A preliminary investigation of impulsivity in generalized anxiety disorder

Few studies have examined the association between impulsivity and generalized anxiety disorder (GAD). This study examined whether individuals with probable GAD display impulsivity in a particular way, and the extent to which impulsivity uniquely predicts GAD severity and GAD status, over and above intolerance of uncertainty (IU), a key cognitive factor in GAD. Individuals with (n = 63) and without (n = 77) probable GAD completed self-report measures of impulsivity and IU. Results revealed that elevations in the severity of GAD symptoms and in IU were associated with impulsive actions in the face of negative affect (i.e., negative urgency), but also greater premeditation and lower “functional” impulsivity (i.e., the ability to take quick action when it is advantageous to do so). Impulsivity led to an increment in the prediction of GAD symptoms and GAD status, over and above IU. Negative urgency and lower functional impulsivity were significant unique predictors of GAD severity or GAD status. The findings highlight a need to consider impulsivity in theories that implicate intolerance of negative affect and uncertainty in excessive and uncontrollable worry.     

Neurocognitive endophenotypes of impulsivity and compulsivity: towards dimensional psychiatry

A key criticism of the main diagnostic tool in psychiatry, the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-IV), is that it lacks a biological footing. In this article, we argue for a biological approach to psychiatry based on 'neurocognitive endophenotypes', whereby changes in behavioural or cognitive processes are associated with discrete deficits in defined neural systems. We focus on the constructs of impulsivity and compulsivity as key examples of the approach and discuss their possible cross-diagnostic significance, applying them to co-morbidities and commonalities across a range of disorders (attention-deficit/hyperactivity disorder, substance dependence, obsessive-compulsive disorder and eating disorders). We argue that this approach has important implications for the future classification of psychiatric disorders, genetics and therapeutics.     

Application of a behavioral theory of motivation to the concepts of anxiety and impulsivity

Gray's model has been employed in attempts to formulate theories concerning the processes underlying various types of psychopathology. In the most direct application of his model, the dominant mood is assumed to reflect the strength of the underlying motivational system—i.e., strong anxiety with a strong behavioral inhibition system (BIS), strong positive affect with a strong behavioral activation system (BAS). This approach would predict strong anxiety to be associated with a dominance of passive avoidance and extinction and, similarly, strong positive affect with a dominance of impulsivity and other approach behaviors.The present paper has argued that these expectations are based on an implicit assumption that equally stressful environments are encountered—an assumption that would be undermined by individual differences in the very motivational systems under consideration. Examination of the approach-avoidance conflict paradigm supported the argument that, at least in the case of anxiety, one should not expect a strong association between behavior and motivational states. In particular, a weak behavioral inhibition system or strong behavioral activation system is likely to facilitate anxiety-producing impulsive behavior, whereas a strong behavioral inhibition system or weak behavioral activation system may facilitate anxiety-reducing cautious behavior. Other factors were also thought to promote independence of affective states and behavioral traits across individuals.On this argument, trait anxiety conceptualized as resulting from a strong BIS may not be highly correlated with frequent anxiety. Stating this another way, the behavioral correlates of a dominant BIS may be relatively independent of a trait involving a dominance of anxious mood. Using Tellegen's (1985) discussion of self-report measures of mood and personality traits, it was proposed that the trait factor of Constraint may be more strongly associated with behavioral consequences of the BAS and BIS, whereas the Negative Emotionality dimension is largely unrelated to the behavioral effects of the BIS. Since Negative Emotionality corresponds to the traditional anxiety/neuroticism factor, this proposal differs from the customary assumptions about the alignment of Gray's motivational systems and personality traits. The personality trait of Positive Emotionality (cf. extraversion) may be associated with individual differences in the strength of the BAS, with both affective and behavioral components. Thus, the hypothesis of motivational-behavioral uncoupling offers an alternative to the usual intepretations of the three major dimensions seen in most personality inventories. Unfortunately, it remains unclear as to how well the three major personality traits (Positive Emotionality, Negative Emotionality, and Constraint) are aligned with the hypothesized underlying motivational dimensions, and any hypotheses must be seen as extremely tentative.Finally, the question of the validity of self-report measures was discussed briefly. Of greatest interest is the possibility that a subset of subjects are unable to accurately report their emotional states, and that methods are available for identifying these individuals. If so, the validity of these self-report measures may be significantly improved, facilitating research on anxiety and impulsivity.     

Changes in cannabis use in emerging adulthood: The influence of peer network,impulsivity, anxiety and depression

IntroductionCannabis is the most commonly used illicit drug with the highest prevalence reported among 15- to 24-year-olds. This specific period of emerging adulthood constitutes a critical age for substance use and for future consumption. Cannabis use patterns change during college or university and the post-college transition; users are at greater risk of adverse health outcomes (especially if they start or maintain a pattern of frequent use).ObjectivesThe overall aim of this study was to highlight psychological and relational factors that might be associated with changes (including cessation and fluctuation) in cannabis use during this specific period, separately for males and females.MethodsThe subjects were 682 first-year college students (69.94% of female), aged between 18 and 25 years (M = 18.59 years, SD = 1.56). Four groups were formed according to cannabis consumption: “non-users” (54.64%), “desisting users” (14.04%), “fluctuating users” (16.23%), and “persistent users” (15.07%). A self-report questionnaire was administered to evaluate prevalence, frequency and trajectory of use, number of peer cannabis users, alcohol use, impulsivity, anxiety (trait and social) and depression.ResultsFemales appear more sensitive to the romantic partner's consumption than males. For both sexes, having more friends who use cannabis appears to be a determinant. Depression and anxiety were not related to changes in cannabis use. Impulsivity is a significant factor for the maintenance of cannabis use in emerging adulthood, with higher lack of premeditation for males and higher sensation seeking for females among fluctuating and persistent users.ConclusionsResults are discussed in terms of maintenance of use and the spiral of consumption, including clinical implications for prevention and interventions.     

Psychological entropy: a framework for understanding uncertainty-related anxiety

Entropy, a concept derived from thermodynamics and information theory, describes the amount of uncertainty and disorder within a system. Self-organizing systems engage in a continual dialogue with the environment and must adapt themselves to changing circumstances to keep internal entropy at a manageable level. We propose the entropy model of uncertainty (EMU), an integrative theoretical framework that applies the idea of entropy to the human information system to understand uncertainty-related anxiety. Four major tenets of EMU are proposed: (a) Uncertainty poses a critical adaptive challenge for any organism, so individuals are motivated to keep it at a manageable level; (b) uncertainty emerges as a function of the conflict between competing perceptual and behavioral affordances; (c) adopting clear goals and belief structures helps to constrain the experience of uncertainty by reducing the spread of competing affordances; and (d) uncertainty is experienced subjectively as anxiety and is associated with activity in the anterior cingulate cortex and with heightened noradrenaline release. By placing the discussion of uncertainty management, a fundamental biological necessity, within the framework of information theory and self-organizing systems, our model helps to situate key psychological processes within a broader physical, conceptual, and evolutionary context.     

The factor structure and dimensional scoring of the generalized anxiety disorder questionnaire for DSM-IV

Despite favorable psychometric properties, the Generalized Anxiety Disorder Questionnaire for the Diagnostic and Statistical Manual of Mental Disorders (4th ed.) (GAD-Q-IV) does not have a known factor structure, which calls into question use of its original weighted scoring system (usually referred to as the dimensional score). Analyses appropriate to categorical item responses in a large sample of undergraduates were used to establish the scale's factor structure. Analyses indicated that a one-factor structure resulted in good fit. A scoring method based on this one-factor structure was compared with a variety of alternative scoring procedures, and it was found that a method based on factor scores did relatively well but that the previously suggested dimensional score failed to perform better than a simple sum of items. Results support the general unity of the measure but raise doubts regarding its scoring and response options.     

Risk-factor research and prevention programs for anxiety disorders: a translational research framework

The aim of the present essay is to discuss the interconnection between risk-factor research and prevention program development for panic-spectrum psychopathology. We argue that prevention of panic-spectrum psychopathology specifically, and anxiety disorders more generally, is likely to be best advanced through active, systematic translation of basic, risk-factor research. After operationalizing key terminology, we present some exemplar risk-factor candidates for panic-spectrum psychopathology, summarize research related to their role as risk-factors for panic problems, and link this discussion to risk-factor nomenclature. We then present a translational framework for extrapolating extant knowledge on these and other potential risk-factors for panic-spectrum psychopathology with respect to the development of preventative interventions. The proposed translational framework is intended to describe a forward-feeding process by which risk-factor research could be used by clinical researchers to inform prevention programs; and reciprocally, how such prevention knowledge could be most effectively utilized to drive new, clinically focused risk-factor research.     

Examining a dimensional representation of depression and anxiety disorders' comorbidity in psychiatric outpatients with item response modeling

The current study replicated, in a sample of 2,300 outpatients seeking psychiatric treatment, a previous study (R. F. Krueger & M. S. Finger, 2001) that implemented an item response theory approach for modeling the comorbidity of common mood and anxiety disorders as indicators along the continuum of a shared latent factor (internalizing). The 5 disorders examined were major depressive disorder, social phobia, panic disorder/agoraphobia, specific phobia, and generalized anxiety disorder. The findings were consistent with the prior research. First, a confirmatory factor analysis yielded sufficient evidence for a nonspecific factor underlying the 5 diagnostic indicators. Second, a 2-parameter logistic item response model showed that the diagnoses were represented in the upper half of the internalizing continuum, and each was a strongly discriminating indicator of the factor. Third, the internalizing factor was significantly associated with 3 indexes of social burden: poorer social functioning, time missed from work, and lifetime hospitalizations. Rather than the categorical system of presumably discrete disorders presented in DSM-IV, these 5 mood and anxiety disorders may be alternatively viewed as higher end indicators of a common factor associated with social cost.     

A framework for integrating dimensional and categorical classifications of personality disorder

Although empirical evidence strongly supports a dimensional representation of personality disorder, there is strong resistance to dimensional classification due in part to concerns about clinical utility. Acceptance of an evidence-based dimensional classification would be facilitated by information on how such a system would map onto existing diagnoses. With this objective in mind, an integrated framework is proposed that combines categorical and dimensional diagnoses. A two-component classification is adopted that distinguishes between the diagnosis of general personality disorder and the assessment of individual differences in the form the disorder takes. Then, the DSM definition of personality disorders is extended by defining individual disorders as categories of trait dimensions. This makes it possible to develop an integrated classification organized around a set of empirically derived primary traits. Assessments of these traits may then be combined to generate categorical and dimensional diagnoses. It is argued that this approach would introduce an etiological perspective into the classification of personality disorder and improve categorical classification by providing an explicit definition of each diagnosis. The clinical utility of incorporating a dimensional classification is discussed in terms of convenience and acceptability, value in predicting outcomes and treatment planning, and usefulness in organizing and selecting interventions.     

Sex differences in impulsivity: a meta-analysis

Men are overrepresented in socially problematic behaviors, such as aggression and criminal behavior, which have been linked to impulsivity. Our review of impulsivity is organized around the tripartite theoretical distinction between reward hypersensitivity, punishment hyposensitivity, and inadequate effortful control. Drawing on evolutionary, criminological, developmental, and personality theories, we predicted that sex differences would be most pronounced in risky activities with men demonstrating greater sensation seeking, greater reward sensitivity, and lower punishment sensitivity. We predicted a small female advantage in effortful control. We analyzed 741 effect sizes from 277 studies, including psychometric and behavioral measures. Women were consistently more punishment sensitive (d = -0.33), but men did not show greater reward sensitivity (d = 0.01). Men showed significantly higher sensation seeking on questionnaire measures (d = 0.41) and on a behavioral risk-taking task (d = 0.36). Questionnaire measures of deficits in effortful control showed a very modest effect size in the male direction (d = 0.08). Sex differences were not found on delay discounting or executive function tasks. The results indicate a stronger sex difference in motivational rather than effortful or executive forms of behavior control. Specifically, they support evolutionary and biological theories of risk taking predicated on sex differences in punishment sensitivity. A clearer understanding of sex differences in impulsivity depends upon recognizing important distinctions between sensation seeking and impulsivity, between executive and effortful forms of control, and between impulsivity as a deficit and as a trait.     

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

Theories of personality and personality disorders are increasingly considering the centrality of emotion regulation and its dimensions. Impulsivity as well is recognized as a personality trait underlying diverse symptom presentations. Although research in this field has mainly regarded borderline personality disorder, recent studies supported the association of both emotion dysregulation and impulsivity with personality styles across all clusters. In the present study, we sought to extend extant research by investigating the joint contribution of selected difficulties in emotion regulation and impulsivity to traits of four personality styles in a community sample (N = 399, mean age = 37.91, 56.6% males). In particular, we focused on depressive, masochistic, passive-aggressive and sadistic personality styles. Multiple regression analyses showed the unique association of several domains of emotion dysregulation with all personality styles examined. Nonacceptance of emotional response was significantly and positively related with scores of all personality styles. Lack of emotional awareness was also characteristic of different styles. Beyond these similarities, distinct patterns were able to distinguish between externalizing (sadistic and passive-aggressive), and internalizing (depressive and masochistic) traits. Beyond the role of emotion dysregulation, trait impulsivity was also related to masochistic, passive-aggressive, and sadistic traits, independently explaining a significant amount of additional variance.     

Systema Temporis: A time-based dimensional framework for consciousness and cognition

This study uses a combined categorical-dimensional approach to depict a hierarchical framework for consciousness similar to, and contiguous with, factorial models of cognition (cf., intelligence). On the basis of the longstanding definition of time consciousness, the analysis employs a dimension of temporal extension, in the same manner that psychology has temporally organised memory (i.e., short-term, long-term, and long-lasting memories). By defining temporal extension in terms of the structure of time perception at short timescales (<100 s), memory and time consciousness are proposed to fit along the same logarithmic dimension. This suggests that different forms of time consciousness (e.g., experience, wakefulness, and self-consciousness) are embedded within, or supported by, the ascending timescales of different modes of memory (i.e., short-term, long-term, etc.). A secondary dimension is also proposed to integrate higher-order forms of consciousness/emotion and memory/cognition. The resulting two-dimensional structure accords with existing theories of cognitive and emotional intelligence.     

The interaction between impulsivity and neighborhood context on offending: the effects of impulsivity are stronger in poorer neighborhoods

This research blends 2 traditions of theorizing on the causes of crime, one focused on the role of individual differences and the other focused on structural and contextual variables. Two related studies examined the relations among impulsivity, neighborhood context, and juvenile offending. The first, cross-sectional study uses a large sample of 13-year-old inner-city boys, whereas the second, longitudinal study offers a conceptual replication using 17-year-old inner-city boys who are a subset of the original sample. Across both studies, results indicate that the effects of impulsivity on juvenile offending are stronger in poorer neighborhoods. Furthermore, nonimpulsive boys in poor neighborhoods were at no greater risk for delinquency than nonimpulsive boys in better-off neighborhoods.     

The spontaneousness of skill and the impulsivity of habit

Synthese - The objective of this paper is to articulate a distinction between habit and bodily skill as different ways of acting without deliberation. I start by elaborating on a distinction...     

Motor inhibition, reflection impulsivity, and trait impulsivity in pathological skin picking

Pathological skin picking (PSP) is often recognized as an impulse control disorder. The current study sought to investigate the relationship between PSP and different forms of impulsivity. University students that met criteria for PSP (n = 55) and university students without history of PSP (n = 55) answered a multidimensional impulsivity questionnaire (the UPPS Impulsive Behavior Scale) and completed 2 neurocognitive tasks that assess impulsivity (the Stop Signal Task and the Information Sampling Task). The PSP group scored significantly higher than the control group on the negative and positive urgency subscales of the UPPS, but the groups did not differ on other subscales or the neurocognitive tasks. Logistic regression demonstrated that the urgency scales added to the prediction of PSP after negative affect and other forms of impulsivity were adjusted for. The results indicate that PSP sufferers are characterized by emotion-based impulsivity and do not appear to be impulsive in other ways.     

The assessment of impulsivity and mediating behaviors in hyperactive and nonhyperactive boys

Twenty boys (6–8 years) rated by their teachers as hyperactive and a matched sample of nonhyperactive boys performed a task that required them to withhold responding for a set time interval in order to be rewarded (DRL 6-second schedule). Half of each group worked on a one-button console while the other half was provided with additional collateral buttons. Results indicated that hyperactive children were relatively unable to perform efficiently on the task, and that this deficit endured regardless of age, IQ, or experimental condition. DRL was thus found to discriminate accurately between teacher-rated and parent-rated hyperactive and nonhyperactive children. Furthermore, a wide variety of self-generated mediating behaviors was observed, and it was determined that a child's DRL performance was related to the kind of mediating behaviors he displayed. Results are discussed in terms of the clinical assessment of hyperactivity and the training of impulsive children.This report is based upon a dissertation submitted by the author in partial fulfillment for the Ph.D. degree. The efforts of Malcolm Helper, David Hothersall, Donald R. Meyer, Marilyn Moody, and Charles Wenar are gratefully acknowledged. The investigation was conducted while the author was a National Research Fellow, supported by Public Health Service Training Grant No. 5 T32 MH14608-02 to The Ohio State University.