The authors report a literature review of impulsivity in the substance abuse disorders, eating disorders, classical disorders of impulse control, self-harm and personality disorders. They suggest that within each of these clinic populations there is a significant number of patients who have a very poor prognosis and are characterised not just by the specific presenting symptom but by multiple impulsive behaviours. It is suggested that this group, who place very large demands both on the psychiatric and emergency services, form a unitary 'multi-impulsive personality' group and that they would repay detailed research which cuts across the boundaries of the specialist services.
"Moral insanity, however, is not present in Verlaine. He sins through irresistible impulse. He is an Impulsivist."'
We report a literature survey of impulsivity in substance abuse and dependence, in eating disorders, specific disorders of impulse control and the personality disorders. Impulsive forms of all these conditions are well recognized and we will refer to these as the 'uni-impulsive disorders'. We have included the eating disorders and concentrated on impulsivity in women as we think this is of considerable importance currently and as we feel that the problems of impulsivity in male sociopaths have previously dominated this area concealing the general importance of impulsive behaviours.
We suggest that within each clinical population of 'uni-impulsive' disorders there are significant num-* Correspondence should be addressed to Dr Evans. bers of patients displaying more than one such problem. This is summarized in Table 1 which gives the percentages of such overlaps. We argue that these multi-impulsive patients represent a distinct group with a 'multi-impulsive personality disorder' which is being treated inappropriately by specialist clinics unable to grapple with the protean manifestations of their fundamental personality problems.
Links between compulsion and substance dependence and eating disorders^ are recognized but how do impulses differ from compulsions? Clearly an impulse is more sudden and less predictable than a compulsion but the distinction between repeated impulses and obsessions can be a fine one. Although some authors talk of impulsive forms of substance abuse and self-harm as 'compulsive behaviours' (e.g. CuUari & Redman') we feel that a dimension from the obsessional to the impulsive is of importance and throws light on the relationship between a variety of disorders.