Self-injurious behavior

Self-injurious behavior (SIB) is the most commonly-used term for self-injury in people with developmental disabilities. It is often repetitive and rhythmic.Shkedy, G., Shkedy, D., Sandoval-Norton, A. H., & Cerniglia, L. (2019). Treating self-injurious behaviors in autism spectrum disorder. Cogent Psychology, 6(1). https://doi.org/10.1080/23311908.2019.1682766 Understanding SIB can be challenging, especially since the people who struggle with it can't always communicate their needs.
Self-injury is a maladaptive coping mechanism.What’s the Relationship Between Autism and Self-Harm?, Healthline Examples of SIB include headbanging, biting, hitting oneself, and more.
The terms self-harm and non-suicidal self-injury are typically used to describe self-injurious behavior in developmentally typical people who have mental health challenges.
==Risk factors and comorbidities==
Risk factors include:A Risk from Within: Understanding and Treating Self-Injury in AutismSummers J, Shahrami A, Cali S, D'Mello C, Kako M, Palikucin-Reljin A, Savage M, Shaw O, Lunsky Y. Self-Injury in Autism Spectrum Disorder and Intellectual Disability: Exploring the Role of Reactivity to Pain and Sensory Input. Brain Sci. 2017 Oct 26;7(11):140. doi: 10.3390/brainsci7110140. PMID: 29072583; PMCID: PMC5704147.
*Intellectual disability
*Autism
*Genetic conditions (Smith-Magenis, Fragile X, Lesch-Nyhan, etc.)
*Impaired communication skills
*Mental health issues
*Frequent repetitive behaviors
People with SIB often have co-occurring medical stressors. These include gastrointestinal problems, metabolic and immune system disorders, seizures, sensory processing difficulties, nutritional issues, anxiety, and sleep issues.Edelson, Stephen. Treating autism with contingent electric shock: Are all possible options really considered? Autism Research Institute. Medical conditions may cause or exacerbate SIB.
Mental health issues may impact stress tolerance. Treating co-occurring mental illnesses may ease SIB.
==Reasons for SIB==
Reasons for SIB are diverse.Essential Guide to Self Injurious Behaviour and Autism, Research Autism (PDF)Self-injurious behaviour - a guide for all audiences, National Autistic Society
Internal
*Pain or discomfort, including sensory overload
*Emotional distress (e.g. frustration, anxiety, helplessness)
*Sensory seeking/boredom
*Low self-worth, which can come from being seen/treated as broken or deficient
Social
*Feeling unheard
*Abuse or mistreatment
*Overhearing or being in an argument
*Getting someone to meet a need (if SIB results in people helping them with something, they may do it the next time they need help)
External
*Lack of control over their own lives
Unfortunately, many people with SIB struggle to communicate their needs. They may not be able to describe what's wrong.
==Interventions==
"Many times, parents are preoccupied with eliminating self-harming behaviors while avoiding what is causing them in the first place. Intentional, crucial conversations are necessary to get to the core of what is emotionally impacting your child." Natalie BunnerSince SIB often emerges under stress, reducing stressors can help resolve it. However, identifying the precise unmet need(s) can be difficult.
In 1977, psychologist Edward Carr suggested a 3-step process:
#Look for medical explanations (e.g. ear infections or lice causing discomfort).
#See which circumstances tend to lead to the behavior and look for a connection.
#Consider if it's a form of self-stimulatory behavior.
Functional behavior analysis can sometimes clarify external triggers. However, these don't always reveal internal experiences and can sometimes be misleading.
A 2019 paper suggested teaching functional communication alongside building frustration tolerance and emotion regulation skills. It compared SIB to self-harm in people with psychiatric disorders, suggesting that dialectical behavior therapy principles could be applied to help.
===Communication skills===
Teaching communication and assertiveness skills can help with unmet needs. If the person can say what's wrong, and if caregivers listen, the need for SIB may decrease.
For example, someone who hits their head when they need a break can be taught to say "I need a break" through speech or AAC.
Communication skills only work if the listener actually listens. If caregivers ignore self-advocacy when it doesn't suit their agendas, the person may resort to SIB more often.
===Root cause fixes===
Solving the root cause of SIB can reduce or stop it.
Identifying and treating underlying medical conditions can help with SIB. One study of autistic children who poked their eyes found a dramatic reduction in the behavior after they were given liquid calcium. Low calcium can cause inflammation and a burning sensation in the eyes. Once their eyes felt better, they stopped poking.
For cases of sensory seeking, providing alternative intense sensory experiences may help.
===Harm reduction===
Harm reduction approaches include things like putting helmets or braces on people. Caregivers may use objects like pillows as barriers.
===Medication===
Medication can sometimes help with anxiety, depression, or irritability.
The National Autistic Society recommends only resorting to medication for SIB that is severe or has lasted a long time.
===Controversial practices===
Controversial ways to manage SIB include restraint, seclusion, ignoring the person, and aversive stimulus such as electric shock.Minshawi NF, Hurwitz S, Fodstad JC, Biebl S, Morriss DH, McDougle CJ. The association between self-injurious behaviors and autism spectrum disorders. Psychol Res Behav Manag. 2014 Apr 12;7:125-36. doi: 10.2147/PRBM.S44635. PMID: 24748827; PMCID: PMC3990505. These may increase stress without addressing underlying causes.
==See also==
* Stimming
* Autism
== References ==
Category:Developmental disabilities
Category:Autism