Remediating Serious Inappropriate Sexual Behavior in a Male with Severe Acquired Brain Injury

Abstract

Inappropriate sexual behaviors such as sexual talk, non-genital and genital touching (non-consensual), exhibitionism and coercive sexual behavior are consistently reported sequelae of severe Acquired Brain Injury (ABI). A single-case experimental design was employed to evaluate the relative effectiveness of environmental controls and facilitated access to a sex worker in the management of inappropriate sexual behavior displayed by a male with ABI. Environmental controls comprised behavioral strategies commonly employed to manage disinhibited behavior secondary to ABI such as redirection, cueing appropriate behavior, and verbal feedback. An additional component, facilitated visits to a sex worker, provided a comparison treatment. The introduction of a sex worker contributed to the reduction and eventual extinction of inappropriate behaviors. Improvements were maintained at follow-up probes 1 and 2 years later. The social validity of the intervention is evaluated, and the legal, safety and ethical issues raised by facilitating access to a sex worker are carefully addressed.

Clinical correlates of verbal aggression, physical aggression and inappropriate sexual behaviour after brain injury

“…As this study is without precedent, there is no empirical data elsewhere with which to compare. In their single case report of psychosocial treatment of inappropriate sexual behaviour after brain injury, Kelly and Simpson [28] have previously speculated that these behaviours have distinct functional features that differ from those involved in aggression. The current results support such a notion; even when applying conservative criteria for how many components should be retained during principal component analysis there was a clear distinction between aggressive and inappropriate sexual behaviours.…”

“…Researchers have predominantly focused on the prevalence of prior brain injury amongst groups of adults who have committed sexual offences [23,24] or individual case reports of inappropriate sexual behaviour following neurological injury/illness [25][26][27][28][29][30][31]. There has been only one study [32] describing the characteristics of inappropriate sexual behaviour (somewhat misleadingly termed 'sexual offending') amongst a large cohort of people with traumatic brain injury.…”

Psychological interventions for treating neuropsychiatric consequences of acquired brain injury: A systematic review

“…Mainly high-quality studies addressed disinhibition after ABI, but with considerable heterogeneity in interventions and symptoms of disinhibition being addressed. Despite this heterogeneity, interesting effective elements can be drawn from the high-quality studies: self-regulation to decrease impulsive behaviour (Arco, Cohen, & Geddes, 2004), differential reinforcement methods to decrease disinhibition, possibly through the addition of self-monitoring (Knight, Rutterford, Alderman, & Swan, 2002) and the combination of differential reinforcement and a sex worker (Kelly & Simpson, 2011) or electrical aversion therapy (despite being regarded as a "last-resort") to decrease inappropriate sexual behaviour (Ter Mors, van Heugten, M, & van Harten, 2012). Elopement behaviour might be effectively diminished through differential reinforcement, as shown in a moderate-quality study (Yody et al, 2000).…”

Modelling verbal aggression, physical aggression and inappropriate sexual behaviour after acquired brain injury

“…This is consistent with previously reported analyses [7,31] showing differing maintaining factors and environmental triggers for aggression and inappropriate sexual behaviour after brain injury. A recent intervention case study [32] also documented the specificity of treatment effects for inappropriate sexual behaviour in a young man following severe traumatic brain injury.…”