Self-injurious behavior: pathophysiology and implications for treatment.

Background: Self-injurious behavior (SIB) is a common clinical problem that affects a diverse group of patients and populations. Little is known about the underlying pathophysiology and pharmacologic treatment of SIB.

Method: The authors selectively reviewed the clinical literature on SIB and related aggressive/impulsive behaviors, with the aim of formulating provisional guidelines for pharmacotherapy.

Results: The serotonergic system is most directly implicated in the pathophysiology of SIB and related behaviors. While there is no well-established "drug of choice" for SIB, the identification of specific subgroups of SIB patients and associated symptoms such as psychosis permits the rational selection of medication. Serotonin selective reuptake inhibitors, other serotonergic agents, antipsychotics, beta-blockers, and opiate antagonists all play a role in the treatment of SIB.

Conclusion: SIB is not a single entity and may have different pharmacologic treatments, depending on the associated symptoms and target population. Medications that act on the serotonergic system appear to be the most promising.