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Précis of Breakdown of Will.

Behavioral science has long been puzzled by the experience of temptation, the resulting impulsiveness, and the variably successful control of this impulsiveness. In conventional theories, a governing faculty like the ego evaluates future choices consistently over time, discounting their value for delay exponentially, that is, by a constant rate; impulses arise when this ego is confronted by a conditioned appetite. Breakdown of Will (Ainslie 2001) presents evidence that contradicts this model. Both people and nonhuman animals spontaneously discount the value of expected events in a curve where value is divided approximately by expected delay, a hyperbolic form that is more bowed than the rational, exponential curve. With hyperbolic discounting, options that pay off quickly will be temporarily preferred to richer but slower-paying alternatives, a phenomenon that, over periods from minutes to days, can account for impulsive behaviors, and over periods of fractional seconds can account for involuntary behaviors. Contradictory reward-getting processes can in effect bargain with each other, and stable preferences can be established by the perception of recurrent choices as test cases (precedents) in recurrent intertemporal prisoner's dilemmas. The resulting motivational pattern resembles traditional descriptions of the will, as well as of compulsive phenomena that can now be seen as side-effects of will: over-concern with precedent, intractable but circumscribed failures of self-control, a motivated ("dynamic") unconscious, and an inability to exploit emotional rewards. Hyperbolic curves also suggest a means of reducing classical conditioning to motivated choice, the last necessary step for modeling many involuntary processes like emotion and appetite as reward-seeking behaviors; such modeling, in turn, provides a rationale for empathic reward and the "construction" of reality.

Animals↗

Compulsive features in the eating disorders: a role for trauma?

There is considerable evidence of a link between reported childhood trauma and the current presence of impulsive behaviors in eating-disordered populations. However, there is no research testing the possibility of links with compulsive behaviors in this group, despite evidence that both impulsive and compulsive behaviors can serve to affect regulation functions. This study of 62 eating-disordered women examined potential links between different forms of reported childhood trauma (emotional, physical, sexual) and current compulsive behaviors (cleaning, checking). Each woman was interviewed to establish diagnosis, reported trauma history, and the presence of compulsive checking and cleaning behaviors. Chi-squared analyses demonstrated that there were no associations of either emotional or physical abuse with checking or cleaning behaviors. However, there was a significant association of reported childhood sexual abuse with the presence of cleaning behaviors. Although further research is needed to establish the generalizability of this conclusion across diagnostic group and measures, it implies that treatment of eating-disordered patients with comorbid compulsive cleaning behaviors might need to include a focus on the cognitive and affective consequences of childhood sexual abuse.

Compulsive Behavior↗

Children should be seen and heard: self-report of feelings and behaviors in primary-school-age children with ADHD.

OBJECTIVE: The belief that children with externalizing disorders have difficulties with self-awareness raises the question of whether children with externalizing disorders are good informants of their own behavior. METHOD: This study investigates how children with ADHD rate their behaviors compared to children without ADHD on a new rating scale (the Self-Evaluation Scale for Children). RESULTS: Preliminary results indicate that this rating scale has acceptable reliability and validity. Furthermore, children with ADHD are found to provide useful information about their feelings and behaviors. Compared to children without ADHD, children with ADHD report more disorganized, disruptive, and impulsive behaviors; poorer self-perception; and poorer social and communication skills. They do not report any less interest in school activities nor more anxiety than the children without ADHD. CONCLUSION: These findings suggest that children with ADHD are more self-aware than previously thought, and this information should inform our clinical and research practice.

Adolescent↗

[Low serum cholesterol and suicidal behavior].

An increasing number of studies have shown that low serum cholesterol levels are associated with a risk of suicidal, violent, and impulsive behaviors. This article reviewed the literature on this possible association. Several randomized controlled trials of lowering cholesterol interventions did not reduce total mortality in spite of reduced mortality due to coronary heart disease. This is partly attributable to an increased mortality rate of death due to suicide or accidents among individuals with lowered serum cholesterol. Cohort studies have shown that individuals with low serum cholesterol levels are more likely to present depressive symptoms and suicidal acts in later years than those with higher cholesterol levels. Many studies comparing suicidal and control subjects have found an association between low serum cholesterol and suicidal behavior. Although contradictive results are also reported, further studies are warranted to conclude the possible relationship between low or lowering serum cholesterol and suicidal behavior. Clinicians should be aware of potential effects of lowering cholesterol interventions on behavioral symptoms.

Anticholesteremic Agents↗

Testing a mediational model of sexually aggressive behavior in nonincarcerated perpetrators.

This study examined a psychological model of male sexually aggressive behavior toward women. Forty-seven men who reported completing or attempting acts that legally represent rape in most states and 56 nonviolent men completed measures assessing early home environment, attitudes regarding women and relationships, impulsive behaviors, and peers' characteristics. As predicted, sexually aggressive behavior was associated with exposure to negative childhood experiences with fathers. These experiences included reports of emotionally distant, uncaring fathers and witnessing father-perpetrated domestic violence. The relationship between poorer fathering and sexually aggressive behavior was partially mediated by impulse control problems as a young adult. Although having delinquent peers and endorsements of hostile attitudes toward women and rigid sex-role beliefs, predicted perpetration, contrary to expectations, neither mediated the relationship between poorer fathering and perpetration.

Adolescent↗

A short-term longitudinal study of impulsivity and antisocial behavior.

This study analyzes the relationships between impulsivity and antisocial behavior in a noninstitutionalized sample, taking into account the multidimensional nature of impulsivity and the diversity of types of antisocial behavior. Data were obtained in 1989 and 1990 from 1,226 adolescents aged 12-18 years (583 boys and 643 girls) as part of a longitudinal study of risk factors for drug abuse and delinquency. The patterns of stability or change of the various dimensions of antisocial behavior (rule breaking, vandalism, theft, aggression, and drug taking) in relation to impulsivity were investigated. The results support that self-report measures of impulsivity are closely correlated with antisocial behavior among adolescents. The longitudinally oriented analysis of this work also shows that impulsivity is associated with a future increase in antisocial behavior.

Adolescent↗

Testing a four-factor model of psychopathy and its association with ethnicity, gender, intelligence, and violence.

Although a 2-factor model has advanced research on the psychopathy construct, a 3-factor model was recently developed that emphasized pathological personality and eliminated antisocial behavior. However, dropping antisocial behavior from the psychopathy construct may not be advantageous. Using a large sample of psychiatric patients from the MacArthur Risk Assessment Study (J. Monahan & H. J. Steadman, 1994), the authors used confirmatory factor analysis to test a 4-factor model of psychopathy, which included interpersonal, affective, and behavioral impulsivity dimensions and an antisocial behavior dimension. Model fit was good for this 4-factor model, even when ethnicity, gender, and intelligence variables were included in the model. Structural equation modeling was used to compare the 3- and 4-factor models in predicting proximal (violence) and distal (intelligence) correlates of psychopathy.

Adult↗

Comparison of the alcohol-preferring P rat to the Wistar rat in behavioral tests of impulsivity and anxiety.

To determine whether the selectively bred alcohol preferring P rat displays impulsive and anxiety-related behaviors, as have been noted in Type 2 human alcoholics, P rats were compared with outbred Wistar rats, the strain from which P rats were derived, on a series of behaviors reflecting impulsivity and anxiety. The two groups were also compared on their volitional consumption of ethanol. When compared with the Wistar rats, the P rats preferred a higher concentration of ethanol and imbibed a much greater amount of ethanol when they were offered their preferred concentration. However, the behavioral tasks produced inconsistent results. The P rats completed 100 bar presses for food in less time when tested on a constant reinforcement schedule, which suggests that they are hyperactive compared to Wistar rats. However, the P rats also emitted a higher percentage of reinforced responses on differential reinforcement of low rate responding (DRL)-10s and gnawed less from a cork stopper, which suggests that they are less impulsive and possibly neophobic. The two groups did not differ on emergence into or activity in an open field, their activity in or open-arm duration in the elevated plus maze, or performance on DRL-5s and DRL-15s. Collectively, the behavioral data suggest that P rat does not serve as a model for the anxiety and impulsiveness associated with the Type 2 alcoholic individual.

Alcohol Drinking↗

Association of aggressive behavior with altered serotonergic function in patients who are not suicidal.

OBJECTIVE: The purpose of this study was to determine whether aggression and serotonergic dysfunction are related in the absence of a history of suicidal behavior. Although serotonergic dysfunction has been implicated in aggressive and impulsive behavior, most studies of such behavior have included individuals with a history of suicide attempts. Low concentrations of CSF 5-hydroxyindoleacetic acid (5-HIAA) have been consistently associated with suicidal behavior, presenting a potential confound in the link between aggression and serotonergic dysfunction. METHOD: The authors examined the association between aggression and CSF 5-HIAA concentrations in a group of 64 patients who had different DSM-III-R axis I diagnoses and no past suicidal behavior. Aggressive (N=35) and nonaggressive (N=29) groups were defined by a median split on a six-item history of adulthood aggressive behavior. RESULTS: The aggressive group had significantly lower CSF 5-HIAA concentrations than the nonaggressive group. Aggressive individuals also scored significantly higher on self-report measures of hostility, impulsiveness, and sensation seeking. CSF 5-HIAA concentrations, however, did not correlate with self-reported hostility and impulsivity. CONCLUSIONS: There is an association between aggressive behavior and serotonergic dysfunction independent of suicidal behavior in patients with axis I disorders who exhibit relatively milder forms of aggressive behavior. Analogous to findings with suicidal behavior, a low concentration of CSF 5-HIAA is related to aggressive behavior but does not show the same relationship to the continuum of aggressive feelings and thoughts.

Adult↗

How is impulsivity related to depression in adolescence? Evidence from a French validation of the cognitive emotion regulation questionnaire.

The aim of this study was to validate a French version of the Cognitive Emotion Regulation Questionnaire (CERQ; Garnefski, N., Kraaij, V., & Spinhoven, P., 2001. Negative life events, cognitive emotion regulation and emotional problems. Personality and Individual Differences, 30, 1311-1327) and to explore its relationships with impulsivity and depression. Teenagers from a junior secondary (n=107, 13-16 years) and a secondary school (n=110, 15-19 years) completed the CERQ, which assesses regulation strategies in response to negative events. The secondary school adolescents also completed the UPPS Impulsive Behavior Scale (Whiteside, S. P., & Lynam, D. R., 2001. The five factor model and impulsivity: Using a structural model of personality to understand impulsivity. Personality and Individual Differences, 30, 669-689) and the Reynolds Adolescent Depression Scale (Reynolds, W. M., 1987. Reynolds Adolescent Depression Scale: Professional manual. Odessa, FL: Psychological Assessment Resources). Factor analysis for the CERQ confirmed the presence of the nine original regulation strategies. In the secondary school students, impulsivity was related to depression. A path analysis revealed that regulation strategies mediated this relationship. The role of emotion regulation in the development of adolescent psychopathology is discussed.

Adolescent↗

Longitudinal characterization of impulsivity phenotypes boosts signal for genomic correlates and heritability.

Genomic correlates of impulsivity have been identified in several genome-wide association studies (GWAS) using cross-sectional designs, but no studies have investigated the molecular genetic correlates of impulsivity phenotypes using longitudinally constructed traits. In 3860 unrelated European participants in the Avon Longitudinal Study of Parents and Children (ALSPAC), we constructed longitudinal phenotypes for delay discounting and impulsive personality traits (as measured by the UPPS-P impulsive behavior scales) via assessment at ages 24, 26, and 28. We conducted GWASs of impulsivity using both cross-sectional and longitudinal phenotypes, estimated heritability and their phenotypic and genetic correlations, and evaluated their association with recently-developed polygenic risk scores (PRSs) for the impulsivity indicators themselves and also related psychiatric conditions. Latent growth curve modeling revealed a stable intercept over time for all impulsivity phenotypes. High genetic correlation of cross-sectional measures over time suggested a stable genetic component for delay discounting (rg = 0.53-0.99) and sensation seeking (rg = 0.99). Heritability estimates of the stable longitudinal phenotypes substantively improved as compared to their cross-sectional counterparts, revealing a significant SNP-heritability for delay discounting (0.22; p = 0.03) and sensation seeking (0.35; p = 0.0007). Consistent with previous reports, GWAS and gene-based analyses revealed associations between specific longitudinal impulsivity indicators and CADM2 and NCAM1 genes. The PRSs for the impulsivity indicators and disorders related to self-regulation were also significantly associated with longitudinal impulsivity traits. Finally, we validated the associations between longitudinal impulsivity phenotypes and their PRSs in an independent 13-wave longitudinal study (n = 1019) and the benefit of longitudinal phenotypes in simulation studies. In this first longitudinal genetic study of impulsivity traits, the results revealed stable genomic correlates of delay discounting and sensation seeking over time and further validated the utility of recently-developed PRSs, both in relation to the observed traits and in connecting them to psychiatric disorders. More generally, these findings support using latent intercepts as novel longitudinal phenotypes to boost signal for heritability and genomic correlates of mechanisms contributing to psychiatric disease liability.

Humans↗

Brain Regional alpha-[11C]methyl-L-tryptophan trapping in impulsive subjects with borderline personality disorder.

OBJECTIVE: Neurotransmission of serotonin (or 5-hydroxytryptamine [5-HT]) is thought to be disturbed in patients exhibiting impulsive behaviors. However, until recently it has not been possible to test this hypothesis in the brains of living humans. METHOD: Unidirectional trapping of the 5-HT precursor analog alpha-[(11)C]methyl-L-tryptophan (alpha-[(11)C]MTrp) has been proposed as an index of 5-HT synthesis capacity. The authors measured brain regional alpha-[(11)C]MTrp trapping with positron emission tomography in medication-free subjects with borderline personality disorder (N=13) and a healthy comparison group (N=11). Impulsivity was assessed by using a laboratory measure of behavioral disinhibition, go/no-go commission errors. RESULTS: Compared to healthy men, the men with borderline personality disorder had significantly lower alpha-[(11)C]MTrp trapping in corticostriatal sites, including the medial frontal gyrus, anterior cingulate gyrus, superior temporal gyrus, and corpus striatum. In the women with borderline personality disorder, significantly lower alpha-[(11)C]MTrp trapping was seen in fewer regions, but in both men and women, negative correlations with impulsivity scores were identified in the medial frontal gyrus, anterior cingulate gyrus, temporal gyrus, and striatum. CONCLUSIONS: Low 5-HT synthesis capacity in corticostriatal pathways may contribute to the development of impulsive behaviors in persons with borderline personality disorder.

Adult↗

Critical involvement of dopaminergic neurotransmission in impulsive decision making.

BACKGROUND: Impulsive decision making, apparent as intolerance for reinforcement delay, is prominent in attention-deficit/hyperactivity disorder. Commonly prescribed for this condition, amphetamine (Adderall), reduces impulsive decision making; however, the neuropharmacologic mechanism of this effect of amphetamine is unclear. METHODS: We investigated the involvement of dopaminergic and noradrenergic neurotransmission in impulsive decision making in rats, using a delayed reward task. RESULTS: Amphetamine and methylphenidate decreased impulsive decision making, which was mimicked by the selective dopamine reuptake inhibitor GBR 12909 but not by the noradrenaline reuptake inhibitor desipramine. Impulsive choice was increased by the dopamine D1 receptor antagonist SCH-23390 but not the dopamine D2 receptor antagonist eticlopride. The effect of amphetamine on impulsive choice was attenuated by pretreatment with eticlopride, whereas amphetamine retained its effect on impulsivity in the presence of SCH-23390. The alpha2 adrenoceptor agonist clonidine increased impulsivity, but the alpha1 adrenoceptor agonist phenylephrine did not affect impulsive decision making. CONCLUSIONS: These data demonstrate an important role for dopaminergic neurotransmission in impulsive decision making, whereby tolerance to delay of reinforcement depends on dopamine D1 receptor activation. Activation of dopamine D2 receptors appears to mediate the beneficial effects of amphetamine on impulsive behavior. Noradrenergic neurotransmission may play a minor role in impulsive choice.

Adrenergic Uptake Inhibitors↗

Comparative symptomatological and evoked potential studies with d-amphetamine, thioridazine, and placebo in hyperkinetic children.

In a double-blind study, 62 hyperkinetic children were randomly assigned to 8 weeks of treatment with either placebo, thioridazine, or d-amphetamine. The overall clinical symptomatology improved with all three substances, although d-amphetamine was significantly superior to placebo and thioridazine. Out of eight symptom clusters rated by the parents, two improved significantly with placebo, one with thioridazine, and six with d-amphetamine. The d-amphetamine was superior to placebo in reducing muscular tension and superior to thioridazine in decreasing hyperactive-impulsive behavior, psychosomatic problems, and muscular tension. Out of four teachers' symptom clusters, inattentive-passive behavior was significantly improved by thioridazine (which was also superior to placebo), while hyperactivity was reduced by d-amphetamine. Quantitative evaluation of visual evoked potentials (VEPs) revealed an increase in latencies and decrease in amplitudes during thioridazine treatment. Paradoxically, d-amphetamine also increased latencies, while tending to augment amplitudes. Regression and correlation analysis of clinical symptomatology with VEP variables showed that the shorter the pretreatment latencies and the higher the amplitudes, the more disturbed was the child. Short latencies and small amplitudes in the pretreatment period were predictors of good therapeutic outcome with subsequent thioridazine treatment, while short latencies and high amplitudes were indicative of such with d-amphetamine treatment. During therapy, the greater the drug-induced augmentation of latencies, the greater the clinical improvement. Finally, VEP differences between therapy-responsive and -resistant patients were explored and discussed.

Administration, Oral↗

Behavioral disinhibition induced by tryptophan depletion in nonalcoholic young men with multigenerational family histories of paternal alcoholism.

OBJECTIVE: A deficit in serotonergic neurotransmission has been linked to impulsive behavior, as well as to disorders characterized by disinhibition. The present study tested the hypothesis that young men at high risk for alcoholism demonstrate greater behavioral disinhibition after acute dietary depletion of tryptophan, the amino acid precursor of serotonin. METHOD: A double-blind, placebo-comparison, between-subjects study design was used. Nonalcoholic young men with a multigenerational paternal family history of alcoholism (N = 13) or with no family history of alcoholism (N = 15) in two previous generations were administered mixtures of tryptophan-deficient amino acid to achieve plasma tryptophan depletion. Comparison subjects with a multigenerational paternal family history of alcoholism (N = 1) and comparison subjects with no family history of alcoholism (N = 18) were given a balanced mixture. Five hours after this, all were tested on a modified Taylor task and a go/ no-go task measuring aggressive response and disinhibition, respectively. RESULTS: Plasma tryptophan levels were reduced by 89% in both groups. Tryptophan depletion had no effect on aggressive response. In contrast, tryptophan-depleted individuals with a family history of alcoholism made more commission errors (responses to stimuli associated with punishment or loss of reward) than did tryptophan-depleted individuals with no family history of alcoholism and those receiving the balanced (comparison) mixture of amino acid in either group. CONCLUSIONS: Low serotonin levels may be implicated in the high disinhibition or impulsivity observed in some individuals with a genetic vulnerability to alcohol abuse or dependence.

Affect↗

Violence, sensation seeking, and impulsivity in schizophrenics found unfit to stand trial.

Many studies have confirmed an association between violent behavior, impulsivity, and sensation seeking in nonpsychotic subjects. Schizophrenic patients (n = 49) who had been found unfit to stand trial were investigated for violence, according to index offenses and longitudinal histories (before and after admission) for violence. Those charged with violent offenses were significantly more often married with children, and were equally likely to direct their assaultiveness to strangers, acquaintances, and family members. The nature of the index offense seemed to be a good indicator of general violent propensity. No significant differences were found on Barratt's Impulsivity Scale and Zuckerman's Sensation Seeking Scale, except that schizophrenic patients with negative histories of violence scored higher on the thrill and adventure subscale. No pattern of substance abuse differentiated the groups. Patients charged with violent offenses more often presented with persecutory delusions, but this did not extend to those whose histories were positive for repetitive violence. Although impulsivity and sensation seeking do not seem to cause violent behavior in this group, psychopathology can also only be regarded as a necessary but not sufficient determinant.

Adolescent↗

Low cerebrospinal fluid 5-hydroxyindoleacetic acid concentration differentiates impulsive from nonimpulsive violent behavior.

Relationships of impulsive and nonimpulsive violent behavior to cerebrospinal fluid (CSF) monoamines and their metabolic concentrations were studied in thirty-six violent offenders. A relatively low 5-hydroxyindoleacetic acid (5HIAA) concentration was found in the CSF of impulsive violent offenders. This was not true for the offenders who had premeditated their acts. Other CSF monoamine or metabolite concentrations were not significantly different between the two groups. Of the groups studied, impulsive violent offenders who had attempted suicide had the lowest 5HIAA levels. A low CSF 5HIAA concentration may be a marker of impulsivity rather than violence.

3,4-Dihydroxyphenylacetic Acid↗

Soft neurological signs and impulsivity in children.

To evaluate the relationship between soft neurological signs and various proposed dimensions of impulsivity (behavioral and cognitive), 31 boys (6-13 years, mean +/- SD 10.1 +/- 1.8) with disruptive behavior disorders, and 45 age-matched boys without DSM-III-R pathology, were independently assessed on clinical ratings of impulsivity, a battery of cognitive tests intended to score impulsive responding, and a neurological examination for soft signs. After being corrected for age, neurological soft signs correlated positively with impulsive responding on the Matching Familiar Figures Test (inpatients and normals) and the Continuous Performance Test (in normals), but not with IQ or clinical impulsivity rating scores. These findings suggest a relationship between neurological dysfunction/immaturity and performance on specific tasks requiring response inhibition, thus adding value to the cognitive assessment of impulsivity.

Adolescent↗