Beyond the urge to move: Impulsivity, aggression and impulse control disorders in restless legs syndrome

Restless Legs Syndrome (RLS) is typically defined as a sleep-related sensorimotor disorder, yet converging evidence indicates that it also involves clinically relevant behavioral dimensions. This case-control study systematically examined impulsivity, aggression, and impulse control disorders (ICDs) in 27 RLS patients compared to 21 healthy controls, using standardized questionnaires (BIS-11, Barratt Impulsiveness Scale-11; AQ, Aggression Questionnaire; mMIDI, Modified Minnesota Impulsive Disorders Interview), a Go/NoGo inhibitory control task, and clinical sleep measures, with reassessment after three months.A markedly elevated prevalence of binge eating emerged in the RLS group compared to controls (44.4% vs 4.5%), suggesting vulnerability to reward-related dysregulation. Although total BIS-11 impulsivity scores did not differ significantly between groups, RLS severity (IRLSRS) correlated with attentional impulsivity and slower reaction times in the Go/NoGo task, pointing to a cognitive impulsivity profile rather than motor disinhibition. RLS severity was also associated with higher verbal aggression and hostility, but not with physical aggression, indicating cognitive-emotional irritability rather than outward violence. Sleep alterations (shorter total sleep time, prolonged latency, reduced REM sleep) were linked to poorer inhibitory control and ICD-related behaviors, implying that sleep fragmentation may exacerbate emotional dysregulation and maladaptive reward seeking. Behavioral measures remained stable at three-month follow-up, supporting the notion that these traits represent persistent characteristics rather than transient states. Overall, findings support conceptualizing RLS as a multisystem disorder extending beyond motor symptomatology to include intrinsic deficits in cognitive control and affective regulation, with implications for systematic behavioral screening and individualized management.