Self-injurious behaviour in children: A treatable catatonic syndrome

Abstract

There is an excellent reason for pub-lishing a paper on an unusual paediat-ric syndrome – self-injurious behaviour (SIB) – in a general psychia-try journal: it is among the few paedi-atric conditions that are highly treatable. The repetitive stereotypic catatonic movements in children with autism and intellectual disabilities, which can have such injurious conse-quences, respond readily to such standard treatments of catatonia as benzodiazepines and electroconvul-sive therapy (ECT). The authors of this paper have discovered this in their respective domains of inquiry: Lee Wachtel, leading a neurobehav-ioural service in a paediatric hospital, and Edward Shorter, who ascertained that in many historical accounts of paediatric SIB other symptoms of cat-atonia were present as well, reinforc-ing Wachtel’s hypothesis of SIB as a form of catatonia. This hypothesis thus has two important pillars of sup-port: the readiness with which SIB responds to anti-catatonic remedies in the clinic today, and the historical evidence that SIB fits in with larger syndromes of catatonia.Thanks to the efforts of Max Fink and the circle of scholars building upon his findings, catatonia has expanded steadily from a subtype of schizophrenia into an independent syndrome that may occur in a variety of psychiatric and non-psychiatric ill-nesses. The reinsertion of the catato-nia diagnosis into psychiatry is being officially recognized in the newly-released DSM-5. We feel that this recognition represents one of the most important developments in psy-chiatric nosology today.SIB is classically defined as any self-inflicted act resulting in bodily harm. It afflicts approximately 5–30% of indi-viduals with intellectual disability (ID), and has negative effects on physical health as well as sharply impairing global psychosocial functioning.It is remarkable to discover that the inclusion of self-injury in the cata-tonic spectrum is not new. In fact, strong evidence of this concomitance can be traced in the international psy-chiatric literature beginning in the late 19th century. The historical evidence of catatonia in self-injury patients offers fascinating parallels to modern self-injurious presentations, raising the central question as to how this rich historical knowledge escaped incorporation into classic models of SIB assessment and treatment, partic-ularly when modern medicine has possessed a safe and efficacious treat-ment for catatonia, namely ECT, for nearly eight decades.