تکانشگری در جمعیت عمومی: مطالعه ملی

Objective The construct of impulsivity is an important determinant of personality differences, psychiatric disorders, and associated risk-taking behaviors. Most existing knowledge about impulsivity comes from clinical samples. To date, no study has estimated the prevalence of impulsivity and examined its correlates in the general population. Method We analyzed data from a large national sample of the United States population. Face-to-face surveys of 34 653 adults aged 18 years and older residing in households were conducted during the 2004–2005 period. Diagnoses of mood, anxiety, and drug disorders as well as personality disorders were based on the Alcohol Use Disorder and Associated Disabilities Interview Schedule—DSM-IV Version. Results Impulsivity was common (17% of the sample), particularly among males and younger individuals, and associated with a broad range of axis I and II disorders, particularly drug dependence, cluster B, dependent and schizotypal personality disorders, bipolar disorder and ADHD. It was associated with behavioral disinhibition, attention deficits, and lack of planning. Individuals with impulsivity were more likely to engage in behaviors that could be dangerous to themselves or others, including driving recklessly, starting fights, shoplifting, perpetrating domestic violence and trying to hurt or kill themselves. They were exposed to higher risk of lifetime trauma and to substantial physical and psychosocial impairment. Conclusion Given the association of impulsivity with psychiatric disorders and multiple adverse events, there is a need to target impulsivity in prevention and treatment efforts.

Impulsivity, defined as ‘a predisposition toward rapid, unplanned reactions to internal or external stimuli with diminished regard to the negative consequences of these reactions to the impulsive individual or to others’ (Chamberlain and Sahakian, 2007), contributes importantly to personality differences and externalizing psychiatric disorders (Moeller et al., 2001), such as substance use disorders (Ersche et al., 2010 and Moeller et al., 2002), antisocial personality disorder (Swann et al., 2009b), and borderline personality disorder (American Psychiatric Association, 1994). Impulsivity is also common in emotionally labile individuals, including those with borderline personality or bipolar disorders (Swann et al., 2009a) and associated with self-injurious behaviors including suicide attempts (Oquendo et al., 2004). Because impulsivity is associated with risk-taking behaviors, such as driving violations (Paaver et al., 2006), high-risk sexual behaviors (Black et al., 2009), domestic violence (Shorey et al., 2010), gambling (Slutske et al., 2005), kleptomania (Bayle et al., 2003) and with increased probability of adverse outcomes, such as driving-related injuries (Cherpitel, 1999), increased risk of contracting HIV (Bornovalova et al., 2008), being arrested (Nilsson et al., 2010), and undesired pregnancies (Kovacs et al., 1994), impulsivity represents an important construct contributing to many public health concerns. Most existing knowledge about impulsivity comes from clinical samples or populations, such as adolescents, who have elevated impulsivity (Sterba et al., 2010 and Paus et al., 2008). To date, no study has estimated the prevalence of impulsivity and examined its correlates in the general population, thus leaving an important gap in our understanding. Differences in neurobiology (af Klinteberg et al., 1987, Manuck et al., 1999 and Ruegg et al., 1997) and cognitive styles and social expectations (Calvete and Cardenoso, 2005) have led to the suggestion that men are typically more impulsive than women. However, findings have been mixed across samples (Gaub and Carlson, 1997 and Rinne et al., 2000), leaving open the question of whether the prevalence of impulsivity is different in men and women. Similarly, impulsivity is considered to have developmental aspects (Paulsen and Johnson, 1980 and Steinberg, 2010), peaking during adolescence and subsequently decreasing after the development of cognitive control capacities and associated maturation of the prefrontal cortex (Galvan et al., 2006 and Gogtay et al., 2004). However, epidemiological studies have not examined whether the prevalence of impulsivity decreases with age. Furthermore, clinical studies have emphasized the association between impulsivity and psychiatric disorders such as alcohol dependence (Rogers et al., 2010), bipolar disorder (Swann et al., 2009a), antisocial (Swann et al., 2009b) and borderline personality disorders (American Psychiatric Association, 1994), pathological gambling (Blanco et al., 1996, Slutske et al., 2005 and Vitaro et al., 1997), attention-deficit hyperactivity disorder (ADHD) (American Psychiatric Association, 1994), and schizophrenia (Nolan et al., 2011), but whether those findings extend to individuals in the general population is unknown. The purpose of this study was to fill these gaps in knowledge drawing on data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a large, representative sample of the United States adult population. Based on prior work (af Klinteberg et al., 1987, Balodis et al., 2009, Manuck et al., 1999, Mehrotra et al., 2009, Nilsson et al., 2010, Paulsen and Johnson, 1980, Swann et al., 2009a and Swann et al., 2009b), we hypothesized that: 1) impulsivity would be more prevalent among males and inversely related to age; 2) there would be a strong association between impulsivity and externalizing disorders, such as substance use disorders and antisocial personality disorder; 3) after adjusting for the presence of psychiatric disorders, impulsivity would be associated with behaviors characterized by disinhibition, attentional deficits, and lack of planning, such as problems with gambling or spending too much money, troubles paying attention and quitting jobs without knowing what to do next; and, 4) individuals with impulsivity would experience more adverse events such as greater number of lifetime traumas, more frequent incarceration, higher prevalence of HIV infection, and poorer perceived health.