Impulsivity in Borderline Personality Disorder: A Matter of Disturbed Impulse Control or a Facet of Emotional Dysregulation?

Abstract

Impulsivity is regarded as a clinical, diagnostic and pathophysiological hallmark of borderline personality disorder (BPD). Self-report measures of impulsivity consistently support the notion of higher impulsive traits in BPD patients as compared to healthy control subjects. Laboratory tests of impulsivity, i.e. neuropsychological tests of impulse control render weak and inconsistent results both across different cognitive components of impulse control and within the same cognitive component of impulse control. One important factor worsening impulsive behaviors and impulse control deficits in BPD is comorbid attention-deficit/hyperactivity disorder (ADHD). In addition, emotional dysregulation interacts with impulse control especially for BPD salient emotions. In sum, although basic mechanisms of impulse control seem not to be disturbed in BPD, clinically well observed impulsive behaviors may be explained by comorbid ADHD or may be the consequence of dysregulation of BPD salient emotions.

Personality styles in a non-clinical sample: The role of emotion dysregulation and impulsivity

“…However, some scholars argued that impulsivity in PDs could only represent a facet of underlying emotion dysregulation (Sebastian, Jacob, Lieb, & Tüscher, 2013). In this case, when controlling for the variance explained by emotion dysregulation, impulsivity should no longer be significantly associated with PDs traits.…”

Using Functional Neuroimaging to Refine the Diagnostic Construct of Borderline Personality Disorder

“…It is readily apparent than an individual's sensitivity to emotion will likely impact their potential for emotion dysregulation, which certainly impacts their interpersonal relationships and their behavioral constraint. As has been highlighted, evidence suggests that emotion dysregulation may underlie behavioral impulsivity and interpersonal sensitivity [141,134], yet we also find suggestive evidence that interpersonal sensitivity (and rejection sensitivity) may underlie many of the other BPD symptoms [38,184]. The goal of this project, therefore, was not to determine, what is, once and for all the chicken and what is the egg in the BPD diagnosis, because that is a futile endeavor.…”

“…Still, though impulsivity is conceptualized as a discrete symptom domain in BPD, some researchers argue that impulsivity in BPD stems from emotion dysregulation, which better characterizes the disorder [134]. Evidence supports this argument, with studies finding that while individuals with BPD endorse higher levels of impulsivity as measured by self-report, laboratory measures have yielded inconsistent and weak findings for impulsivity in emotionally neutral situations [135,136].…”

Elucidating DSM-5 and ICD-11 Diagnostic Features of Borderline Personality Disorder Using Schemas and Modes

“…We considered this to be meaningful as the schema of Abandonment/Instability may generate instability in significant relationships in terms of schemas’ automatic striving for consistency eventually resulting in situations that prove the content of the schema [17]. Likewise, the manifest mode of impulsivity may indeed cause relational instability due to socially harmful impulsive behaviors [46]. …”

“…Moreover, this criterion was also strongly related to modes of Enraged Child and Bully and Attack, which may reflect the interpersonally harmful aspects of impulsive behaviors [46]. …”