Impulsivity in Borderline Personality Disorder

A couple weeks ago, a client was telling me about a big work project she had due soon. When I asked how it was coming along, she matter-of-factly told me “I haven’t started; I need the adrenaline of the last minute to focus.” To my client, procrastination was inevitable - a tendency she just had to accept about herself.

Over the years, I've heard many versions of this same story from the people with borderline personality disorder (BPD) I work with. The narratives they tell themselves – "I'm going to screw it up anyway, so I might as well quit now" or "I can't stand this feeling" – sound like observations about reality. But they're actually interpretations that have been repeated so many times they feel like facts.

The more certain you are that you’re "the kind of person" who needs the pressure of the last minute, quits when things get hard, or can't tolerate emotional pain, the more likely you are to behave accordingly.

Impulsivity Is More Than Acting Without Thinking

When most people think about impulsivity in BPD, they imagine dramatic behaviors like reckless spending, substance use, unsafe sex, or self-harm. While these certainly can be expressions of impulsivity, they represent only part of the picture. Research suggests that it is useful to think about impulsivity as showing up in four distinct but related ways.

Some people struggle with planning ahead. They repeatedly put off important tasks because they tell themselves they work better under pressure. This can look like procrastinating on a project, waiting until the last minute to pack, or even failing to keep track of your commitments.

Others struggle with following through; they begin projects, relationships, or goals with enthusiasm but abandon them as soon as they hit a setback. This could look like ordering take-out when you committed to cooking at home because you had a hard day, or giving up on sobriety because you had one drink.

Others act impulsively in response to intense emotions, desperately trying to escape emotional pain. This is what we usually think of when we picture impulsivity in BPD.

Still others seek out novelty and excitement, hoping to cut through feelings of emptiness or numbness. This could look like driving fast, using substances, or even just skipping out on work to go to the beach.

Although these behaviors look very different, they are driven by similar processes.

How Impulsive Behaviors Become Part of Our Identity

People with BPD often have a biological predisposition to experience emotions more intensely and to be especially sensitive to immediate rewards. But biology is only part of the story. The explanations we give ourselves for our behavior also determine the likelihood we’ll repeat them.

Take procrastination: Imagine you delay working on an important presentation because thinking about it makes you anxious. The moment you give yourself permission to put it off until tomorrow, you’ll likely feel relieved. Your behavior reinforced the idea that you can’t handle stress - why else would you have avoided working on the project? Days later, with the deadline looming, you mistake the panic you’re feeling for “adrenaline” and conclude “I’m the type of person who needs pressure to get work done.”

The same process happens with the other forms of impulsivity. Suppose you abandon a difficult goal the moment you encounter a setback. By quitting, you no longer have to face the possibility of failing, and that relief reinforces the decision to walk away. Your brain begins to conclude that quitting is what protects you from disappointment. Before long, "I'm going to fail anyway" no longer feels like a fear. It feels like an accurate description of who you are.

Next, imagine you lash out at someone or engage in self-harm during an intense emotional moment. The relief that follows reinforces the idea that your emotions are simply too overwhelming to tolerate. Finally, if shopping, drinking, or another risky behavior briefly replaces feelings of emptiness with excitement, you may come to believe that you need those experiences to feel alive.

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Changing the Story Changes the Behavior

In a new evidence-based treatment for borderline personality disorder, we start by uncovering the thinking that powers impulsive actions. Clients are asked to identify the behaviors they use in each of the categories described above: problems making plans, problems following thought, emotion-driven impulses, and sensation seeking. Then, they’re prompted to reflect on why they use that behavior.

Behavior: Binge eating

Because: It helps me numb out when my emotions are too intense

Once those thoughts are brought into awareness, we use cognitive flexibility to ask whether they are the only possible interpretation or whether there might be other possibilities. Are your emotions really too intense to tolerate? Is binge eating the only strategy you can use to cope, or have you just trained yourself to rely on it? You might remind yourself that strong emotions always become less intense over time, even without doing something to push them away.

Of course, simply thinking differently isn't enough to undo years of learning. The brain needs evidence that a different story is true.

New Behaviors Create New Beliefs

Conducting a behavioral experiment allows you to test whether your new way of thinking about the situations that provoke impulsive behavior hold merit. You act as though an alternative explanation might be true and see what happens.

For example, when my clients believe they need the adrenaline of an approaching deadline to get started, I remind them that adrenaline is for lifting cars off of toddlers, not opening a word document. Then, I challenge them to get started on their project early. Specifically, I ask them to set a timer for 5-minutes and work until it goes off. Usually, they persist longer than five minutes because getting started is the hardest part. This experience becomes evidence that they can, in fact, prepare in advance.

This works with other forms of impulsivity. If you believe your emotions are unbearable, you might practice allowing an urge to rise and fall without immediately trying to escape it. And if you've come to rely on shopping, drinking, or other risky behaviors to break through feelings of emptiness, you might try out other, less-damanging activities like making plans with friends or journaling. .

As you collect more evidence, your narrative starts to shift. You are no longer the type of person who needs the pressure of the last minute.

"The Kind of Person You Are"

One of the hardest parts of living with BPD is believing that your patterns define you. But the thoughts that drive impulsive behavior aren't facts. They're learned interpretations. When you begin questioning them and collecting evidence for a different story, impulsive behavior starts to lose its grip.