A very interesting preliminary report presented at the annual Movement Disorders Society meeting in Sydney looks at impulsive behavior in people with Parkinsons. Dr. Katharina Goerlich-Dobre from the Department of Neurology at Christian-Albrechts University in Kiel, Germany studied 91 people with Parkinson’s and tested them for alexithymia and found a close correlation between impulsive behaviors and a risk for pathological additive behaviors in people who scored high in alexithymia.
The word alexithymia comes from the Greek “A” for “lack”, ,”lexis” for “word” and “thymos” meaning emotion. It was first described by psychiatrists Peter E. Sifneos and John C. Nemiah in 1972 when patients they were working with displayed a marked difficulty in talking about their emotions. Since then, it has received more attention in psychology and has come to be understood as difficulty identifying feelings or distinguishing between bodily sensations and emotions, a lack of certain types of imagination and difficulty talking about their own feelings or the feelings of others. People with alexithymia often are rather rigid in the way they relate to life events, tending to be more focused on the mundane or the minute details of daily living. They are more externally oriented, and tend to prefer to live with strict rules, social conformity and in predictable patterns and may try to maintain them compulsively. They may be very intellectually accomplished, but are unable to relate to spontaneously imagined or inspired situations or events. When presented with situations that they find unpredictable, they may make hasty decisions , impulsively, because they are unable to imagine what the outcome of the decision might be.
Anxiety, compulsivity, impulsivity and depression are often discussed in Parkinson’s literature, but little attention has been given to alexithymia. Dr. Goerlich-Dobre found that many individuals with Parkinson’s are unable to identify their feelings or may suppress feelings they cannot put into words. She says “The possibly intense emotional arousal accompanying those feelings may prompt alexthymic individuals to engage in impulsive-compulsive behaviors in order to quickly alleviate their distress, as their access to healthier ways of processing those feelings is compromised.”
Neuropsychiatric assessments of Parkinson’s patients’ emotional awareness with an inclusion of alexithymic evaluations my help identify patients who are at risk of impulsive or compulsive behaviors, including pathological addictive behaviors.