Disinhibited behaviours

What are disinhibited behaviours?

Disinhibited behaviours are actions which seem tactless, rude or even offensive. They occur when people don’t follow the usual social rules about what or where to say or do something.

Disinhibited behaviours can place enormous strain on families and carers. They can be particularly upsetting when someone, who has previously been private and sensitive, behaves in a disinhibited way.

Disinhibited behaviours may include any of the following:

  • Tactless or rude remarks - A person with dementia may comment tactlessly about another person’s appearance for instance. They appear to have lost their social manners, and it can look as if they are trying to deliberately embarrass or harass the other person.
  • Bold behaviour - A person with dementia may inappropriately flirt with someone or make sexual comments.
  • Exposure - A person with dementia may take some, or all of their clothes off at inappropriate times or in inappropriate settings.
  • Fondling - Forgetting social rules, a person with dementia may publicly fondle themselves or masturbate in front of others.

What causes these behaviours?

There are many reasons why behaviours change. Every person with dementia is an individual who will react to circumstances in their own way. Sometimes the behaviour may be related to changes taking place in the brain. In other instances, there may be events or factors in the environment triggering the behaviour. In some instances a task may be too complex. Or the person may not be feeling well. 

Understanding the behaviours

It is important to try to understand why the person with dementia is behaving in a particular way. If family members and carers can determine what may be triggering the behaviour, it may be easier to figure out ways to prevent the behaviour happening again.

Frequent causes of disinhibited behaviours are outlined below:

Confusion

Some behaviours occur because the person with dementia confuses the identity of people. They may believe that a care worker, or their daughter, is actually their wife and behave in a way that is inappropriate as a result.

Discomfort

Some of these behaviours, such as undressing or fondling themselves in public, may be the result of discomfort. For instance, feeling too hot or cold, or that clothes are too tight, may mean that they are removed in order to feel more comfortable. Urinary tract infections and itching can lead to handling the genital area.

Forgetting and the loss of skills

Sometimes these behaviours occur because the person has forgotten where they are, the appropriateness of being discreet, how to dress, or even the importance of dressing. They may need to urinate, but have forgotten where the bathroom is, or how to use it. Remember that the lack of judgement that leads to the inappropriate behaviour may be the result of the brain damage that is part of the dementia.

Disorientation

The person may be confused about the time of day and believe that they should be getting ready for a bath or for bed. Or they may believe that they are in the bathroom or bedroom. 

Some behaviours occur because the person with dementia confuses the identity of people. They may believe that a care worker, or their daughter, is actually their wife and behave in a way that is inappropriate as a result.

Some of these behaviours, such as undressing or fondling themselves in public, may be the result of discomfort. For instance, feeling too hot or cold, or that clothes are too tight, may mean that they are removed in order to feel more comfortable. Urinary tract infections and itching can lead to handling the genital area.

Sometimes these behaviours occur because the person has forgotten where they are, the appropriateness of being discreet, how to dress, or even the importance of dressing. They may need to urinate, but have forgotten where the bathroom is, or how to use it.

Remember that the lack of judgement that leads to the inappropriate behaviour may be the result of the brain damage that is part of the dementia. The person may be confused about the time of day and believe that they should be getting ready for a bath or for bed. Or they may believe that they are in the bathroom or bedroom.  

What to try

  • Look for a reason behind the behaviour. Understanding why someone is behaving in a particular way will help you respond to it
  • The doctor may be able to check whether there is a physical illness, undesirable side effects of medication or discomfort and provide some advice
  • React with patience and gentleness. Try not to over-react, even though the behaviours may be very embarrassing. Remember that they are part of the illness
  • Give the person plenty of appropriate physical contact such as stroking, hugging and rubbing. Often the person is anxious and needs reassurance through touch and gentle loving communication
  • If the person is engaging in inappropriate sexual behaviours gently remind them that the behaviour is inappropriate. Lead them to a private place or try to distract them by giving them something else to do, or something else to fidget with
  • Adjust the person’s clothes. Consider buying pants without zippers.

Disinhibited behaviours can be very difficult for families and carers. The behaviours are symptoms of dementia and are not meant to upset you. Remember to look after yourself and take regular breaks. 

Who can help?

Discuss with the doctor your concerns about behaviour changes and their impact on you.