OBJECTIVE: The authors describe the clinical characteristics of self-
injurious behavior, giving special emphasis to self-injurious behavior
occurring among individuals with character disorders. DATA COLLECTION: They
review data suggesting the involvement of serotonergic, dopaminergic, and
opiate neurotransmitter systems in the expression of self-injurious
behavior. FINDINGS: Self-injurious behavior occurs among mentally retarded
individuals, psychotic patients, prison populations, and individuals with
severe character disorders. Although theoretical psychological models of
self-injurious behavior are helpful in understanding the patient's
experience of self-injury, no generally useful therapeutic approach has yet
evolved from these models. Data derived from animal models and treatment
studies suggest the involvement of opiatergic and dopaminergic mechanisms
in self-injury among the mentally retarded. Serotonergic influences on
self-injurious behavior may be present in varying forms of this behavior.
The scientific literature on the benefits of pharmacological agents for
mentally retarded individuals is beset with a number of problems. Support
is emerging, however, for the use of lithium and carbamazepine with
self-injuring mentally retarded patients, and some behavioral interventions
appear to be successful for mentally retarded individuals. Self-injuring
patients with borderline personality disorder may benefit from milieu
treatment. CONCLUSIONS: Although no form of treatment has yet been
demonstrated to be of general benefit, the literature suggests that
therapeutic trials with dopamine antagonists, serotonin reuptake
inhibitors, and opiate antagonists may be of value.
Abstract Teaser