Shadow World Impulsive: 10. Reflections
Feb 13, 2026
Valerie Voon, neuropsychiatrist and researcher who advises on impulse control disorders, explains why dopamine agonist behavioral side effects are stigmatized. She discusses how to reframe these changes as medical side effects. The conversation covers lack of patient insight, shifting identities and the heavy personal and financial costs people can face.
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Behavioural Side Effects Are Misframed
- Patients often view side effects as physical rather than psychological, making behavioural changes hard to accept as medication effects.
- Valerie Voon says normalising these behaviours encourages open reporting and proper management by clinicians.
Treat Impulse Disorders Like Normal Side Effects
- Tell patients that impulse control problems are manageable and should be treated like other side effects.
- Advise clinicians to titrate down or stop the medication when these behaviours emerge to reverse the effect.
Marriage Shattered By Behavioural Change
- Francis describes his husband Andrew defrauding clients and later taking his own life after behavioural changes on medication.
- He questions where the medication ended and the person began, showing relationships altered by personality change.