Understanding and Coping with Impulse Control Disorders
Impulse control disorders (ICDs) can occur in people with Parkinson’s disease (PD) due to a variety of factors, and may present complex challenges for carepartners. Examples of behaviours seen in people with ICDs include hypersexuality, compulsive gambling or shopping, binge eating, and aggressive outbursts. There are estimates that between 10% and 20% of people with PD will develop some form of impulse control disorder throughout the course of their illness (International Parkinson and Movement Disorder Society, 2018). ICDs can develop in gradual and subtle ways, with neither the person with Parkinson’s nor their loved ones immediately recognizing what is happening. Because of their close relationship to the person with PD, carepartners are uniquely positioned to help spot the earliest signs of impulse control problems, but may also be on the receiving end of the negative effects of such disorders.
Parkinson’s medications, especially dopamine agonists, have long been known to contribute to the development of impulse control disorders. For some people with Parkinson’s, dopaminergic drugs may boost levels of dopamine in motor pathways, but can also cause an unwanted overabundance of dopamine in other parts of the brain that are less affected by PD, such as the mesocorticolimbic system, which plays an important role in learning, memory, and motivation. As a result, the individual may become especially sensitive to rewards and develop an impulse control disorder (Eisinger et al., 2019).
However, medications are not the only cause of ICDs – there are many additional risk factors that may make someone more susceptible to their development. In general, men are more likely than woman to develop an ICD, especially those of a hypersexual nature. Younger people with Parkinson’s are also more susceptible, as well as those with a longer disease duration. Some researchers have suggested that the reason for this is because younger individuals will be exposed to more dopaminergic medication throughout their lives simply by getting the disease at an earlier age, but studies are still divided on the topic. Finally, people who have a family history of impulsivity are more likely to develop impulse control disorders, as well as those who have experienced anxiety and depression in the past (Eisinger et al., 2019).
Understandably, impulse control disorders can be especially distressing for carepartners. What is more frustrating is that the person with Parkinson’s may not be able to identify that they have a problem. In fact, the impulse control behaviours that cause carepartners the most difficulty are those the person with PD does not see as troublesome; they may deny that there is a problem at all, or disagree with the carepartner’s assessment of its severity (Erga et al., 2020). One study interviewed over a dozen carepartners about their experiences with impulse control disorders and found similar patterns in their stories. The impulsive behaviour tended to come on gradually, which often resulted in a delay in identifying that the medication may have been causing the changes. Some carepartners thought they could stop the impulsive behaviours by persuading or bribing their partner. Others tried to accept the problematic changes due to shame in discussing these topics with a neurologist, or fear of damaging their partner’s reputation with loved ones. However, as time went on, all the carepartners in the study described the behaviours as having a significant impact on their quality of life. This included feeling distressed when being on the receiving end of explosive aggressive outbursts, anxiety watching their spouse overspend, and relationship strain caused by attempts to stop the behaviours (McKeown et al., 2020).
Fortunately for both people with PD and their loved ones, there are ways to manage impulse control disorders and their effects, such as:
- Talking to a neurologist or doctor. As soon as an impulse control disorder is suspected, it is essential to speak with one's healthcare provider. As ICDs may make people with PD unable to see the problematic nature of their behaviour, carepartners may need to seek advice on their loved one’s behalf. Medication changes can be made, but people with PD should never attempt to reduce or stop dopaminergic medication without the guidance a medical professional (International Parkinson and Movement Disorder Society, 2018). It is important to note that while medication changes or reductions are likely to help the problem, this is not a guarantee. In some people with Parkinson’s, ICDs may persist –one large study found that more than 50% of ICDs did not go away after stopping dopamine agonists (Eisinger et al., 2019).
- Implementing behavioural measures. Carepartners can help manage ICDs by helping prevent the negative consequences by limiting access to things such as credit cards, the Internet, and unhealthy food. Gambling intervention programs can also be helpful in some instances (Pontone, 2018).
- Seeking mental health support. The help of a trained professional, such as a psychologist or counsellor, is critical when dealing with an impulse control disorder. Professionals can help the person with PD better cope with their impulses and break the habit of reward-seeking. One study found that cognitive behavioural therapy (CBT) greatly improved impulse control disorder severity in people with Parkinson’s (Kelly et al., 2020).
- Finding a supportive community. Support groups are a safe space to share with others who are experiencing similar difficulties. Carepartners can greatly benefit from knowing they are not alone. Parkinson Society BC offers numerous carepartner support groups; to learn more and join a group, please visit www.parkinson.bc.ca/supportgroups.
Impulse control disorders are a challenge for people with Parkinson’s and their loved ones. While much is understood about how and why they develop, there still remains a lot we do not fully understand. Carepartners, despite weathering many of the hardships that come about as a result of ICDs, can be powerful catalysts for change.
Sources
Eisinger, R. S., Ramirez-Zamora, A., Carbunaru, S., Ptak, B., Peng-Chen, Z., Okun, M.S., & Gunduz A. (2019). Medications, Deep Brain Stimulation, and Other Factors Influencing Impulse Control Disorders in Parkinson's Disease. Frontiers in Neurology, 10. https://doi.org/10.3389/fneur.2019.00086
Erga, A. H., Alves, G., Tysnes, O. B., & Pedersen, K. F. (2020). Impulsive and compulsive behaviors in Parkinson's disease: Impact on quality of and satisfaction with life, and caregiver burden. Parkinsonism & Related Disorders, 78, 27-30. https://doi.org/10.1016/j.parkreldis.2020.07.007
International Parkinson and Movement Disorder Society. (2018). Impulse Control Disorders in Parkinson's Disease: Essential Facts for Patients. https://www.movementdisorders.org/MDS/Resources/Patient-Education/Impulse-Control-Disorders-in-Parkinsons-Disease.htm
Kelly, M. J., Baig, F., Hu, M. T., & Okai, D. (2020). Spectrum of impulse control behaviours in Parkinson’s disease: pathophysiology and management. Journal of Neurology, Neurosurgery & Psychiatry (91), 7. http://dx.doi.org/10.1136/jnnp-2019-322453
McKeown, E., Saleem, T., Magee, C., & Haddad, M. (2020). The experiences of carers looking after people with Parkinson’s disease who exhibit impulsive and compulsive behaviours: An exploratory qualitative study. Journal of Clinical Nursing, 29(23-24), 4623-4632. https://doi.org/10.1111/jocn.15499
Pontone, G. (2018). What are Impulse Control Disorders? https://www.apdaparkinson.org/what-is-parkinsons/symptoms/impulse-control-disorders
This content was published in the Spring 2023 edition of our quarterly magazine, Viewpoints. The content was accurate as of this publication date.