Repetitive Self-Injurious Behavior: The Emerging Potential of Psychotropic Intervention

By Rendueles Villalba, M.D., and Colin Harrington, M.D.
Psychiatric Times February 2003 Vol. XX Issue 2

Self-injurious behavior (SIB) is intentional self-directed tissue injury inflicted without conscious intent to kill oneself (Simeon et al., 1992). A provisional nosology, based on the clinical phenomenology of self-injurious behavior, has been developed (Table 1) (Villalba and Harrington, 2000). However, this typology awaits etiological grounding. While a variety of neurotransmitter systems may be involved in the initiation and maintenance of repetitive self-injurious behavior (rSIB), most clinical studies to date have attended to the role of serotonin or endogenous opioids. This focus has emerged from a conceptualization of rSIB as a problem of impulse control (primarily mediated by serotonin) and/or as a maladaptive pain-related behavior (ultimately mediated by opioids) (Villalba and Harrington, 2000). Clinically significant forms of self-mutilation occur predominantly in mental retardation, pervasive developmental disorders, major psychotic disorders and cluster B personality disorders (Simeon et al., 1992). Psychodynamic formulations have suggested that self-inflicted injury may promote affect regulation, relieve anxiety, terminate dissociative experiences, discharge sexual arousal, support (dysfunctional) interpersonal relationships, generate euphoria, serve as self-punishment, establish ego/self boundaries and/or serve as a nonlethal alternative to suicide (Haines et al., 1995; Herpertz et al., 1997; Suyemoto, 1998). In this review, we address biological aspects of rSIB.

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