Nov 10, 2015

When Loss of Inhibition Leads to Problem Behaviors


Gary walked into the dining room at the memory care facility where he lived and promptly took off all his clothes amid screams from two of the ladies.

His wife, Delores, who was visiting him at the time, was mortified. Gary had been doing this for days and nothing she said or did caused him to stop.

When he did it last week it was even worse because he’d urinated right then and there.

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By Marie Marley
Alzheimer's Reading Room

According to an article published on Caring.com,
as dementia slowly robs self-awareness, the person becomes less inhibited, losing both the memory of how he or she once behaved as well as a sense of social norms. It’s as if an internal filter on what’s polite behavior or not is turned off.”
What Happens: Loss of inhibition is not uncommon in people living with dementia. Some of the classic resulting behaviors, listed in an article entitled, “Symptom Guide,” published on the Dementia Guide website, are:
  1. Makes comments that are mean or hurtful
  2. Curses and uses foul language
  3. Makes sexually suggestive comments or advances
  4. Lacks modesty (e.g., changes in front of people, urinates in public)
  5. Tells jokes that are offensive
Why It Happens: Another Dementia Guide article, “Alzheimer’s Disease: Inhibition, states that “The majority of these behavioural problems can be traced to damage in the frontal lobe.” The article continues:
The frontal lobe is responsible for many important higher level functions such as thinking, reasoning and language. These are the functions that make us who we are, to ourselves and others. Thus, when this area suffers damage from Alzheimer’s or another disease, it can greatly affect a person, and those who care about him/her.
Previous Alzheimer’s Reading Room Article About Loss of Inhibition, written by Barbara Pursley described her mother’s overt sexual behavior, which she assumed was due to a reduced sense of inhibition.

Two comments from the article.
My mother-in-law just last week started behaving just this way, with the 'sexual' behaviors. Also, she has become very verbally 'uninhibited', telling people exactly where to go! Her moods can swing so drastically, from being 'Mrs. Nice Little old Lady' for a visiting nurse, to a monster 'performing' for her family when the nurse leaves. 
As a nurse who works in an adult day care, I guess I have a harder time finding this behavior "amusing." A lot of the staff's time is spent keeping male clients from sexually touching female clients and distracting many of them from sexual behavior generally. Staffs have to be well trained and very professional to deal with this aspect of clients' behavior.

Come Back Early Today A Memoir of Alzheimer's Care

Examples From My Personal Experience: Ed went through a phase in which he frequently took off all his clothes and eliminated in the dining room at his facility. The staff requested that I get him some jumpsuits that zipped down the back to prevent these behaviors.

The very fact that a company made such apparel shows that this type of behavior is not uncommon in people living with dementia.

What to Do About It: The Caring.com article lists several suggestions as to what you can do about negative behaviors resulting from a reduction in inhibition. These include, among others:
  1. Know that some behaviors aren't what they look like. People with dementia who are losing language skills often express themselves with actions. For example, someone who unzips his pants may need to use the restroom. A person who disrobes may be hot. Someone who hurls a stream of foul language may feel stressed.
  2. Notice what else is going on when a behavior occurs; something about the environment may be triggering a reaction in the form of this inappropriate behavior. Pay attention to the noise level, who's present, the time of day, whether the person has eaten or used the bathroom. Jot down this information if an odd behavior happens more than once.
  3. Ignore these behaviors where possible. Reacting to them -- especially with outrage or disapproval -- may only egg on or upset the person.
  4. React with calm reassurance. The person may be acting out because he or she feels uncomfortable, insecure, or overwhelmed by noise (such as in a public place). End of block quote
Something very unusual happened when I researched this topic. I only found information about negative behaviors caused by a lack of inhibition.

My personal experience, however, revealed that disinhibition can lead to precious, loving behaviors.

This will be the topic of my next article.

Has anyone found other successful strategies for dealing with unwanted behavior problems resulting from a lessening of inhibition? Care to share with us?

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Marie Marley is the award-winning author of the uplifting book, Come Back Early Today: A Memoir of Love, Alzheimer’s and Joy. Her website (ComeBackEarlyToday.com) contains a wealth of information for Alzheimer’s caregivers. She is also the co-author (with Daniel C. Potts, MD, FAAN) of the forthcoming book, “Finding Joy in Alzheimer’s: New Hope for Caregivers.’

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