Inappropriate Sexual Behaviour

An acquired brain injury can lead to disinhibited or poorly controlled sexual behaviour which can involve:

• 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 do not occur because the person has an increased sexual drive, but occur because the person has lost the ability to inhibit behaviour and comply with accepted social norms. They may had decreased insight or awareness of their behaviour and a lack of understanding of usual social and interpersonal conventions. They may not appreciate that they are making other people feeling uncomfortable or threatened. Sexual behaviour can then occur at the wrong time or place or with the wrong person. This can be very uncomfortable for family and friends and could result in the person with the brain injury be subject of unwanted attention or even assault.

It is important not to ignore inappropriate sexual behaviour. The only way the person is likely to realise the effects of their behaviour is to talk to them about their behaviour and other persons expectations and perceptions. If they have an awareness of how they are making other people feel they can then work on managing their own behaviour. Feedback should be early, clear and consistent to help the person to learn.

It may assist to implement strategies to minimise sexually disinhibited behaviour. Try to predict situations were inappropriate behaviour is more likely. Pre-brief the person on your expectations before going into the situation; and then debrief the person afterwards. They may have behaved really well or they may have passed a comment they should not have or intruded in someone’s ‘personal space’. By pre-briefing and then debriefing the person can start to learn an appropriate way to behave and which behaviour is inappropriate and is to be avoided. Patience is key.

Personal supervision or one to one support may be required until the behaviour can be minimised or brought under control. Additional support may have to be put in place if the person has severely disinhibited sexual behaviour and is at risk of exposing himself or inappropriately touching someone. Contact with children or other vulnerable groups should be considered and managed.