Self-Injurious Behavior

Written by Stephen M. Edelson, Ph.D.

Self-injurious behavior often refers to any behavior that can cause tissue damage, such as bruises, redness, and open wounds. The most common forms of these behaviors include head-banging, hand-biting, and excessive scratching or rubbing.

There are two major sets of theories on why people engage in self-injury-- physiological and social. Some of the physiological theories (and suggested treatments) are:

These behaviors release beta-endorphins in the person's brain, which in turn, provides the person with a form of internal pleasure (beta-endorphins are endogenous opiate-like substances in the brain). (Treatment: If a person is given naltrexone, a beta-endorphin inhibitor, self-injury may decrease.)
Sudden episodes of self-injury may be caused by sub-clinical seizures. Sub-clinical seizures are not typically associated with the characteristic behaviors of conventional seizures, but they are characterized by abnormal EEG patterns. (Treatment: The person should receive an extensive EEG to determine if the self-injury is associated with sub-clinical seizures.)
Head-banging or ear hitting may be caused by a middle ear infection. (Treatment: The person should be given an extensive ear examination.)
Some forms of self-injury may be a result of overarousal (such as frustration). Self-injury acts as a release, and thus, lowers arousal. (Treatment: One should try to reduce the person's general arousal level, such as through relaxation/visual imagery therapy, deep pressure, and exercise.)
In some cases, self-injury may be a form of self-stimulatory, stereotypic behaviors. That is, they are repetitive, ritualistic behaviors which provide the individual with some form of sensory stimulation or arousal. (Treatment: Person could be given sensory integration therapy to normalize the senses.)

Some of the social theories explaining these behaviors are:

Some individuals engage in self-injurious behaviors to obtain attention from other people. (Treatment: People in the environment should ignore the person when he/she engages in self-injury; thus, the person will learn that the behavior will not lead to attention.)
Some individuals exhibit self-injury to escape or avoid a task. (Treatment: The person should be asked to complete the task rather than escape the task.)

Although it has not been discussed in the research literature, there is also the possibility that these behaviors could be related to hypersensitivity to certain sounds in the environment. For example, if a sound bothers an individual, he/she may react by hitting one's head or ears. (Treatment: One may consider trying auditory integration training.)

Basically, there are many reasons why people engage in self-injurious behavior. The best way to determine the reason for the behavior in an individual is to conduct a functional analysis. This involves analyzing what occurs prior to the behavior as well as what happens immediately after the behavior. If one can rule out possible social influences on the behavior, then physiological causes should be investigated.