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For people with Down syndrome, family members, caregivers and professionals.

Self-Injurious Behavior

March 2020 | Brian Chicoine, MD - Medical Director, Adult Down Syndrome Center

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. 

Causes

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:
  • Anxiety

  • Depression

  • Grief

  • Psychosis, a severe mental disorder that causes people to lose contact with reality (although, this is not seen commonly in people with Down syndrome)

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 

person speaking and person hearing

Some examples of sensory causes are: 
  • A person might strike or poke their eyes if they are sensitive to certain lights. 

  • A person might hit their head against a wall in response to sensitivity to loud sounds. 

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: 
 
  1. Assessing for and treating underlying physical and mental health problems

  2. Assessing for contributing sensory issues

  3. Counseling when appropriate

  4. Utilizing relaxation techniques per the individual's preferences (e.g. soft music, darkened rooms)

  5. Using visual reminders

    • For example:

      • A visual could be used that shows a picture of the undesired SIB with a red "X" through it and pictures of appropriate relaxation techniques.visual of healthy coping mechanisms

      • A self-modeling video could be made that shows the individual using the more appropriate relaxation techniques.

    • It can be helpful for individuals to look at the visuals or watch the videos at the beginning of each day to remind them to use appropriate relaxation techniques throughout the day. 

  6. Behavioral management

    • 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 on SIB can be found in this article on the website of the Kennedy Krieger Institute. 

 

Articles on Naltrexone

Hauptman AJ. Naltrexone for severe eye-gouging in Down syndrome. Am J Psychiatry Resid J. 2017;11(1):12-13. https://doi.org/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. https://doi.org/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. https://psycnet.apa.org/record/1991-02265-001. Accessed February 10, 2020.

Smith, BD. Self-mutilation and pharmacotherapy. Psychiatry (Edgmont). 2005;2(10):28-37. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2993516/. Accessed February 10, 2020.

Please note: The information on this site is for educational purposes only and is not intended to serve as a substitute for a medical, psychiatric, mental health, or behavioral evaluation, diagnosis, or treatment plan by a qualified professional. We recommend you review the educational material with your health providers regarding the specifics of your health care needs.

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