Hiraoka Takashi, Yagi Masami
Department of Rehabilitation Medicine, Kawasaki Medical School, Kurashiki City 701-0192, Japan.
Rehabilitation Center, Kawasaki Medical School Hospital, Kurashiki City 701-0192, Japan.
Brain Sci. 2023 Aug 21;13(8):1227. doi: 10.3390/brainsci13081227.
Higher brain dysfunction commonly occurs following traumatic brain injury (TBI), and may manifest in a social behavioral impairment which can significantly impede active social participation. We report two cases, one of voyeurism and the second of alcohol abuse, which might have been caused by TBI resulting in disinhibition, a type of social behavioral impairment. We discuss the underlying pathophysiological mechanisms to raise awareness of such cases and aid the development of effective interventions. Patient 1 suffered a TBI at 18 years of age, 2 years after which he presented repeated episodes of sexually deviant behavior (voyeurism). At 28, he committed suicide, since he was unable to control his aberrant behavior. Patient 2 suffered a TBI at the age of 13. He first displayed problematic behavior 7 years later, which included drinking excessive amounts of alcohol and stealing while inebriated. Despite both patients having sound moral judgment, they had irrational and uncontrollable impulses of desire. Imaging findings could explain the possible causes of impulse control impairments. Damage to the basal ganglia and limbic system, which are involved in social behavior, presumably led to desire-dominated behavior, leading to the patients conducting unlawful acts despite intact moral judgment. It is crucial to educate society about the prevalence of these disorders, explain how these disinhibitions start, and develop effective interventions.
严重脑功能障碍常见于创伤性脑损伤（TBI）后，可能表现为社会行为障碍，这会严重阻碍积极的社会参与。我们报告了两例病例，一例为窥阴癖，另一例为酒精滥用，可能是由TBI导致的去抑制引起的，去抑制是一种社会行为障碍。我们讨论了潜在的病理生理机制，以提高对此类病例的认识，并有助于开发有效的干预措施。患者1在18岁时遭受TBI，2年后他出现了反复的性变态行为（窥阴癖）。28岁时，他自杀了，因为他无法控制自己的异常行为。患者2在13岁时遭受TBI。7年后他首次出现问题行为，包括过量饮酒和醉酒时偷窃。尽管两名患者都有健全的道德判断力，但他们有不合理且无法控制的欲望冲动。影像学检查结果可以解释冲动控制障碍的可能原因。参与社会行为的基底神经节和边缘系统受损，可能导致以欲望为主导的行为，导致患者尽管道德判断力完好却做出非法行为。对社会进行关于这些疾病的普遍性教育、解释这些去抑制是如何开始的以及开发有效的干预措施至关重要。
