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Impulsive borderline personality disorder: definition, causes, symptoms, and treatments

Reading time: 9 mins
Impulsive borderline personality disorder: definition, causes, symptoms, and treatments

An impulsive borderline personality disorder is one of four subtypes of borderline personality disorder (BPD). People with impulsive BPD tend to be charismatic, energetic, engaging, and do things impulsively, in addition to not being able to regulate their emotions.

The causes of impulsive BPD are childhood trauma, neurobiological factors, environmental factors, and brain abnormalities.

The symptoms of this mental illness include increased anxiety, depression, self-criticism, mood swings, and emotional instability.

Treatments for impulsive borderline personality disorder include psychotherapy and medications, and hospitalization. The latter is necessary in the most severe cases of this condition.

What is impulsive borderline personality disorder?

Impulsive borderline personality disorder (BPD) is a mental illness indicated by symptoms of BPD and a pattern of engaging in impulsive high-risk behaviors. A person with this condition struggles and usually fails to control their impulses.

Even though it’s not in DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) by the American Psychiatric Association, impulsive BPD is a nonofficial subtype of borderline personality disorder. Out of four types of BPD, this one is considered the most charismatic. Other types of BPD are discouraged, petulant, and self-destructive.

On the other hand, ICD-11 (International Classification of Diseases, 11th Revision) by the World Health Organization (WHO) recognizes two variants of borderline personality disorder. One of these variants is the impulsive type.

A borderline personality disorder is a complicated mental health condition. For that reason, psychiatrists and psychologists focused on differentiating different types based on the most dominant symptoms. The most significant classification, which includes impulsive BPD, comes from the work published by American psychologist Theodore Millon in 1996. His classification of different types of BPD derived from research and clinical observation. Each subtype shares the core features of BPD with one, two, or three other personality disorders.

How common is impulsive borderline personality disorder?

An impulsive borderline personality disorder is not as common as many other mental illnesses, but its exact prevalence is unclear. At this point, there is no specific data regarding the number of people who have an impulsive borderline personality disorder.

Since there is no data about impulsive BPD prevalence specifically, it’s useful to mention that the lifetime prevalence of borderline personality disorder, in general, is around 6%. The disorder can be reliably diagnosed in patients as young as 11. The prevalence of BPD in adolescents is around 3%, according to a paper published by Dr. Jean Marc Guile of Amiens-Picardie University Medical Center in Amiens, France and his team in the Adolescent Health, Medicine and Therapeutics journal.

When it comes to gender-related differences, there are no significant differences in the prevalence of BPD among men and women in the general population. However, in a clinical setting, the ratio of women to men is about 3:1.

The January 2022 edition of Current Opinion in Psychiatry published a paper by D’Agostino et al. that showed the prevalence of BPD in the elderly population is decreasing. The estimated prevalence of BPD among older people in the community is about 10%, according to a paper that Dr. Aparna Mordekar and Dr. Sean A. Spence of University of Sheffield published in Advances in Psychiatric Treatment.

What are the causes of impulsive borderline personality disorder?

The causes of impulsive borderline personality disorder are multifactorial and include a combination of several causes that may lead to impulsive BPD rather than one specific factor. Potential causes of impulsive borderline personality disorder are listed below:

  • Childhood trauma
  • Neurobiological factors
  • Environmental factors
  • Brain abnormalities

1. Childhood trauma

Experiencing or witnessing traumatic events in childhood can be a foundation for the development of mental health problems in adolescence or adulthood. Impulsive BPD is also strongly associated with childhood trauma. Evidence confirms that diagnosis of borderline personality disorder is linked to a history of child abuse (especially sexual abuse) and neglect to a greater extent than any other personality disorder. Traumatic experiences from childhood are also strongly associated with the severity of symptoms, according to a paper by Nadia Catane et al. from the June 2017 issue of BMC Psychiatry.

Trauma can contribute to the development of impulsive BPD by affecting the function of several regions in the brain. In other words, it contributes to brain abnormalities and neurobiological factors. Additionally, people don’t always process childhood trauma adequately. Failing to cope with traumatic experiences can also contribute to the development of mental illnesses such as impulsive BPD.

Persons with this disorder often report their caregivers failed to validate their feelings and provide protection when they were children. This could also act as an underlying mechanism through which childhood trauma takes part in the onset of impulsive BPD.

2. Neurobiological factors

Neurobiological factors refer to the anatomy, physiology, and pathology of the nervous system. The development of borderline personality disorder, including the impulsive type, is linked to impaired levels of the hormone estrogen.

While more research on this subject is necessary, a paper from Biological Psychology published by T. A. Eisenlohr-Moul et al. at the University of Kentucky and the University of North Carolina at Chapel Hill reports that ovarian hormones are relevant to the cognitive, emotional, and behavioral aspects of this mental illness. It’s unclear how estrogen influences the onset of impulsive BPD, but it could act on brain functions.

3. Environmental factors

Environmental factors include a person’s surroundings and social life, which have a strong influence on their mental health. Being a victim of abuse can lead to impulsive BPD even when it doesn’t occur in childhood.

Growing up in an unstable household and a family with a history of personality disorders is also an environmental factor that contributes to the development of impulsive BPD. The disorder could arise when a person’s emotional needs aren’t met in cases when they don’t feel safe. Environmental factors work in combination with biological causes in predisposing a person to impulsive BPD.

4. Brain abnormalities

Brain abnormalities are changes in the structure and function of certain brain regions and neurotransmitters that may act as one of the causes of impulsive BPD. For example, this personality disorder is associated with a reduced size of the amygdala and hippocampus. Amygdala is the center for emotions, motivation, and emotional behavior, whereas the hippocampus is involved in learning and memory.

Additionally, in people with this disorder, the prefrontal cortex is less active. This brain area is involved in personality expression, planning complex cognitive behavior, moderating social behavior, and decision-making. At the same time, levels of the stress hormone cortisol and abnormalities in the hypothalamic-pituitary-adrenal (HPA) axis are present in people with impulsive BPD. Elevated production of cortisol could stem from childhood trauma, which only confirms that multiple causes work together in the development of this disorder.

A paper from Psychiatric Times reports that people with borderline personality disorder exhibit deficits in neural connectivity, which may result in misidentification with neural stimuli. Problems with neurotransmitters such as serotonin and dopamine are also implicated in the onset of impulsive BPD.

What are the symptoms of impulsive borderline personality disorder?

Symptoms of impulsive borderline personality disorder are associated with emotional instability, impulsiveness, disturbed patterns of thinking and perception, and intense or unstable relationships with others. People can experience impulsive BPD differently. But, the most common symptoms are listed below:

  • Increased anxiety, nervousness, tension, worry, and panic
  • Depression
  • Excessive self-criticism
  • Moodiness
  • Emotions that are easily aroused

1. Increased anxiety, nervousness, tension, worry, and panic

Anxiety is the intense feeling of nervousness, worry, panic, and tension. People with impulsive BPD often experience intense symptoms of anxiety that may last anywhere from a few hours to several days. That happens because a person with this mental illness struggles to control their reaction to stress or other negative stimuli.

Physical effects of this symptom include headaches, faster breathing, irregular heartbeat, indigestion, abdominal pain, fatigue, chest pain, dizziness, insomnia and muscle aches.

Behavioral effects of anxiety include social withdrawal, avoiding certain places, poor performance at work or school, relationship problems, and argumentative and dismissive behaviors.

2. Depression

Depression is a mood disorder indicated by a persistent feeling of sadness, hopelessness, and loss of interest in activities that a person once enjoyed. Depressive symptoms in people with impulsive BPD tend to be transient in nature and are associated with interpersonal stress. People with this disorder can develop symptoms of depression to express feelings they’re unable to express in a more adaptive manner.

Physical effects of depression include appetite changes and subsequent weight gain or weight loss, muscle, and joint pain, chronic fatigue, chronic pain, higher risk of heart and kidney diseases, hormonal imbalances, gastrointestinal issues, and insomnia.

Behavioral effects of depression include loss of interest and motivation, reduced performance and productivity, and social isolation.

3. Excessive self-criticism

Excessive self-criticism refers to the constant tendency to engage in negative self-evaluation. Doing so results in feelings of worthlessness, guilt, and failure, and may contribute to the development of depression in persons with an impulsive borderline personality disorder.

Physical effects of excessive self-criticism include a higher risk of diseases, sleep problems, and health problems linked to increased levels of stress. These include high blood pressure, diabetes, and obesity.

Behavioral effects include the development of eating disorders, body image issues, and social anxiety.

4. Moodiness

Moodiness refers to changing moods suddenly. Moodiness, also known as mood swings, manifests through rapidly switching from happy to angry, depressed, or irritated moods. In people with impulsive BPD, mood swings are particularly intense as people feel uncertain about how they see themselves.

Physical effects of moodiness include headaches, shortness of breath, high-stress levels and subsequent hormonal imbalances, blood sugar changes, increased or decreased appetite, heart palpitations, and indigestion.

Behavioral effects of moodiness are impulsiveness, threatening behaviors, high risk of self-harm, social withdrawal, and aggressiveness depending on the specific mood.

5. Emotions that are easily aroused

Emotions that are easily aroused are, actually, strong emotions that people with impulsive BPD may have. Everyone feels emotions like anger, fear on a daily basis, but in people with this disorder, they are strong and very intense.

Physical effects of this symptom include high blood pressure, headaches, stomach ulcers, shortness of breath, digestive issues, overeating or not eating enough, and weight changes.

Behavioral effects of emotional instability include aggression, fearfulness, conflicts with other people, legal troubles, problems with decision-making, struggle with problem-solving, financial difficulties due to unemployment, suicidal thoughts and tendencies, and social isolation.

Who is affected by impulsive borderline personality disorder?

Impulsive borderline personality disorder usually affects adolescents and young adults. Females are slightly more affected than men. This mental illness primarily affects people who have experienced trauma in the past. They haven’t processed their traumatic experience properly or the high stress caused by the event contributed to brain abnormalities. People may have a genetic predisposition as well.

What are the risk factors for impulsive borderline personality disorder?

woman pulling her hair and shouting

The risk factors for an impulsive borderline personality disorder are listed below:

  • Family history of personality disorders and other mental illnesses
  • Personal history of mental illness
  • Experiencing abuse (verbal, emotional, physical, sexual) or neglect in childhood
  • Abandonment in childhood or adolescence
  • Unstable household environment
  • Unhealthy communication in the family

How is impulsive borderline personality disorder diagnosed?

An impulsive borderline personality disorder is diagnosed following a physical exam and psychiatric evaluation. There is no specific diagnostic test for impulsive BPD, but a doctor will start with a physical exam that often involves blood and urine tests, and imaging tests such as MRI or CT may also be required. These tests help doctors determine whether the symptoms occur due to a physical cause or illness.

The doctor will also refer a patient to a psychiatrist. Psychiatric evaluation includes completing a questionnaire about symptoms, behaviors, impulsiveness, and emotions. The psychiatrist will also ask questions regarding personal and family history of mental illness. They will use DSM-5 to make sure a patient meets the diagnostic criteria for BPD. However, impulsive BPD is not in DSM-5 and, thereby not an official diagnosis. Psychiatrists may categorize a patient’s BPD as impulsive to provide a deeper insight into their mental health. This is done when a patient exhibits impulsive behaviors, including engaging in risky activities and high potential for self-harm.

How to prevent impulsive borderline personality disorder?

It’s impossible to prevent impulsive borderline personality disorder. This mental illness can be inherited. It may also occur after a traumatic childhood. Plus, the exact causes are still unclear, which is why there is no specific strategy to prevent impulsive BPD. People who are in the high-risk group may want to see a doctor who will educate them on how to get treatment as early as possible.

Men and women who have experienced trauma before may want to learn to cope in a healthy manner. This usually includes regular therapy. During therapy sessions, patients learn to handle traumatic experiences in the past and prevent them from affecting their mental health and quality of life.

Taking care of one’s mental health is also equally important. Manage stress properly and practice a healthy lifestyle that strengthens and protects both body and mind. While these techniques don’t entirely avoid impulsive BPD, they can help reduce the risk or enable a patient to manage their condition.

What are the treatments for impulsive borderline personality disorder?

old woman with impulsive borderline personality disorder on hospital bed

Treatments for an impulsive borderline personality disorder are listed below:

  • Psychotherapy: the cornerstone of impulsive BPD treatment. The therapist chooses the type of therapy based on the patient’s needs. The main goal of therapy is to help patients focus on their current ability to function, learn to manage their emotions, reduce impulsiveness, and work on improving relationships. The most common approach is dialectical behavior therapy (DBT), which was specifically created for people with borderline personality disorder. This therapy relies on a skills-based approach to teach patients to manage their emotions, improve relationships, and cope with distress. The number of sessions depends on the severity of the symptoms. Duration of DBT can last anywhere from six months to two years. Cognitive-behavioral therapy (CBT) is also helpful for patients with impulsive BPD as it allows them to get a closer insight into their emotions, thoughts, and behaviors. With CBT sessions, patients understand how their thoughts influence their actions in order to adopt healthier thinking patterns. 16 to 18 sessions or more are necessary. A therapist may also recommend schema-focused therapy, mentalization-based therapy (MBT), or transference-focused psychotherapy.
  • Medications: at this point, there are no FDA-approved medications for impulsive BPD. The healthcare provider may prescribe antidepressants, antipsychotics, or mood-stabilizing medications to manage symptoms such as depression, impulsiveness, anxiety, and aggression. Medications are combined with therapy; they’re never the only treatment approach.
  • Hospitalization: only necessary when symptoms are so severe there is a high risk of harm to others or oneself. In these cases, the patients need more intense treatment and medical supervision for their own safety.

Does impulsive borderline personality disorder have a cure?

No, impulsive borderline personality disorder doesn’t have a cure, but it can be effectively managed and monitored. Although there is no quick fix for impulsive BPD, people with this disorder can successfully manage the symptoms and reduce their intensity. Effective management of impulsive BPD is achieved by adhering to the treatment process. As a person sticks to the treatment, they can get better over time and significantly improve their quality of life.