Coping With Inappropriate Sexual Behaviour (ISB) In Dementia Patients
Dementia is a collective term used to describe a progressive disease affecting a person’s mood, behaviour, personality, and mainly the decline of the brain functioning that can impair one’s daily life. It is caused by damage to the brain cells, which interferes with the ability for proper communication between the cells. When hurt in a particular brain area, it can lead to various dementia symptoms like personality changes, coordination and memory loss, hypersexuality, and many more.
Cause of Dementia
One of the most common causes of dementia is Alzheimer’s disease, which affects the hippocampus area of the brain. This region is in charge of learning and memory, which is why the first symptom of Alzheimer’s and dementia is always associated with memory loss.
Other dementia causes include:-
- Behavioural variant frontotemporal dementia that can cause hypersexuality, empathy and inhibition loss, repetitive behaviour
- Dementia with Lewy bodies can bring on hallucination, delusions, reduced perception and coordination abilities etc.
- Vascular dementia due to reduced blood flow to the brain can cause severe personality changes, depression, and disorientation.
- Others include Parkinson’s disease, Hunting’s, or mixed dementia.
Signs of Dementia
Several signs can determine the disease, which may vary from person to person. The early signs of dementia include:
- Difficulty in understanding or retaining recent events and information
- Memory loss
- Impaired judgements and reasoning
- Repetition of questions
- Disorientation of place, season, time
- Increased confusion
Symptoms of moderate to late dementia stages can include aggression, agitation, inappropriate sexual behaviours, loss of apathy, pacing and hitting.
Hypersexuality & Dementia
A person diagnosed with dementia can start to experience ISB, also known as inappropriate sexual behaviour, that can cause severe stress to all parties involved. This is particularly found in patients diagnosed with behavioural variant frontotemporal dementia that affects the region in charge of interpersonal behaviour. It can be challenging to the patient, their partner, children and caregiver as it may cause confusion, embarrassment and distress.
As the disease progresses, the person experiences behavioural changes that involve increased or decreased sexual appetite, loss of empathy and apathy that can cause them to do inappropriate public sexual acts, mistaking their partner for someone else.
The most important thing is to understand that the cause of brain damage is why they act the way they do. Dementia causes the loss of ability to control one’s emotions that may lead to confusing and aggressive sexual behaviour towards spouses or anyone they come in contact with. A dementia patient can feel lonely or bored and often require intimacy and yet cannot perceive the acceptable norms for appropriate public behaviour. They may try to masturbate, touch themselves or remove clothes in public. It may be because they cannot comprehend the fact they are in public or just a simple need to use the toilet. These acts can signify distress, pain, certain medications, and loneliness.
They may exhibit several ISB symptoms and signs of dementia that include: –
1. Their response to sex and intimacy
Intimacy and sexuality are two important factors of human nature. The act of intimacy can vary from person to person. A dementia diagnosis can affect how the person perceives sex. They can be cold and demanding without empathy toward their partner’s needs. They may express a change in their sexual orientation and exhibit inappropriate sexual needs. The patient can lose all interest in sex and may also forget who their partner is. These can be very confusing and distressing for the patient and their spouse as they can cause a lot of guilt, distaste and disdain towards each other.
2. Inappropriate sexual behaviour
The patient may exhibit inappropriate sexual behaviour towards caregivers and children due to their perceived understanding of social cues. They can easily mistake the personal care given by the staff as a sexual activity which causes them to act it out. They may say vulgar comments or acts, especially while bathing them or in the presence of children and strangers. It is very important to understand that they do not know what has to be done about their sexual desires and when and where to express them.
3. Forgetting their partners or confusing them with someone else
Dementia can cause memory loss and psychotic and mood disorders towards the end stages. It can lead to inappropriate advances toward certain people due to delusions and hallucinations caused by the disease. They can forget that they have partners or mistakenly behave in a sexual way toward someone else. Usually met with aggression when rejected or can display uncharacteristic behaviour.
4. Aggressive Sexual behaviour or increased sexual demands
Some patients with severe dementia symptoms can display aggressive mood disorder due to increased libido, loss of inhibitions and judgement. They may want repetitive sexual favours from their spouses or certain people and can be aggressive and moody when rejected. The lack of privacy and restrictive attitudes can also lead to inappropriate behaviour. However, it is of utmost importance to remove yourself and seek help if you find yourself in a non-manageable threat.
5. Loss of inhibition leading to public sexual acts
One of the major signs of dementia is the loss of inhibition. This can lead to inappropriate sexual acts and behaviours from the patient. They may express their private sexual desires and feelings publicly because they have no sense of their time or place. This can include fondling or touching themselves, unwanted sexual advances toward strangers, and removing and lifting clothes. These behaviours can be due to their perception of sexual partners, the need to go to the bathroom, or simply because they feel hot. The understanding of social norms and cues are different for dementia patients are often misinterpreted.
How to Cope with ISB in Dementia Patients?
Dealing with inappropriate sexual behaviours is challenging and exhausting. It can be a nerve-racking job and can lead to caregivers’ burnout and several unnecessary accusations if not handled carefully. Each patient may respond to these tips and ways differently, and here are suggestions to make it easier for you and the patient.
1. Sexual needs and intimacy of the couple
The act of intimacy and sexual needs is a complex decision between the two of you. Important to understand that your and the patients’ needs may change during the disease, and it is encouraged to adapt accordingly. Spouses can consider seeing a therapist to deal with their feelings and these discussions.
Consider giving a lot of physical attention like kissing, snuggling, positive affirmations etc., to the patient during the early onset of dementia. This may help them trust and identify your positive presence in their lives. You can also make separate sleeping arrangements based on the situation.
2. Managing the inappropriate sexual behaviour
Ensure to remain calm and patient when it comes to inappropriate behaviour. Try to distract them with a positive activity they can associate with, like music, a snack or as simple as asking a question.
Engage in a conversation that gently and firmly conveys that their behaviour is inappropriate and will not be tolerated. It is encouraged to match their body language and show them non-verbal cues like shaking your head or hands so they understand it easily.
It is important to maintain firm and consistent boundaries when dealing with the dementia disease, to avoid the repetition of these behaviours. You can always remove them from the current environment and lead them to privacy.
3. Mistaken identity or forgetting the spouse
Understand that this is a dementia symptom and not one’s personality. It is natural to be upset, but do not be discouraged by many false accusations or unwanted attention given to another person. Try to maintain the peace by calmly removing them from the trigger and explaining it to the other person.
If staying in assisted living, ask the staff and caregiver to approach and dissolve the situation in such a way to maintain the dignity of all involved.
4. Dealing with aggressive sexual behaviour
While dealing with aggressive sexual behaviour, it is most important to maintain one’s safety. Let your friends and family know that dementia is causing your loved ones to make such demands and behaviour.
Best to advise children and other vulnerable adults to avoid contact while the patient is in such a mood. Encourage them to learn more about the disease and its effects on people to understand it better.
At any point, if the situation becomes dangerous, you are encouraged to contact professionals or the authorities who can help you with any assistance.
5. Public display of sexual acts
This can be not very comfortable for people around. However, it is important to know what triggers such behaviour. Patients with dementia may interpret cues differently and can act based on their perception of the situation.
For example, a caregiver bathing them can be taken as a sexual cue by the patient or if one is trying to remove their clothes because they need to use a bathroom.
It helps to carry a help card showing a person’s diagnosis in public so you can maintain their dignity.
You can also dress them in specially designed clothes with back closure to make it difficult for them to remove the clothes in public.
6. Manage the symptoms by identifying the triggers
A lot of times, the person is simply bored or lonely. Encourage them with alternative activities like sensory toys or activities that can keep them engaged.
Based on their likes and dislikes, it is ideal for maintaining a journal which can help identify triggers, activities and things they enjoy. These can be helpful for the professional caregivers or hospitals in case of hospitalisation or emergencies.
7. Sort help from the support community and professionals
As a caregiver or spouse, you will need emotional support sooner or later. It helps to talk to like-minded people in the same situation as yours. The doctors, nurses and other professionals in the medical field can help you plan your loved one’s dementia treatment and course of action.
Letting your friends and family know of the progress of the disease can often help in dealing with your distress and emotional needs. They can also offer a helping hand if and when you need it.
Treatment & Care for Dementia
Hypersexuality in dementia patients can lead to severe emotional damage and distress to one’s family, thereby increasing the chance of early institutionalisation. Treatment for dementia may depend upon the type of exhibited behaviour, urgency, underlying medical conditions, and several other factors. However, various treatment plans do not involve the use of drugs or medication that helps reduce or manage certain symptoms of ISB.
1. Supportive psychotherapy can be helpful for the spouses of the patient. It helps the spouse’s mindset by reframing the patient’s sexual demands with the need to touch or need for normal expression of sexual activity to improve the quality of life or understanding that it is a symptom of the disease.
2. Modifications in behavioural and environmental approaches can include changing a female to a male caregiver or several distraction techniques that can help when inappropriate behaviour occurs. The dementia treatment for ISB often includes avoiding overly sexual content on TVs, consented spouse visits to satisfy their normal sexual drives and so on.
Since there is no cure for progressive dementia, certain dementia medications can control symptoms and temporarily slow down the progress of brain damage.
Conclusion
Dementia is a progressive disease that can impact one’s quality of life. Sexual inappropriate behaviours in patients are one of the most difficult dementia symptoms to handle and can cause severe emotional damage to oneself and the family. There are no preventive methods or cures for dementia caused by age or genetic conditions. However, research shows that adopting a healthy lifestyle like a nutritious diet, exercise, cognitive stimulation etc., can prevent or reduce the risk of cognitive damage.
FAQs
What are the first signs of having dementia?
The early onset of dementia can include symptoms like memory loss, inability to recall recent events, decreased perception of time and place, repetition of questions in a short time, and so on.
Can dementia cause inappropriate behaviour?
One of the symptoms of the moderate or late stage of dementia is sexually inappropriate behaviour. It can be due to the loss of inhibition, mistaken identity, increased libido due to medications and many other triggers.
What is hypersexuality in dementia?
Signs of hypersexuality can include higher sexual drive, aggressive sexual demands, public masturbation or removal of clothes, etc.
How do you calm someone with dementia?
It is best to stay calm and talk to them patiently. You can use several distraction techniques like music, snacks etc., to calm them down. Identify the trigger and remove the patient from a private place.
