Impulsive and Compulsive Behaviours
Impulsive and compulsive behaviors are possible side effects of some Parkinson’s medications. Only a small number of people experience these behaviours, but it can have a significant impact on the person affected and those around them.
Impulsive behaviour is when a person cannot resist the temptation to carry out certain activities. These are often activities that give an immediate reward or pleasure, such as gambling, eating, shopping, or an increase in sexual thoughts, feelings and behaviours. Some people may demonstrate more than one of these behaviours.
A person with impulsive behaviour may carry out a particular activity without giving any thought to the future or to the long-term consequences. For example, someone who has the impulse to shop may buy a new item of clothing, even if they can’t really afford it.
This behaviour may lead to harmful social, financial or legal consequences.
Compulsive behaviour is when a person has an overwhelming drive to act in a certain way, often repetitively, to reduce the worry or tension that they get from their urge.
Parkinson’s and Impulsive and Compulsive Behaviours
Impulsive and compulsive behaviour is related to dopamine levels in the brain. Dopamine is the chemical messenger in the brain that is primarily affected in Parkinson’s. As well as helping to control movement, balance and walking, dopamine also plays a big role in the part of the brain that controls reward.
People affected by impulsive and compulsive behaviour are motivated to do something that gives them an instant reward. Some Parkinson’s medications have been linked to these types of behaviour. The medications most likely to cause these behaviour side effects are Dopamine Agonists and occasionally Levodopa.
It is important to remember that this is a reaction to medication and not a problem with the person or a personality flaw.
The majority of people who take Parkinson’s medication will not experience impulsive and compulsive behaviour problems
Types of Impulsive and Compulsive Behaviours
- Addictive gambling
- Binge eating
- Obsessive shopping
- Punding: the repetitive performance of tasks such as sorting, organising or using the Internet.
- Addiction to Parkinson’s medication
Risk of experiencing these behaviours
It is important that all people with Parkinson’s are assessed for any potential risk of impulsive and compulsive behaviour before they start taking their medication. This is an important discussion to have with your specialist.
Research has shown that around 17% of people with Parkinson’s who take dopamine agonists experience impulsive and compulsive behaviour.
For a small number of people, levodopa, has also been shown to have similar side effects. The research suggests that 7% of people who take these other kinds of medication are affected.
Evidence suggests that you may be more likely to experience impulsive and compulsive behaviour if you are:
- Younger person with Parkinson’s
- Single person who lives alone
- Someone with a history of addictive behaviour
- Someone who has a family history of gambling or alcohol abuse
It’s important to emphasise that not everyone will experience this behaviour. It is a possible side effect. It should not put you off taking your medication. Your specialist will assess your risk of impulsive and compulsive behaviours and you can work together to find the most appropriate treatment option for you.
A checklist to monitor changes in behaviour can be used by your specialist. Continually monitor your behaviour and communicate with your specialist, family and friends to ensure that if any behaviour changes occur, they can be addressed quickly.
- Consult your specialist
If you as a person with Parkinson’s or as a family member / friend / carer of a person with Parkinson’s notice any of the behaviours listed, then please make an immediate appointment with the neurologist. It is important to explain fully what you have been experiencing. The specialist will most likely change your medication so that the impulse control disorder is resolved.
- Seek professional support
- Use harm minimisation techniques until the issue is resolved such as:
- Give control of your financial matters to someone you trust (eg. a partner)
- Tell those around you about the behaviour as a form of public accountability
- Never carry huge sums of cash on you or engage in jobs that gives you access to large sums of cash
- If you do decide to continue gambling, always set limits and keep an eye on how much you are spending
Support for you
- Call the Parkinson’s Victoria Information Line for free and confidential advice and support on 1800 644 189