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Prevalence, Clinical Features, and Correlates of Inappropriate Sexual Behavior After Traumatic Brain Injury: A Multicenter Study

Simpson, Grahame K. PhD; Sabaz, Mark PhD; Daher, Maysaa B. Psych

Section Editor(s): Sander, Angelle M. PhD

Journal of Head Trauma Rehabilitation: May/June 2013 - Volume 28 - Issue 3 - p 202–210
doi: 10.1097/HTR.0b013e31828dc5ae
Original Articles

Objective: Investigate the prevalence and clinical features of inappropriate sexual behavior (ISB) among a community-based cohort of clients of the New South Wales Brain Injury Rehabilitation program.

Setting: All 11 community-based rehabilitation services of the statewide network.

Participants: Five hundred seven clients with severe traumatic brain injury.

Design: Cross-sectional multicentre study.

Main Measures: Overt Behavior Scale, Disability Rating Scale, Sydney Psychosocial Reintegration Scale-2, Health of the Nation Outcome Scale–Acquired Brain Injury, Care and Needs Scale.

Results: The point prevalence rate of ISBs was 8.9% (45/507) over the previous 3 months. Inappropriate sexual talk comprised 57.9% of all ISBs, followed by genital and nongenital touching behaviors (29.8%) and exhibitionism/public masturbation (10.5%). In 43 of 45 cases, ISBs were accompanied by other challenging behaviors, most often inappropriate social behavior, and/or aggression. Individuals who sustained more severe injuries and who were younger were significantly more likely to display ISBs. People displaying ISBs were more likely to display higher levels of challenging behaviors overall, lower levels of social participation, and more neuropsychiatric sequelae than 2 other groups: people displaying no challenging behaviors and people displaying challenging behaviors but no ISBs respectively.

Conclusions: ISBs pose a complex clinical challenge among a minority of individuals with severe TBI.

Liverpool Brain Injury Rehabilitation Unit, Liverpool Hospital, Sydney, Australia (Drs Simpson and Sabaz and Ms Daher); and Rehabilitation Studies Unit, Sydney School of Medicine, University of Sydney (Dr Simpson).

Corresponding Author: Grahame Simpson, PhD, Liverpool Brain Injury Rehabilitation Unit, Liverpool Hospital, Locked Bag 7279, Liverpool BC NSW 1871, Australia (

The New South Wales Agency for Clinical Innovation funded the project. Dr Mark Sabaz was employed by the Agency for Clinical Innovation when working on the project. The authors thank Dr Jeffrey Rogers, Inika Gillis, and the Project steering committee.

The authors declare no conflicts of interest.

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.