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.