide a brief overview of the research on the UPPS-P in order to clarify the importance of thinking about a broad topic such as impulsivity in a more specific manner.
Negative urgency, the most heavily researched of these variables, has been shown to predict a variety of problematic outcomes. In particular, high levels of negative urgency have been shown to predict elevations in aggression, drinking alcohol to reduce negative affect, compulsive buying behaviors, hostile attribution style, substance use disorders, and early marijuana use in men (Billieux, Rochat, My Lien Rebetez, & Van der Linden, 2008; Fischer, Anderson, & Smith, 2004; Fischer, Smith, & Anderson, 2003; Lynam & Miller, 2004; Miller, Flory, Lynam, & Leukefeld, 2003; Verdejo-Garcia, Bechara, Recknor, & Perez-Garcia, 2007). Fischer and Smith (2008) found that negative urgency interacts with expectancies, such that high levels of negative urgency in combination with the expectation that a behavior will reduce negative emotions is highly predictive of the likelihood of using that behavior. The authors demonstrated this in a variety of dysregulated behaviors, including binge eating, problematic drinking, and gambling. Additionally, Anestis, Selby, and Joiner (2007) found that increases in levels of negative urgency predicted increases in drinking to reduce negative emotions, binge eating, and excessive reassurance seeking over a six-week period. Anestis, Selby, Fink, & Joiner (2007) found that negative urgency interacts with distress tolerance such that high levels of negative urgency and low levels of distress tolerance resulted in the greatest level of binge eating behaviors.
So what do all these findings tell us? Individuals with high levels of negative urgency are likely to engage in a variety of problematic behaviors when they are upset. Their use of such behaviors is driven in large part by their emotional experiences, indicating that such individuals are in need of training in emotion regulation skills. If negative urgency is, in fact, driving a behavior, it is thus imperative for a clinician to identify this fact, as the drive to reduce negative affect is often predictive of the worst outcome in behaviors such as alcohol consumption (Cooper, 1992).
What about the other scales? Although there is not as much research on the other scales as of yet, there is enough to demonstrate that, while they are all related to the broad idea of impulsivity, they are also quite distinct from one another. Sensation seeking, for instance, does not predict a similar list of behaviors. In fact, whereas negative urgency is negatively correlated with distress tolerance, sensation seeking is positively correlated with distress tolerance. In other words, individuals high in negative urgency typically can not tolerate much negative emotion whereas individuals high in sensation seeking are typically capable of tolerating significant negative emotional experiences. Additionally, whereas negative urgency is not significantly correlated with the acquired capability for suicide, sensation seeking is positively correlated with the acquired capability (Bender, Anestis, Anestis, & Joiner, 2009). Because individuals high in sensation seeking tend to engage in thrilling, dangerous behaviors, they habituate to fear and physiological pain and, over time, become capable of enacting lethal self-harm. Remember, the desire for suicide and the capability for suicide are distinct from one another, but this finding nonetheless is important as it means that, if an individual high in sensation seeking desires suicide, they are much more likely to utilize a lethal attempt method than is an individual low in sensation seeking.
Using a term like "impulsive" to describe an individual's behavior thus misses the point. Impulsivity can mean many different things and the precise meaning plays a significant role in determining the nature of the behavior. Understanding the mechanism driving behaviors is thus important for a variety of reasons. First, as I began to demonstrate above and will demonstrate further in future posts, different mechanisms predict different outcomes. Secondly, if two individuals engage in the same behavior for different reasons (e.g., gambling to distract from negative emotions versus gambling to sustain positive emotions), they are likely to respond differently to treatment. The UPPS-P is a fairly new scale, but research on this topic is drawing a lot of attention and producing compelling results. As new findings are published, we will be sure to discuss them on PBB.
I would love to hear from readers regarding their thoughts on this scale. Do you think there are types of impulsivity not mentioned in the subscales? Do you think the subscales overlap too heavily? Do you think it matters whether an individual utilizes a behavior to reduce negative emotions or for some other reason? How do you think this scale can be used by therapists to help drive treatment?
If you would like to read more about the behaviors mentioned above, we recommend the following products, all of which are available through our online store:
- Understanding Nonsuicidal Self-Injury: Origins, Assessment, and Treatment
- Freedom from Selfharm: Overcoming Self-Injury with Skills from DBT and Other Treatments
- Cognitive-Behavioral Treatment of Borderline Personality Disorder
- Skills Training Manual for Treating Borderline Personality Disorder
- Crave: Why You Binge Eat and How to Stop
- Overcoming Binge Eating
- Handbook of Emotion Regulation
Mike Anestis is a doctoral candidate in the clinical psychology department at Florida State University.
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