For those of us living with bipolar disorder, impulsivity adds a whole new chaotic dimension to our lives. While others may spontaneously pick up a chocolate bar in a supermarket queue and chastise themselves later for impulsively buying and eating it (big deal!), our careless conduct can lead us to cataclysmic credit card sprees, alcohol and cocaine addiction, reckless sexual encounters, speeding, stealing, divorce, homelessness, sectioning, arrest and a prison sentence. Y’see, non-bipolar readers? We’re just like you.
In order to fan, or douse, the flames of mania, we are prone to the most vicious and costly forms of impulsivity. My kamikaze impulsivity to spend, spend, spent (yes, ‘spent’ is not a typo) eventually led me to a diagnosis. Before that, the good old NHS in England had accounted all of my psychotic, rapid cycler bipolar 1 mood swings to a problem with my thyroid. (And if I sound a little bit sarcastic about my experiences at the hands of the No Hope Saloon (NHS), I’m not being sarcastic enough.)
Impulsivity is generally interpreted to represent acting and speaking without thinking, or caring, about the consequences. For us, our irrational impulses when we’re manic are often the reason we hate ourselves when we’re depressed. Our bipolarity creates a vicious cycle of extreme behaviors.
Impulsivity has been identified as having 4 tributary dimensions:
Urgency. We want something right here, right now. So, we act rashly, giving in (without knowing we’re giving in) to our urgent desire to avoid the negative feelings associated with resisting what we want. “If I have, or do this, my impulse will be quietened and my life will improve.”
Lack of Premeditation. We don’t think about the future carefully, or at all. We act before we plan.
Lack of Perseverance. We act urgently, without discipline. We get bored fast and the rational side (chink?) of our bipolar brains is overpowered easily by our impulses.
Sensation Seeking. We crave excitement and have intense needs for the highs (and subsequent mania-combating mellowness) associated with taking risky actions. We act without any regard to the consequences, or fall-out of our actions.
There is no limit to our impulsivity during manic episodes. Whether we’re spending, gambling (our money, or our lives), drinking, taking (unprescribed) drugs, engaged in risky sexual encounters, investing in crazy schemes, shop-lifting, driving an insane speeds, living in the fast lane in every possible way, if we’re bipolar, and we’ve not yet accepted treatment, there are countless, calamitous times when we’ve failed to control our illogical compulsions, manage our mouths, or abort self-sabbotaging actions.
Impulsivity wreaks havoc in (at least) eight areas of our well-being:
Personal: We experience intense, debilitating shame, guilt, fear and embarrassment once our tsunami of mania has passed and we’re left flailing and drowning in a sea of destruction. Our impulsive actions cause us private humiliation, public humiliation (especially if we are arrested), as well as humiliation to our families and close friends.
Emotional: Our self-esteem takes a giant hit. We’re hopeless, useless, every negative word that ends in ‘ess’.
Relational: We lose friends and alienate people, sabotage family dynamics.
Social: We are forced to deal with the excruciating and devastating ramifications of other people’s reactions to what we said or did.
Vocational: We cause upheaval in the workplace, and can risk losing our jobs (especially if our employers have no inkling of what our disorder is, or does). We may purposefully mislead our colleagues, choosing to explain we were very, very, drunk at the time, to protect our ‘bipolar secret’.
Financial: We require funding to fuel our impulsive addictions, so we fund our extravagant lifestyle on credit cards, take out huge loans, or giant mortgages we don’t have a hope of repaying. We can’t pay our bills, have our electricity and gas unceremoniously cut off. By then, we’re prisoners inside our own homes, until we lose our homes altogether. We continuously disappoint and frustrate our families, relationships fracture, then crumble, to be swept away by the wind. (This is an accurate portrayal of my own life pre-diagnosis, not me being misleadingly melodramatic. If you’ve not been affected to this extent, bully for you.)
Physical: We could contract STDs, or liver disease, and increase our chances of a heart attack.
Spiritual: Our faith in our judgement is severely tested (blown apart), leading to a crisis of confidence so vast that it feels like a spiritual meltdown.
Figuring out exactly what provokes our impulsivity is like asking what causes bipolar disorder: senseless, with no conclusive answers, not even by leading experts. (I used to be an expert on what makes me tick. Now I’m a pert, along with the rest of the free world.) But, it is suspected that the irrational addictive impulses, forming a part of the manic psyche, all boils down brain chemistry. Unfortunately brain scientists still understand less than 5% of what our brains actually do. But it’s believed communication in our impulsive brains becomes chemically unstable and radically out of control. (No shit.) Rational thinking when we’re feeling well does not stop rash behavior when we’re not. Although, of course, there are plenty of little things we can do to ‘rewire’ our brains to manage our impulses; including taking medication, eating healthily for our minds, taking vitamins and exercising (not just by speed-walking around the mall, laden down by impulse purchases, carrying our credit cards between our teeth).
Why do we, as bipolar people, often feel better following impulsive behaviors, not worse?
In a high drive to numb the pain of low self-esteem, or gain temporary relief from mania, we engage in reckless behavior. Impulsivity becomes a type of self-medication—a way to cope with underlying issues of bipolarity and calm mood swings.
Distressingly, it is a sad fact that our tolerance for an impulsive behavior grows, not dissipates. We keep spending/ carousing/ gambling more and more with increasingly less regard for consequences. Like petty criminals who move onto bigger and bolder crimes, we become MORE impulsive, not less, as a behavioral pattern emerges, before manifesting as an addiction.
A huge proportion of us are at risk of being diagnosed purely as addicts, instead of as bipolar. The truth is we are addicts, at least when we’re manic. There is an important difference, however, at least from my own experience (insane personal theory coming up:) While most people who are addicts engage in impulsive behaviors to combat depression and in pursuit of a temporary high, I only behave impulsively when I’m manic, not to fan the flames, but to douse them, since spending an obscene amount of money would mellow me out in the same way others may smoke a joint. And, after talking to others with bipolar, I’ve realized, oddly enough, I’m not alone. For some of us bipolar types, our impulsivity helps us mellow mania. (Although I certainly wouldn’t recommend it as a homeopathic remedy for mania, since, as I’ve already mentioned, this particular brand of DIY therapy resulted in my loss of marriage, marbles, electricity and home.)
The problem with impulsivity is we have to spend more/ indulge in even riskier behaviors to experience the same high (for straightforward addicts, if there is such a thing, which I doubt), or to experience that mania-busting ‘post-coiltal’ feeling of mood-calming mellowness (some of us bipolar types). To experience the same mood-elevating impact, we must jeopardize EVERYTHING we have until we lose it all. Which is why it’s so crucial to get an early diagnosis, seek help and seek therapy, because our impulsivity will ruin us one way or another. Or, if you’re like me, in every way.
For those of us who are not taking prescribed medications, our impulsivity also raises the risk of alcoholism and recreational drug use. We may kid ourselves we’ve made a choice to do these things, but all bad choices, made enough times, add up to addiction, or an underlying mental illness. But the biggest, most powerful Catch 22 for us bipolar types is that after acting impulsively in a fit of mania-induced madness, we can be certain that depression will swiftly follow. In this situation, not only do we have to wrestle with the horrible aftermath of our impulsive behaviors during mania, along with our accompanying intense feelings of shame and guilt, but we must deal with bleak reality and intolerable shameful feelings in the middle of an depressed mood-state. By not taking action to curb our bipolar impulses, we are effectively gambling that we won’t feel suicidal in the future about giving in to our impulses. Which, if we’re bipolar, is a very silly way to think.
Impulsivity is one of the more complex symptoms of bipolar disorder. Mania feeds impulsivity and vice versa—it’s a vicious cycle. In pursuing treatment for bipolar disorder, if we fail to address impulsivity specifically and it is a huge issue for us, we’re gambling with our illness and with our lives in much the same way as a heroin addict. Happy gambling!
Managing Self Harming Impulses
So, how can we begin to get a handle on our self-harming? (Because that’s what it is – we don’t need to be cutting ourselves, or injecting our veins with smack to self-harm.)
At minimum, we should discuss our irrational impulses with our doctors or therapists. Since impulsivity often involves embarrassing symptoms that neither you, nor your doctor, may be comfortable discussing, this can present problems. Sometimes GPs are hesitant to burden patients with heavy labels, like “alcoholic” or “sex addict”. They know that merely prescribing a pill can’t resolve these issues, so they won’t address them, unless you do. If broaching the subject is difficult, use this article as a bridge to get the conversation started.
In addition to seeking professional help, we can take control of impulsivity in other ways. Let me give you A START.
Acknowledge and accept. First and foremost, you must admit that a problem exists and must be addressed. Seek support. Don’t attempt to deal with your impulses, and feelings about them afterwards, by yourself. Attend a support group — a bipolar support group, AA or NA, or whatever the most appropriate support group is to deal with your specific impulse.
Tame triggers. Guard against what you know provokes negative impulses to self-harm.
Adjust attitude. Adopt a new, healthy and positive mindset toward tackling the problem.
Repair and replace. Repair past damage, and replace old habits and bad relationships with healthy ones. (Easier said than done, I know, but attending a support group and being around others with the same issues as you will be hugely beneficial.)
Tackle therapeutically. Take an active role in therapy, be transparent and get to the root cause of impulses and underlying issues.
Managing impulsivity often requires putting firm precautions in place. It helps to have an agreed-upon plan with family/ friends, or with your doctor/ therapist. Depending on the scale and damage of your impulsive tendencies, you may have to restrict or monitor socializing, arrange for safekeeping or supervision of credit cards, ATM cards, or even car keys. Don’t take risks with your own safety and the safety of others. Remember, if you don’t ask for help, you can’t expect to magically receive it. If you ask for help, you’ll most likely not just receive it, you’ll be respected for your bravery in taking positive action to make life changes. Also, if your impulses are habitual, not ingrained in your personality. It takes 5 days to make or break a habit.
Taking control of impulsivity is essential. If you don’t take measures to control impulsivity, it can absolutely come to control you.
Bipolar Hong Kong 