Inappropriate Sexual Behavior Research Articles

Successful Treatment of Inappropriate Sexual Behavior and Disinhibition in Dementia With Paroxetine.

Successful Treatment of Inappropriate Sexual Behavior and Disinhibition in Dementia With Paroxetine.

Exploring the business skills, experiences and preparedness of UK-based private physiotherapists when establishing and developing a physiotherapy business: A hermeneutic phenomenological study

AimTo explore the business skills, experiences and preparedness of UK-based private physiotherapists when establishing and developing a physiotherapy business. DesignA hermeneutic phenomenological approach. ParticipantsSix UK-based private physiotherapy practice owners were recruited via purposive and snowball sampling. MethodsIn-depth, semi-structured video interviews (n = 12) were audio-recorded and transcribed. Field notes, respondent validation and a reflexive diary were used. Data underwent line-by-line analysis, identifying codes and themes. Constant comparison of data, codes and themes occurred throughout. Peer review was utilised, and small sections of data and all emerging codes were independently reviewed. ResultsKnowledge acquisition: participants acquired business knowledge from training, external help, and trial-and-error approaches. Improved physiotherapy-related business training was requested. Business skills: Business plans were generally organic or lapsed with time. Success and timing of marketing strategies varied widely. The altruistic nature of many physiotherapists creates difficulties in requesting payments for services. Clinical policies: Lone working risks appeared more weighted towards protecting staff from physical abuse rather than allegations. ConclusionsImproved physiotherapy-related business support and guidance may be beneficial. Focusing on word-of-mouth, website marketing, and establishing support networks may benefit practice owners. Greater consideration of the potentially negative implications of lone working, particularly accusations of inappropriate sexual behaviour, is recommended.

Sexual behaviours of individuals with developmental disabilities in South Korea: A qualitative study exploring the views and experiences of professionals

ABSTRACT Background Despite the considerable number of young adults with developmental disabilities experiencing sexual desire and exhibiting sexual behaviours as part of their natural biological growth and development, there is a lack of research on effective intervention. This study aimed to explore the views and experiences of professionals on the sexual behaviours of individuals with developmental disabilities. Methods Semi-structured interviews with eight professionals specialising in developmental disabilities and/or inappropriate sexual behaviours were conducted, and their responses were analysed using a qualitative method. Results Professionals’ experiences were categorised into three based on the groups involved in intervention: people with developmental disabilities (desire, factors leading to lack of desire fulfilment), their family/parents (emotions and cognition/behaviours toward their child’s disability and sexuality), and professionals (current intervention method, lack of human/material resources). Conclusion Based on these findings, we suggest future directions for interventions to address sexual behaviours among individuals with developmental disabilities.

Sex and Sexuality in Autism Spectrum Disorders: A Scoping Review on a Neglected but Fundamental Issue.

ASD consists of a set of permanent neurodevelopmental conditions, which are studded with social and communication differences, limited interests, and repetitive behaviors. Individuals with ASD have difficulty reading eye gestures and expressions, and may also have stereotyped or repetitive language, excessive adherence to routines, fixed interests, and rigid thinking. However, sexuality in adolescents and young adults with ASD is still a poorly studied and neglected issue. This review aims to evaluate sexual function and behavior in individuals with ASD to foster a greater understanding of this important, although often overlooked, issue. This review was conducted by searching peer-reviewed articles published between 01 June 2000 and 31 May 2022 using the following databases: PubMed, Embase, Cochrane Database, and Web of Science. A comprehensive search was conducted using the terms: "Autism" OR "ASD" AND "Sexuality" OR "Romantic relation" OR "sexual behavior" AND/OR "sexual awareness". After an accurate revision of 214 full manuscripts, 11 articles satisfied the inclusion/exclusion criteria. This review found that, although individuals with ASD may have sexual functioning, their sexuality is characterized by higher prevalence rates of gender dysphoria and inappropriate sexual behavior. Furthermore, sexual awareness is reduced in this patient population, and the prevalence of other variants of sexual orientation (i.e., homosexuality, asexuality, bisexuality, etc.) is higher in adolescents with ASD than in non-autistic peers. Sexual health and education should be included in the care path of patients with ASD in order to improve their quality of life and avoid/reduce inappropriate and risky behaviors.

The disclosure of children who exhibit problematic sexual behaviors

BackgroundPractitioners mandated to protect child development are sometimes dealing with children's inappropriate sexual behaviors. This set of behaviors presents a potential hindering impact on the child's development and important consequences for all children involved. Denial during the questioning of the child complicates the investigation of these cases. ObjectiveThe objective of this study was to explore and to identify the different contexts of questioning in which children disclose or deny having committed a sexual behavior that appears to be problematic for his/her development as well as identifying the individual and contextual variables that influence the outcome of the questioning. Participants and settingThe sample comprised of 120 instances of inappropriate sexual behavior exhibited by 85 children aged between 5 and 17 years old and reported to the Youth Protection Department at the Integrated Health and Social Services University Network in the province of Quebec, Canada. MethodsBivariate statistical analyses were performed to investigate the association between the outcome of disclosure or non-disclosure, and contextual factors (questioning person's role, parents' reaction to the child's behavior, the child's expression of remorse, presence of a witness, use of coercion during the sexual behavior). Logistical regression (GLMM) was then used to determine the strength of the association between the covariates and the outcome of the questioning. ResultsResults show that disclosure appears to be influenced by a combination of contextual variables, namely the role/status of the person questioning the child, expression of remorse reported by the child, and the presence of a witness to the behavior/s. ConclusionsOur findings point to the importance of developing more comprehensive and specialized knowledge about the questioning context that favors the disclosure of children who are thought to have exhibited inappropriate sexual behaviors.

A challenging case of mixed dementia with inappropriate sexual behaviours

Sexual disinhibition in dementia is a distressing and embarrassing behaviour. Currently, there are no guideline‐directed management aims to address this behaviour in patients with dementia. This case report highlights a combined non‐pharmacological and pharmacological approach for managing dementia in a patient who showed marked sexual disinhibition.

Opinions of special education teachers on inappropriate sexual behaviors in adolescents with intellectual disabilities

Inappropriate sexual behaviors may be observed in individuals with intellectual disabilities (ID), especially during adolescence. There are several undesired consequences of exhibiting such behaviors in public spaces, such as schools. The competencies and attitudes of special education teachers, who are responsible for the education of individuals with ID, are of significant influence. This study was conducted to investigate the views of special education teachers working with adolescents with ID on inappropriate sexual behaviors exhibited in educational settings. Accordingly, semi-structured interviews were conducted with 12 special education teachers. The phenomenological research design, one of the qualitative research methods, and thematic analysis were used in this study. Five themes were identified after the analysis of the findings of the study, namely, common behaviors, teacher attitudes, teacher competencies, teacher interventions, and educational content. The findings were discussed on the basis of the relevant studies in the literature and a number of conclusions were reached. Accordingly, the inappropriate sexual behaviors that special education teachers encounter the most frequently are masturbation, undressing, and touching, and when these behaviors are exhibited aggressively, teachers have difficulty in intervening. Participants regard themselves to be incompetent in terms of sexual education and consider relevant educational content inadequate.

Analysis of the Differential Efficacy of the Reduced Version Over the Extended Version of an Affective-Sexual Education Program for Adults with Intellectual Disabilities

Recently, with the increase in demand, multiple intervention proposals aimed at improving the sexual health of people with intellectual disabilities have emerged. Among them is the SALUDIVERSEX program, which takes a positive approach to sexuality. It has an extended version, consisting of 16 sessions and whose efficacy has already been proven, and a reduced version of 10 sessions. Thus, the present study aimed to test the differential efficacy of the two versions. A total of 208 participants (103 women and 105 men) aged between 19 and 67 years (M = 37.23, SD = 10.66) completed a battery of instruments before and after the intervention. Statistical analyses showed that users who participated in the reduced version of the program presented a significantly higher rate of improvement in their sexual behaviors compared to those who participated in the extended version (Sexual response: β10 = − 0.46 ± 0.19, p = .034; Sex practices: β10 = − 0.52 ± 0.23, p = .037; Use condoms: β10 = − 1.56 ± 0.59, p = .017), as well as a significantly higher decrease in the risk of suffering sexual abuse (β10 = 3.95 ± 0.64, p < .001). However, no statistically significant differences in sexuality knowledge were obtained with respect to the improvement between the two versions (β10 = − 0.09 ± 1.21, p = .94). Meanwhile, the professionals who applied the program found that those who participated in the reduced version, although they presented a significantly greater increase in their knowledge about privacy (β10 = − 0.48 ± 0.08, p < .001), did not improve their concerns about their inappropriate sexual behaviors as much as the users of the extended version (β10 = − 1.35 ± 0.21, p < .001). Thus, although both versions were effective, the reduced version seems to do so to a greater extent and in a shorter time, which makes it the more recommendable option.

Fitness to practise and the spectre of erasure: Some reflections from a psychiatrist assessor.

Referral of doctors to the General Medical Council concerning their fitness to practise is an important subject, not only because of potential risk to patients, but because of its impact on the mental wellbeing of the doctors concerned. This paper is based on the case histories of 124 doctors (1990-2015) reported to the GMC and for whom I was requested to undertake a psychiatric assessment. My findings are summarised under three headings: psychiatric problems, substance misuse and inappropriate sexual behaviour. Nerve-wracking though GMC referral is for any individual doctor, most investigations do not proceed beyond the triage stage, after which the case is closed. I also reflect on the changing pattern of doctors' professional identity and how this might help them seek help for mental disorders at an earlier stage than in the past, thus preventing referral to the GMC.

Sexual harassment in schools

Richard Oldershaw, legal adviser at Coram’s Child Law Advice Service, outlines statutory guidance revisions on safeguarding in education and their impact on how schools should tackle inappropriate sexual behaviour

OBSCENE BEHAVIOR: A REAL CHALLENGE FOR THERAPEUTIC RELATIONSHIP

Background and Aims: Number of studies in healthcare context has described the rehabilitators as harassment perpetrator and patient as the victim, in particular therapists. Therefore, these issues must examine the dynamics of patient-therapists’ relationships to understand the factors related to the inappropriate sexual behavior. Methodology: A cross-sectional survey was conducted on physical and occupational therapists, recruited via convenience sampling technique. The data was collected through Inappropriate Patient Sexual Behavior questionnaire, sent to participants via email or WhatsApp groups. Results: A total number of 106 participants including 12.3% males and 87.7% females with 71.7% physical and 28.3% occupational therapist. The finding revealed that 82.1% therapists never had training in the context of understanding the inappropriate patient sexual behavior. Whereas 28.3% revealed that a patient has stared the body that made them uncomfortable, 9.5% reported to have sexual flattering remarks, 4.7% had purposeful touched in a sexual manner. Unfortunately, only 37.7%has expressed their disgust and raised voice to report the issues. Conclusion: It was concluded that relatively very low percentage of IPSB is present and reported cases are usually recorded as disgust feeling or raised voice. Thus for healthy therapeutic relationship, training for handling obscene behavior must be conducted and the curriculum should promote knowledge of this aspect.

A systematic review of relationships and sex education outcomes for students with intellectual disability reported in the international literature.

BackgroundLittle is known about how to evaluate relationships and sex education (RSE) delivered to students with intellectual disability and what stakeholders perceive are important outcomes. The present study aimed to systematically review existing studies on outcomes of RSE, as the first step in the development of a core outcome set (COS) for students with intellectual disability.MethodA systematic literature process included two stages: (1) searching for studies reporting on RSE outcomes for students with intellectual disability and (2) studies reporting on measurement properties (e.g. validity, reliability and responsiveness) of standardised instruments identified in stage 1.ResultsA total of 135 RSE outcomes were extracted from 42 studies: 43 outcomes for students in secondary education and 92 outcomes for students in further education. No RSE outcomes were reported for primary education. Outcomes referred to the human body, hygiene, relationships, sexuality, sex and its consequences, inappropriate and appropriate social and sexual behaviour, keeping safe, emotional vocabulary and positive self‐esteem. Outcomes were predominantly knowledge‐based, rather than relating to skills and attitudes development. Students with intellectual disability, parents and teachers perceive different RSE outcomes meaningful. Five instruments were used to measure the outcomes, but none have established psychometric properties with this population.ConclusionsThe comprehensive list of RSE outcomes for students with intellectual disability will be used to inform the next steps of a Core Outcome Set needed for RSE evaluations in research and education settings. There is an urgent need to develop standardised instruments validated for students with intellectual disability.

Is Thalamic Lesion a Contributing Factor for Inappropriate Sexual Behavior in Older Adults with Cognitive Impairment?

Thalamus is a group of nuclei located deep inside the brain, well known for its sensory and cognitive functions. However, its role in the reward and behavior regulation is less explored. In this case series, we have presented four cases with inappropriate sexual behaviors (ISB) that are temporally related to thalamic infarction. We have discussed about the limbic part of thalamus and its extensive connections with other regions in regulating sexual behaviors. Although in all the four cases described there was underlying cognitive impairment that can itself increase the risk of ISB, there was potential contributing role of thalamic lesions.

Memantine resolves inappropriate sexual behavior in an elderly male with intellectual disability.

<h3>Introduction</h3> Memantine is a non-competitive N-methyl-d-aspartate receptor antagonist approved for the treatment of moderate to severe Alzheimer's disease. Given its connection with glutamate pathways, memantine is effective in many psychiatric conditions as monotherapy and as an adjunct. Inappropriate sexual behavior (ISB) incorporates sex talk, implied sexual behavior (openly reading pornography, requesting unnecessary genital care) and sexual acts (touching, grabbing, exposing, masturbating) privately or publicly. Hypersexuality has been regarded as a form of obsessive compulsive disorder. There is a dearth of literature about ISB in individuals with intellectual disability (ID), and diagnosing major neurocognitive disorder (NCD) is difficult, due to the lack of standardized diagnostic criteria. In this population, NCD is suspected in the context of new onset cognitive impairment, behavior disturbance and a functional decline. The prevalence of behavioral and psychiatric symptoms of minor and major neurocognitive disorders is 50–80 %, respectively. This patient was initially diagnosed with NCD and memantine was initiated. However, clinical follow ups and serial, stable Montreal Cognitive Assessments (MOCA) over three years, did not support this diagnosis. <h3>Methods</h3> Casereport of a male with ID who manifested novel, ISB at age 67. This includes history, clinical follow ups, physical and cognitive evaluation, neuroimaging, laboratory (lab) tests, literature review using PubMed. ISB uncontrolled with various pharmacologic agents eventually resolved with the addition of memantine which was gradually increased to 10 mg twice daily (BID). When a recurrence of ISB occurred after two years, it remitted with memantine 25 mg (administered in two divided doses). <h3>Results</h3> A67 year-old, single, white male with ID, hypertension, diabetes type 2 and hyperlipidemia who followed up in psychiatry for intermittent explosive disorder and anxiety, was stabilized on citalopram 40 mg daily (QD) and gabapentin 300 mg thrice daily (TID). He had special education through 12th grade and an intelligence quotient of 68. New onset ISB toward men was reported on January 2016. Episodes occurred in communal areas involving the touching of penises with pants down, propositioning someone at a public pool, and placing himself very close to a man during a class. Due to complaints, a team with a behaviorist was formulated to assist in preventing triggering of sexual impulse. Gabapentin was progressively increased to 600 mg TID; later risperidone was initiated, then increased to 0.5 mg BID in combination with citalopram 40 mg. Thereafter, the undesirable behavior gradually subsided. MOCA was 16/30. Labs included: creatinine; 1.28mg/dl (N<1.34mg/dl), GFR; >60ml/min(N), fasting glucose; 129mg/dl (N60-99mg/dl), vitamin B12; 291pg/ml(N>200pg/ml), vitamin B1; 75 nmol/L (N70-180 nmol/L), Methylmalonate, MRI and other dementia related labs were unremarkable. Vitamin B1 and B12 were started. Although ISB had ceased, the patient was seen again after two months due to progressive unsteadiness, falls, slurred speech and worsening cognition after gabapentin was increased. Mini mental status examination was 17/30. Memantine 5 mg daily was initiated and Gabapentin was gradually decreased to 300 mg QD. After two months, improved cognition with resolution of ISB was reported. After two years of stability, he began pursuing a man obsessively in a sexual manner over a two-month period. When examined on April 2019, his MOCA was 16/30 with stable labs. Memantine was increased to 10 mg in am and 15 mg at pm to target ISB. After 44 days, ISB was reported to have resolved soon after increasing memantine. At this visit, escitalopram 15 mg replaced citalopram 40 mg QD due to safety concerns. Sustained remission of ISB was reported in January, 2020. In March 2020, patient was seen again as he had touched a female inappropriately a few times during pool classes. MOCA was 18/30 (increased by two-points). He admitted to experiencing slight urges, but later quit the class and declined to attend the Pride parade to curb temptation. Although he had age related physical decline, there was no evidence of cognitive or functional impairment compared to baseline. Subsequently, the diagnosis of major neurocognitive disorder (NCD) was questioned. Additionally, he had demonstrated insight and successfully resolved ISB. To date, his ISB is in remission with stable labs. <h3>Conclusions</h3> Resolution of ISB in a patient with ID is a previously unreported therapeutic effect of memantine. ISB remitted with the addition of memantine 20 mg daily after multiple failed trials of various psychotropics. Two years later, the reemergence of ISB resolved with memantine 25 mg, and was well tolerated with stable medical tests. Memantine could be a promising medication for the control of ISB in these patients when used as an adjunct. <h3>This research was funded by</h3> NA

GAMBARAN PERSEPSI ORANG TUA TERHADAP PENTINGNYA SEX EDUCATION PADA REMAJA AUTISME FASE PUBERTAS DI SLB NEGERI DENPASAR

Sex education is given to prevent adolescents from the negative risks of sexual behavior. However, many parents consider sex education to be a taboo subject, so parents do not teach sex education to adolescents with autism. Basically, adolescents with autism also experience sexual development, but because of their cognitive limitations, adolescents with autism often experience problems during adolescence such as showing inappropriate sexual behavior. The role of parents is very decisive for adolescents in preparing for the changes that will occur in themselves so that positive perceptions from parents are needed so that adolescents with autism have positive attitudes towards sex. This study aims to describe the perception of parents on the importance of sex education in adolescents with autism puberty phase. This research was done with a quantitative descriptive study and supplemented with a cross sectional approach. The sample used were parents who have autistic adolescents aged 11-14 years who attend SLB Negeri 1 and SLB Negeri 3 Denpasar. This study also used a total sampling technique so as to get a sample of 44 people. The results of this study showed parents with negative perceptions as many as 25 people (56.8%) and who had positive perceptions as many as 19 people (43.2%). It was concluded that the majority of parents had a negative perception of the importance of sex education, so there was a need for additional information to parents about sex education.

Impact of Sexual Harassment on the Overall Well-Being of Female Senior Non-Teaching Workers of Public Tertiary Institutions in Ogun State, Nigeria

Cases of inappropriate sexual behaviours have been on the increase in Nigerian society and they transcend age limits and gender of the victims. This study examined the impact of sexual harassment on the overall well-being of female senior non-teaching workers of public tertiary institutions in Ogun State, Nigeria. Three research hypotheses were formulated and a descriptive research design was adopted for the study. The population used was 150 female senior non-teaching workers from the selected public tertiary institutions in Ogun State, Nigeria. Purposive and simple random sampling techniques were used to select 50 samples from each of the selected tertiary institutions. The data collected was analysed using descriptive statistic of frequency and percentage while inferential statistics was used to test the hypotheses. The findings of the study revealed that sexual harassment has a significant impact on the overall well-being of female senior non-teaching workers. Based on the findings of this study, it was recommended that the proprietors of these public institutions should make relevant legislation and regulations to guide against this as there seems to be no specific punishment for sexual harassment in the code of conduct of these institutions aside from lumping it up under general misconduct.

The imperfect fit: Fetal alcohol spectrum disorder as the basis to commit individuals involuntarily as sexually violent predators/persons.

Prenatal alcohol exposure produces a broad range of primary disabilities that lead to adverse life course outcomes in children raised in adverse environments. Inappropriate sexual behaviors are a commonly occurring secondary disability, with a large minority of individuals with fetal alcohol spectrum disorder (FASD) displaying sexual aggression. Adults with FASD who commit repeated criminal sexual acts may be subject to legal proceedings for indefinite involuntary civil confinement as sexually violent predators/persons (SVP) in certain jurisdictions in the United States. Studies about the diagnostic practices among psychologists and psychiatrists retained by states to evaluate individuals as SVP do not recognize FASD as a mental disorder, despite the likelihood that hundreds of individuals petitioned for involuntary commitment suffer from FASD. Establishing an FASD diagnosis may provide exculpatory evidence to refute a government petition that an individual suffers from a mental condition that affects emotional or volitional capacity by predisposing the person to committing criminal sexual behavior. This article provides a framework for identifying, assessing, and deciding whether individuals with the FASD diagnosis suffer from the legally defined mental disorder that is necessary to indefinitely confine individuals as SVP.

Inappropriate Patient Sexual Behavior in Physiotherapy: A Systematic Review

A behavior which is increasing in prevalence is sexual harassment initiated by a client and displayed towards the healthcare professionals and students of these healthcare-related professions. This is termed inappropriate patient sexual behaviour (IPSB). The consequences of IPSB can be significant, including decreased academic and work performance, decreased attention/concentration, reductions in work satisfaction, and a loss of confidence. The primary aim is to evaluate the literature on sexual harassment in physiotherapy. The secondary aim is to report on the incidence, situational factors, and suggested strategies. The databases Pubmed, Ovid MEDLINE, CINAHL Plus, Embase via OVID, ProQuest, and EBM Reviews were searched from inception up to 5 November 2021. Data on the incidence, situations, and strategies were extracted by at least two independent researchers. The quality of included articles was assessed. Nine studies of cohort and cross-sectional design were included. The incidence of IPSB was reported to be between 48–100% of the samples of physiotherapy students and/or therapists. The situational factors are reported, and the recommended educational strategies are discussed. Articles suggest that educating physiotherapists and/or students about sexual harassment would be beneficial. This will help predict potential issues and highlight strategies to empower therapists in the workplace and in training.

Medicolegal Aspects of Huntington Disease.

Unlawful behaviors have been reported in association with Huntington's disease (HD), although their overall prevalence and clinical significance remain unknown. Recognition of problematic behavior is limited by stigma and lack of routine clinical assessment, as well as the absence of validated screening measures. We performed a retrospective chart review of 289 patients treated for HD at Vanderbilt University Medical Center from 2006 to 2020 to assess the frequency of illegal activity in our HD population. We identified 31 patients with HD who have a documented history of unlawful behavior, comprising 11 percent of the charts reviewed. Physical violence was the most common behavior reported, followed by reckless driving, substance abuse, illegal financial activity, and inappropriate sexual behavior. Mean age at the time of the first offense was 37 years. Patients with criminal offenses were more likely to be male and in the early stages of disease with associated psychiatric symptoms. Our results emphasize that illegal activities are a significant clinical problem in individuals with HD, particularly young adult males with comorbid psychiatric symptoms. These findings highlight the need for improved screening measures to detect high-risk behaviors in individuals with HD, as well as evidence-based protocols to guide triage and management of patients engaging in potentially detrimental activities.

Working together to address sexual misconduct in the Canadian Armed Forces

LAY SUMMARY In 2015, the Canadian Armed Forces (CAF) implemented Operation HONOUR to eliminate sexual misconduct (SM) in the military. Sexual assault, inappropriate sexual behaviours, sexual harassment, and gender discrimination are all types of SM. Experiencing SM can result in depression, substance abuse, physical health problems, and even posttraumatic stress disorder (PTSD). Despite Operation HONOUR, SM still happens in the CAF. At this time, many groups are working together to address SM and to support those who have experienced SM. Canadian-based researchers, policy makers, military members, Veterans, and clinicians are collaborating to identify new approaches to training, culture change, research, and treatment relating to SM in the CAF. The end goal of working together is to minimize SM in the CAF and ensure the health and safety of all CAF members and Veterans.