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This fact sheet was written by the Acquired Brain Injury Outreach Service (a Queensland Health service) for families and support workers of people who have acquired a brain injury.

Inappropriate sexual behaviours

Disinhibited or poorly controlled behaviour, particularly sexual behaviour, can be a distressing change following acquired brain injury.

Inappropriate sexual behaviours can include:

  • Sexual conversation or content.
  • Comments and jokes of a personal or sexual nature.
  • Inappropriate touching or grabbing.
  • Explicit sexual behaviour:
    • Sexual propositions.
    • Exposure of genitals in public.
    • Masturbation in a public place.
    • Sexual assault.

Inappropriate sexual behaviours occur because the person doesn’t follow social rules about when and where to say / do something. This means that sexual thoughts, impulses or needs are expressed in a direct or disinhibited way, for example:

  • In inappropriate situations.
  • At the wrong time.
  • With the wrong person.

Why do inappropriate sexual behaviours happen?

Most people with brain injury do not have increased sexual libido after an injury. In fact decreased sexual libido is more common. There are a number of other reasons for Inappropriate sexual behaviour. These can include:

Decreased awareness

Decreased awareness and insight, and poor self-monitoring of a person’s own behaviour can result in inappropriate behaviours. For example, a person may not realise their conversation or behaviour is offensive to someone else.

Impulsiveness

Impulsivity and disinhibition can result in behaviour that is not controlled by usual social or interpersonal rules.

  • Thoughts, which are usually private, may be spoken out aloud.
  • They may act too hastily or on an impulse.
  • They may not think about the consequences of behaviour – e.g. impact on relationships.

Changes in communication skills

A person may have impaired verbal and non-verbal communication skills, resulting in:

  • Inappropriate choices of jokes, comments, questions, or conversations.
  • Misunderstanding social relationships – believing a relationship is closer than it is.
  • Not picking up verbal and nonverbal cues and feedback from others e.g. not picking up disapproval, dislike or fear.
  • Awkward expression or inappropriate use of language.
  • Difficulties with social communication skills such as eye contact, social distance, space, and appropriate touching, may also cause social behaviour that makes others feel uncomfortable or threatened.

Inability to express sexual needs

This may mean that:

  • Opportunity to maintain or form relationships is reduced.
  • Relationships are still just as important to the persons’ identity and self-esteem.
  • Impaired cognitive, communication, and behavioural skills can reduce ability to make and keep new social and sexual relationships.
  • Limited social opportunities and isolation can result in lack of understanding of appropriate behaviour.

Things to try:

Talk about behaviour

  • Talk to the person about their behaviour and what you expect.
  • Let them know if behaviour is not appropriate – if they don’t know, they can’t change it.
  • Let them know how the behaviour makes you feel e.g. “I feel uncomfortable when…”
  • Let other people know what strategies to use.

Provide feedback about behaviour

Provide the person with frequent, direct and clear feedback. Feedback should:

  • Be immediate and early.
  • Be direct.
  • Be concrete and describe the behaviour.
  • Give direction.
  • Be consistent.
  • Not reinforce/encourage behaviour.
  • Help the person to learn.
  • Not be demeaning or humiliating.
  • Doesn’t impose your own values

Manage the environment

Some individuals have limited insight and awareness about sexually disinhibited behaviour. Or they may have very limited capacity to change behaviour due to severe cognitive and behaviour impairments. In this case you may need to find strategies to manage the environment. For example:

  • Try to predict situations where the behaviour is more likely.
  • Work out strategies ahead of time.
  • Restrict any opportunity to engage in inappropriate behaviour.
  • Limit any “at risk” social activities. e.g. crowded clubs or pubs or where alcohol is being consumed.
  • Provide cues about behaviour – what the person should/should not do – before, during, and after social activities.
  • Provide alternative activities e.g. small groups verses large groups.
  • Keep a comfortable distance so the person cannot touch, grab or get too close e.g. when providing personal care.

Provide supervision and structure

  • Provide one-to-one support and supervision in any “at risk” situations.
  • Provide cues and prompts about appropriate or inappropriate behaviour.
  • Redirect, distract or divert the person e.g. more appropriate topics of conversation, or change the activity or task.

Plan ahead

If a person has a history of severe disinhibited sexual behaviour (exposure, masturbation in public, or sexual assault), it is essential that you plan ahead regarding personal safety.

Consider:

  • Having two people provide care.
  • Limiting home visits.
  • Supervising children.
  • Limiting access.

In the person’s home:

  • Always visit with another person.
  • Make sure someone knows you are there when you visit.
  • Take a mobile phone with you, and carry it at all times.
  • Have your car keys in your pocket.
  • Get familiar with the home, so you know where the doors are located.
  • Keep a comfortable distance. For example, sit across a table, sit close to the door or exit.

Addressing sexuality needs

A person may need others to give them space and privacy to express their sexual needs e.g. privacy to masturbate, watch videos or to have a sexual relationship.

Remember that sexuality is a normal part of life and just because the person has a disability because of their brain injury, does not mean they don’t have normal sexual needs.

Encourage the person to access information and advice regarding sexual activity and choices (contraception, STD’s, safe sex practices). Information may be available from:

  • Family Planning
  • General Practitioner
  • Rehabilitation services

Extra Resources

  • See other Acquired Brain Injury Outreach Services Information sheets.
  • “You and Me” by Grahame Simpson, Brain injury Rehabilitation Unit, South Western Sydney Area Health Service, 1999.
  • Talk to a Psychologist, Psychiatrist, Social Worker, or other professional.

You can download the pdf fact sheet What are inappropriate sexual behaviours? or simply view it below.

abios_inappropriate_sexual_behaviours

 

2 comments

  1. Comment by Marie

    Marie Reply October 31, 2016 at 10:54 pm

    I am looking everywhere for answers to why my life is in turmoil. We have raised 7 children… 5 of them girls. The youngest are not 13 and 15. The 13 year old had accused my husband of inappropriate touching. He and myself thought she was crazy… Never did i think it would be true. I started to question my 15 year old more about it as the 13 year old has pressed charges. She finally admitted to me that yes it happened to her as well. My husband is in shock as well as i yet again. I love my husband and we have been together for 25 years. This is not in his makeup of a person. He swears he doesn’t remember doing anything to the girls and swears he loves them and would never hurt them.
    I believe my girls yet i believe my husband as well. he is a weekend and holiday drinker and can drink up to 48 beers during a weekend. I know this is alot but he is always a happy drunk and its never interfered with his work so i never thought it was a problem. I don’t want to give him excuses to use to try and get out of this but is it possible that he has damaged his brain to the point where he really cant remember? I have also spoken to my 3 older daughters 25,21,20 and they say that nothing has ever happened. if there is a direction I should be going towards I would appreciate any help you can give me. Thanks

    • Comment by M

      M Reply April 2, 2017 at 10:30 pm

      How has the criminal case worked out? My husband a Veteran who seeks his medical care through the VA system, fell in December 2016 while carrying my Dad down stairs in a wheelchair. My husband lost his footing and went airborne over my Dad’s wheelchair once his abdomen pushed into the handle of the wheelchair sending my Dad and chair down the remaining stairs, flipping the chair back and Dad hit his head on the bottom concrete. My husband landed in the yard head first. Both were 911 for triage. Dad ended up better than my husband. My husband sustain a head trauma with a moderate hematoma, neck, shoulder right hand injuries and 2 hernias. When instructed to follow up with his VA doctor the doctor on 4 attempts to seek treatment from him, refused to treat or entertain any of the injuries including all the symptoms of TBI. 3 months later my husband molested our granddaughter. She said he acted like someone she didn’t know. He was acting really weird. My daughter when to the police and they arrested my husband. Since this the VA System has jumped to diagnose him with TBI Postconcussive Syndrome with Impulsive and Dishibition. We have a $100,000 bond we had to put up and hired JAG lawyers to the tune of $15,000 so far. My husband is looking at 42yrs. We asked our landlord to allow the VA to install a ramp back in October of 2016 but she refused claiming it would ruin her property. We have a long road ahead if the landlord allowed the ramp all of this could have been avoided.

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