It is reported that between 6 – 35% of people with Parkinson’s have impulsive and compulsive behaviours. The large variation is due to definition and assessment variation. A report by Erga and colleagues ‘Impulsive and Compulsive Behaviors in Parkinson’s Disease: The Norwegian ParkWest Study’ published in the Journal of Parkinson’s disease in November of last year questioned whether this was significantly higher when compared to an age and gender matched normal population. They concluded that the participants with Parkinson’s were three times more likely to have impulsive-compulsive behaviours compared to controls.
So what is impulsive and compulsive behaviour? Impulsive behaviour is when a person can not resist the temptation to do something, whilst compulsive behaviour is when a person has an overwhelming urge to act in a certain way, often repeatedly. Impulsive-compulsive behaviours tend to centre around activities such as eating, gambling, shopping, hobbies and sexual acts and thoughts; our focus in this blog is eating. These behaviours are most commonly observed in people with early onset Parkinson’s, males, smokers, those with depression or a family history of addictive behaviour, but not exclusively.
The driver of impulsive and compulsive behaviour is stimulation of the reward centres in the brain and dopamine release. Treatment for Parkinson’s commonly includes agonist drugs targeting dopamine. Current thinking is that these drugs create reward seeking behaviour in some people.
Compulsive eating is a concern as it can lead to obesity and obesity associated health conditions. Non drug induced compulsive eating is linked to negative emotions such as depression, anxiety, stress and low self esteem. It can take the form of consistent overeating or short periods of binge eating during which a high amount of calories is consumed at a fast rate in a short period of time. There is an observed relationship of high intake of foods that are possibly addictive such as sugar (see last week’s blog) but food addiction and compulsive eating are still classed as separate behaviours. Non drug induced compulsive eating is seen more frequently in women than in men (the reverse of what is seen in Parkinson’s) but interestingly is more likely in teens and early adulthood in females but middle age in men.
The recommended treatment for impulsive and compulsive behaviours is psychotherapy. Hypnotherapy is very effective for reducing food addictions, compulsive eating and other addictions such as smoking. However with eating hypnotherapy effectiveness is due to the reframing of eating behaviours in the mind and disconnecting associations with emotions. With cigarette addiction the hypnotherapy suppresses the urge but importantly the drug (tobacco) is stopped during and after treatment . The effectiveness of hypnotherapy on agonist drug driven behaviours is under researched. Speaking to the British Society of Clinical Hypnosis they were uncertain whether hypnosis would be effective as the agonist drug would be a constant – this is not to say it would not be effective, we just don’t know. But do not lose hope, a study in 2012 by Prof. David looking at managing compulsive and impulsive behaviours in Parkinson’s concluded that talking based therapies can help – more details of this can be found at
So where to from here? It is important to bring to the fore and create discussion around issues that affect people with Parkinson’s and those close to people with Parkinson’s. We have not given you any clear answers but hopefully awareness will create a better understanding of behaviors and eventually we will see more research in this area.