Repetitive self-injurious behavior: a neuropsychiatric perspective and review of pharmacologic treatments

Semin Clin Neuropsychiatry. 2000 Oct;5(4):215-26. doi: 10.1053/scnp.2000.16530.


The phenomenology, pathophysiology, and psychopharmacology of repetitive self-injurious behavior (rSIB) are reviewed. Although numerous neurotransmitter systems are thought to be involved in the initiation and maintenance of rSIB, the majority of clinical studies attend 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). A developmental perspective of rSIB is emphasized, highlighting the biased prevalence of rSIB among patients with mental retardation and severe personality disorders and the significance of critical developmental events leading to pathology in "pedagogical" neural circuits. A novel typology is offered in an effort to better match interventions with rSIB subtypes. Achievement of this ultimate goal however, must await further research.

Publication types

  • Review

MeSH terms

  • Adult
  • Child
  • Child Development Disorders, Pervasive / epidemiology
  • Cognitive Behavioral Therapy
  • Combined Modality Therapy
  • Comorbidity
  • Humans
  • Incidence
  • Intellectual Disability / epidemiology
  • Narcotic Antagonists / therapeutic use
  • Personality Disorders / epidemiology
  • Practice Guidelines as Topic
  • Randomized Controlled Trials as Topic
  • Self-Injurious Behavior / classification
  • Self-Injurious Behavior / drug therapy*
  • Self-Injurious Behavior / epidemiology
  • Serotonin Receptor Agonists / therapeutic use
  • Serotonin Uptake Inhibitors / therapeutic use
  • United States / epidemiology


  • Narcotic Antagonists
  • Serotonin Receptor Agonists
  • Serotonin Uptake Inhibitors