Impulsiveness in patients with pathological love

Avaliação de impulsividade em pacientes com amor patológico

LETTER

Impulsiveness in patients with pathological love

Avaliação de impulsividade em pacientes com amor patológico

Talita Vendrame^I; Andrea Lorena da Costa^I; Cintia Cristina Sanches^I; Daniel Carr Ribeiro Gulassa^I; Eglacy Cristina Sophia^I; Monica L. Zilberman^II

^IUniversidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas (HCFMUSP), Ambulatório Integrado dos Múltiplos Transtornos do Impulso (Pró-AMITI)

^IIHCFMUSP, Instituto de Psiquiatria, Departamento de Psiquiatria, Programa de Pós-Graduação. Laboratório de Psicofarmacologia LIM-23

^{Endereço para correspondência}

Dear Editor,

The behavior of caring and paying too much attention to one's partner in an excessive and uncontrolled way is called pathological love (PL)¹.

Impulsiveness is a characteristic of human behavior associated with decision making that may be elevated in several psychiatric disorders². It has been observed that PL subjects are more impulsive than healthy subjects¹.

Patton et al.³ conceive impulsiveness as a multidimensional construct composed by lack of attention, lack of planning, and motor impulsiveness.

Another paradigm used to measure impulsiveness is the Delay Discount Task⁴ which is based on the concept that impulsive people tend to prefer immediate rewards, even if smaller, instead of choosing a greater reward to come after some time.

Twenty-five PL subjects > 18 years who felt their romantic relationship caused suffering were selected through media advertisement. A personal interview was conducted to eva­luate if volunteers fit the following criteria: 1) withdrawal symptoms when far from partner; 2) caring for partner more than wanted; 3) unsuccessful attempts to reduce/control pathological behavior; 4) long time spent trying to control partners activities; 5) abandonment of interests/activities previously valued; 6) behavior maintained despite personal/family problems¹.

Thirty healthy subjects were selected among the control participants of a clinical trial using the Self-Report Questionnaire (SRQ-20)¹.

PL subjects and healthy volunteers were mostly women (n = 43; 78.2%) with 36.0 years of age (SD = 9.8) and 15 years of education (SD = 4.3). Subjects gave written consent to fulfill the Barratt Impulsiveness Scale (BIS) and the Delay Discount Task⁵. For this, subjects should choose between two imaginary monetary rewards being delivered immediately or after a certain time interval. Delay intervals investigated ranged from 6 hours to 25 years. The value of immediate rewards available ranged from R$ 1000 to R$ 1. They were also administered the Mini International Neuropsychiatric Interview⁵.

Subjective value of time-delayed rewards was studied by the indifference point, the value in which the preference for immediate reward equals the one of the delayed reward. When indifference points are determined to variable intervals of time, an indifference curve is obtained, which provides information about how fast the subjective value of the reward decreases with time. This curve is explained by the equation: Vd = V/(1+kd), in which Vd is the current subjective value of a delayed reward (i.e. the indifference point), V is the value of the delayed reward, d is the delay length, and k is a constant proportional to the speed of reward discount (that can be obtained by the equation given that other values are known). The higher the value of k, the faster the value of a reward falls with rise of the advancement interval to obtain such reward⁵. Thus, higher values of k are associated with faster discount time, hence, higher impulsiveness⁵. The Student t test was used for BIS comparisons and the Mann-Whitney (U) test for k comparisons due to non-linear distribution⁴.

In PL subjects, the most frequent psychiatric comorbidities were depression (n = 14; 56%), anxiety disorders (n = 4; 16%), and social phobia (n = 3; 12%); 16% (n = 4) presented no comorbidity.

PL subjects, compared to healthy subjects, present hi­gher scores in lack of planning [29.9 (5.1) vs. 24.0 (4.5), t = -4.353, p = 0.001], lack of attention [24.0 (6.0) vs. 18.2 (3.5), t = -4.259, p = 0.001], and motor restlessness [21.3 (3.8) vs. 17.5 (2.4), t = -4.314, p = 0.001].

As for the ability to wait for a higher reward, no significant differences were observed in the delay discounting task [30.6 (SD = 765.0) vs. 26.8 (SD = 831.0), U = 335.000, n.s.].

Results suggest that PL subjects may be impulsive under certain aspects (those measured by BIS), yet not under others (as related to the delay discount paradigm), reinforcing the multidimensional nature of the impulsiveness concept. These results must be considered when developing therapeutic strategies for these subjects.

Recebido em 10/5/2012

Aprovado em 1/6/2012

• 1. Sophia EC, Tavares H, Pereira AP, Costa AL, Oliveira CN, Gorenstein C, et al. Pathological love: impulsivity, personality, and romantic relationship. CNS Spectrums. 2009;14(5):268-74.
• 2. Zilberman ML, Tavares H, Gorenstein C, Gentil V. Impulsivity in healthy volunteers: an open trial with clomipramine at low doses. Psychopharmacol. 2007;21(7):A47.
• 3. Patton JH, Stanford MS, Barratt ES. Factor structure of the Barratt impulsiveness scale. J Clin Psychol. 1995;51(6):768-74.
• 4. Green L, Fry A, Myerson J. Discounting of delayed rewards: a life span comparison. Psychol Sci. 1994;5:33-46.
• 5. Madden GJ, Petry NM, Badger GJ, Bickel WK. Impulsive and self-control choices in opioid-dependent patients and on-drug-using control participants: drug and monetary rewards. Exp Clin. 1997;5(3):256-62.

Publication Dates

• Publication in this collection
  01 Oct 2012
• Date of issue
  2012