Impulse control behaviours
Some Parkinson’s medications can cause impulse control behaviours. We explain what these behaviours are, why they happen, and where to get help.
Key points
- Some Parkinson’s medications, especially dopamine agonists and levodopa, can cause strong urges that are difficult to control. This is a known side effect and not your fault.
- These urges can make you want to gamble, shop, eat more, have sex more often, use the internet a lot, take extra medication, or repeat the same activities.
- Family or friends may notice changes before you do.
- If you notice changes, speak to your Parkinson’s nurse or specialist. Support is available and early help makes a difference.
- You can report side effects using the Yellow Card scheme.
What are impulse control behaviours?
Impulse control behaviours are actions you feel a strong urge to do and find hard to stop.
These urges can feel powerful. You may act without thinking about the consequences or realising what is happening at the time. You may also find that you repeat the behaviour even when it causes problems.
Many people do not realise these behaviours are linked to their Parkinson’s medication. It’s common to feel embarrassed or want to hide them. It's important to remember that they aren't your fault.
Common types of impulse control behaviours include:
- gambling, shopping, or using the internet too much
- repeating the same activities
- increased sexual thoughts or behaviour
- changes in eating habits or food preferences.
Not everyone who takes Parkinson’s medication will develop impulse control behaviours. These possible side effects should not stop you taking your medication.
In the past, we described these as “impulsive and compulsive behaviours”.
We now use the term “impulse control behaviours” because research shows the behaviours are driven by strong urges linked to the brain’s reward system, rather than driven by anxiety.
Hallucinations, delusions, or paranoia
Some people may also have side effects from Parkinson’s medication that affect thinking or perception. This can include hallucinations, delusions, or paranoia. These experiences can be very distressing or frightening. They are different from impulse control behaviours. We have information on these side effects and how to get support for them.
Why do impulse control behaviours happen?
Impulse control behaviours can happen because some Parkinson’s medications change how your brain reacts to urges. This can make some urges feel stronger and harder to resist.
Medicines called dopamine agonists carry the highest risk. But these behaviours can sometimes happen with other Parkinson’s medications, like levodopa.
Your specialist should explain the possible risks before you start these medicines. They may also give you written information to take home.
Your Parkinson’s nurse or specialist should ask about these behaviours at your medication review appointments, especially if your medication changes. If they do not, it’s okay to bring them up yourself.
These behaviours can be hard to notice or talk about. Often, family members or friends see changes before you do.
Who is more likely to experience impulse control behaviours?
Some people taking Parkinson’s medications are more likely to develop these behaviours. This includes people who:
- take dopamine agonists
- take high doses of levodopa or apomorphine
- developed Parkinson’s at a younger age
- have had Parkinson’s for longer
- have more severe symptoms
- are men
- have had depression, a lack of motivation (apathy), or thinking and memory problems
- have a personal or family history of gambling, alcohol misuse, or smoking.
It’s important that everyone taking Parkinson’s medication, and those close to them, is aware of the risk of developing impulse control behaviours.
Your Parkinson’s nurse or specialist should speak with you regularly to check whether you’re experiencing impulse control behaviours.
How common are these behaviours?
It’s hard to know exactly how many people experience impulse control behaviours linked to their medication.
Studies suggest that between 1 in 10 and 4 in 10 people with Parkinson’s taking Parkinson’s medication may experience these behaviours at some point. The range varies because some studies include milder impulse control behaviours, while others only count diagnosed impulse control disorders. Studies also use different methods and include different groups of people, such as people at different stages of Parkinson’s or on different treatments.
Some people may not realise these behaviours are happening, or may feel embarrassed to talk about them, so not every case gets reported.
When do these behaviours become an impulse control disorder?
Some people notice only mild changes to their behaviour, while others may develop behaviours that are more persistent or harmful.
Health professionals may refer to these behaviours as impulse control behaviours (ICBs).
If these behaviours become severe or very hard to control, your specialist may diagnose an impulse control disorder (ICD).
This may be the case if the behaviours:
- happen often or feel impossible to stop
- affect your daily life, work, hobbies, or sleep
- cause problems with money, relationships, or your health.
Health professionals recognise ICDs as a side effect of some Parkinson’s medication.
If you or other people notice urges are affecting your life, it’s important to talk to your specialist or Parkinson’s nurse as soon as possible. They can help review your medication and help you manage the behaviours.
Types of impulse control behaviours
It’s possible to have more than one behaviour at the same time.
Reward-seeking behaviours
We call these behaviours "reward-seeking" because they may bring quick pleasure or excitement, or briefly improve low mood.
These behaviours may start as things you previously enjoyed in moderation, but can become stronger and harder to control after starting Parkinson’s medication.
Gambling
Gambling is betting money on something with an uncertain outcome, for example in a game, on a horse race, or on a sporting event. If you guess right, you win money or prizes. If you guess wrong, you lose the money you gambled.
You may feel a strong urge to gamble, even if you’re losing money or it’s causing arguments or financial problems.
This can include gambling in betting shops or online casinos, using gaming apps, or buying lottery tickets. You might gamble more often than before, spend more money than planned, or try to hide your gambling from others.
Some people may also start to use money they cannot afford to lose. This can include using credit cards, taking out loans, taking money from work or other sources, or borrowing money from others. This can lead to serious debt.
Compulsive eating
You may feel a strong urge to eat and find it difficult to stop, even when you’re not hungry or already feel full.
This often involves a change in your food preferences, with a strong craving for sweet foods such as cakes and biscuits. This may lead to eating these foods repeatedly because of the urge rather than hunger.
You might eat alone or at night and feel guilt or embarrassment afterwards.
Hypersexuality
Hypersexuality means having much stronger sexual thoughts or urges than usual.
You may find these urges difficult to control. They may happen at times that feel inappropriate or in ways that are out of character.
This can include:
- masturbating much more than before
- spending a lot of time viewing pornography or online sexual content
- using online sex chats or paying for sexual interaction online
- seeking sexual contact more often, including outside a usual relationship or paying for sexual services
- taking sexual risks that you would not usually take.
These changes can affect relationships. They may feel upsetting or worrying for you and for the people around you.
Read our information on relationships, sex and Parkinson’s.
Compulsive shopping and spending money
Compulsive shopping is when you feel a strong urge to buy things, even if you do not need them or cannot afford them. This can happen in shops or online.
You may:
- shop more often than before
- spend more money than you planned
- buy items you do not use, or buy the same items repeatedly
- hide purchases from other people
- feel guilty after shopping
- get into debt because of your spending.
Problematic internet and social media use
Problematic internet use is when you feel unable to stop spending time online.
You may spend long periods of time:
- browsing websites
- using social media
- gaming
- shopping online
- looking at adult content.
You might lose track of time or stay up late using the internet. This can mean you miss meals, have poor sleep, avoid responsibilities or withdraw from family and friends.
Other repetitive behaviours
These behaviours involve repeating activities over and over again. They may not bring pleasure in the same way as reward-seeking behaviours, but you still feel a strong urge to continue.
Punding
Punding is when you keep doing an activity over and over again with no clear goal or purpose.
You might spend long periods handling, sorting, or arranging objects. For example, you may take electronic equipment apart, organise items, or collect a particular type of object.
Some people may walk or drive around without a clear reason.
You may stay up very late or all night doing these activities, which can affect your sleep. You might feel irritated or frustrated if someone interrupts you. Over time, this behaviour can cause problems at home, socially, or at work.
Hobbyism
Hobbyism is when you feel unable to stop doing a hobby or interest.
Hobbies are usually enjoyable and healthy. But with hobbyism, you may spend an unusually long time on the activity or find it difficult to stop. The hobby can begin to take over your daily life.
For example, you might spend so much time gardening, researching one topic in detail, or doing crafts that you miss meals, avoid social plans, or neglect other responsibilities.
Hoarding
Hoarding is where you collect lots of things and find it very difficult to get rid of them. It’s often linked to difficulty organising or making decisions.
You may feel upset or anxious at the thought of throwing things away, even if the items have little value.
Over time, items can build up and create clutter. This can make everyday life more difficult and may cause stress for you and the people around you.
Dopamine dysregulation syndrome (DDS)
A small number of people with Parkinson’s develop a condition called dopamine dysregulation syndrome (DDS). It’s usually considered a separate condition from impulse control behaviours.
DDS is when a person compulsively takes more Parkinson’s medication than they are prescribed. It often occurs alongside other impulse control behaviours such as punding, gambling, or hypersexuality.
You might take extra doses because:
- you enjoy the way the medication makes you feel
- you want to avoid unpleasant Parkinson’s symptoms when your medication is not working as well ("off" periods).
You may not realise you’re taking more than prescribed. Some people may keep extra tablets without telling anyone or carry on taking higher doses even when their specialist recommends taking less.
Over time, DDS can lead to serious problems, including changes in your mood and physical health.
Getting help
When you start Parkinson’s medication, your specialist or nurse should tell you about possible side effects, including impulse control behaviours.
They should give you and the people close to you information about:
- the types of behaviours that can happen
- how someone might hide or downplay these behaviours
- who to contact if you’re worried.
Your specialist should ask if you’ve noticed any changes in your behaviour at medication review appointments.
Talking to health professionals
Noticing changes can feel worrying, and you may feel embarrassed. Being honest about what’s happening allows health professionals to help you. Family members, friends, or carers can also come to appointments or share what they’ve noticed. This helps you get the best support.
Not everyone who takes Parkinson’s medication will develop impulse control behaviours. These possible side effects should not stop you taking your medication.
Sometimes family, carers, or friends notice changes before you do. Try to take their concerns seriously and share them with your Parkinson’s nurse or specialist.
Ignoring these behaviours can lead to serious problems, such as money troubles, health problems, or relationship difficulties.
Changes to your medication
If you or other people notice changes in your behaviour, speak to your specialist or Parkinson’s nurse. They can:
- explain why the behaviour may be happening
- review your medication and change it if needed
- suggest ways to manage urges and reduce the behaviour.
Any changes to your medication will be made slowly and carefully monitored. This helps keep your Parkinson’s symptoms under control and lowers the risk of side effects and withdrawal symptoms.
Never stop taking or change your medication yourself.
Talking therapies
Talking therapies involve speaking with a trained therapist to help you understand and manage your thoughts, feelings, and behaviours.
Cognitive behavioural therapy (CBT) is a type of talking therapy. It may help you manage urges and change unhelpful behaviours. It can be especially helpful alongside medication changes, or if medication changes alone are not enough.
In some cases, you may be referred to a more specialist service, such as neuropsychiatry. These services are not widely available, and waiting times can be long.
Do not wait until a behaviour causes serious problems. Getting support early can make a big difference.
Report side effects
It’s important to report any side effects from your Parkinson’s medication. This helps make medicines safer for everyone.
The MHRA (Medicines & Healthcare products Regulatory Agency) runs the Yellow Card scheme to track the safety of UK healthcare products. They use reports to update patient leaflets and alert doctors to new safety warnings.
You can report side effects:
- online on the MHRA website
- by calling 0800 731 6789
- by picking up a Yellow Card form, available from your pharmacist, GP, or specialist, and posting it back.
You can report side effects for yourself or for someone else, with their permission. Health professionals can also report them.
Support for specific behaviours
Specialist support is available for different behaviours. Your health professionals can explain what’s available and help you access the right service.
With your permission, a family member or someone you trust can support you day to day, for example by helping you manage money or stick to routines and avoid triggers.
Support services can also help alongside medication changes.
Gambling
You can set limits on gambling apps to help control spending. You may also choose to self-exclude, which means you ask gambling companies to block you from using their services for a set period of time or permanently. This can apply to online gambling and betting shops.
GamCare offers confidential advice and local support for people affected by problem gambling. They also offer the National Gambling Helpline, which operates 24/7 and is free to call on 0808 8020 133.
Dunlewey Addiction Services provides free counselling and support for adults affected by gambling problems in Northern Ireland. You can call their Problem Gambling Helplines on 08000 886 725.
Visit the Dunlewey Addiction Services website.
Obsessive shopping and spending money
Money advice services like MoneyHelper and National Debtline can help you:
- set budgets or spending limits
- manage debt
- get support with planning and managing your day-to-day spending.
Spending limits can be set on banking apps and cards. You may find it helpful to ask a family member or someone you trust to support you with budgeting or keeping track of spending, if you feel comfortable doing so.
MoneyHelper provides free, impartial money advice across the UK. Visit the MoneyHelper website or call 0800 011 3797.
National Debtline provides free debt advice in England, Scotland, and Wales. Visit the National Debtline website or call 0808 808 4000
Local charities may also be able to offer practical support.
Compulsive eating
You can get support from NHS dietitians and specialist therapists who can help you understand the emotional triggers for eating and develop healthier eating habits. You can ask your specialist or Parkinson’s nurse for a referral to a dietitian.
Beat is the UK eating disorder charity providing advice and support. Visit the Beat eating disorders website or call Beat's helpline on:
-
0808 801 0677 in England
-
0808 801 0434 in Northern Ireland
-
0808 801 0432 in Scotland
-
0808 801 0433 in Wales.
Hypersexuality
You can get help from:
- sexual health services for confidential advice and support
- specialist therapists who can help you manage urges safely
- organisations like Relate.
Relate provides self-help resources, counselling, and sex therapy in England and Wales. Visit Relate's website or call:
-
0300 100 1234 in England
-
0300 003 2340 in Wales.
If you live in Northern Ireland, visit Relate NI's website or call 028 9032 3454.
Relationships Scotland provides counselling and family support in Scotland. Visit Relationships Scotland's website or call 0345 119 2020.
You can also contact our helpline on 0808 800 0303 or email [email protected] for confidential advice and support about any behaviour changes linked to Parkinson’s medication.
Advice for family, friends and carers
Sometimes people with Parkinson’s may not realise they have an impulse control behaviour, or they may hide it. You might notice changes in their behaviour that worry you. If so, it’s important to talk to them and get support from their specialist or Parkinson’s nurse.
Some behaviours may appear long after starting Parkinson’s medication, and they might not be obvious even to close family and friends.
You might notice the person you support with Parkinson’s doing things such as:
- taking more Parkinson’s medication than prescribed
- changes in eating habits, including binge eating
- spending more money or being secretive with finances
- repeating tasks
- collecting and organising objects
- spending more time online, on shopping, gambling, or sexual content sites
- changes in sexual behaviour
- feeling more restless, irritable, or aggressive.
It can be upsetting to see someone close to you struggling with these behaviours. You do not need to watch them all the time. But look out for changes and gently raise it with them if you’re worried.
If you raise concerns, the person may sometimes seem upset, argumentative, or surprised. This can be part of the behaviour. Stay calm and focus on letting them know you want to support them.
Early support from their specialist or Parkinson’s nurse can make a big difference and help manage these behaviours safely.
You can also contact our helpline free on 0808 800 0303 or email [email protected] for confidential advice and support.
Read our information on supporting someone with Parkinson’s.
Download this information
Download Impulse control behaviour in Parkinson's (PDF, 283KB).
We know lots of people prefer having something in their hands to read rather than looking at a screen, so you can order printed copies of our information by post, phone or email.
My obsession with photography
"Very quickly, I became fixated with photography. Every waking hour of my life was devoted to looking at the light, the dark, the scenic, the ugly."
Pete describes how he became 'addicted' to photography as a side effect of his medication.
Helpline and local advisers
Our helpline and Parkinson's local advisers are here to answer any questions you have about impulse control behaviour.
Call us on 0808 800 0303.
Next update due 2029
If you’d like to find out more about how we put our content together or be part of the volunteer team that reviews our information, please get in touch with us at [email protected]