Dr James presented research in Israel as part of a larger study. He was the first to investigate the underlying forms of aggressive behaviour and inappropriate sexual behaviour.

301 individuals with severe acquired brain injuries (ABI) of various aetiologies took part in the study. This examined the relationship between the type of brain injury sustained, including resulting neurocognitive impairments (e.g. communication and self-awareness) and the type of brain (i.e. clinical history). Behaviour monitoring tools, neuropsychological tests and clinical outcome measures were used to collect precise clinical data of the relevant factors.

Variables such as gender, type of injury, time since injury, adjustment and participation were linked to different types of behavioural disorders. For example, severe verbal aggression was more frequent among those who sustained a traumatic brain injury (TBI) as opposed to stroke or hypoxic brain injury and had more adjustment difficulties. Severe physical aggression was associated with greater impairment in social participation. A premorbid history of substance misuse and being injured at a younger age predicted the presence of inappropriate sexual behaviour.

Perhaps unsurprisingly, males were more likely to demonstrate these behaviours after brain injury. This suggests aggressive and inappropriate sexual behaviour may be separate clinical entities, rather than manifestations of a general behavioural disinhibition. The results indicate the type of brain injury plays a more important role in determining the presence of disordered interpersonal behaviour than pre-morbid clinical variables. Andrew's research also suggests verbal aggression, physical aggression and inappropriate sexual behaviour should be considered separately in clinical practice as well as clinical research. This invites further exploration to understand the relationships between brain function and neurobehavioural disorders following acquired brain injury.


  • James, A. & Young, A. (2014). Neurobehavioural predictors of verbal aggression, physical aggression and inappropriate sexual behaviour after acquired brain injury. Journal of the International Neuropsychological Society, 20

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