Impulsivity in Bipolar Disorder, Borderline Personality Disorder, ADHD

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Investigators observed that impulsivity increased in patients with bipolar disorder who also experienced a traumatic childhood experience.
Investigators observed that impulsivity increased in patients with bipolar disorder who also experienced a traumatic childhood experience.

Impulsivity is significantly associated with attention-deficit/hyperactivity disorder (ADHD) and borderline personality disorder (BPD) and is indicated in bipolar disorder (BD) with the presence of traumatic childhood experiences, according to a study published in the Journal of Affective Disorders.

Investigators sought to determine levels of impulsivity in participants with BP, BPD, and ADHD and in healthy control patients. They also examined whether a history of childhood maltreatment had an effect on the level of impulsivity. All participants underwent clinical interviews and completed self-reported questionnaires (Barratt Impulsivity Scale and the Childhood Trauma Questionnaire) and structured interviews. A total of 744 patients were then categorized into 5 groups and compared with 47 healthy control patients.

Using the Barratt Impulsivity Scale questionnaire, researchers found that impulsivity was significantly different among all 4 groups: BD, mean total score (mean), 47.0±12.4; BPD, mean, 65.7±17.4; ADHD, mean, 76.4±16.9; and control group, mean, 41.2±10.5. After the post hoc analysis, researchers observed there was no significant difference between Barratt Impulsivity Scale total scores for participants in the control group and participants in the BD group.

Similarly, Childhood Trauma Questionnaire scores were significantly different among the groups: BD, mean, 38.1±10.4; BPD, mean, 51.7±18.3; ADHD, mean, 46.1±14.7; and control group, mean, 34.4±12.7. Participants in the BP group reported more emotional abuse, emotional neglect, and physical neglect. Participants in the BPD group had significantly higher scores than the control and BP groups for all subscales.

The researchers noted that impulsivity was measured on the basis of a questionnaire as opposed to a neuropsychological test; however, the scale used in the study has been shown to adequately measure "real-life" impulsiveness, despite its limitations. The researchers also pointed out that they cannot be sure what medications or treatments the patients received.

Investigators stated that, "[the] level of global impulsivity differs significantly among disorders: with ADHD subjects being the most impulsive, followed by BPD subjects, then subjects diagnosed with BD and controls." In addition, the study also found a significant association between impulsivity and childhood trauma in a control group and for people with BD but not ADHD or BPD. The researchers suggested that "impulsivity might be more biologically determined in ADHD and BPD and more environmentally driven in BD and controls."

The researchers concluded that impulsivity is likely not a feature of BD and is rather associated with the presence of traumatic childhood experiences.

Reference

Richard-Lepouriel H, Kung A-L, Hasler R, et al. Impulsivity and its association with childhood trauma experiences across bipolar disorder, attention deficit hyperactivity disorder and borderline personality disorder. J Affect Disord. 2019;244:33-41.

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