Available online at www.sciencedirect.

com

Psychiatry Research 158 (2008) 155 – 163

www.elsevier.com/locate/psychres

Impulsivity is associated with behavioral decision-making deficits

Ingmar H.A. Franken ⁎, Jan W. van Strien, Ilse Nijs, Peter Muris
Institute of Psychology, Erasmus Affective Neuroscience Lab, Erasmus University Rotterdam, The Netherlands
Received 11 August 2006; received in revised form 23 February 2007; accepted 3 June 2007

Abstract

Impaired decision-making is a key-feature of many neuropsychiatric disorders. In the present study, we examined task
performance in a healthy population consisting of those whose scores indicated high and low impulsivity on several behavioral
decision-making tasks reflecting orbitofrontal functioning. The measures included tasks that assess decision-making with and
without a learning component and choice flexibility. The results show that subjects high on impulsivity display an overall deficit in
their decision-making performance as compared with subjects low on impulsivity. More specifically, subjects with high impulsivity
show weaknesses in learning of reward and punishment associations in order to make appropriate decisions (reversal-learning task
and Iowa Gambling Task), and impaired adaptation of choice behavior according to changes in stimulus–reward contingencies
(reversal-learning task). Simple, non-learning, components of reward- and punishment-based decision-making (Rogers Decision-
Making Task) seem to be relatively unaffected. Above all, the results indicate that impulsivity is associated with a decreased ability
to alter choice behavior in response to fluctuations in reward contingency. The findings add further evidence to the notion that trait
impulsivity is associated with decision-making, a function of the orbitofrontal cortex.
© 2007 Elsevier Ireland Ltd. All rights reserved.

Keywords: Reversal learning; Decision-making; Impulsivity; Frontal functions; Reward

1. Introduction choice, it is now believed that human decision-making is

Decision-making is a cognitive function concerned
with the process of reflecting on the consequences of a
certain choice (Bechara, 2005). In recent years, decision-
making functions have become a major research topic
within neuropsychology, cognitive psychology, neuro-
science, and economics. One of the topics of interest is
the role of emotions on decision-making. In contrast to
earlier theories that viewed decision-making as a rational
⁎ Corresponding author. Institute of Psychology, Erasmus University
Rotterdam, Woudestein T12-35, P.O. Box 1738, 3000 DR Rotterdam,
The Netherlands. Fax: +31 10 4089009.
E-mail address: franken@fsw.eur.nl (I.H.A. Franken).
mainly based on emotions, especially on the expected
hedonic outcome of the choice (Cabanac, 1992).1 In
some classical studies, Bechara et al. (1994, 2000a)
demonstrated that patients with frontal lobe damage have
problems with emotional decision-making: they often
pursue actions that bring some kind of immediate
reward, despite severe long-term consequences such as
the loss of job, home, and family. Several psychiatric and
neurological conditions have been associated with such
specific disturbances in emotional decision-making (for
1
Recent studies highlight the importance of explicit strategy and
knowledge in decision-making, especially in the Iowa Gambling Task
(Maia and McClelland, 2004).

0165-1781/$ - see front matter © 2007 Elsevier Ireland Ltd. All rights reserved.
doi:10.1016/j.psychres.2007.06.002
156 I.H.A. Franken et al. / Psychiatry Research 158 (2008) 155–163
reviews, see Rahman et al., 2001; Brand et al., 2006). For
example, impaired decision-making has been reported in
relation to addiction (Hester and Garavan, 2004), frontal
lobe dementia (Rahman et al., 1999), borderline per-
sonality disorder (Bazanis et al., 2002), attention deficit
hyperactivity disorder (Toplak et al., 2005), eating
disorders (Cavedini et al., 2004), obsessive-compulsive
disorders (Cavedini et al., 2002a), pathological gambling
(Cavedini et al., 2002b), and disruptive behavior
disorders (Ernst et al., 2003). One topic that needs to
be resolved is whether these deficits are specific for
clinical populations (Rogers, 2003). As it is well known
that the personality trait of impulsivity is a major
ingredient of several psychiatric (Moeller et al., 2001),
personality (Rogers, 2003), and neurological disorders
(Miller, 1992), including the aforementioned disorders.
In the burgeoning neuropsychopharmacological litera-
ture on decision-making, the personality trait of
impulsivity has been frequently suggested to be as-
sociated with weaknesses in decision-making. That is,
impulsive persons display a decreased reflection on the
consequences of their choice.
These suggestions are in keeping with the notion that
real-life decision-making involves choices that are
based on expected but uncertain rewards and penalties,
and that optimal choices are based on well-considered
strategies. As such, it seems plausible to assume that
impaired decision-making reflects a variety of impulse
control problems (Morgan et al., 2006). Two studies
addressed the relationship between impulsivity and
decision-making in healthy subjects. A first study by
Franken and Muris (2005) examined the link between
decision-making, as indexed by the Iowa Gambling
Task, and individual differences in functional and dys-
functional impulsivity and the impulsivity-related trait
of reward sensitivity. The researchers found no relation
between Iowa Gambling Task performance and dys-
functional impulsivity scores. However, reward sensitiv-
ity, a trait associated with impulsivity, was significantly
related to the Iowa Gambling Task score. Surprisingly,
this link was positive, suggesting that a higher level of an
impulsivity-related trait is associated with better decision-
making. In another study, also using the Iowa Gambling
Task, Zermatten et al. (2005) found that decision-making
was influenced by the impulsivity-related trait of ‘lack of
premeditation’. Higher scores on ‘lack of premeditation‘
were positively linked to disadvantageous decision-mak-
ing. Thus, while there is certain clinical evidence for the
detrimental effects of impulsivity on decision-making,
studies in non-clinical samples have yielded less con-
vincing results. This may well have to do with the fact that
these studies have only employed one specific test of
decision-making, the Iowa Gambling Task, so it remains
to be seen whether different findings will emerge if other
behavioral tests of decision-making are used.
In this study, we focus on three decision-making
tasks reflecting related but distinct aspects of decision-
making: the Iowa Gambling Task (Bechara et al., 1994),
which measures affective decision-making and includes
a learning component, the Rogers Decision-Making
Task (Rogers et al., 1999a), which also taps affective
decision-making but does not include a learning
component, and a probabilistic reversal-learning task
(O'Doherty et al., 2001), which assesses affective
decision-making with a learning component as well as
the ability to alter choice behavior in response to
fluctuations in reward contingency. In more detail, the
Rogers Decision-Making Task taps explicit decision-
making strategies without a reward-based learning
element. This means that for each trial, all relevant
information is presented to the participant; the partici-
pant does not need previously learned information in
order to make a correct decision. The Iowa Gambling
Task, on the other hand, measures decision-making
strategies in which the participant has to learn to
discriminate the advantageous choices from the disad-
vantageous choices. This means that the Iowa Gambling
Task, unlike the Rogers Decision-Making Task, requires
reward-based learning capacity (Fellows, 2004). The
reversal-learning task (Rolls, 1999), measures not only
reward-based learning but is also designed to index the
adaptation of behavior according to changes in stimu-
lus–reward contingencies (i.e., reversal learning; Clark
et al., 2004), a capacity which is regarded as a basic
requirement for normal social and emotional behavior
(Cools et al., 2002; Kringelbach and Rolls, 2003; Rolls,
1996). Emotion-related visual reversal-learning tasks
reflect the ability to alter choice behavior in response to
fluctuations in reward contingency (Rahman et al.,
1999). To summarize, all the tasks used in the present
study reflect decision-making under risk. The Rogers
Decision-Making Task only measures reward-based
decision-making. The Iowa task adds a reward-based
learning aspect to the decision-making process, whereas
the probabilistic reversal task adds both a reward-based
learning aspect and a reversal aspect2 that measures
adaptive decision-making skills.
Neuroimaging studies, which employed decision-
making tasks without a learning element similar to the
2
It can be argued that the Iowa task also comprises a reversal-
learning aspect as the disadvantageous decks offer higher gains at the
beginning of the task compared with decks C and D. However, this
reversal aspect is minimal compared with the reversal-learning task.
 I.H.A. Franken et al. / Psychiatry Research 158 (2008) 155–163
Rogers Decision-Making Task, show that the orbito-
frontal cortex is involved in this type of decision-making
(Rogers et al., 1999b). Furthermore, neurological patients
with prefrontal damage show significant deficits on all
these types of decision-making tasks (Mavaddat et al.,
2000; Rogers et al., 1999a). Neuroimaging studies
employing decision-making tasks with a learning element,
such as the Iowa Gambling Task, show medial prefrontal
activity during this task (Fukui et al., 2005; Northoff et al.,
2006). In addition, neurological patients with prefrontal
damage show deficits on this task (for a review, see
Bechara, 2004; Dunn et al., 2006). Several neuroimaging
studies among healthy subjects show that the prefrontal
cortex is also activated during a probabilistic reversal task
(Cools et al., 2002; Kringelbach and Rolls, 2003; Remijnse
et al., 2005). And again, deficits in reversal learning are
also observed after prefrontal cortex damage (Hornak
et al., 2004; Rahman et al., 1999; Rolls et al., 1994). To
summarize, a wealth of data suggests that the orbitofrontal
cortex is an essential structure for adequate decision-
making (Clark et al., 2004; Ridderinkhof et al., 2004).
In the present study, two main research questions were
addressed. First, we examined whether healthy subjects
with high-impulsivity scores would have impaired deci-
sion-making performance compared with subjects with
low-impulsivity scores. We expected that subjects with
high impulsivity would have an impaired overall perfor-
mance on the Rogers Decision-Making Task, the Iowa
Gambling Task, and the reversal-learning task. However, in
line with the nature of impulsivity, it would be expected that
subjects with high impulsivity would have shorter
deliberation times on these decision-making tasks. Second,
we explored which specific aspects of decision-making
would be associated with impulsivity.
2. Methods
2.1. Participants and procedure
A sample of 70 undergraduate psychology students
(20% males) participated in the present study. The mean
age of the sample was 20.8 years (S.D. = 2.9). The group
was median-split into a high impulsiveness group (n = 30;
high-impulsives) and a low impulsiveness group (n = 40;
low-impulsives) based on their score (range = 0–17;
median = 4) on the impulsiveness scale of the I7 question-
naire (Eysenck et al., 1985). The low-impulsives had a
mean I7 impulsiveness score of 2.3 (S.D. = 1.4) and the
mean score of the high-impulsives was 9.5 (S.D. = 3.5).
After participants provided informed consent, they were
asked to complete the questionnaires and then the
decision-making tasks were administered in the following
157
order: reversal-learning task, Rogers Decision-Making
Task, Iowa Gambling Task. The study was approved by
the ethical committee of the Erasmus Medical Centre.
2.2. Instruments
2.2.1. I7 Impulsiveness Scale
The Dutch version of the 19-item Impulsiveness
Scale of the I7 questionnaire (Eysenck et al., 1985;
Lijffijt et al., 2005) was used as the measure of
impulsivity. In this questionnaire, impulsiveness is
regarded as acting without first considering the possible
consequences. The impulsiveness scale contains items
such as ‘Do you often buy things on impulse?’, and ‘Are
you an impulsive person?’ Respondents answered the
items on a dichotomous (i.e. ‘yes’ and ‘no’) response
scale. The I7 is a frequently employed questionnaire to
assess the personality trait of impulsivity (see Lijffijt
et al., 2005). The scale has good psychometric pro-
perties, with good reliability and validity. Cronbach's
alpha of the Dutch version was reported to be 0.80
(Lijffijt et al., 2005); in this study, alpha was 0.72.
2.2.2. Positive and Negative Affect Scales
In order to compare both impulsivity groups on
current affect, the Positive and Negative Affect Scales
(PANAS; Watson et al., 1988) were administered. The
PANAS is a 20-item bidimensional mood inventory.
The Positive Affect scale reflects the extent to which
a person feels enthusiastic, active, and alert (Watson
et al., 1988), whereas the Negative Affect scale is an
index of subjective distress and unpleasurable engage-
ment that subsumes a variety of aversive mood states,
including anger, contempt, disgust, guilt, fear, and
nervousness (Watson et al., 1988). Psychometric
properties of the PANAS scales are adequate, with
good reliability and validity (Boon and Peeters, 1999;
Watson et al., 1988). Cronbach's alpha of the Dutch
version was reported to be 0.89 and 0.86 for the PA
and NA scales, respectively (Boon and Peeters, 1999).
2.2.3. Rogers Decision-Making Task
The Rogers Decision-Making task was identical to
the task as described by Rogers et al. (2003). However,
the present version consisted of 40 trials randomly
presented within two blocks. On each trial, participants
had to choose one of the two presented gambles in order
to collect as many points as possible. The gambles were
represented in the form of a histogram. The height of
this histogram indicated the probability of gaining, and
the possible amounts of gains were indicated in green
above the histogram. The possible amounts of losses
158 I.H.A. Franken et al. / Psychiatry Research 158 (2008) 155–163
were indicated in red beneath the histogram (see Rogers
et al., 2003). For each trial, one gamble acted as the
control gamble, which consisted of a 50% probability of
winning 10 points and a 50% probability of losing 10
points. The other simultaneously presented gamble was
the “experimental gamble”. This trial type varied on
three factors: the probability of winning, high (75%) vs.
low (25%); the possible gains, large (80 points) vs. small
(20 points); and the possible losses, large (80 points) vs.
small (20 points). This procedure resulted in eight
different gambling situations, and because the experi-
mental gamble appeared randomly on the left or the
right of the screen, this resulted in a total of 16 different
gambling situations. Participants had to choose one of
the two gambles by pressing the numbers ‘1’ or ‘2’ on a
keyboard. Three indices of decision-making were
derived from the Rogers Decision-Making Task. First,
we took the overall proportion of choices of the
experimental over the control gamble. Furthermore,
following Rogers et al. (2003), we also included two
types of “all or nothing” trials. In the “gains only” trial
type, participants had to choose between a guaranteed
win of 40 points or a 50% chance of winning 80 points.
In the “losses only” trial type, participants had to choose
between a guaranteed loss of 40 points or a 50% chance
of losing 80 points. For the ‘gains only’ and ‘losses only’
trials, the dependent measure was the proportion of
choices on which volunteers chose the uncertain out-
come (experimental trial). Third, we also recorded the
time needed to make a decision (deliberation time).
After choosing, participants received feedback on the
amount of points they won or lost and the total amount
of points they had gathered so far.
2.2.4. Iowa Gambling Task
In the present study we used the computerized
version of the Iowa Gambling Task (Bechara et al.,
1994), which consisted of 100 successive trials in
which subjects were required to choose a card from
one of four decks. The participants were instructed to
try to gain as much money as possible by drawing
cards from one of four decks (A, B, C, D). The
decisions to choose from the decks are motivated by
reward and punishment schedules inherent in the task.
Two of the decks (A and B) are disadvantageous,
producing immediate gains (large rewards), but these are
accompanied by larger losses in the long run (larger
punishments). The C and D decks are advantageous:
here, gains are modest but more consistent and losses are
smaller. A net score ((C + D) − (A + B)) was computed,
with a higher score indicating that a subject is more often
choosing advantageous decks.
2.2.5. Probabilistic reversal-learning task
This task was similar to the one used by O'Doherty
et al. (2001), except for the fact that we used a fixed
number of trials (i.e. 100), and in our task a reversal took
place after five correct choices. Subjects had to choose
one of two stimuli (S+ and S−, which were easily
discerned geometrical figures) that were presented
simultaneously on the computer screen above each
other. The S+ (advantageous) stimulus had the follow-
ing properties: a reward–punishment ratio of 70:30, a
reward range of 80–250 points, and a punishment range
of 10–60 points. The S− (disadvantageous) stimulus
had the following properties: a reward–punishment ratio
of 40:60, a reward range of 30–60 points, and a
punishment range of 250–600 points. Accordingly,
persistent selection of S+ resulted in an overall gain, and
persistent selection of S− resulted in an overall loss.
When starting, subjects were unaware whether the upper
or the lower geometrical figure was the S+ or S−. They
had to learn by trial and error which one was the ad-
vantageous stimulus. Every time the participants chose
the S+ stimulus five times in a row, there was an S+ and
S− reversal (which the participant was unaware of).
Refer to O'Doherty et al. (2001) for a detailed
description. Scores derived from the probabilistic
reversal task were the total number of reversal
contingencies, the total number of errors, and the
mean deliberation time of the choices (Swainson et al.,
2000; Evers et al., 2005). Furthermore, a win-stay and
lose-stay analysis was conducted (Budhani and Blair,
2005). To change choice after large gain can be regarded
as disadvantageous choice behavior, and change after
large loss could be regarded as advantageous choice
behavior. This resulted in two additional scores: the
proportion of choices that can be classified as “stay after
large win” and the proportion of choices that can be
classified as “stay after large loss”.
2.3. Data analysis
Before analyzing the decision-making variables, we
examined the characteristics of the two groups. Age,
affect (PANAS score) and gender differences between
the two groups were analyzed using Students t-test or
a Fischer's Exact test. To answer the main research
questions, the groups were compared on their behavioral
decision-making performance by a multivariate analysis
of variance (MANOVA) with a Bonferroni correction for
multiple comparisons. Additionally, in order to explore
the relationships among various decision-making mea-
sures, Pearson correlation coefficients of these measures
were calculated. Further, to test which of the behavioral
 I.H.A. Franken et al. / Psychiatry Research 158 (2008) 155–163 159

Table 1 Subsequent pairwise comparisons indicated that high-

Mean values (standard deviations) of low- and high-impulsives on impulsives had lower scores on the Iowa Gambling Task
several indices of decision-making behavior
compared to low-impulsives, F(1,69) = 4.4, P b 0.05,
Low-impulsives High-impulsives η2 = 0.06. In Fig. 1, the mean scores of both impulsivity
IGT net score 13.6 (30.7) − 0.9 (23.5) a groups over the five blocks on the Iowa Gambling Task
RDMT proportion of 0.52 (0.15) 0.58 (0.13) are shown. On the Rogers Decision-Making Task, high-
risky choices
impulsives had shorter deliberation times, F(1,69) = 4.4,
RDMT proportion of risky 0.43 (0.23) 0.50 (0.16)
choice on “all or P b 0.05, η2 = 0.09. High-impulsives did not made overall
nothing trials” more risky choices on the Rogers Decision-Making Task
RDMT mean deliberation 3192.7 (1423.5) 2402.5 (1123.6) a F(1,69) = 1.9, P = 0.09, η2 = 0.04. On the probabilistic
time (ms) reversal task, high-impulsives reached a lower number of
PRT stay after large 0.85 (0.14) 0.79 (0.13) a
reversals F(1,69) = 6.3, P b 0.05, η2 = 0.09, had a higher
gain proportion
PRT stay after large 0.27 (0.16) 0.36 (0.17) a proportion of stay after large loss choices, F(1,69) = 5.0,
loss proportion P b 0.05, η2 = 0.07, and a lower proportion of stay after
PRT number of reversals 7.3 (3.6) 5.2 (3.0) a large gain choices, F(1,69) = 5.0, P b 0.05, η2 = 0.06,
PRT number of errors 34.9 (9.3) 39.6 (8.4) a and had a higher number of errors, F(1,69) = 4.7,
PRT mean deliberation 620.2 (330.1) 547.4 (190.2)
P b 0.05, η2 = 0.07. Regression analyses showed that
time (ms)
the Iowa Gambling Task score was the most powerful
Notes. N = 70. IGT = Iowa Gambling Task, RDMT = Rogers Decision-
predictor of self-reported impulsivity and explained 27%
Making Task, PRT = probabilistic reversal task.
a
Significant differences in MANOVA. of the variance of self-reported impulsivity (standardized
β = −0.27, partial r = −0.27, P b 0.05).
measures was the most powerful predictor of self-re- The Pearson correlation coefficients among the three
ported impulsivity, a stepwise multiple regression ana- decision-making questionnaires are displayed in Table 2.
lysis was employed including all behavioral measures as Besides obvious correlations among sub-scores within
independent variables, and self-reported impulsivity as tasks, we also observed a significant positive corre-
the dependent variable. lation between the net score of the Iowa Gambling
Task and the number of reversals on the reversal-
3. Results learning task (r = 0.24, P b 0.05). Further, the deliber-
ation times on the Rogers Decision-Making Task and
3.1. Group characteristics

The groups of low-impulsives and high-impulsives

were equal with regard to gender ratio (23% vs. 17%
males; P = 0.76), mean age (20.7 vs. 21.0 years,
respectively; P = 0.62), mean positive affect score (33.4
vs. 34.8, respectively; P = 0.22), and mean negative
affect score (19.4 vs. 18.4, respectively; P = 0.55).

3.2. Decision-making

Mean scores of both groups on the decision-making

variables are displayed in Table 1. There was an overall
effect of impulsivity on the behavioral measures of
choice behavior, Wilks' Lambda = 0.85, F(10,57) = 2.1,
P b 0.05, η 2 = 0.27, indicating that high-impulsives
displayed generally impaired decision-making perfor-
mance as compared to low-impulsives.3

3
We conducted an extreme group analysis with top and bottom 20%
impulsivity scores. This analysis yielded a similar pattern of results on
the individual tasks effect on decision-making. However, due to the loss Fig. 1. Mean net score (advantageous–disadvantages choices) of both
of power, some of the differences dropped below the significance level. groups on the Iowa Gambling Task over the five blocks.
160 I.H.A. Franken et al. / Psychiatry Research 158 (2008) 155–163

Table 2
Correlations among the behavioral measures of decision-making
1 2 3 4 5 6 7 8
1. IGT net score –
2. RDMT proportion of risky choices − 0.21 –
3. RDMT proportion of risky choice on “all or nothing trials” − 0.02 0.17 –
4. RDMT mean deliberation time 0.17 −0.17 − 0.02 –
5. PRT stay after large gain proportion 0.13 −0.11 − 0.01 − 0.19 –
6. PRT stay after large loss proportion − 0.15 0.20 0.07 − 0.04 − 0.22 –
7. PRT number of reversals 0.24⁎ −0.14 0.00 − 0.05 0.61⁎⁎ − 0.33⁎⁎ –
8. PRT number of errors − 0.18 0.20 − 0.06 0.06 − 0.39⁎⁎ 0.68⁎⁎ − 0.77⁎⁎ –
9. PRT mean deliberation time − 0.03 −0.07 − 0.13 0.27⁎ − 0.03 0.10 − 0.18 0.26⁎
Notes. N = 70. IGT = Iowa Gambling Task, RDMT = Rogers Decision Making Task, PRT = Probalistic Reversal Task.
⁎P b 0.05; ⁎⁎P b 0.01.

the Reversal Task were positively correlated (r = 0.27,
P b 0.05).
4. Discussion
The current study examined the relation between
behavioral decision-making and the personality trait of
impulsivity. It was found that high-impulsives displayed a
general deficit in their decision-making abilities as
compared to low-impulsives. That is, high-impulsives
had sub-optimal performance on various decision-making
indices. The effect size of the overall performance deficit
was large (Cohen, 1988). More specifically, impairments
were found on several measures: High-impulsives dis-
played a decreased performance in learning of reward and
punishment associations in order to make appropriate
decisions, and impaired adaptation of choice behavior
according to changes in stimulus–reward contingencies.
The results on simple, non-learning, components of re-
ward- and punishment-based decision-making were less
clear; these seemed relatively unaffected as compared
with the tasks that require reward-based learning strate-
gies. Above all, the results indicate that impulsivity is
associated with a decreased ability to alter choice behavior
in response to fluctuations in reward contingency.
Interestingly, impulsives display lowered delibera-
tion times on the Rogers Decision-Making Task, and
it would be tempting to conclude that high-impul-
sives act before considering the consequences of their
choice. However, the performance on Rogers' task is
equal for both groups, suggesting that impulsives have
a more efficient decision-making strategy on this spe-
cific task.
The present study demonstrated that high-impulsives
have lower scores on the Iowa Gambling Task net score
compared with low-impulsives. In addition, the results
of regression analyses showed also that the Iowa
Gambling Task net score was the most powerful
predictor of self-reported impulsivity. The observed
association between impulsivity and Iowa Gambling
Task performance is in line with the study of Zermatten
et al. (2005) in which the authors found a negative
relation between the impulsivity-related trait of ‘lack
premeditation’ and the Iowa Gambling Task score.
However, this outcome is at variance with other studies
among healthy populations (Franken and Muris, 2005).
In contrast to the present study, in that study no
correlation between decision-making, as measured by
the Iowa Gambling Task and impulsivity could be
observed. A fact that may explain this divergence is that
in the Franken and Muris study a gambling task with a
progressive schedule of increased delayed punishments
was used (punishments increased progressively as
subjects selected more cards from the disadvantageous
decks, see Bechara et al., 2000b) resulting in a somewhat
different task that may not be related to impulsivity.
Further, in both studies different questionnaires were
employed for measuring impulsivity (i.e., the Dickman
Impulsivity Inventory vs. the I7). It is conceivable that
different impulsivity questionnaires tap different behav-
ioral aspects of impulsivity. In addition, the observed
association between impulsivity and decision-making is
also at variance with studies among psychiatric patient
populations which did not observe a relation between
impulsivity and behavioral decision-making (Bazanis
et al., 2002; Jollant et al., 2005). Clearly, more research
on which aspects of decision-making are related to
various indices of impulsivity is needed.
The present results contribute to the discussion about
the inconsistency of the definition of impulsivity (Even-
den, 1999a,b). Roughly, a distinction can be made between
definitions stressing the inhibition of an activated
response, as is measured using Go–Nogo tasks, and
definitions stressing the integration of reward/punishment
information in order to choose between two or more re-
sponse options, as is measured using the current decision-
 I.H.A. Franken et al. / Psychiatry Research 158 (2008) 155–163
making tasks. Interestingly, in a study of Lijffijt et al.
(2004), the authors found no difference between low- and
high-impulsives on behavioral measures of inhibitory
motor control using the same impulsivity measure as in the
current study. This suggests that the I7, and similar
impulsivity questionnaires tapping trait impulsivity, reflect
problems with the integration of reward/punishment infor-
mation and not the inhibition of motor control. Besides the
distinction between response inhibition and integration of
reward/punishment integration, other subclassifications of
impulsivity have been suggested. For example, Barratt
(1985) distinguishes three different aspects of impulsivity:
cognitive impulsiveness which is involved in making
quick cognitive decisions, motor impulsiveness which is
involved in acting without thinking, and non-planning
impulsiveness which involved a lack of “looking into the
future” or planning. The presently used impulsiveness
scale, the I7, reflects poor behavioral control and inabil-
ity to delay gratification of which the latter aspect is
obviously close to the behavioral decision-making instru-
ments used in the present study. Using multifactorial
impulsivity scales, it would be interesting to study which
specific facets of impulsivity relate to specific neuropsy-
chological mechanisms of decision-making.
Further, these results show also that reversal-learning
tasks tap a somewhat different aspect of impulsivity and
may be a useful addition to the behavioral measures
of impulsivity. Our additional correlational analyses
among the behavioral tasks show that, although all
measures tap decision-making, these do not measure
equal aspects. Except for the small correlations between
the Iowa Gambling Task net score and the number of
reversals on the reversal-learning task, and the small
correlation between the deliberation times on the Rogers
Decision-Making Task and the Reversal Task, there
were no significant correlations observed between the
various decision-making tasks. This suggests that these
measures indeed tap different aspects of choice be-
havior. Note that the correlation between the Iowa
Gambling Task net score and the number of reversals on
the reversal-learning task suggests that these tasks tap,
at least partly, a similar concept. This supports Clark
et al.'s (2004) notion that parallels exist between re-
versal learning and decision-making.
The present results also add new evidence to the
notion that impulsivity is associated with frontal lobe
deficits (King et al., 2003; Miller, 1992; Spinella, 2004),
more specifically, since both gambling tasks and reversal
learning are associated with orbitofrontal functioning,
suggesting a specific site of action. Probably, the as-
sociation between impulsivity and executive functions is
due to common neuroanatomical pathways. It is known
161
that both impulsivity and decision-making functions
have common prefrontal neural substrates. The present
results indicate that persons scoring high on the I7
impulsivity questionnaire display sub-optimal decision-
making strategies, which are probably modulated by the
ventral prefrontal cortex (Clark et al., 2004).
It is interesting to consider these results in the light of
the discussion of whether decision-making deficits that
characterize drug addiction (Clark and Robbins, 2002)
are the result of drug-induced changes in the prefrontal
cortex (e.g. Schoenbaum et al., 2006) or are already
present before the use of drugs. Although the present
study is not specifically designed to resolve this
question, this can only be done by prospective designs;
it shows that decision-making deficits can be present in
impulsive, normal individuals. Because it is known that
drug addiction is associated with augmented levels of
impulsivity (Dawe and Loxton, 2004) which results in
drug use (Sher et al., 2000), the current results suggest
that an individual with drug addiction may have pre-
existing impulsivity associated decision-making defi-
cits. Again, it must be kept in mind that this issue can
only be resolved in studies with longitudinal designs.
The present study has several limitations. We em-
ployed a sample of young students with an overrepre-
sentation of females. However, we do not think that this
is critical for the conclusions since it is not plausible to
assume that the relationship between behavioral deci-
sion-making and self-reported impulsivity is different for
other healthy populations. A further limitation is that we
have no data on psychiatric morbidity in this population.
However, previous studies among student populations
show that these numbers are typically very low. In
addition, the reliability of the behavioral decision-
making tasks employed in the present study is unknown.
Clearly, future studies should address this important
topic. Lastly, impulsivity status was based upon a
median-split rather than extreme values or clinical cut-
off points. However, it must be noted that clinical cut-
points for impulsivity have not yet been developed.
To summarize, the results indicate that impulsivity is
associated with a decreased ability to alter behavior in
response to fluctuations in emotional significance to
stimuli. The findings add further evidence to the notion
that trait impulsivity is associated with decision-making,
a function of the orbitofrontal cortex.
Acknowledgements
This work was supported by the Netherlands
Organization for Scientific Research (NWO). The
authors thank Dr. A. Bechara for providing the Iowa
162 I.H.A. Franken et al. / Psychiatry Research 158 (2008) 155–163
task, Manon de Long for writing a Dutch version of the
Iowa task software, and Saskia van Dantzig for assisting
with the learning reversal and decision-making tasks.
References
Barratt, E.S., 1985. Impulsiveness subtraits: arousal and informa-
tion processing. In: Spence, J.T., Izard, C.E. (Eds.), Motivation,
Emotion and Personality. Elsevier North Holland, pp. 137–146.
Bazanis, E., Rogers, R.D., Dowson, J.H., Taylor, P., Meux, C., Staley,
C., Nevinson-Andrews, D., Taylor, C., Robbins, T.W., Sahakian,
B.J., 2002. Neurocognitive deficits in decision-making and
planning of patients with DSM-III-R borderline personality
disorder. Psychological Medicine 32, 1395–1405.
Bechara, A., 2004. The role of emotion in decision-making: evidence
from neurological patients with orbitofrontal damage. Brain and
Cognition 55, 30–40.
Bechara, A., 2005. Decision making, impulse control and loss of
willpower to resist drugs: a neurocognitive perspective. Nature
Neuroscience 8, 1458–1463.
Bechara, A., Damasio, A.R., Damasio, H., Anderson, S.W., 1994. Insen-
sitivity to future consequences following damage to human prefrontal
cortex. Cognition 50, 7–15.
Bechara, A., Damasio, H., Damasio, A.R., 2000a. Emotion, decision
making and the orbitofrontal cortex. Cerebral Cortex 10,
295–307.
Bechara, A., Tranel, D., Damasio, H., 2000b. Characterization of the
decision-making deficit of patients with ventromedial prefrontal
cortex lesions. Brain 123, 2189–2202.
Boon, M.T., Peeters, F.P., 1999. Affectieve dimensies bij depressie
en angst (Dimensions of affectivity in depression and anxiety).
Tijdschrift voor Psychiatrie 41, 109–113.
Brand, M., Labudda, K., Markowitsch, H.J., 2006. Neuropsycholog-
ical correlates of decision-making in ambiguous and risky
situations. Neural Networks 19, 1266–1276.
Budhani, S., Blair, R.J.R., 2005. Response reversal and children with
psychopathic tendencies: success is a function of salience of con-
tingency change. Journal of Child Psychology and Psychiatry 46,
972–981.
Cabanac, M., 1992. Pleasure: the common currency. Journal of Theore-
tical Biology 155, 173–200.
Cavedini, P., Riboldi, G., D'Annucci, A., Belotti, P., Cisima, M., Bellodi,
L., 2002a. Decision-making heterogeneity in obsessive–compulsive
disorder: ventromedial prefrontal cortex function predicts different
treatment outcomes. Neuropsychologia 40, 205–211.
Cavedini, P., Riboldi, G., Keller, R., D'Annucci, A., Bellodi, L.,
2002b. Frontal lobe dysfunction in pathological gambling patients.
Biological Psychiatry 51, 334–341.
Cavedini, P., Bassi, T., Ubbiali, A., Casolari, A., Giordani, S., Zorzi,
C., Bellodi, L., 2004. Neuropsychological investigation of
decision-making in anorexia nervosa. Psychiatry Research 127,
259–266.
Clark, L., Robbins, T.W., 2002. Decision-making deficits in drug
addiction. Trends in Cognitive Sciencess 6, 361–363.
Clark, L., Cools, R., Robbins, T.W., 2004. The neuropsychology of
ventral prefrontal cortex: decision-making and reversal learning.
Brain and Cognition 55, 41–53.
Cohen, J., 1988. Statistical Power Analysis for the Behavioral
Sciences, 2 ed. Erlbaum, Hillsdale, NJ.
Cools, R., Clark, L., Owen, A.M., Robbins, T.W., 2002. Defining
the neural mechanisms of probabilistic reversal learning using
event-related functional magnetic resonance imaging. Journal of
Neuroscience 22, 4563–4567.
Dawe, S., Loxton, N.J., 2004. The role of impulsivity in the devel-
opment of substance use and eating disorders. Neuroscience and
Biobehavioral Reviews 28, 343–351.
Dunn, B.D., Dalgleish, T., Lawrence, A.D., 2006. The somatic marker
hypothesis: a critical evaluation. Neuroscience and Biobehavioral
Reviews 30, 239–271.
Ernst, M., Grant, S.J., London, E.D., Contoreggi, C.S., Kimes, A.S.,
Spurgeon, L., 2003. Decision making in adolescents with behavior
disorders and adults with substance abuse. American Journal of
Psychiatry 160, 33–40.
Evenden, J.L., 1999a. Impulsivity: a discussion of clinical and experi-
mental findings. Journal of Psychopharmacology 13, 180–192.
Evenden, J.L., 1999b. Varieties of impulsivity. Psychopharmacology
146, 348–361.
Evers, E.A.T., Cools, R., Clark, L., van der Veen, F.M., Jolles, J.,
Sahakian, B.J., Robbins, T.W., 2005. Serotonergic modulation of
prefrontal cortex during negative feedback in probabilistic reversal
learning. Neuropsychopharmacology 30, 1138–1147.
Eysenck, S.B.G., Pearson, P.R., Easting, G., Allsopp, J.F., 1985. Age
norms for impulsiveness, venturesomeness and empathy in adults.
Personality and Individual Differences 6, 613–619.
Fellows, L.K., 2004. The cognitive neuroscience of human decision
making: a review and conceptual framework. Behavioral and
Cognitive Neuroscience Reviews 3, 159–172.
Franken, I.H.A., Muris, P., 2005. Individual differences in decision-
making. Personality and Individual Differences 39, 991–998.
Fukui, H., Murai, T., Fukuyama, H., Hayashi, T., Hanakawa, T., 2005.
Functional activity related to risk anticipation during performance
of the Iowa Gambling Task. NeuroImage 24, 159–253.
Hester, R., Garavan, H., 2004. Executive dysfunction in cocaine
addiction: evidence for discordant frontal, cingulate, and cerebellar
activity. Journal of Neuroscience 24, 11017–11022.
Hornak, J., O'Doherty, J., Bramham, J., Rolls, E.T., Morris, R.G.,
Bullock, P.R., Polkey, C.E., 2004. Reward-related reversal learning
after surgical excisions in orbito-frontal or dorsolateral prefrontal
cortex in humans. Journal of Cognitive Neuroscience 16, 463–478.
Jollant, F., Bellivier, F., Leboyer, M., Astruc, B., Torres, S., Verdier, R.,
Castelnau, D., Malafosse, A., Courtet, P., 2005. Impaired decision
making in suicide attempters. American Journal of Psychiatry 162,
304–310.
King, J.A., Tenney, J., Rossi, V., Colamussi, L., Burdick, S., 2003.
Neural substrates underlying impulsivity. Annals of the New York
Academy of Sciences 1008, 160–169.
Kringelbach, M.L., Rolls, E.T., 2003. Neural correlates of rapid
reversal learning in a simple model of human social interaction.
NeuroImage 20, 1371–1383.
Lijffijt, M., Bekker, E.M., Quik, E.H., Bakker, J., Kenemans, J.L.,
Verbaten, M.N., 2004. Differences between low and high trait
impulsivity are not associated with differences in inhibitory motor
control. Journal of Attentional Disorders 8, 25–32.
Lijffijt, M., Kenemans, J.L., Caci, H., 2005. Validation of the Dutch
translation of the I7 questionnaire. Personality and Individual
Differences 38, 1123–1133.
Maia, T.V., McClelland, J.L., 2004. A reexamination of the evidence for
the somatic marker hypothesis: what participants really know in the
Iowa gambling task. Proceedings of the National Academy of
Sciences of the United States of America 101, 16075–16080.
Mavaddat, N., Kirkpatrick, P.J., Rogers, R.D., Sahakian, B.J., 2000.
Deficits in decision-making in patients with aneurysms of the
anterior communicating artery. Brain 123, 2109–2117.
 I.H.A. Franken et al. / Psychiatry Research 158 (2008) 155–163
Miller, L.A., 1992. Impulsivity, risk-taking, and the ability to syn-
thesize fragmented information after frontal lobectomy. Neuro-
psychologia 30, 69–79.
Moeller, F.G., Barrat, E.S., Dougherthy, D.M., Schmitz, J.M., Swann,
A.C., 2001. Psychiatric aspects of impulsivity. American Journal
of Psychiatry 158, 1783–1793.
Morgan, M.J., Impallomeni, L.C., Pirona, A., Rogers, R.D., 2006.
Elevated impulsivity and impaired decision-making in abstinent
ecstasy (MDMA) users compared to polydrug and drug-naive
controls. Neuropsychopharmacology 31, 1562–1573.
Northoff, G., Grimm, S., Boeker, H., Schmidt, C., Bermpohl, F.,
Heinzel, A., Hell, D., Boesiger, P., 2006. Affective judgment and
beneficial decision making: Ventromedial prefrontal activity
correlates with performance in the Iowa Gambling Task. Human
Brain Mapping 27, 572–587.
O'Doherty, J., Kringelbach, M.L., Rolls, E.T., Hornak, J., Andrews,
C., 2001. Abstract reward and punishment representations in the
human orbitofrontal cortex. Nature Neuroscience 4, 95–102.
Rahman, S., Sahakian, B.J., Hodges, J.R., Rogers, R.D., Robbins,
T.W., 1999. Specific cognitive deficits in mild frontal variant
frontotemporal dementia. Brain 122, 1469–1493.
Rahman, S., Sahakian, B., Cardinal, R., Rogers, R., Robbins, T., 2001.
Decision making and neuropsychiatry. Trends in Cognitive
Sciences 5, 271–277.
Remijnse, P.L., Nielen, M.M.A., Uylings, H.B.M., Veltman, D.J.,
2005. Neural correlates of a reversal learning task with an
affectively neutral baseline: an event-related fMRI study. Neuro-
Image 26, 609–618.
Ridderinkhof, K.R., van den Wildenberg, W.P., Segalowitz, S.J.,
Carter, C.S., 2004. Neurocognitive mechanisms of cognitive
control: the role of prefrontal cortex in action selection, response
inhibition, performance monitoring, and reward-based learning.
Brain and Cognition 56, 129–140.
Rogers, R.D., 2003. Neuropsychological investigations of the impulsive
personality disorders. Psychological Medicine 33, 1335–1340.
Rogers, R.D., Everitt, B.J., Baldacchino, A., Blackshaw, A.J., Swainson,
R., Wynne, K., Baker, N.B., Hunter, J., Carthy, T., Booker, E.,
London, M., Deakin, J.F., Sahakian, B.J., Robbins, T.W., 1999a.
Dissociable deficits in the decision-making cognition of chronic
amphetamine abusers, opiate abusers, patients with focal damage to
prefrontal cortex, and tryptophan-depleted normal volunteers:
evidence for monoaminergic mechanisms. Neuropsychopharmacol-
ogy 20, 322–339.
163
Rogers, R.D., Owen, A.M., Middleton, H.C., Williams, E.J., Pickard,
J.D., Sahakian, B.J., Robbins, T.W., 1999b. Choosing between
small, likely rewards and large, unlikely rewards activates inferior
and orbital prefrontal cortex. Journal of Neuroscience 19, 9029–9038.
Rogers, R.D., Tunbridge, E.M., Bhagwagar, Z., Drevets, W.C., Sahakian,
B.J., Carter, C.S., 2003. Tryptophan depletion alters the decision-
making of healthy volunteers through altered processing of reward
cues. Neuropsychopharmacology 28, 153–162.
Rolls, E.T., 1996. The orbitofrontal cortex. Philosophical Transactions
of the Royal Society of London. Series B, Biological Sciences 351,
1433–1443.
Rolls, E.T., 1999. The Brain and Emotion. Oxford University Press,
New York.
Rolls, E.T., Hornak, J., Wade, D., McGrath, J., 1994. Emotion-related
learning in patients with social and emotional changes associated
with frontal lobe damage. Journal of Neurology, Neurosurgery and
Psychiatry 57, 1518–1524.
Schoenbaum, G., Roesch, M.R., Stalnaker, T.A., 2006. Orbitofrontal
cortex, decision-making and drug addiction. Trends in Neuro-
sciences 29, 116–124.
Sher, K.J., Bartholow, B.D., Wood, M.D., 2000. Personality and
substance use disorders: a prospective study. Journal of Consulting
and Clinical Psychology 68, 818–829.
Spinella, M., 2004. Neurobehavioral correlates of impulsivity: evidence
of prefrontal involvement. International Journal of Neuroscience 114,
95–104.
Swainson, R., Rogers, R.D., Sahakian, B.J., Summers, B.A., Polkey,
C.E., Robbins, T.W., 2000. Probabilistic learning and reversal
deficits in patients with Parkinson's disease or frontal or temporal
lobe lesions: possible adverse effects of dopaminergic medication.
Neuropsychologia 38, 596–612.
Toplak, M.E., Jain, U., Tannock, R., 2005. Executive and motivational
processes in adolescents with Attention-Deficit-Hyperactivity
Disorder (ADHD). Behavioral and Brain Functions 1, 8.
Watson, D., Clark, L.A., Tellegen, A., 1988. Development and validation
of brief measures of positive and negative affect: the PANAS Scales.
Journal of Personality and Social Psychology 54, 1063–1070.
Zermatten, A.M., Van der Linden, M.P., d'Acremont, M.M., Jermann,
F.M., Bechara, A.P., 2005. Impulsivity and decision making.
Journal of Nervous and Mental Disease 193, 647–650.