Impulse Control

Impulse control disorders (ICDs), including compulsive gambling, sexual behaviors, shopping, and eating are common in people with Parkinson's who take dopamine agonists. ICD's are characterized by:

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• The perpetuation of repeated negative behaviors regardless of negative consequences

• Progressive lack of control over engaging in these behaviors

• Mounting tension or craving to perform these negative behaviors before acting on them

• A sense of relief or pleasure in performing problematic behaviors

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People who experience impulse control disorders may or may not plan the acts; however, the acts themselves nearly always fulfill their immediate wishes, even if they are ultimately distressing to the person and make them feel out of control.

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The most common ICDs reported in people with Parkinson's are pathological gambling, hypersexuality, compulsive shopping and compulsive eating. More than 25% of the people who have ICDs have two or more of these behaviors. Those who are more susceptible to developing ICDs include:

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• Being male

• Younger age at diagnosis

• History of drug abuse

• History of gambling

• Impulsive sensation personality traits

• Family history of psychiatric disorders

• Depression

• Overuse of dopaminergic medications due to dopamine dysregulation syndrome

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The first line of treatment when the behaviors are severe and destructive is to reduce the offending medication. In most cases, reducing or discontinuing the dopamine agonist reduced or eliminated the severity of the ICD. The most important thing to remember about impulse control disorders is that it's a medical condition, not the result of personal weakness. If help is sought, it is possible to get better.

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