Impulsivity can be associated with disinhibition, which is defined by the DSM-V as “the orientation toward instant gratification that leads to impulsive behavior driven by current external thoughts, feelings, and stimuli, without regard for past learning or consideration of future consequences.” Disinhibition is considered one of the five dimensions of the personality trait.2 The chronic impulsivity associated with these conditions can be harmful to a person or those around them, often leading to serious problems such as job loss, lack of social support, financial difficulties, or legal problems. Some of the most common pulse control conditions are explained below. Intertemporal decisions are typically measured in the lab using a “delayed actualization paradigm,” which measures the process of devaluation of rewards and punishments that will take place in the future. [100] In this paradigm, subjects must choose between a smaller reward that will soon be issued and a larger reward that will be delivered late. Choosing the smallest reward is considered impulsive. By making these decisions repeatedly, the points of indifference can be estimated. For example, if someone chooses $70 now instead of $100 a week, but chooses the $100 a week instead of $60 now, we can infer that they are indifferent between $100 a week and an intermediate value between $60 and $70. A delay reduction curve can be obtained for each participant by plotting their indifference points with different reward amounts and delay times. Individual differences in discount curves are influenced by personality traits such as self-reports of impulsivity and place of control; personal characteristics such as age, gender, IQ, race and culture; socio-economic characteristics such as income and education; and many other variables. [101] on substance abuse. [102] [103] Lesions to the nuclear subregion of the nucleus accumbens [104] or basolateral amygdala [105] lead to changes towards the choice of the smaller early reward, suggesting the involvement of these brain regions in the preference for delayed strengthening agents.
There is also evidence that the orbitofrontal cortex is involved in actualizing delays, although it is currently debated whether lesions in this region lead to more or less impulsivity. [106] Impulsive individuals are generally described as follows: Two common modes of assessing impulsivity are self-reported measures (e.g., questionnaires) and laboratory behavioural instruments. Each of them has certain strengths that can be used to answer a particular question, and both approaches have a potentially important place in informing the legal process. Self-report measures are important for assessing a person`s understanding of their own behaviour over a period of time. At the same time, these types of measures rely on introspection, accuracy in remembering past events, or interpreting patterns (Dougherty, Mathias, & Marsh, 2003e). These are not small problems in a forensic context, as a person may have a reduced ability to accurately perform processes of introspection, remembering, and interpreting their past behavior, or they may be motivated to intentionally misrepresent that behavior. In contrast, behavioral measures provide an objective method for assessing impulsivity at a given point in time. These objective measures are less susceptible to concealment and can also provide information about different non-global components of behavioral impulsivity. Therefore, using behavioural measures to complement traditional self-report measures is likely to be a more balanced understanding of an individual`s impulsive behaviour. Knowledge of the specific components of impulsive behaviour affected in criminal populations can be useful in criminal proceedings.
As described in the introduction, conduct disorder involves a variety of symptoms that are likely to result in contact with the criminal justice system, where the appropriateness of various forms of punishment and rehabilitation must be weighed. A relatively common prison diversion program for teens is “boot camp,” which typically uses, among other things, the symbolic economy system, where rewards and punishments are earned based on certain behaviors. Based on the current findings, we would expect adolescents with adolescent celiac disease to perform very poorly in such a token economy system, as they might have a specific deficit in tying appropriate decisions to the long-term benefits of these choices. At the same time, there are specific formations that can reduce the impulsivity of sensitivity to consequences. For example, some researchers have used training techniques to help individuals understand that their current choices are linked to their future choices, and that by taking this link into account, the person can learn to optimize their set of decisions, resulting in less impulsive performance of sensitivity to consequences (Ainslie and Monterosso, 2001; Kirby and Guastello, 2001). So if this training was available to the CD group with early teens, then the boot camp environment could provide a good rehabilitation experience where they can practice and develop this new skill. This is a concrete example of how the results of the multimodal behavioural assessment of impulsivity can be used to identify deficits specific to certain individuals that would inform the legal process and increase the chances of success in rehabilitation by tailoring the program to their specific deficits. Behavioural disorder is not a homogeneous diagnostic category and various methods have been proposed to more specifically identify subpopulations within the disorder. One method was to focus on the age of onset of CD, and the DSM-IV-TR (American Psychiatric Association, 2000) classified the disorder into two subtypes: early childhood (symptoms of celiac disease before age 10) and early adolescence (symptoms of celiac disease that occur at age 10 or older).
The clinical differentiation and validity of this classification system have been proven by numerous studies. For example, CD in childhood is closely associated with the number of aggressive behaviours in childhood (Lahey et al., 1998), an increased risk of chronic antisocial behaviour, antisocial personality disorder, and substance use disorders in early adulthood (Lahey & Loeber, R, 1994; Loeber, Green, Lahey, Christ, & Frick, 1992; Mannuzza, Klein, Konia, & Giampino, 1990; Moffitt, Caspi, Harrington, & Milne, 2002; Patterson, DeBaryshe & Ramsey, 1989), as well as other mental health problems or impairments in verbal and executive functions (Moffitt, 1993). In contrast, adolescents with CD in adolescence tend to be less aggressive, have more normative relationships with their peers, and be less likely to have persistent CD or develop antisocial personality disorder in adults (American Psychiatric Association, 2000; Lahey et al., 1998; Moffitt, 1993; Robins et al., 1991; Tolan and Thomas, 1995). Therefore, the childhood CD group may be particularly likely to come into contact with the legal system in childhood and continue into adolescence and adulthood. With CBT and many other therapies, the overall wait is about 12 sessions; However, this may change depending on your therapy provider, the cost, and the severity of impulsivity on your life. DBT tends to be more timely — and can be more expensive — because it`s usually structured with one individual session and one group therapy session per week for a period of time, depending on the schedule and severity of your behavior and impulsivity. Dopamine, serotonin, opioids, glutamate, norepinephrine) may also be present. [83] Sensitivity to the consequences of behavioural actions is a third component of impulsive behaviour. Impulsive individuals often show a general preference for more immediate rewards, even if they are smaller than what could be achieved by waiting longer for a larger reward. This type of consequence sensitivity method is adapted from time-discounting models, in which the perceived value of a reward decreases with the time it takes to receive the reward (Ainslie, 1975; Rachlin, 2000). The most common method for assessing consequence sensitivity is a forced choice procedure, which typically presents a range of choices between two different types of rewards: a smaller reward received after a short delay or a larger reward received after a longer delay.