What is self-injurious behavior?
Self-injurious behavior (SIB) is behavior that an individual does that results in harm to their own body. These behaviors may include hitting oneself, striking a body part against an object, throwing oneself on the floor, and/or head banging. Individuals with SIB are rarely trying to end their life through suicide.
There are many possible causes of SIB, and it can be challenging to treat.
Some examples of physical causes are:
A person might hit their head when they have face or head pain from a sinus infection.
A person might become agitated due to hyperthyroidism (overactive thyroid).
A person might stomp or kick their feet in response to numbness or discomfort caused by peripheral neuropathy, a condition that occurs when nerves outside the brain and spinal cord are damaged. Diabetes can cause peripheral neuropathy.
A person might scratch their face or arms in response to a seizure.
Some examples of psychological causes are:
Some examples of social causes are:
Stressors at school, work, or home
Inappropriate interactions with others
The desire for attention that is successfully obtained through SIB
Some examples of sensory causes are:
Some researchers have also suggested that SIB may lead to a release of endorphins which brings a sense of pleasure to the individual.
Assessment and Treatment
We recommend a variety of assessment and treatment techniques that include:
Assessing for and treating underlying physical and mental health problems
Assessing for contributing sensory issues
Counseling when appropriate
Utilizing relaxation techniques per the individual's preferences (e.g., soft music, darkened rooms)
Using visual reminders
This may include a reward system for appropriate behavior. Enlisting the assistance of a professionally trained behaviorist can be helpful. A behaviorist can assess for contributing environmental factors, suggest rewards to use, and identify techniques to avoid inadvertently rewarding inappropriate behaviors.
When additional treatment is needed, there are several small studies (see below) that describe using naltrexone to reduce self-injurious behavior in those with intellectual disabilities and in children. Naltrexone may reduce the "pleasure" that the person gets from SIB and, thus, reduce the drive to do it.
Additional information is available in an article on SIB on the Kennedy Krieger Institute website and in Chapter 23 of Mental Wellness in Adults with Down Syndrome.
Articles on Naltrexone
Hauptman AJ. Naltrexone for severe eye-gouging in Down syndrome. Am J Psychiatry Resid J. 2017;11(1):12-13. doi:10.1176/appi.ajp-rj.2016.110104
Kars H, Broekema W, Glaudemans-van Gelderen I, Verhoeven WMA, van Ree JM. Naltrexone attenuates self-injurious behavior in mentally retarded subjects. Biol Psychiatry. 1990;27(7):741-746. doi:10.1016/0006-3223(90)90589-T
Sandman CA, Barron JL, Colman H. An orally administered opiate blocker, naltrexone attenuates self-injurious behavior. Am J Ment Retard. 1990;95(1):93-102. Accessed February 10, 2020.
Smith, BD. Self-mutilation and pharmacotherapy. Psychiatry (Edgmont). 2005;2(10):28-37. Accessed February 10, 2020.