The behavior is not better explained as a compulsion (as in obsessive-compulsive disorder), a tic (as in tic disorders), a stereotype that is part of a Generalized development issue or a hair pull (as in trichotillomania) (Criterion D). The behavior is also not due to the direct physiological effects of a substance or to a general medical condition (Criterion E). Motor behaviors must persist for at least 4 weeks (Criterion F). Stereotypical movements may include hand shaking, rocking, hand playing, finger tapping, spinning objects, head butting, biting, pricking the skin or body orifices, or hitting different parts of one's own Body.
Sometimes the subject uses an object to perform these behaviors. The behaviors in question can cause permanent and disabling injuries, which sometimes endanger the life of the subject. For example, head butting or forceful blows can cause cuts, bleeding, infection, retinal detachment, and blindness. Specifications The clinician can specify with self-injurious behavior whether the behavior causes harm that requires specific treatment (or that could cause bodily harm if measures were not used protective).
Associated symptoms and disorders
Descriptive characteristics and associated mental disorders. The subject can resort to self-containment methods (p. (g., keeping hands under sweater, pants, or pockets) in order to try to control self-injurious behaviors. When self-restraint is interfered with, behaviors are resumed. If the behaviors are extreme or are repulsive to other people, complications can appear psychosocial due to the exclusion suffered by the subject with respect to certain social and community activities. Stereotyped movement disorder is frequently associated with mental retardation. The more severe the delay, the greater the risk of self-injurious behavior.
This disorder can also appear associated with severe sensory deficits (blindness and deafness) and may be more frequent in institutional settings, where the subject receives stimulation insufficient. Self-injurious behaviors appear in some medical illnesses associated with mental retardation (p. eg, Fragile X syndrome, Lange syndrome and especially Lesch-Nyhan syndrome, characterized by severe self-biting). Laboratory findings. If there are self-injurious behaviors, the laboratory data will reflect their nature and severity (eg. g., anemia due to chronic blood loss due to self-inflicted rectal bleeding). Findings of the physical exploration and related medical illnesses.
Signs of chronic tissue damage may be seen (eg. e.g. bruises, bite marks, cuts, scratches, skin infections, rectal fissures, foreign bodies in the body orifices, visual disturbances due to ocular emptying or traumatic cataract, and deformation fractures bone). In less severe cases there may be chronic skin irritation or calluses from bites, punctures, scratches or salivary discharge. Age- and sex-dependent symptoms Self-injurious behaviors occur in individuals of any age. There is evidence that head butting is more prevalent in men (about 3: 1) and self-biting is more prevalent in women.
Prevalence
There is very little information about the prevalence of stereotyped movement disorder. Estimates of the prevalence of self-injurious behaviors in subjects with mental retardation vary from 2 to 3% in children and adolescents living in the community and approximately 25% of adults with severe or profound mental retardation living in institutions. Course There is no typical age of onset or pattern of onset for stereotyped movement disorder. Such an onset can follow a stressful environmental event. In nonverbal subjects with severe mental retardation, stereotyped movements can be caused by a painful medical condition (eg. g., a middle ear infection leading to head butting).
Stereotypical movements they tend to peak in adolescence, and can gradually decline from this point on. However, especially in subjects with severe or profound mental retardation, the movements can persist for years. The target of these behaviors changes frequently (p. (g., a person may incur hand biting, disappear this behavior, and then start hitting the head). Differential diagnosis Stereotyped movements can be associated with mental retardation, especially in subjects located in non-stimulating environments.
Stereotyped movement disorder should only be diagnosed in subjects whose stereotyped or self-injurious behavior is severe enough to be a therapeutic target. Repetitive stereotyped movements are a feature of pervasive developmental disorders. Stereotyped Movement Disorder is not diagnosed if the stereotypies are better explained by the presence of a Pervasive Developmental Disorder. Obsessive-compulsive disorder compulsions are often more complex and ritualistic, and are performed in response to an obsession or by following rules that must be rigidly applied.
It is relatively easy to differentiate the complex movements characteristic of stereotyped movement disorder from simple tics (eg. g., blinking), but differential diagnosis with complex motor tics is less easy. In general, stereotyped movements appear to be more motivated and purposeful, while tics have a more involuntary quality and are not rhythmic.
By definition, repetitive behavior in trichotillomania is limited to hair pulling. Self-induced lesions of stereotyped movement disorder must be distinguished from disorder factitious with a predominance of physical signs and symptoms, where the motivation for self-harm is to assume the role of sick. The self-mutilation associated with certain psychotic disorders and personality disorders is premeditated, complex and sporadic, and has meaning for the subject within the context of severe mental disorder underlying (p. g., it is the result of a delusional thought).
Involuntary movements associated with neurological diseases (such as Huntington's disease) usually follow a typical pattern, with the signs and symptoms of the neurological disorder in question being present. Young children's self-stimulating behaviors specific to their developmental level (p. g., thumb sucking, rocking, and nodding) are often very limited and rarely produce injuries that require treatment. Self-stimulating behaviors in individuals with sensory deficits (p. g., blindness) do not usually cause dysfunction or self-harm.
Criteria for the diagnosis of Stereotyped Movement Disorder
- Repetitive motor behavior, which seems impulsive, and not functional (p. g., shaking or shaking hands, rocking the body, butting the head, nibbling objects, self-sucking, puncturing the skin or body orifices, hitting one's own body).
- The behavior interferes with normal activities or results in bodily injury self-inflicted that require medical treatment (or would cause injury if not taken precautionary measures).
- If there is mental retardation, the stereotyped or self-injurious behavior is of sufficient severity to constitute a therapeutic objective.
- The behavior is not better explained by a compulsion (as in obsessive-compulsive disorder), a tic (as in obsessive-compulsive disorder), tics), a stereotype that is part of a pervasive developmental disorder, or a hair pull (as in the trichotillomania).
- The behavior is not due to the direct physiological effects of a substance or to a general medical condition.
- The behavior persists for 4 weeks or more.
Specify if: With self-injurious behavior: if the behavior results in bodily harm that requires specific treatment (or that would result in bodily harm if no action was taken protective).
