Anxiety is associated with impulsivity in bipolar disorder Charles T. Taylor, Dina R. Hirshfeld-Becker, Michael J. Ostacher, Candice W. Chow, Richard T. LeBeau, Mark H. Pollack, Andrew A. Nierenberg, Naomi M. Simon * Department of Psychiatry, Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital and Harvard Medical School, United States Received 15 August 2007; received in revised form 4 September 2007; accepted 5 September 2007 Abstract Impulsivity and anxiety, common features of bipolar disorder (BD), are each associated with a number of negative outcomes in BD. The relationship between anxiety and impulsivity, however, has not been a focus of study in BD. In this paper, we present data regarding the association between anxiety and impulsivity as measured by the Barratt impulsiveness scale (BIS-11) in 114 outpatients with BD. Results revealed that patients with a comorbid anxiety disorder displayed significantly higher levels of impulsivity relative to patients without an anxiety disorder. Moreover, a broad range of anxiety-related symptom domains was associated with greater impulsivity. Exploratory analyses also revealed that baseline anxiety symptoms were associated with elevated impulsivity at 9-month follow-up, although these relationships were less robust after covariate adjustment. These data demonstrate that anxiety is positively associated with impulsivity in patients with BD. Further studies are needed to elucidate the implications of and reasons for this association. # 2007 Elsevier Ltd. All rights reserved. Keywords: Bipolar disorder; Anxiety disorder; Anxiety; Impulsivity; Comorbidity; Behavioral disinhibition 1. Introduction A growing literature indicates that anxiety comor- bidity is common and disabling in individuals with bipolar disorder (BD) (Kessler, Rubinow, Holmes, Abelson, & Zhao, 1997; McElroy et al., 2001). In a recent large-scale investigation, more than half (51.2%) of patients with BD were identified as having a co- occurring anxiety disorder at some point in their lifetime, while 30.5% were diagnosed as having a current anxiety disorder (Simon et al., 2004). Anxiety disorder comorbidity in BD is associated with a number of negative sequelae, including greater bipolar severity, reduced duration of euthymic episodes, elevated substance abuse, greater functional impairment, and an overall diminished quality of life (Cassano, Pini, Saettoni, & Dell’Osso, 1999; Simon et al., 2004; Young, Cooke, Robb, Levitt, & Joffe, 1993). Moreover, anxiety comorbidity bodes poorly for the prognosis of BD and its treatment outcome (Feske et al., 2000), and both anxiety disorders and anxiety symptoms have been clearly linked to increased risk of suicidal ideation and attempts (Engstrom, Brandstrom, Sigvardsson, Clonin- ger, & Nylander, 2004; Fawcett et al., 1990; Frank et al., 2002; Simon et al., 2004, 2007a). Impulsivity is a core feature of bipolar disorder (APA, 1994; Moeller, Barratt, Dougherty, Schmitz, & Swann, Journal of Anxiety Disorders 22 (2008) 868–876 * Corresponding author at: Department of Psychiatry, Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, Simches Research Building, 185 Cambridge Street, Suite 2200, Boston, MA 02114, United States. Tel.: +1 617 726 7913; fax: +1 617 643 3080. E-mail address: nsimon@partners.org (N.M. Simon). 0887-6185/$ – see front matter # 2007 Elsevier Ltd. All rights reserved. doi:10.1016/j.janxdis.2007.09.001