Self-Injurious Behavior

Part 1: How science is delivering answers

by Joy Simpson

5 to 17 percent of persons with mental retardation and autism do serious harm to themselves by biting, pulling out hair, banging their head or gouging their eyes -- on a regular basis. Unlike psychiatric disorders, this kind of self-destruction is not a suicide attempt. It is a repetitive ritual that causes mutilation, and in the past, was generally stopped with restraints. Because it is so disturbing to the family and difficult to control, a person with SIB (self-injurious behavior) would often have no choice but to live in an institution. Today, most people experiencing SIB live in the community.

Since the 1960's, scientists in medicine, neuroscience, psychology and education have been documenting the reasons for SIB and developing effective treatments. The National Institutes of Health and the Office of Special Education and Rehabilitation Services have been instrumental in funding research at many universities across the United States. Today, we have some significant answers and a few approaches that bring relief.

Here is a sampling of facts from various research fields:

• For some people with intellectual deficits, SIB is a way of communicating that something is wrong or they want to be left alone. Therefore, teaching new strategies for expressing needs and relating to other people is critical -- a behaviorist approach.
• Chronic health problems increase the tendency to engage in SIB. It is important to diagnose and treat health conditions that are a constant aggravation, such as difficulty sleeping, inner ear imbalance, and digestive ailments.
• Persons with certain kinds of mental retardation are likely to have chemical imbalances in the brain. Their treatment must include medication.

"To be effective, we must treat the person's medical condition and make changes in the living environment as well," says Stephen Schroeder, retired Director of the Life Span Institute at the University of Kansas. Schroeder believes that researchers from the behaviorist camp and from the disciplines of biomedicine must work together even though their approaches are vastly different. For this very reason, he directed the 1999 Merrill Center conference that brought together leading experts on SIB in the United States. Fifty scholars contributed to the book Schroeder recently edited with colleagues Travis Thompson and Mary Lou Oster-Granite. Self-Injurious Behavior: Gene-Brain-Behavior Relationships is the most comprehensive book on SIB to be released since 1992.

References

Luiselli, J., Singh, N.N., and Matson, J. (Editors) (1992). Analysis, assessment, and treatment of self-injury. New York: Springer-Verlag.

Schroeder, S.R., Oster-Granite, M.L., and Thompson, T. (Editors) (2002). Self-injurious behavior: Gene-brain-behavior relationships. Washington, D.C.: American Psychological Association.

Thompson, T., and Gray, D.B. (Editors) (1994). Destructive behavior in developmental disabilities: Diagnosis and treatment. Thousand Oaks, California: Sage Publications.

The feature on Self-Injurious Behavior was released in three parts and includes interviews with Stephen Schroeder who recently retired from the University of Kansas.

Read Part 2: Breakthroughs in Drug Treatment