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Sexual Behavior Among Persons With Cognitive Impairments

  • Sexual Disorders (G Dwyer, Section Editor)
  • Published:
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Abstract

Although the cognitively impaired are frequently included in heterogeneous studies of problematic sexual behavior, the epidemiology, etiology, and approach to assessment and treatment of persons with dementia and intellectual disability are distinct from those of the general population. The incidence of inappropriate sexual behavior among the intellectually disabled is 15–33%; however, the nature tends to be more socially inappropriate than with violative intent. Limited sociosexual education is a large contributor, and better addressing this area offers a target for prevention and treatment. A thorough clinical assessment of problematic sexual behaviors in the cognitively impaired requires understanding the patient’s internal experience, which can be challenging. Assessment tools validated for the general population have not been validated for this population. Very few studies have assessed treatment approaches specifically among the cognitively impaired; however, research does suggest utility in habilitative, psychotherapeutic, and pharmacologic approaches which have been validated among the general population.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Perlin ML. Hospitalized patients and the right to sexual interaction: Beyond the last frontier? New York University Review of Law and Social Change. 1994;20:517–47.

  2. Perlin ML, Lynch AJ. ‘Love is Just a Four-Letter Word’: sexuality, international human rights, and therapeutic jurisprudence. Can J Comp Contemp Law. 2014. doi:10.2139/ssrn.2380714.

  3. CDCHealthyAging [homepage on the Internet]. Atlanta, GA: CDCHealthyAging; [last updated April 2014, 1; cited 2015 Oct 28]. Available from: http://www.cdc.gov/aging/healthybrain/index.htm.

  4. Shapiro S. Delinquent and disturbed behavior within the field of mental deficiency. In: de Reuck AVS, Porter R, editors. The mentally abnormal offender. New York: Grune & Stratton; 1986.

    Google Scholar 

  5. Steiner J. Group conselling with retarded offenders. Soc Work. 1984;29:181–2.

    Google Scholar 

  6. Lyketsos CG, et al. Mental and behavioral disturbances in dementia: findings from the Cache County Study on Memory in Aging. Am J Psychiatry. 2000;157:708–14.

    Article  CAS  PubMed  Google Scholar 

  7. Tsai SI, et al. Inappropriate sexual behaviors in dementia: a preliminary report. Alzheimer Dis Assoc Disord. 1999;13:60–2.

    Article  CAS  PubMed  Google Scholar 

  8. Devanand DP, et al. Behavioral syndromes in Alzheimer’s disease. Int Psychogeriatriacs. 1992;4:161–84.

    Google Scholar 

  9. Kuhn DR, Greiner D, Arseneau L. Addressing hypersexuality in Alzheimer’s disease. Gerontol Nurs. 1998;24:44–50.

    Article  CAS  Google Scholar 

  10. Gilby R, Wolf L, Golberg B. Mentally retarded adolescent sex offenders: a survey and pilot study. Can J Psychiatr. 1989;34:542–8.

    Article  CAS  Google Scholar 

  11. Griffiths DM, Quinsey VL, Hingsburger D. Changing inappropriate sexual behavior: a community based approach for persons with intellectual disabilities. Baltimore: Paul H. Brookes Publishing; 1989.

    Google Scholar 

  12. Griffiths D. Sexuality and people with developmental disabilities: from myth to emerging practices. In: Brown I, Percy M, editors. Developmental disabilities in Ontario. 2nd ed. Toronto, ON: Ontario Association on developmental disabilities; 2003. p. 677–90.

    Google Scholar 

  13. Goscinski I, et al. The KluverBucy syndrome. J Neurosurg Sci. 1997;41:269–72.

    Article  CAS  PubMed  Google Scholar 

  14. Perlin ML. International human rights and mental disability law: when the silenced are heard. New York: Oxford University Press; 2011. pp. 143–59.

  15. Lockheart K, et al. Defining “sexualized challenging behaviour” in adults with intellectual disabilities. Journal of Policy and Practice in Intellectual Disabilities. 2009;6(4):293–301.

    Article  Google Scholar 

  16. Money J. Lovemaps: clinical concepts of sexual/erotic health and pathology, paraphilia, and gender transposition in childhood, adolescence, and maturity. NY: Irvington Publishers; 1968.

    Google Scholar 

  17. Gudjonsson GH, et al. Child and adult witnesses with intellectual disability: the importance of suggestibility. Leg Criminol Psychol. 2003;8:241–52.

    Article  Google Scholar 

  18. Cederborg AC, et al. Repetition of contaminating question types when children and youths with intellectual disabilities are interviewed. J Intellect Disabil Res. 2009;53(5):440–9.

    Article  PubMed  Google Scholar 

  19. Babchishi KM et al. The RRASOR, Static-99R and Static-2002R all add incrementally to the prediction of recidivism among sex offenders. (Corrections Research User Report 2011-01). Ottawa, ON, Canada: Public Safety.

  20. •• Helmus L, et al. Absolute recidivism rates predicted by static-99r and static-200r sex offender risk assessment tools vary across samples: a meta-analysis. Crim Justice Behav. 2012;39:1148. A meta-analysis that examines the predictive accuracy for recidivism of STATIC-99R and STATIC-200r. Although there was consistent predictive accuracy across studies, there was large variability of predicted recidivism.

    Article  Google Scholar 

  21. Fedoroff JP et al. Risk assessment for men with paraphilias and developmental delay. Poster session presented at the twenty-seventh annual meeting of International Academy of Sex Research. Montreal. 2001.

  22. Saleh FM, et al. The management of sex offenders: perspectives for psychiatry. Harv Rev Psychiatry. 2010;18(6):359–68.

    Article  PubMed  Google Scholar 

  23. • Perlin ML. “All his sexless patients”: persons with mental disabilities and competence to have sex. Wash L Rev. 2014;89(2):257. A review of factors that should be considered in determining “sexual competence” and the right of persons with cognitive disabilities to voluntarily engage in sexual activity.

  24. Saleh FM, et al., editors. Sex offenders: identification, risk assessment, treatment and legal issues. New York, NY: Oxford University Press; 2009.

    Google Scholar 

  25. •• Blasingame GD, Boer DP, Guidry L, Haaven J, Wilson RJ. Assessment, treatment, and supervision of individuals with intellectual disabilities and problematic sexual behaviors. Beaverton, OR: Association for the Treatment of Sexual Abusers; 2014. Available from www.atsa.com . A guideline for assessing, treating, and supervising persons with intellectual disabilities with problematic sexual behaviors.

  26. Griffiths DM, Gardner WI, Nugent JA, et al. Individual centered behavioral interventions. National Association for Dual Diagnosis: Kingston, NY; 1998.

  27. Terry K, et al. Motivation and sex offender treatment efficacy: leading a horse to water and making it drink? Int J Offender Ther Comp Criminol. 2001;45:663–72.

    Article  Google Scholar 

  28. Marshall WL, et al. Working positively with sexual offenders: maximizing the effectiveness of treatment. J Interpers Violence. 2005;20(9):1096–114.

    Article  PubMed  Google Scholar 

  29. Favrod J, et al. Cognitive and behavioural therapy of voices for with patients intellectual disability: two case reports. Ann General Psychiatry. 2007;19(6):22.

    Article  Google Scholar 

  30. Davis TE, et al. Cognitive-behavioral treatment for specific phobias with a child demonstrating severe problem behavior and developmental delays. Res Dev Disabil. 2007;28(6):546–58.

    Article  PubMed  Google Scholar 

  31. Guay DR. Inappropriate sexual behaviors in persons with cognitive impairments older individuals. Am J Geriatr Pharmacother. 2008;6(5):269–88.

    Article  PubMed  Google Scholar 

  32. Tosto G, et al. Effect of citalopram in treating hypersexuality in an Alzheimer’s disease case. Sci. 2008;29(4):269–70.

    Google Scholar 

  33. Langeluddeke A. Castration of sexual criminals (German). Berlin: De Gruyter; 1963.

    Google Scholar 

  34. Weinberger LE, et al. The impact of surgical castration on sexual recidivism risk among sexually violent predatory offenders. J Am Acad Psychiatry Law. 2005;33:16–36.

    PubMed  Google Scholar 

  35. Light SA, et al. The use of medroxyprogesterone acetate for the treatment of sexually inappropriate behaviour in patients with dementia. J Psychiatry Neurosci. 2006;31(2):132–4.

    PubMed  PubMed Central  Google Scholar 

  36. Davies TS. Cyproterone acetate for male hypersexuality. J Int Med Res. 1974;2(2):159–63.

    Article  CAS  PubMed  Google Scholar 

  37. Rösler A, Witztum E. Treatment of men with paraphilia with a long-acting analogue of gonadotropin-releasing hormone. N Engl J Med. 1998;338(7):416–22.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Brigham and Women’s Hospital, Beth Israel Deaconess Medical Center, Harvard Medical School, Beth Israel Deaconess Medical Center Rabb-2, Psychiatry 330 Brookline Ave, Boston, MA, 02215, USA

    Robyn P. Thom

  2. University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA

    Albert J. Grudzinskas Jr.

  3. Beth Israel Deaconess Medical Center, Harvard Medical School, Beth Israel Deaconess Medical Center Rabb-2, Psychiatry 330 Brookline Ave, Boston, MA, 02215, USA

    Fabian M. Saleh

Authors
  1. Robyn P. Thom
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  2. Albert J. Grudzinskas Jr.
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  3. Fabian M. Saleh
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Correspondence to Robyn P. Thom.

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Robyn P. Thom, Albert J. Grudzinskas, Jr., and Fabian M. Saleh declare that they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Sexual Disorders

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Thom, R.P., Grudzinskas, A.J. & Saleh, F.M. Sexual Behavior Among Persons With Cognitive Impairments. Curr Psychiatry Rep 19, 25 (2017). https://doi.org/10.1007/s11920-017-0777-7

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  • DOI: https://doi.org/10.1007/s11920-017-0777-7

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