Psychosexual consequences of traumatic brain injury: methodology and preliminary findings

Social, neuroradiologic, medical, and neuropsychologic correlates of sexually aberrant behavior after traumatic brain injury: a controlled study

OBJECTIVE

To identify social, neuroradiological, medical, and neuropsychological correlates of sexually aberrant behavior (SAB) after traumatic brain injury (TBI).

DESIGN

A controlled study using a retrospective file review.

SETTING

A brain injury unit providing inpatient and outpatient rehabilitation services.

PARTICIPANTS

A sample of males (n = 25) exhibiting SABs and a control group (n = 25) matched for gender, severity of injury, age at injury, and time after injury.

MAIN OUTCOME MEASURES

A protocol that recorded data on demographic, injury, radiological, medical, and neuropsychological variables.

RESULTS

The SAB group had a significantly higher incidence of postinjury psychosocial disturbance in areas of nonsexual crime and failure to return to work than the matched TBI group. There were no significant differences between the two groups in the incidence of premorbid psychosocial disturbance or postinjury radiological, medical, or neuropsychological variables.

CONCLUSIONS

The study results caution against simplistic explanations of SAB as the product of damage to the frontal-lobe systems or premorbid psychosocial disturbance. Furthermore, the results suggest that a wide-ranging assessment of people with TBI who exhibit SABs is required, because results of neuropsychological examination alone cannot be considered conclusive. Future research into the etiology of SABs could examine additional factors such as lack of insight, lack of empathy, and premorbid history of family dysfunction.

Sex offending as a psychosocial sequela of traumatic brain injury

OBJECTIVE

To describe the nature and extent of sexual offending after traumatic brain injury (TBI).

DESIGN

Retrospective file review.

SETTING

A brain injury unit providing inpatient and outpatient rehabilitation services.

PARTICIPANTS

A review of five years of admissions to the Brain Injury Rehabilitation Unit (N = 477) identified a sample of 29 males who committed 128 incidents of sex offending.

MAIN OUTCOME MEASURES

A protocol to record data on demographic, injury, radiological, and psychosocial variables and offending behaviors.

RESULTS

Of the total population of 445 clients with TBI, 6.5% (n = 29) were identified as having committed some form of sexual offense. Alcohol was a factor in only three (2.3%) of the incidents, and only two clients had a preinjury history of sexual offending. The most common offenses were the "touching" offenses, followed by exhibitionism and overt sexual aggression. Staff members were the most common targets of the offenses, followed by members of the general public, other people with TBI, and family members.

CONCLUSIONS

Sex offending is a significant clinical problem among a small minority of men after TBI. The absence of alcohol and preinjury histories of sexual offending suggest that the brain injury and contingent sequelae were a significant etiological factor underlying the offenses. A number of implications for the clinical management of clients with sexually aberrant behaviors is identified and discussed.

The role of imagery in sexual arousal disturbances in the male traumatically brain injured individual

Over 50% of individuals who suffer traumatic brain injury (TBI) demonstrate a decrease in sexual arousal post-injury. This study investigated the basis of this loss and hypothesized that it occurred as a consequence of the effect of the injury on cognition: specifically, diminution of the ability to form and manipulate sexually arousing imagery. The study compared 14 male participants who identified themselves as having alteration in sexual functioning following traumatic brain injury with a further 14 non-brain injured participants, case matched to them for age and education. All TBI participants were assessed after 2 years following injury, and had had a loss of consciousness of 3 days or greater. The results indicated that the two groups differed in terms of their performance on the Bett's QMI Scale, the Gordon Test of Visual Imagery Control, the Vividness of Sexual Imagery Scale of the Imaginal Processes Inventory, the State Trait Anxiety Inventory, and the Beck Depression Inventory. After correction for the level of depression by analysis of covariance, the TBI participants still featured lower levels of performance on the Sexual Imagery sub-scale of the Imaginary Processes Inventory. The results indicate that sexual arousal disturbances may exist above and beyond the disturbances to affect associated with the psychosocial effects of the TBI.

A review of the effect of traumatic brain injury on the human sexual response

A human sexual response format was used to describe possible sexual dysfunctions after TBI. Additional material was also included to qualify the information drawn from the above format. A number of possible conclusions were drawn, indicating that the causes and effects of sexual functioning after TBI are very confusing and that the literature does not clarify this confusion. One cannot accurately differentiate between primary and secondary sexual problems and, therefore, cannot evaluate the contribution of each problem to the presented sexual dysfunction.

Incidence of sexual dysfunction in TBI patients during the early post-traumatic in-patient rehabilitation phase

OBJECTIVE

The aim of the study is to find whether sexuality and intimacy dysfunction are already present at the early rehabilitation phase of TBI patients.

METHODS

Forty-four consequent severe TBI patients were studied. The GCS and the duration of unconsciousness determined the initial severity of the injury. Patients' function regarding motor, language, cognition and behaviour were assessed by an interdisciplinary team. Sexuality and intimacy were evaluated by using a special closed questionnaire.

RESULTS

Regarding self confidence 81% of patients described themselves as having high or average self confidences; 78% described themselves as having high or average feeling of being sexually appealing; mood level was average or high in 80% of patients. Only 7.7% of patients reported having sexual dysfunction at that phase of rehabilitation.

CONCLUSIONS

Sexual dysfunction in Severe TBI patients is uncommon at the early post-traumatic phase. It is suggested that sexual dysfunction appearing during later stages of recovery is most probably related to reactive behavioural changes.

Medroxyprogesterone in the treatment of aggressive hypersexual behavior in traumatic brain injury

Sexual function is among the many areas affected by traumatic brain injury. The most common change is decreased sexual performance and satisfaction, for the brain injured person and the sexual partner. Hypersexuality, especially inappropriate sexual comments and gestures, is also a common result of traumatic brain injury. A case of hypersexuality in a severely disabled brain injured man is presented. He was successfully treated with medroxyprogesterone acetate after failure of multiple other treatment strategies. The literature is reviewed. An evaluation and treatment strategy for sexual dysfunction post traumatic brain injury is presented.

Sexual adjustment and its predictors after traumatic brain injury

The aim of this study was to investigate the impact of traumatic brain injury (TBI) on sexual ability, activity and satisfaction and to relate the findings to neurological status, functioning and well-being. A total of 92 TBI persons (65 men, 27 women) participated. Their ages ranged from 20-70 years (median 40 years); the median age at injury was 32 years, ranging from 16-56 years. The elapsed time since injury ranged from 1-20 years (median 9 years). The participants were examined according to a procedure including neurological examination, self-assessment of general health status and functioning and mood, and collection of data on social conditions. A structured study-specific questionnaire was developed to assess various aspects of sexuality before and after the injury. Fifty-three of the participants had a stable partner relationship at the time of the investigation. This study showed that a TBI commonly alters sexual functioning as well as desire. Many of the respondents reported decreased ability to achieve an erection, decreased ability to experience organism, decreased sexual desire and diminished frequency of intercourse. A high degree of physical independence and maintained sexual ability were the most important predictors for sexual adjustment. Considering that many TBI persons in this study reported physiological sexual disturbances and decreased sexual ability, it is important to inform patients about possibilities of optimizing their sexual ability. Organized programmes of sexuality education should be an integral component of TBI rehabilitation.

Sexual functioning following traumatic brain injury

In this study we investigated sexual functioning in 52 outpatients with a history of traumatic brain injury to determine: (1) the prevalence of reported sexual dysfunction; and (2) the relationship between sexual functioning and age, severity and locus of injury, time since injury, and physical and cognitive function. Reports of sexual functioning indicated a reduction below levels within non-injured populations, but only to statistically significant levels on two scales of the Derogatis Interview of Sexual Function (DISF): Orgasm and Drive/Desire. Location of injury was related to sexuality in that patients with frontal lobe lesions reported an overall higher level of sexual satisfaction and functioning than those individuals without frontal lobe lesions. Time since injury was inversely related to reports of levels of sexual arousal; that is, patients with more recent injuries reported greater levels of arousal than those not recently injured. Right hemisphere injuries also correlated with higher scores on reports of sexual arousal and sexual experiences.

Head injury and sexual dysfunction

An extensive review of the head injury and human sexuality literature was completed, to augment an understanding of the impact of traumatic head injury on sexual functioning. Despite clinical evidence that sexual dysfunction after head injury is prevalent and of great import, sexual concerns have been neglected in much of the post-traumatic head injury and rehabilitation literature. Characteristics of head injury concerning cerebral physiology, post-traumatic sequelae, and the effects on sexual functioning are examined. Rehabilitation and family/spouse literature was also examined for information on sexuality. The majority of this article reviews research on sexual sequelae after head injury, such as impulsiveness/inappropriateness, changes in libido and sexual frequency, global sexual difficulties, and specific sexual dysfunctions. Treatment models for the sexual problems after head injury are also reviewed and found to be limited in number. Treatment issues and suggestions are addressed. This article provides information about the sexual problems of head-injured patients to facilitate the development of diagnostic and intervention programmes.

Sexual functioning among women with physical disabilities

OBJECTIVE

Three a priori hypotheses were tested: (1) There are significant differences in sociosexual behaviors of women with physical disabilities compared with women without disabilities; (2) the sexual functioning of women with disabilities is significantly related to age at onset of disability; (3) psychological factors explain more of the variance in the sexual functioning of women with physical disabilities than do disability, social and environmental factors.

DESIGN

Case-comparison study using written survey.

SETTING

General community.

PARTICIPANTS

The questionnaire was mailed to 1,150 women with physical disabilities who were recruited as volunteers or through independent living centers. Each woman gave a second copy of the questionnaire to an able-bodied female friend, which comprised the comparison group. The response rate was 45%, with 475 cases and 425 comparisons eligible to participate. The most common disability type was spinal cord injury (24%), followed by polio (18%), muscular dystrophy (11%), cerebral palsy (11%), multiple sclerosis (10%), joint disorders (7%), and skeletal abnormalities (5%).

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

Sexual-functioning, consisting of four factors: (1) sexual desire, (2) sexual activity, (3) sexual response, (4) sexual satisfaction.

RESULTS

Highly significant differences were found in level of sexual activity (p = .000001), response (p = .000009), and satisfaction (p=.000001) between women with and without disabilities. No significant differences were found between groups on sexual desire. Severity of disability was not significantly related to level of sexual activity.

CONCLUSIONS

Psychological and social factors exert a strong impact on the sexual functioning of women with physical disabilities. Further investigations is needed of the effect of social environment on development of self-esteem and sexual self-image, and how these influences affect levels of sexual functioning in women with physical disabilities.

Othello syndrome secondary to right cerebrovascular infarction

The Othello syndrome, or delusional jealousy, occurs in idiopathic psychoses and in neurodegenerative diseases, but has rarely been described in patients with cerebrovascular infarction. A patient was observed to exhibit the delusion shortly after cerebral ischemic injury in the absence of other psychiatric symptoms. The underlying pathology was consistent with recent reports on content-specific delusions, implicating right hemisphere and frontal lobe involvement in the misinterpretation and misidentification of complex information. Psychological factors were hypothesized to shape the content of the delusional misinterpretations.

Effect of supported employment on the vocational outcomes of persons with traumatic brain injury

This paper reports the job placement of 5 males with severe traumatic brain injury. An individual placement model of supported employment was used. All individuals were placed in competitive employment and received staggered intervention over time by trained employment specialists. A multiple baseline design across persons was used to evaluate results. All individuals had been unable to work consistently or at all in competitive work environments. The range of wages was $4.25 to $5.00 per hour with an average of 339 hours of employment specialist intervention time required per case. The major problems experienced by employment specialists were insubordinate and disruptive behaviors as well as other inappropriate social behaviors displayed at the job site.