Assessment and Treatment of Self-Injury

Self-injurious behavior (SIB) is among the most serious behavior disorders affecting children. The disorder consists of a highly heterogeneous set of repetitive behaviors that can produce tissue and sensory damage in a single act, or more often, have cumulative effects that can be debilitating or life threatening in severe cases. These self-injurious responses include, but are not limited to, head banging, face slapping, skin picking and scratching, body punching, ingestion of inedible objects, hair pulling, and eye, ear, and nose poking and gouging. Although SIB is occasionally observed in individuals with normal intellectual development, the disorder is most commonly associated with mental retardation. Prevalence studies indicate that up to 25,000 United States citizens suffer from serious forms of the disorder (National Institutes of Health, 1989), constituting 2.6% of the school age (Griffin et al., 1987) and 10% to 17% of the institutionalized population of persons with mental retardation (Baumeister & Rollings, 1976; Schroeder, Schroeder, Smith, & Dalldorf, 1978). The social and medical consequences of SIB, which can be enormous, include institutionalization, hospitalization, aversive treatment, and chemical or mechanical restraint (Favell et al., 1982).