Challenging & complex behaviours: sexual behaviour
These behaviours can be very
distressing for partners and family.
Disinhibited sexual behaviour can include:
- sexual conversation or content
- comments and jokes of a personal or sexual nature
- inappropriate touching or grabbing
- sexual propositions
- exposure of genitals in public
- masturbation in a public place
- sexual assault.
Disinhibited sexual behaviour can be defined as a person not
following social rules about when and where to say or 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 does it 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 disinhibited sexual
behaviour. These can include:
- Decreased awareness and insight, and poor self-monitoring of a
person's own behaviour (e.g. not realising conversation or
behaviour is offensive to someone else)
- Impulsivity and disinhibition, resulting in behaviour that is
not controlled by the usual social or interpersonal rules
- Thoughts, which are usually private, may be spoken out
- Acting too hastily or on an impulse
- Not thinking about the consequences of behaviour (e.g. impact
Much of this impulsive behaviour and lack of self-awareness is
particularly common after injury to the frontal lobes which is
common after a traumatic brain injury.
Changes in communication skills can result in:
- inappropriate choices of jokes, comments, questions, or
- misunderstanding social relationships -believing a relationship
is closer than it is
- not picking up verbal and non-verbal 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
Inability to express sexual needs 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
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 so there is a
Provide feedback about the behaviour
Provide the person with frequent, direct and clear feedback.
- be immediate and early
- be direct
- be concrete and describe the behaviour
- give direction
- be consistent
- not reinforce or encourage the behaviour
- help the person to learn
- not be demeaning or humiliating
- not impose your own values
Manage the environment
Some individuals have limited insight and awareness about sexually
disinhibited behaviour, and/or 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
- Work out strategies ahead of time
- Restrict any opportunity to engage in inappropriate behaviour
(planning, proximity, opportunity and means)
- 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 and
should not do - before, during, and after social activities
- Provide alternative activities (e.g. small groups versus large
- Keep a comfortable distance so the person cannot touch, grab or
get too close (e.g. when providing personal care).
- Provide supervision & structure
- Provide one-to-one support and supervision in any "at risk"
- Provide cues and prompts about appropriate or inappropriate
- Redirect, distract or divert the person (e.g. more appropriate
topics of conversation, or change the activity or task).
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.
- 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
- 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). Useful tips are:
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
Information may be available from:
- Family planning
- General Practitioner
- Rehabilitation services.
- See other ABIOS fact sheets at
- "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
References and further information
This article is reprinted with permission from the ABIOS fact
sheets available at www.health.qld.gov.au/abios/
The Acquired Brain Injury Outreach Service is a rehabilitation
service assisting people with Acquired Brain Injury in Queensland,
their families, and carers. Ring ABIOS on 07 3406 2311 or email