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What Causes Impulse Control Disorders and Who Gets Them?

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Updated April 13, 2009

What Causes Impulse Control Disorders and Who Gets Them?

Some impulsive control behaviors include gambling, eating, shopping, hypersexuality, and punding.

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Question: What Causes Impulse Control Disorders and Who Gets Them?
There is a strong association between dopamine agonist therapy and ICDs. Some people using these may find it hard to control impulses like gambling, sex, spending, and eating. While most persons with Parkinson's disease (PD) exhibit some mild impulsivity on subtle psychological tests, it is usually the younger and male Parkinsons disease patients that exhibit the most troubling Impulse Control Disorders. Most forms of impulse control disorder (ICD) can be treated by adjusting medication dosage levels.
Answer:

ICDs manifest as a reduced ability to control your impulses and to make good decisions about your impulses…impulses to spend, to eat, to pursue sexual interests and so on. The most troubling ICDs include pathological gambling, hypersexuality, compulsive buying, compulsive eating, kleptomania, and trichotillomania. What’s trichotillomania you ask? The repetitive, twirling and pulling out of your hair.

Who gets these ICDs? While most persons with PD exhibit some mild impulsivity on subtle psychological tests, it is usually the younger and male PD patients that exhibit the most troubling ICDs. Studies show 6% to 14% of persons with PD exhibit serious forms of ICDs during the course of PD. Most authorities believe that these percentages are gross underestimates of the prevalence of ICDs in the PD population. People do not want to tell their doctors that they suddenly spent all of the family savings or that they developed an interest in pornography. These are delicate and embarrassing situations for the person with PD and for families and thus these behaviors are likely only rarely reported. Doctors too are reluctant to ask about such behaviors so we have a bad situation all round.

The shame around ICDs while understandable just increases the suffering associated with the behaviors. Once reported, your doctor can treat these behaviors effectively merely by adjusting doses of the medications you are receiving. The disease itself seems NOT to be the culprit in this story. Rather the treatment for the disease…loading the system up with dopamine, seems to be largely responsible for eliciting ICDs in persons who have the genetic susceptibility to ICDs. Dopamine medications trigger or activate an underlying susceptibility -- after all no untreated persons with PD exhibit ICDs.

Dopamine agonists and impulsivity

Not all types of treatment for PD elicit impulsivity. There is a strong association between dopamine agonist therapy and ICDs. The dopamine agonist medications are pramipexole, ropinirole, and pergolide. Levodopa only rarely produces ICDs. For example, in one study the prevalence of ICDs on dopamine agonist therapy was 13.7%, versus 0.7% on levodopa. About 98% of the cases of pathological gambling in PD are associated with dopamine agonist therapy.

The ICDs, furthermore appear to be dose-dependent, that is the higher the dose you are on, the greater the severity of the ICD. The flip side of this dose-dependent relationship between dopamine agonist therapy and the appearance and severity of ICDs is that most cases respond to a reduction in dose. Your doctor can help you reduce the impulsive urges by reducing the dose of the dopamine agonist you are taking. Of course, only consider this after speaking with your doctor.

Cognitive factors associated with impulsivity

One factor that can contribute to impulsive behaviors is sluggish thinking or poor decision-making skills. Many persons with PD develop subtle problems with their thinking and decision-making capacities and these problems make it more difficult to cope with strong urges or impulses.

Sources:

Lim SY, Evans AH, Miyasaki JM. Ann. Impulse control and related disorders in Parkinson's disease: review. N Y Acad Sci. 2008 Oct;1142:85-107.

Weintraub D. Review. Dopamine and impulse control disorders in Parkinson's disease. Ann Neurol. 2008 Dec;64 Suppl 2:S93-100.

Isaias IU, Siri C, Cilia R, De Gaspari D, Pezzoli G, Antonini A. The relationship between impulsivity and impulse control disorders in Parkinson's disease. Mov Disord. 2008 Feb 15;23(3):411-5.

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