Working with people with bipolar, I have learned several helpful strategies that they use to support themselves around managing risks related to impulsivity and risky decision making.
Bipolar impulsive decisions series#
“These series of vulnerabilities often lead to risky decisions,” Phillips notes.” In certain situations where a big reward is possible, such as gambling, ventrolateral activity is heightened significantly more in people with bipolar disorder than in those without bipolar.įurthermore, Phillips and her colleagues have found that the excitement associated with the possibility of a future reward increases disproportionately during mania, feeding even more juice to emotional urges and compromising the ability to regulate them-much as floodwaters may overwhelm a normally sturdy dam. Phillips, MD, director of the Mood and Brain Laboratory at the University of Pittsburgh School of Medicine. Meanwhile, a neighboring area called the ventrolateral prefrontal cortex (“forward and left”) may be “increasingly relevant to our understanding of impulsivity, particularly in people with bipolar disorder,” says Mary L.
The ventromedial prefrontal cortex has been implicated in other behaviors that involve deciding between future consequences and immediate pleasure, such as overeating, overspending, and substance overuse. Those with bipolar had greater neural activity for risky bets, while those in the comparison group showed more response to “safe” bets. That 2014 study also found different patterns of activity within an area called the ventromedial prefrontal cortex (roughly, a “forward and middle” segment) that is active when we are weighing risk versus reward. “When British researchers had a group of people with bipolar perform a roulette-style task, they showed stronger activation in the nucleus accumbens than a comparison group of people without bipolar.” What is happening in the brain to someone with bipolar disorder that may differ from someone without the diagnosis that may account for an increase in impulsivity? Robin Flanigan discusses some of the relevant research in her blog post “Impulsivity: What’s Happening in the Brain.” On the other hand, impulsivity increases susceptibility to addiction and intensifies cravings for excitement that can be profoundly self-destructive. Hypomanics live on the edge, between normal and abnormal.” Anyone who slows them down with questions ‘just doesn’t get it.’ Hypomanics are not crazy, but ‘normal’ is not the first word that comes to mind when describing them. They think, talk, move and make decisions quickly. “Hypomanics are brimming with infectious energy, irrational confidence and really big ideas. “My new hypothesis became that American entrepreneurs are largely hypomanic,” writes Gartner. “Why is America so rich and powerful?” asks Gartner. This led John Gartner to write a book arguing that hypomania is responsible for some of the success of American entrepreneurs, The Hypomanic Edge: The Link Between (A Little) Craziness and (A Lot of) Success in America.
On the one hand, the greater lure of reward can fuel goal-directed achievement. In addition, the reward system seems to be more sensitive, so that the lure of a prize wields more power. “Studies suggest that the part of the brain that plans and analyzes tends to have a weaker grip on emotional circuitry in people with bipolar-akin to worn brake pads that can’t stop a speeding car in time. N addition, to impulsivity being linked to mood states, Robin Flanigan in her blog post “Bipolar and Controlling Impulsivity,” notes that research suggests a link to brain differences in people with bipolar disorder regardless of mood states which makes them more prone to risk and impulsivity. When depressed, especially in a “mixed” state, impulsive decisions in bipolar increase the risk of suicide. It can result in compulsive gambling, risky sex, excessive spending, and other risky behavior. Nevertheless, in a hypomanic or manic state, an increase in impulsive decision-making is often a key feature of the change in mood. And this increase is not just something seen during a mood episode, people with bipolar seem to have a generally increased tendency to quick or impulsive decisions. Impulsive decision-making is more common in people with bipolar. Sometimes the consequences of an impulsive action are minimal. We have all had moments when we have said something impulsively that we regret or have gotten carried away with an idea. Impulsivity is something everyone has experienced.
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