Impulsive Aggression and the Significance of Bullying in Attention-Deficit/Hyperactivity Disorder

I found the special issue on impulsive aggression (IA) very interesting and useful. Its importance in attention-deficit/hyperactivity disorder (ADHD) was emphasized by Saylor and Amann (2016) who pointed out that the severity of impairment often equated to the level of aggression. However, I found little discussion of the notion that acts of aggression might be experienced as rewarding and reinforcing and that bullying might, therefore, be a goal in itself. This is despite the emphasis in Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) on deliberate malice across the progression from oppositional defiant disorder through conduct disorder to antisocial personality disorder (American Psychiatric Association 2013). Bullying might apply not only to premeditated aggression but also to IA, as an individual might impulsively seize opportunities to hurt another without obvious cause. If this were the case, it would explain why IA would be strongly predictive of peer rejection (Saylor and Amann 2016).

This raises the question of why someone would bully another person for pleasure. One possible explanation is that their subjective experience of reward is deficient and they, therefore, experience less satisfaction from achievement. This might make them more moody and less motivated to carry out their daily tasks, together with pathological reward-seeking behavior (Poulton 2015). If the emotional reward is greater than the immediate negative consequences, bullying could be highly resistant to treatment.

Individuals with ADHD would have the impairment associated with their executive functioning deficits exacerbated if they also lacked motivation to achieve as a result of coexisting reward deficiency (Poulton and Nanan 2014). Bullying could, therefore, be a manifestation of reward deficiency, its presence signaling an additional, independent mechanism contributing to symptom severity in ADHD.