Brain study shows impulsivity may weigh down some individuals

Researchers at the Center for BrianHealth at The University of Texas at Dallas have found a link between having an impulsive personality and a high body mass index (BMI).

The findings published in the journal Obesity demonstrate that having an impulsive personality — the tendency to consistently react with little forethought — is the key factor that links brain patterns of impulsivity and a high BMI. BMI is a measure of body fat for adults, based on height and weight.

“Our research points to impulsive personality as a risk factor for weight gain,” said Dr. Francesca Filbey, principal investigator and associate professor in the School of Behavioral and Brain Sciences and the Center for BrainHealth. “Thus, addressing impulsive personality traits is essential to developing effective weight management programs that can help the 70 percent of Americans who are overweight or obese.”

For the study, researchers recruited 45 individuals, ages 22 to 43 with an average BMI of 30.7, and analyzed three separate measures to understand the role of impulsivity in body weight, including a self-report, neuropsychological testing and functional magnetic resonance imaging (fMRI).

For the self-report, researchers used an impulsive sensation-seeking scale to gauge innate personality characteristics. Participants were asked to rate how much they agreed with statements such as: “I tend to change interests frequently” or “I tend to begin a new job without much advance planning on how I will do it.”

The neuropsychological measure sought to assess whether an individual’s decision-making style was more impulsive or cautious. It evaluated a participant’s ability to distinguish between visual images on a screen and indicate an accurate response while being tested for speed. An fMRI was used to examine brain activation and connectivity during an impulse control task that required participants to push one of two buttons depending on visual cues and refrain from pushing a button if an audio cue occurred at the same time as the visual cue.

“Despite performing similarly to controls on the impulse-control task in the scanner, individuals with a high BMI exhibited altered neural function compared to normal weight individuals,” Filbey said. “We expected that an impaired ability to inhibit impulses would be the factor linking high BMI and brain change, but our study showed that having the inherent, impulsive personality trait, not an impulsive decision-making state in a specific situation or in response to vices, is the mediating factor.

“Given our findings, treatments that provide coping skills or cognitive strategies for individuals to overcome impulsive behaviors associated with having an impulsive personality could be an essential component for effective weight-loss programs,” Filbey said. “Others have found that increased self-awareness of impulsive behaviors is helpful in being able to regulate behavior.”

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Materials provided by Center for BrainHealth. Note: Content may be edited for style and length.

Borderline personality disorder: As scientific understanding increases, improved clinical management needed

Even as researchers gain new insights into the neurobiology of borderline personality disorder (BPD), there’s a pressing need to improve diagnosis and management of this devastating psychiatric condition. A scientific and clinical research update on BPD is presented in the September/October special issue of the Harvard Review of Psychiatry, published by Wolters Kluwer.

The special issue comprises seven papers, contributed by experts in the field, providing an integrated overview of research and clinical management of BPD. “We hope these articles will help clinicians understand their BPD patients, encourage more optimism about their treatability, and help set a stage from which the next generation of mental health professionals will be more willing to address the clinical and public health challenges they present,” according to a guest editorial by Drs. Lois Choi-Kain and John Gunderson of the Adult Borderline Center and Training Institute at McLean Hospital, Belmont, Mass.

Borderline Personality Disorder — Research Advances, Emerging Clinical Approaches

Although the diagnostic criteria for BPD are well-accepted, it continues to be a misunderstood and sometimes neglected condition; many psychiatrists actively avoid making the diagnosis. Borderline personality disorder accounts for nearly 20 percent of psychiatric hospitalizations and outpatient clinic admissions, but only three percent of the research budget of the National Institute of Mental Health. (The NIMH provides information about BPD online at http://www.nimh.nih.gov/health/topics/borderline-personality-disorder)

The Guest Editors hope their special issue will contribute to overcoming the disparity between BPD’s public health importance and the attention received by psychiatry. Highlights include:

  • A research update on the neurobiology of BPD. Evidence suggests that chronic stress exposure may lead to changes in brain metabolism and structure, thus affecting the processing and integration of emotion and thought. This line of research might inform new approaches managing BPD — possibly including early intervention to curb the neurobiological responses to chronic stress.
  • The urgent need for earlier intervention. A review highlights the risk factors, precursors, and early symptoms of BPD and mood disorders in adolescence and young adulthood. While the diagnosis of BPD may be difficult to make during this critical period, evaluation and services are urgently needed.
  • The emergence of evidence-based approaches for BPD. While these approaches have raised hopes for providing better patient outcomes, they require a high degree of specialization and treatment resources. A stepped-care approach to treatment is proposed, using generalist approaches to milder and initial cases of BPD symptoms, progressing to more intensive, specialized care based on clinical needs.
  • The critical issue of BPD in the psychiatric emergency department. This is a common and challenging situation in which care may be inconsistent or even harmful. A clinical vignette provides mental health professionals with knowledge and insights they can use as part of a “caring, informed, and practical” approach to helping BPD patients in crisis.

The special issue also addresses the critical issue of resident training — preparing the next generation of mental health professionals to integrate research evidence into more effective management for patients and families affected by BPD. Drs. Choi-Kain and Gunderson add, “For clinicians, educators, and researchers, we hope this issue clarifies an emerging basis for earlier intervention, generalist approaches to care for the widest population, and a more organized approach to allocating care for individuals with BPD.”

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Materials provided by Wolters Kluwer Health. Note: Content may be edited for style and length.

Self-understanding helps criminal substance abusers

Impulsiveness, crime and problems with social interaction. Many substance abusers also struggle with antisocial personality disorders, which makes it difficult for them to complete a drug or alcohol treatment programme. New research from the Centre for Alcohol and Drug Research at Aarhus BSS reveals that just six additional counselling sessions may lower the drop-out rate and increase the outcome of the treatment programme.

A total of 175 substance abusers with antisocial personality disorders took part in the project. 80 of these were offered a standard treatment programme, and out of these, 54 per cent dropped out. For the remaining 95 participants, the standard treatment was supplemented by the Impulsive Lifestyle Counselling programme. Among these participants, the drop-out rate was 42 per cent, and three months later, they were also taking fewer drugs than participants on the standard programme.

“The participants on the Impulsive Lifestyle Counselling programme had a lower drop-out rate than both other people with antisocial personality disorders and substance abusers in treatment in general. This shows us that we can increase the help for people who are impulsive and who, as a result, live a life of instability,” says Associate Professor Morten Hesse, who is responsible for the research project together with Associate Professor Birgitte Thylstrup, both from Aarhus BSS.

The researchers are hoping that the treatment can be used in both the social sector and the Prison and Probation Service, which offer only few treatment programmes for people with antisocial personality disorders. These people are typically regarded as very difficult to treat and they rarely seek treatment themselves, apart from when they have problems with drug abuse.

Focus on behaviour and consequences

The Impulsive Lifestyle Counselling programme consists of six structured sessions. The sessions focus on the participant’s dreams and aspirations in life, and on how the impulsive and criminal behaviour stands in the way of their dreams.

“One of the participants had trashed his apartment, because his girlfriend had spent a night at a friend’s house without telling him. Instead of debating whether the anger was fair or not, the counsellor and the participant considered the consequences — the flat was trashed, and the girlfriend left him. This motivated the participants to find other ways of reacting,” explains Morten Hesse.

In the programme, crime and impulsive behaviour are seen as a way of life rather than a diagnosis. This makes it easier to talk about the problems without stigmatising the participant as a criminal or as a patient.

Simple methods that work

In the research project, the Impulsive Lifestyle Counselling programme was conducted by staff at the treatment facilities after taking a course of just one and a half days. The positive effect of the programme was achieved despite the fact that the participants only showed up for three sessions on average. Morten Hesse does not rule out that other types of motivational counselling may have a similar effect, but he sees great advantages of the Impulsive Lifestyle Counselling programme in particular.

“Many treatment facilities experience high staff turnover rates. They need simple methods that are easy to learn. That’s why we have developed the Impulsive Lifestyle Counselling programme as a structured manual, which does not require the counsellor to be a formally trained therapist,” says Morten Hesse.

FACTS

Impulsive Lifestyle Counselling — about the programme

The treatment programme consists of six hours of individual session on the following topics:

  • Thoughts and behaviour related to antisocial personality structure
  • Impulsive behaviour and immediate consequences
  • Impulsive behaviour in relation to pride and self-worth
  • Values that may support or prevent changes
  • Social support
  • Follow-up

The different topics are presented, and the participants may work with examples from their own life if they wish to.

You can find the manual on the website of the Centre for Alcohol and Drug Research: http://psy.au.dk/forskning/forskningscentre-og-klinikker/center-for-rusmiddelforskning/

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Materials provided by Aarhus University. Original written by Charlotte Juul Sørensen. Note: Content may be edited for style and length.