Defining Features Of Personality Disorders: Impulse Control Problems

What is Impulse Control, and How Does it Affect Daily Life?

In the same manner that people with personality disorders may have challenges with affective (emotional) regulation, they also tend to have problems regulating their impulses. These can manifest as either overcontrolled or under-controlled impulses. (Under-controlled impulse control is commonly called a “lack of impulse control.”) We can think of impulse regulation along a continuum ranging from over-control to under-control, with healthy personalities falling somewhere in the middle between these two poles.

Impulse control is defined as the ability to resist a temptation, desire, or drive to perform a certain action.[1,2] It’s a skill that people can develop and improve upon over time, although some conditions, such as impulse control disorders (ICDs), can make it difficult to manage behaviors or reactions. ICDs can cause significant impairment in daily functioning and cause harm to the person with the condition as well as others.[3]

The Spectrum of Impulse Control

Everyone falls at different points on the impulse control spectrum, which encompasses a continuum of behaviors.

Overcontrol involves excessive inhibition and rigid self-regulation, often leading to emotional suppression and restricted expression.

On the other hand, under-control manifests as impulsivity and difficulty regulating behaviors, characterized by a lack of inhibition.

This spectrum provides a framework for understanding variations in self-regulation and their impact on people’s mental health and well-being. Impulse control plays a vital role in daily functioning and mental health, as it allows people to manage their emotions and make beneficial decisions. According to research, effective impulse control contributes to better emotional regulation and cognitive flexibility, promoting overall well-being and successful navigation of daily challenges.[5]

Overcontrolled vs. Under-Controlled Behaviors

Over-controlled	Under-controlled
Risk-averse and emotionally constricted	Impulsive and emotionally dysregulated
Cautious	Risk-taking
Patient and can delay gratification	Unable to delay gratification or rewards
Punctual	Unpunctual
Organized	Chaotic or disorganized

Overcontrolled vs. Under-Controlled Conditions

In some cases, individuals with the following conditions may exhibit under-controlled behavior:

• Borderline Personality Disorder
• Antisocial Personality Disorder
• Conduct Disorder
• During a manic episode
• Substance use disorder

Individuals with the following conditions may have over-controlled behaviors: 

• Internalizing disorders, such as depression and anxiety.

Some individuals with depression and anxiety (especially generalized anxiety disorder) may have difficulties with emotion regulation and impulse control, although it should be noted that these issues do not always manifest as over-control.

Striking a Balance

In some circumstances, the inhibition of our impulses promotes our success in both relationships and the workplace.

Two areas of particular concern are aggressive and sexual impulses. If we were to act on every aggressive or sexual impulse, we would easily get ourselves into a great deal of trouble.

On the other hand, the overcontrol of impulses leads to its own set of problems. A certain amount of carefully considered risk-taking is necessary to reap the benefits of creative expression, rewarding relationships, and successful problem-solving.

Some amount of risk-taking is part of the excitement, fun, and spontaneity associated with an enjoyable life. With too much impulse control, we end up feeling restricted, bored, and dull; with too little, we can face grave consequences. A balance between these two extreme poles of over- and under-control represents a healthy personality.

The challenge to strike the right balance of impulse control affects everyone from time to time, including people with healthy personalities. We all have had occasions where we behaved irresponsibly or unwisely and chose to act upon an impulse. At other times, we may have been too controlled, failing to take a risk that would have ultimately benefited us.

Understanding Impulse Control

Impulse control helps people regulate their behaviors by allowing them to pause, consider consequences, and make intentional choices rather than act impulsively.

An individual’s impulse control can be affected by many things, including:[6]

• Neurological factors such as neurotransmitter functioning and brain development
• Environmental influences, including social support, stress levels, and traumatic experiences
• Psychological factors such as personality traits and emotional regulation skills

Neurobiologically, impulse control is linked to the functioning of brain regions involved in decision-making, such as the prefrontal cortex, as well as neurotransmitter systems like dopamine regulation.[7]

Moreover, personality traits play a significant role in influencing impulse control, with conscientiousness and self-control positively associated with better regulation of impulses. Research also shows that people with high rates of conscientiousness tend to exhibit greater self-discipline and impulse control, while those low in conscientiousness may struggle with impulsivity.[8]

The Role of Flexibility in Impulse Control

Once again, flexibility enables healthy personalities to achieve the proper balance of impulse control most of the time. People with personality disorders are distinguished by the rigidity of their pattern of over- or under-control and the severity and persistence of their impulse control problems. 

Rigid and persistent overcontrol of impulses can manifest as inhibition, reluctance to do anything that involves uncertainty or risk, reluctance to start new things or try new activities, and over-conscientiousness or scrupulousness. 

On the other hand, rigid and persistent under-control can manifest as recklessness and a disregard for the rights and needs of others. This pattern can lead to dangerous problems such as drug use, risky sexual liaisons, overspending, assault, or self-injury.

Dr. Brindusa Vanta, MD, says, “Traditionally, psychological health focused on positive emotions, strengths, and meeting basic psychological needs. Psychological flexibility is now recognized as an essential factor. Psychological flexibility promotes adaptability, resilience, alignment with our personal values, and it supports healthy impulse control.”

Examples of Impulse Control Problems

Let’s look at two examples of specific personality disorders to illustrate over- or under-controlled impulses. 

It is important to note that impulse control issues may play a role in the behavior of individuals with Avoidant Personality Disorder and Obsessive-Compulsive Personality Disorder, but it is not a key determinant. A combination of factors, such as cognitive, emotional, and interpersonal influences, in addition to impulse control, contribute to the clinical presentation. 

Antisocial Personality Disorder

On the other side of the continuum, a lack of impulse control can manifest as a failure to plan or think about long-term consequences. Lack of impulse control is evidenced by such things as impulsive spending, risky sexual behavior, combative and assaultive behaviors, substance use, recklessness, gambling, and binge eating.

People with Antisocial Personality Disorder don’t really plan ahead, and they can engage in risky behavior because it feels good in the moment. They do not consider the consequences of their behavior or its effects on other people or themselves. This can lead to breaking the law, getting into trouble, and hurting others.

Dr.Brindusa Vanta, MD, says, “The description of Antisocial Personality Disorder above provides a brief explanation of the impulsivity associated with this condition. However, it is important to understand that the reckless behavior isn’t solely driven by immediate gratification. Other features of this personality disorder play a role in their behavior, like disregard for norms and lack of empathy.”

Borderline Personality Disorder

People with Borderline Personality Disorder can have similar problems. For someone with Borderline Personality Disorder, the inability to regulate their intense emotions, when coupled with poor impulse control, can lead to dire consequences. An emotion can become so intense that it becomes very difficult to avoid acting upon the immediate impulse or urge to do something.

Powerful negative emotions coupled with a lack of impulse control will often have disastrous results, such as assault or self-injury. Some impulsive behaviors, such as alcohol or other drug use, risky sex, and binge eating, can also function as coping mechanisms for people with Borderline Personality Disorder. These behaviors may represent ineffective attempts to cope with intense and difficult emotions. While the behavior may enable the person to feel relieved in the moment, it ultimately has harmful long-term consequences.

As we have emphasized throughout, three core features of personality disorders can have profound and negative impacts on interpersonal relationships: 
1) problems with disordered thinking
2) problems with affective regulation (feeling)
3) problems with impulse control (behavior)

As a result, the fourth core feature of personality disorders, which we are about to discuss, is considered the most significant and defining feature of all personality disorders.