Impulsive Borderline Personality Disorder (BPD)

What Is Impulsive Borderline Personality Disorder (BPD)?

Impulsive BPD (occasionally and colloquially referred to as “impulsive personality disorder”) is a subtype of borderline personality disorder (BPD) characterized by acting on impulses and engaging in high-risk behaviors with difficulty controlling such urges.¹ Generally, BPD includes a pervasive pattern of impulsivity and instability of interpersonal relationships, self-image, and affect.

Impulsivity involves seeking out immediate gratification without regard for past mistakes or consideration of future consequences. It also entails not planning ahead of time to engage in these behaviors. These can range from small, harmless actions (e.g., taking a spontaneous drive) to highly dangerous and potentially even fatal behaviors and patterns (e.g., attempting suicide).

Those experiencing impulsive BPD may engage in such behaviors to satisfy their urges for immediate gratification, to connect with others, or to receive attention, despite such attention tending to be superficial rather than deep or meaningful.

The symptoms of impulsive BPD often overlap with those of histrionic personality disorder as both share externalized self-centered qualities with a seemingly theatrical expression of emotions, a need to be the center of attention, chaotic relationships, and sexual provocativeness.² While these disorders share many characteristics and defining symptoms (and they may even co-occur), impulsive BPD is distinct in that individuals are more prone to anger, feelings of emptiness, self-destructive behavior, and identity disturbance.

Signs & Symptoms of Impulsive BPD

In addition to experiencing the symptoms of BPD, those with impulsive BPD tend to act quickly on desires, engaging in potentially dangerous behaviors without considering the consequences. They often feel pulled toward anything that offers instant gratification, as it helps them avoid a sense of emptiness or lack of fulfillment.

They may feel angered by criticism of these behaviors and relish any positive attention, such as compliments or reports that their stories are entertaining. So, while the person’s actions may be frowned upon by their peers, they are often reinforced due to the attention the behaviors garner.

Signs and symptoms of impulsive BPD include:

• Risky behavior (unsafe sex, substance misuse, driving under the influence, thrill-seeking)
• Aggressive behavior (such as yelling, fighting, breaking or damaging things, and getting physical with others)
• Impulsive self-harm or suicidality
• High emotional reactivity
• Lack of stability (e.g., frequently switching between jobs, starting and ending romantic relationships)
• Attention- and reassurance-seeking behaviors
• Thrill-seeking behaviors
• Binging (food, alcohol, etc.)
• Acting charismatic and dramatic despite often feeling empty or unfulfilled
• Overspending
• Making one’s mind up quickly or jumping to conclusions
• Changing one’s mind or opinion seemingly out of nowhere

What Causes Impulsive BPD?

Impulsive BPD is believed to be caused by a combination and transaction of genetic and environmental factors, such as trauma or chronic invalidation. Some studies have also suggested that people with BPD have brain abnormalities in the areas responsible for controlling levels of impulsivity.

Possible causes of impulsive BPD include:

Genetics

While no specific gene has been identified as causing impulsive BPD (nor BPD in general), research shows that the development of BPD may have a genetic factor.³ In fact, many with impulsive BPD have a family history of impulsive disorders such as binge eating disorder, BPD, and ADHD.⁴

Brain Functioning

Some studies suggest that people with BPD have abnormalities in the areas of the brain responsible for emotional regulation and impulse control.⁵ It is also believed that decreased activity in the prefrontal cortex, common among those with BPD, contributes to certain aspects of impulsivity.⁶ For those who have experienced trauma, excessive production of cortisol and hypothalamic-pituitary-adrenocortical hyperactivity are other possible contributors.³

Childhood Trauma

Impulsive BPD may also develop in response to childhood trauma or other adversities including parental neglect or loss, sexual abuse, incest, or inconsistent parenting.⁴ Many children who experienced such events may have found that, as children, demonstrating risky behavior was the only way to get the attention of their caregivers, which reinforced the idea that impulsivity garners love and attention. Further, many people engage in risky behaviors, like unprotected sex and substance use, as a way of coping with the effects of trauma.

Other Environmental Factors

Other environmental and social factors, such as family conflict, chronic invalidation, rapid social change, and loss of social cohesion are possible predictors.⁴ It’s also been posited that impulsivity is a learned behavior, meaning it may arise as a result of modeling by caregivers or as a behavior children learn to engage in to get their needs met more quickly.⁶

How Is Impulsive BPD Treated?

Dialectical behavior therapy (DBT) is often considered the treatment of choice for individuals diagnosed with impulsive BPD. DBT for BPD is a multi-dimensional approach to treatment for BPD that involves individual and group therapy, phone coaching in-between sessions, and a skills group that focuses on building skills in the following areas: mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness.

Mindfulness practices for BPD are also helpful for those diagnosed with impulsive BPD as it increases awareness of the present moment, which can help identify present urges and think through the potential consequences of acting on them.

While a medication to treat BPD doesn’t exist, several medications are used to treat the symptoms of impulsive BPD (impulsivity, anxiety, and depression) and it is often recommended that they be used in tandem with psychotherapy.⁷

Whether for you or a loved one, it’s important to find a therapist who has training and experience working with people who have BPD. A great way to find the right therapist is by searching an online therapist directory, where you can sort by a therapist’s specialty.

Final Thoughts

Impulsive borderline personality disorder can be challenging to deal with, both as the person experiencing it and as a loved one. That being said, there are ways to cope and options for treatment that can increase your quality of life and help manage your symptoms.