Measurement of sexual disinhibition in dementia: A systematic review

Abstract

Sexual disinhibition in dementia is correlated with multiple negative care recipient and caregiver outcomes but remains largely overlooked in the literature. Its prevalence is not well understood, with studies reporting between 1.8% and 25% presence of sexual disinhibition in dementia samples. One reason for the variability in the reported presence of sexual disinhibition may be lack of standardized methods for assessment. Several widely used measures for neuropsychiatric symptoms do not include items to assess sexual disinhibition. When measures do include sexual disinhibition, it is not addressed in a consistent manner. Inconsistency in how questions about sexual disinhibition are phrased is problematic, given that recent work shows it can differentially influence endorsement. Working toward a gold standard of sexual disinhibition measurement in dementia is needed. To this end, a systematic review of the literature to identify potentially appropriate instruments for measurement of sexual disinhibition in this population was conducted through the Web of Science and PubMed databases between January 2019 and February 2019. An overview of the 20 measures identified in this search is provided. Each measure is evaluated for appropriateness of use in dementia samples through broad examination of psychometric properties, structure, and format and the extent to which measure content overlaps with current conceptualizations of sexual disinhibition in dementia. Five common content domains were identified: hypersexuality, lewd/aberrant sexual behavior, inappropriate sexual advances, inappropriate sexual comments, and socially disruptive sexual behavior. No single measure addressed all content domains. Directions for future research are identified and discussed.

Development of an assessment measure for sexual disinhibition in dementia

“…34 Regarding caregiver type, analyses revealed that spouses/significant others, compared to adult children, reported higher rates of Inability to Inhibit-type behaviors. This finding extends previous work 9 by suggesting that the relationship between caregiver type and SD may depend on the type of SD exhibited. It is unsurprising that, because of the intimate nature of the relationship, spouses/ significant others may elicit certain types of SD more readily than adult children.…”

Pharmacological and nonpharmacological approaches to reduce disinhibited behaviors in dementia: a systematic review

“…Canevelli et al, 2013;Mendez et al, 2007;Segrec et al, 2016). Sexual disinhibition (also termed inappropriate sexual behavior and hypersexuality) is characterized by inappropriate sexual behaviors (Chapman and Spitznagel, 2019) that include inappropriate verbal and physical behaviors and hypersexuality (i.e. increased libido).…”

“…Disinhibited behaviors can cause significant distress to those experiencing them and people around them (Chapman and Spitznagel, 2019). Disinhibited behaviors, particularly those of a sexual nature, remain highly controversial and labeling them as occurring due to illness may have enormous individual, cultural, and medico-legal implications (Nagaratnam and Gayagay, 2002).…”

“…This study also found disinhibition was associated more with vascular dementia compared to AD. The presence of sexual disinhibition in people living with dementia has been reported as between 1.8% and 25% (Chapman and Spitznagel, 2019); apathy and indifference to sex are reported more frequently (de Giorgi and Series, 2016). Earlier studies report more frequent occurrence of sexual disinhibition in older men (Harris and Wier, 1998), whereas later studies report equal frequency in men and women (Series and Dégano, 2005).…”

Dysfunctional sexual behaviors: definition, clinical contexts, neurobiological profiles and treatments

“…The underlying causes of these conditions are not yet fully known, even though the prevalent orientation in the literature is certainly multifactorial: genetic, neurobiological, hormonal, psychological, environmental [12]. But also specifi c pathological conditions, such as epilepsies [19,20], dementia [21,22], obsessive-compulsive disorder [23] ADHD [24], impulse control disorder [25] and vascular diseases [26].…”