By Stephen Propst
In order to fan the flames of mania or pacify the pain of depression, we are particularly prone to a more costly form of impulsivity.
You’re in the checkout aisle at the supermarket when you spontaneously grab a chocolate bar to be rung up as well. You’ve just made an impulse purchase. There are plenty of folks who do this every day.
But those of us who live with bipolar disorder face a more serious sort of impulsivity that moves us from cheap candy in the checkout lane to careless conduct in the fast lane. In order to fan the flames of mania or pacify the pain of depression, we are particularly prone to a more costly form of impulsivity.
Faces of impulsivity
According to Gerard Moeller, MD, professor of psychiatry and behavioral sciences at UT Medical School–Houston, impulsivity can be defined as “a predisposition toward rapid, unplanned reactions to internal or external stimuli without regard to the negative consequences of these reactions to the impulsive individual or to others.” In other words, a person acts or speaks without thinking or caring about the fallout.
Four major dimensions* of impulsivity have been identified:
- Urgency. You want something now, not later. So, you act rashly, giving in to your desire to avoid the negative feelings associated with resisting what you want.
- Lack of Premeditation. You don’t think about the future carefully, or at all. You act before you plan, and your big ideas rarely get off the ground.
- Lack of Perseverance. You act without discipline. You have poor follow-through, getting bored fast and giving up easily.
- Sensation Seeking. You crave excitement and have an intense need for the positive feelings associated with risky actions. You act without regard to consequences.
There is simply no limit to the chancy choices we can make in the midst of a mood swing. We can commit sexual indiscretions at a bar or online. We can spin slots in a casino or do dollar damage at the horse track. We can go on wild shopping sprees or invest in crazy schemes. We can drink too much or drive too fast. In living with bipolar, there have been countless times when I failed to control my compulsions, manage my mouth or abort my actions.
Kinds of Fallout
What price do we pay for acting on impulse? Impulsivity has far-reaching, often devastating consequences in at least eight areas:
- Personal: You experience shame and embarrassment, maybe even public humiliation.
- Emotional: Your self-esteem takes a huge hit.
- Relational: You lose friends and sabotage family dynamics.
- Social: You suffer the ramifications of others’ reactions to what you said or did.
- Vocational: You create upheaval in the workplace, and risk losing your job.
- Financial: You require major funding to fuel your addictions.
- Physical: You may contract an STD or liver disease, depending on your behavior.
- Spiritual: Your faith can be severely tested.
Moreover, there could be major legal implications. I know a fellow who set his house on fire while in a manic moment, and he spent 10 years in federal prison. I myself spent a little time in jail for driving impulsively (translation: driving over 100 mph!). But, I was lucky. The repercussions could have been far more serious. Another time, I hooked up with total strangers and took off on a spur-of-the-moment trip on a private jet. I once bought a new car without so much as kicking a tire. Later, I could have kicked myself! And, in a moment of misguided mania, I took a vehicle from my place of employment for a joyride, without permission and without thinking twice. In every instance, there was a price to pay, from facing shame and embarrassment to running up a debt to losing my job.
The Vicious Cycle
Figuring out exactly what provokes impulsivity is like asking what causes bipolar disorder. Neither answer is black-and-white. But it is suspected that, as with bipolar, brain chemistry is involved. Communication in the brain can become chemically unstable and out-of-control. And, unfortunately, rational thinking does not stop rash behavior.
In a high drive to numb the pain of low self-esteem (a common symptom of bipolar), we engage in reckless behavior. Impulsivity becomes a type of self-medication—a way to cope with underlying issues and calm mood swings.
Distressingly, it’s a fact that our tolerance for an impulsive behavior grows. We keep spending/carousing/gambling more and more with increasingly less regard for consequences.
Impulsivity also raises the risk of alcoholism and drug use. Moreover, after acting impulsively, those of us with bipolar can expect depression to follow. Now, not only do we have to wrestle with the aftermath of our behavior and our accompanying shame and embarrassment, but we must do so while in the midst of a depressed state.
Impulsivity can be one of the more complex symptoms of bipolar. Mania feeds impulsivity, and vice versa—it’s a vicious cycle. In pursuing treatment for bipolar, don’t fail to address impulsivity specifically.
Getting a Grip
So, how do you begin to get a handle on impulsivity?
At minimum, talk with your doctor or therapist. This may present another challenge, as impulsivity often involves embarrassing symptoms that neither you nor your doctor, may be comfortable talking about.
Sometimes, doctors are hesitant to burden patients with heavy labels, like “alcoholic” or “sex addict.” And, because they know that merely prescribing a pill can’t resolve these often deep-seated issues, they won’t address them, unless you do.
If broaching the subject is difficult, use this article as a bridge to get the conversation started.
How to Start Taking Control of Impulsivity
In addition to seeking professional help, you can take control of impulsivity in other ways. Let me give you A START.
- A – Acknowledge and accept. First and foremost, you must admit that a problem exists and must be addressed.
- S – Seek support. Attend a support group —from DBSA to AA or NA—based on what you’re confronting.
- T – Tame triggers. Guard against what you know provokes the impulsive behavior.
- A – Adjust attitude. Adopt a new, healthy, and positive mindset toward tackling the problem.
- R – Repair and replace. Repair past damage, and replace old habits and bad relationships with healthy ones.
- T – Tackle therapeutically. Take an active role in therapy, be transparent, and get to the root of underlying issues.
Managing impulsivity often requires putting particular precautions in place. It helps to have an agreed-upon plan with family/friends or with your doctor/therapist.
Depending on your impulsive tendencies, you may have to restrict or closely monitor Internet usage, arrange for safekeeping or supervision of credit cards, ATM cards, or even car keys, or even put a Power of Attorney into place.
Taking control of impulsivity is essential. When you don’t learn to control impulsivity, it can absolutely come to control you. And thinking there’s nothing you can do about it only increases the likelihood that the situation will remain “as is.”
The choices we make have consequences and sometimes lifelong implications. If you live with bipolar disorder and face a problem with impulsive behavior, it’s time to get A START on dealing with it. That’s one decision you don’t have to think about twice.
* UPPS Impulsive Behavior Scale (Whiteside and Lynam, 2001)
Used by permission.