When someone living with dementia starts showing disinhibited behaviours, it can be embarrassing and confusing – even distressing – for family and friends.
It’s important to remember, though, that your loved one isn’t acting that way on purpose, and may not understand the impact of their behaviour. Here is some information to help you understand why they act inappropriately, and what you can do to help.
What are disinhibited behaviours?
Disinhibited behaviours are actions which don’t follow the usual social rules. They often seem rude or offensive, and are out of character for the person who exhibits the behaviour.
Disinhibited behaviours include:
- rude remarks, such as commenting tactlessly about another person’s appearance
- using offensive language that the person wouldn’t have used before
- showing bold behaviour, such as inappropriately flirting with someone or making sexually suggestive comments
- inappropriately sharing personal information with strangers
- exposing themselves by taking off some or all of their clothes in public settings
These behaviours can be stressful for families and carers, especially when they are out of character. It can be difficult to know how to react, or what to do when the situation arises.
What causes disinhibited behaviours?
Every person with dementia is an individual with their own behaviours and reactions. In most cases, disinhibition is caused by changes in the brain, but it can also be triggered by certain events or circumstances. These triggers may be:
- Confusion or disorientation about time or space: the person may believe someone is their close family member or spouse, and become overly affectionate without meaning to be inappropriate. They may think it’s bed time so remove their clothes for sleep, or they may think they are in the bathroom instead of a public space.
- Being uncomfortable – the person may remove their clothes because they are too hot or tight-fitting. They may touch their genital area because they need to use a toilet, or have a urinary tract infection.
- Lack of judgment – the person may not understand the need to be discreet in public spaces as a result of changes to their brain. This can lead to engaging in inappropriate behaviour, or forgetting about the importance of dressing.
- Unrealistic expectations – sometimes, a person with dementia may be attempting to do a task that is too complex for them, leading to an angry outburst or an out of proportion response.
It is important to remember that the person with dementia does not understand that what they are doing is inappropriate. No matter the situation, they should always be treated dignity, sensitivity and care.
How you can help
By seeing things from your loved one’s perspective and exploring the causes behind the behaviour, you will be more likely to offer effective support. Here’s some tips that may help.
Understand the reason behind the behaviour
Explore why the person might be behaving in a particular way. If you can work out the trigger (e.g. they are misinterpreting someone helping them get dressed in the morning, or they need help knowing where the bathroom is), you may be able to come up with strategies to prevent it from happening again. It’s also worth getting a doctor to do a check-up, in case the behaviour is caused by illness or medication side effects.
React calmly and be patient
It may be difficult, but try to refrain from overreacting to their behaviour, even though you may feel distressed or embarrassed. Remember that they are not doing it on purpose, and speak to them in a kind and patient manner. Some carers find it helpful to have a sense of humour about the situation, or to think about whether the behaviour really matters in the long run (talking to a stranger, for example, may be a good way to get social interaction).
Provide comfort and reassurance
Alongside being patient and gentle, give your loved one plenty of encouragement and appropriate physical contact, such as giving them a hug, rubbing their back or touching their arm. Sometimes the person may be feeling anxious, and needs reassurance that everything is okay through touch and gentle communication.
Redirect the person
Distraction can be a helpful way to stop inappropriate behaviour without having a confrontation. Gently lead the person to a place where they can have privacy, give them something to do, or focus their attention on something else. If a person speaks rudely, try re-directing them gently rather than correcting the comment or behaviour.
Explain the situation to others
Some people find it worthwhile to explain their loved one’s circumstances to other people in their life, so they can understand why the person is behaving in a certain way. Knowing that inappropriate behaviour is a symptom of dementia can help friends and family be more understanding. They may also have helpful suggestions on how to best handle the situation.
Check their clothes
If undressing in public is an issue, it may be worth checking your loved one’s clothes. Are their clothes too tight or uncomfortable? Are they too hot for the weather outside? You could also try different clothing solutions., such as pants without zippers.
Take care of yourself
Surprisingly, this is one of the most important things you can do. Managing disinhibited behaviours can be very stressful for families and carers. It is hard to care for someone if your own tank is empty. Make sure you get time out to have a break, do things you enjoy to recharge, and speak to people who can help share the mental burden of caring.