The most common medical treatments used to manage Parkinson’s replace or imitate dopamine.

Impulse control disorders such as addiction to gambling, sex, compulsive buying or binge eating may affect up to one in four people on dopamine therapy at any stage of Parkinson’s.

Parkinson’s & Impulse Control Disorders

Impulse control disorders (ICDs) in Parkinson’s are the inability to resist intense urges that lead to repetitive, potentially harmful behaviours. Common ICDs include pathological gambling, hypersexuality, compulsive shopping, binge eating, and compulsive hobbyism. These behaviours are often linked to the use of dopamine agonist medications, which are commonly prescribed to manage motor symptoms of Parkinson’s. Effective management typically involves adjusting medicines under medical supervision, providing behavioural therapies to enhance impulse control, and educating both you and your caregivers about recognising and managing these challenging symptoms, as your support is crucial in this journey.

Dopamine receptor agonists are the strongest risk factor for impulse control disorders (ICDs).(1)  If you think you may have Parkinson’s-related impulse control symptoms, please see your GP as soon as possible.

It is one of the most negatively impactful side-effects people with Parkinson’s may experience. Due to the nature of the behaviours, there is also a lot of stigma, shame and misunderstanding of the nature of these behaviours. Remember: You are not alone, and help is available. Carers, friends and family should also read about ICD risks and signs and watch for it in the person with Parkinson’s.

Signs and symptoms of Impulse Control Disorders (ICDs)

Impulse control disorder is an inability to control impulses that may result in self-destructive behaviour. Risk factors include:

  • History of addictive or compulsive behaviour
  • Being male
  • Having young onset Parkinson’s
  • Use of dopamine agonists (e.g. Sifrol)

Most health professionals will regularly screen people with Parkinson’s for the disorder, especially if dopamine treatment is given.

Common ICD behaviours include

Punding

Punding is a term to describe complex, excessive, prolonged, purposeless, repetitive and stereotyped behaviours. (3, 4, 5) Some examples are non-goal oriented behaviours like continuously sorting and re-sorting items, tinkering with electronic devices, or engaging in repetitive grooming. Unlike ICDs, punding is not driven by pleasure, anxiety, or obsessions.  People exhibit behaviours that seem more peculiar and less stressful. (6) However, any interruption or disruption of the activity often leads to irritation, anxiety, and frustration.(7) People that experience punding can recognise that time and money spent on their behaviours are excessive and inappropriate; however, they are not able to stop the behaviour, which can lead to devastating psychosocial consequences with a significant impact on their quality of life. (4, 5)

Compulsive hobbyism

Hobbyism refers to an excessive preoccupation with hobbies or activities that are normally enjoyable and healthy when done in moderation. People with hobbyism may spend an excessive amount of time and effort on their hobbies, often to the detriment of their personal, social, or work life.(8) Spending hours organising collections, engaging in repetitive crafting activities, or constantly engaging in a particular sport or activity are some examples of hobbyism.

Compulsive buying / shopping

Uncontrolled buying, addictive buying, addictive consumption, excessive buying, shopaholism, and spendaholism all have been used to describe this overwhelming need to buy.(9) Often the urge to buy is focussed on a particular group of items, such as hats. Online shopping has hidden this addiction behaviour and made it worse. Imposing a credit card limit may help. If you notice this problem, discuss it with family and the care team.

Sex addiction / hypersexuality

Hypersexuality is characterised by an excessive preoccupation with sexual thoughts, urges, or behaviours that are out of character for the individual and can have negative consequences on their personal and social life. This may include an increased frequency of sexual thoughts, engaging in risky sexual behaviours, and a heightened desire for sexual activity. (10) Sexual feelings and thoughts may become very strong, uncontrolled and compulsive. This may cause distress to the person and their partner. This problem should be discussed with the medical specialist because adjusting medication may help solve the problem.

Overeating

Binge eating involves consuming large quantities of food in a short period, often beyond the point of being ‘full’, and can lead to significant weight gain and other health issues. People on dopamine therapy often have a ‘sweet tooth’ that adds to overeating. Compulsive overeating may occur during the night, especially if sleep is disturbed. Discuss this with your medical specialist who may refer you to a dietitian.

Dopamine Dysregulation Syndrome (DDS)

DDS is characterised by compulsive behaviours, mood swings, and impulsivity, all linked to an imbalance in the brain’s dopamine system. Symptoms may include intense cravings for medication, compulsive gambling, hypersexuality, repetitive behaviours (like punding), mood swings and aggressive outbursts. (11)

This rare condition is the compulsive overuse of Parkinson’s medications. People with the syndrome may seem joyful. Young men are more at risk of developing this syndrome. The affected person may not recognise or acknowledge the problem. Family should watch for medication overuse and discuss it with the care team.

Key Statistics

  • The main risk factor is using dopamine agonists, particularly at high doses (1). However, people with Parkinson’s who tend to seek out new things or who are impulsive can be at higher risk for developing ICDs. A history of gambling or alcohol abuse can also increase your risk.
  • Research has shown that around 17.5% of people with Parkinson’s who take dopamine agonists experience impulsive and compulsive behaviour (2).
  • Men and people living with young onset Parkinson’s seem to get ICDs more often (13).

The Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s Disease–Rating Scale (QUIP-RS)

The QUIP-RS is a tool used to measure the severity of impulsive and compulsive behaviours in people with Parkinson’s (12). It was developed to support the diagnosis of ICDs and related disorders, and to monitor changes in symptom severity over time. You can take it as a self-test and bring to the attention of your care team if scoring high on the scales or overall test. QUIP-RS Instructions.

Key Features of QUIP-RS:

  • It consists of 28 items that assess the frequency of various impulsive and compulsive behaviours.
  • Each item is rated on a scale from 0 (never) to 4 (very often), based on the frequency of behaviours over the past four weeks.
  • The QUIP-RS evaluates four primary domains: compulsive gambling, compulsive buying, compulsive eating, and compulsive sexual behaviour.
  • It also assesses three related disorders medication overuse, punding (repetitive, purposeless activities), and hobbyism.

Scoring and Interpretation:

  • Each domain has a score ranging from 0 to 16, with higher scores indicating greater severity of symptoms.
  • The total QUIP-RS score ranges from 0 to 112, with higher scores indicating more severe impulsive-compulsive symptoms.
  • Higher scores suggest more frequent and severe impulsive-compulsive behaviours, which may require clinical attention and intervention.

What you should do

Care partners suffer huge burden from mental stress specifically on spousal safety (1). ICDs are associated with high rate of relationship issues. It is important to recognise the disease and treat it without delay.

When starting dopamine therapy, discuss any side effects with your neurologist or doctor and ask for written information about:

  • The increased risk of impulse control disorders and that the person affected may conceal them.
  • The different types of impulse control disorders.
  • Who to contact if impulse control disorders develop.
  • The possibility that if impulse control disorders develop, dopamine therapy will be reviewed and may be reduced or stopped.

Your medical specialist should review your medications if you have any impulse control disorder symptoms.

  • You must follow all instructions given by the medical specialist or risk the unwanted side effects of over-medicating.
  • Adjusting or withdrawing from dopamine therapy may be difficult. Withdrawal may reduce symptom control and increase anxiety and a desire to go back on medication.
  • An increased levodopa dose because of a change in dopamine may not help withdrawal effects.

It is important to get a care team together early: doctors, physiotherapists, occupational therapists, speech pathologists, dietitians, psychologists, social workers and specialist Parkinson’s nurses.

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References:

(1) Zhang, J. F., Wang, X. X., Feng, Y., Fekete, R., Jankovic, J., & Wu, Y. C. (2021). Impulse Control Disorders in Parkinson’s Disease: Epidemiology, Pathogenesis and Therapeutic Strategies. Frontiers in psychiatry, 12, 635494. https://doi.org/10.3389/fpsyt.2021.635494

(2) Antonini, A., Siri, C., Santangelo, G., Cilia, R., Poletti, M., Canesi, M., … & Barone, P. (2011). Impulsivity and compulsivity in drug‐naïve patients with Parkinson’s disease. Movement Disorders, 26(3), 464-468.

(3) Rajasumi Rajalingam, M.D., & Alfonso Fasano, M.D., Ph.D. (2022). Punding in Parkinson’s Disease: An Update. Movement Disorders Clinical Practice, 5(4), 345-356. https://doi.org/10.1002/mdc3.13748

(4) Evans AH, Katzenschlager R, Paviour D, O’Sullivan JD, Appel S, Lawrence AD, Lees AJ. Punding in Parkinson’s disease: its relation to the dopamine dysregulation syndrome. Mov Disord 2004; 19(4): 397–405.

(5) Voon V. Repetition, repetition, and repetition: compulsive and punding behaviors in Parkinson’s disease. Mov Disord 2004; 19(4): 367–370.

(6) Zhang G, Zhang Z, Liu L, Yang J, Huang J, Xiong N, Wang T. Impulsive and compulsive behaviors in Parkinson’s disease. Front Aging Neurosci 2014; 6: 318.

(7) Fullana MA, Mataix-Cols D, Caspi A, et al. Obsessions and compulsions in the community: prevalence, interference, help-seeking, developmental stability, and co-occurring psychiatric conditions. Am J Psychiatry 2009; 166(3): 329–336.

(8) Barbosa, P., O’Sullivan, S. S., Joyce, E., Lees, A. J., Warner, T. T., & Djamshidian, A. (2021). Neuropsychiatric Features of Punding and Hobbyism in Parkinson’s Disease. Movement disorders clinical practice, 9(1), 82–86. https://doi.org/10.1002/mdc3.13363

(9) Cho, H., Kwan, J.-H., & Seo, H.-J. (2008). Compulsive Shopping in Parkinson’s Disease – A Case Report. Journal of Movement Disorders, 1(2), 97-100. https://doi.org/10.14802/jmd.08019

(10) Codling, D., Shaw, P. and David, A.S. (2015), Hypersexuality in Parkinson’s Disease: Systematic Review and Report of 7 New Cases. Mov Disord Clin Pract, 2: 116-126. https://doi.org/10.1002/mdc3.12155

(11) Neurolaunch (2024). Dopamine Dysregulation Syndrome: Causes, Symptoms, and Treatment Options. https://neurolaunch.com/dopamine-dysregulation-syndrome/ accessed on the web on 20/1/2025

(12) Weintraub, D., Hoops, S., Shea, J. A., Lyons, K. E., Pahwa, R., Driver-Dunckley, E. D., Adler, C. H., Potenza, M. N., Miyasaki, J., Siderowf, A. D., Duda, J. E., Hurtig, H. I., Colcher, A., Horn, S. S., Stern, M. B., & Voon, V. (2009). Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s Disease (QUIP). Movement Disorders, 24(10), 1461–1467. https://doi.org/10.1002/mds.22571

(13) International Parkinson and Movement Disorder Society (MDS), 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  accessed 20/1/2025

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