Genetic factors behind impulsive choices tied to metabolic and mental health

Researchers from University of California San Diego have identified 11 genetic regions linked to delay discounting - the tendency to prefer smaller, immediate rewards over larger, delayed ones - shedding new light on how impulsive decision-making relates to both mental and physical health. The study, published on Nov. 25, 2025 in Molecular Psychiatry, analyzed genome-wide data from 134,935 23andMe participants and found that the same genetic factors that influence impulsive decision-making also overlap with risks for conditions like obesity, diabetes and other metabolic health issues.

Impulsive decision-making is something we all experience, but its biological roots have been surprisingly difficult to pin down. These findings show that delay discounting is not just a behavioral tendency, it is deeply intertwined with genetic pathways involved in brain development, cognition and physical health."

Sandra Sanchez-Roige, Ph.D., associate professor of psychiatry at UC San Diego School of Medicine and senior author of the study

Building on a previous genome-wide association study five times smaller, the team mapped 11 independent genetic regions and identified 93 candidate genes associated with delay discounting. Several of these genes were involved in dopamine signaling, neuronal growth metabolic pathways and brain structure - systems also implicated in psychiatric disorders, obesity, chronic pain and educational outcomes. Subsequent analyses found genetic correlations between delay discounting and 73 traits ranging from substance use and depression to gastrointestinal disorders and sleep duration.

The researchers also conducted a network analysis to determine which biological mechanisms are shared across traits. "We found clusters of overlapping pathways - particularly involving cognition, metabolism and externalizing behaviors - that may explain why delay discounting is a common feature across many mental health conditions," said Abraham A. Palmer, Ph.D., professor and vice chair for basic research in the Department of Psychiatry at UC San Diego School of Medicine and co-author of the study. Additional analyses showed that many associations persisted even after adjusting for cognitive measures such as intelligence and educational attainment, indicating that delay discounting has a partially distinct genetic basis.

To explore downstream clinical impacts, the team developed polygenic scores for delay discounting and tested them in a hospital cohort of more than 66,000 individuals. "We identified that these scores, which represent the genetic tendency to favor smaller immediate rewards, were associated with 212 medical outcomes, including type 2 diabetes, chronic pain, ischemic heart disease, mood disorders and tobacco use disorder", said first author Hayley Thorpe, Ph.D., a visiting scholar in Sanchez-Roige's lab and postdoctoral researcher at Western University. "This highlights how impulsive decision-making may influence long-term health risk".

"Understanding the genetic and biological roots of delay discounting opens up many new possibilities," Sanchez-Roige said. "In the future, delay discounting could become a clinically useful marker, one that helps us improve behavioral and pharmacological treatments aimed at impulsivity." Unlike many studies that examine the causes of specific disease, "these studies explore the genetic basis of trans-diagnostic genetic tendencies, which are the fundamental building blocks that influence people's behavior throughout life and are interwoven with disease susceptibility, as well as economic and social outcomes" adds Palmer.

The authors note that while the study identifies promising genetic targets, future research should explore causal relationships and test whether modifying delay discounting can improve health outcomes. They also emphasize the need for replication of newly discovered genetic associations and for studies integrating environmental factors such as socioeconomic status.

"Delay discounting is measurable, highly heritable and relevant to many aspects of health," Sanchez-Roige added. "By continuing to investigate this fundamental decision-making process, we may uncover new ways to prevent or treat a wide range of conditions."