5.7 Understanding and Managing Sexual Disinhibition

Injury to the frontal lobes is common after a TBI and it is the frontal lobes that help us to control our behaviour and behave appropriately in different situations.

Therefore, after suffering a brain injury some people exhibit inappropriate behaviours.

Although this behaviour is a result of the brain injury it is possible to help them control the behaviour by changing the way we interact with them.

When people behave in a sexually inappropriate way it is important that everyone responds in the same way to the behaviour, to reduce the frequency and, hopefully, eliminate it. Sometimes staff and family members will feel embarrassed by such behaviour and will laugh to cover up their embarrassment. While this is understandable, this sort of response is likely to encourage the patient to continue so it’s important to adopt a firm, ‘matter of fact’ tone of voice when talking to him. At the same time it’s important not to display anger or disgust in your manner or voice as the patient may derive some satisfaction from this so be as neutral as possible.

Strategies

• When a person makes a sexually inappropriate remark, say to him, using a firm, calm tone of voice, “I don’t like you saying those things so stop now”.  You don’t have to use these exact words; say whatever you feel comfortable with.
• Change the topic of conversation immediately

• If the person can’t be distracted to another topic of conversation or if you feel too uncomfortable to stay, walk away from the person immediately without saying anything further.

• If it’s not possible to leave because you’re in the middle of carrying out some procedure (eg. helping him to shower) then continue on with what you were doing and don’t enter into any further discussion about his remarks.  If he continues to make inappropriate remarks, ignore him and don’t make any eye contact. Then leave as soon as you’ve finished.
  

• However, if he continues to make remarks and it is possible to leave him safely, then leave the room without further discussion.  Go back after a few minutes, don’t make any reference to the previous remarks and continue again with what you were doing.  If the behaviour starts again, tell him you don’t like it and walk away again.

• If the person is touching himself in an inappropriate way say “You’re not to do that when other people are with you”

• If the person touches you in an inappropriate manner tell him to stop immediately.

• If the person later apologises for his remarks/behaviour don’t get into a discussion about the matter.  Say something along the lines of “OK let’s forget about it now” then continue on with what you were doing and change the topic of conversation. Sometimes people will apologise but then get some satisfaction from continuing to go on apologising excessively.

If you know that someone has the potential to be sexually inappropriate it is important to be careful about topics of conversation if you’re chatting to him.  People will often ask personal (and seemingly innocent) questions about whether you have a boyfriend/are married etc. They then go on to ask for increasingly personal information such as are you happy with your boyfriend etc. which then leads onto sexually inappropriate remarks/behaviour. When someone first asks a personal question it is better to say “Look I’m your  (eg nurse) and sorry but I don’t talk about personal information” (or use whatever words you feel comfortable with). Then start to talk about something else.