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J Neurol Neurosurg Psychiatry. 2004 August; 75(8): 1149–1155.
PMCID: PMC1739182

Self injurious behaviour in Tourette syndrome: correlates with impulsivity and impulse control

Abstract

Background: Self injurious behaviour (SIB), the deliberate, repetitive infliction of self harm, is present in a wide variety of neuropsychiatric disorders, including Tourette syndrome (TS). Although SIB occurs in up to 60% of individuals with TS, and can cause significant clinical impairment and distress, little is known about its aetiology.

Objective: This study examined the relationship between SIB and other behavioural features that commonly co-occur with TS in nearly 300 subjects with TS participating in three genetic studies. SIB, obsessions, compulsions, tic severity, attention deficit hyperactivity disorder related impulsivity, risk taking behaviours, and rages were systematically assessed in all subjects.

Methods: Using logistic regression, a best fit model was determined for both mild to moderate SIB and severe SIB.

Results: Mild/moderate SIB in TS was correlated with the presence of obsessive and compulsive symptoms such as the presence of aggressive obsessions or violent or aggressive compulsions, and with the presence of obsessive–compulsive disorder and overall number of obsessions. Severe SIB in TS was correlated with variables related to affect or impulse dysregulation; in particular, with the presence of episodic rages and risk taking behaviours. Both mild/moderate and severe SIB were also correlated with tic severity.

Conclusions: This study suggests that mild/moderate and severe SIB in TS may represent different phenomena, which has implications for clinical management of these symptoms.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Herpertz S. Self-injurious behaviour. Psychopathological and nosological characteristics in subtypes of self-injurers. Acta Psychiatr Scand. 1995 Jan;91(1):57–68. [PubMed]
  • Haw C, Hawton K, Houston K, Townsend E. Psychiatric and personality disorders in deliberate self-harm patients. Br J Psychiatry. 2001 Jan;178(1):48–54. [PubMed]
  • Robertson MM, Trimble MR, Lees AJ. Self-injurious behaviour and the Gilles de la Tourette syndrome: a clinical study and review of the literature. Psychol Med. 1989 Aug;19(3):611–625. [PubMed]
  • Freeman RD, Fast DK, Burd L, Kerbeshian J, Robertson MM, Sandor P. An international perspective on Tourette syndrome: selected findings from 3,500 individuals in 22 countries. Dev Med Child Neurol. 2000 Jul;42(7):436–447. [PubMed]
  • Eisenhauer GL, Woody RC. Self-mutilation and Tourette's disorder. J Child Neurol. 1987 Oct;2(4):265–267. [PubMed]
  • Cath DC, Spinhoven P, Hoogduin CA, Landman AD, van Woerkom TC, van de Wetering BJ, Roos RA, Rooijmans HG. Repetitive behaviors in Tourette's syndrome and OCD with and without tics: what are the differences? Psychiatry Res. 2001 Mar 25;101(2):171–185. [PubMed]
  • Robertson MM, Gourdie A. Familial Tourette's syndrome in a large British pedigree. Associated psychopathology, severity, and potential for linkage analysis. Br J Psychiatry. 1990 Apr;156:515–521. [PubMed]
  • Nixon Mary K, Cloutier Paula F, Aggarwal Sanjay. Affect regulation and addictive aspects of repetitive self-injury in hospitalized adolescents. J Am Acad Child Adolesc Psychiatry. 2002 Nov;41(11):1333–1341. [PubMed]
  • Favazza AR, Rosenthal RJ. Diagnostic issues in self-mutilation. Hosp Community Psychiatry. 1993 Feb;44(2):134–140. [PubMed]
  • Leckman JF, Riddle MA, Hardin MT, Ort SI, Swartz KL, Stevenson J, Cohen DJ. The Yale Global Tic Severity Scale: initial testing of a clinician-rated scale of tic severity. J Am Acad Child Adolesc Psychiatry. 1989 Jul;28(4):566–573. [PubMed]
  • Budman Cathy L, Rockmore Lori, Stokes John, Sossin Mark. Clinical phenomenology of episodic rage in children with Tourette syndrome. J Psychosom Res. 2003 Jul;55(1):59–65. [PubMed]
  • Bravo M, Woodbury-Fariña M, Canino GJ, Rubio-Stipec M. The Spanish translation and cultural adaptation of the Diagnostic Interview Schedule for Children (DISC) in Puerto Rico. Cult Med Psychiatry. 1993 Sep;17(3):329–344. [PubMed]
  • Bodfish JW, Symons FJ, Parker DE, Lewis MH. Varieties of repetitive behavior in autism: comparisons to mental retardation. J Autism Dev Disord. 2000 Jun;30(3):237–243. [PubMed]
  • Haw Camilla, Houston Kelly, Townsend Ellen, Hawton Keith. Deliberate self harm patients with depressive disorders: treatment and outcome. J Affect Disord. 2002 Jun;70(1):57–65. [PubMed]
  • Villalba R, Harrington CJ. Repetitive self-injurious behavior: a neuropsychiatric perspective and review of pharmacologic treatments. Semin Clin Neuropsychiatry. 2000 Oct;5(4):215–226. [PubMed]
  • Symons FJ, Sutton KA, Bodfish JW. Preliminary study of altered skin temperature at body sites associated with self-injurious behavior in adults who have developmental disabilities. Am J Ment Retard. 2001 Jul;106(4):336–343. [PubMed]
  • Miguel EC, do Rosário-Campos MC, Prado HS, do Valle R, Rauch SL, Coffey BJ, Baer L, Savage CR, O'Sullivan RL, Jenike MA, et al. Sensory phenomena in obsessive-compulsive disorder and Tourette's disorder. J Clin Psychiatry. 2000 Feb;61(2):150–157. [PubMed]
  • Leckman JF, Zhang H, Vitale A, Lahnin F, Lynch K, Bondi C, Kim YS, Peterson BS. Course of tic severity in Tourette syndrome: the first two decades. Pediatrics. 1998 Jul;102(1 Pt 1):14–19. [PubMed]
  • Schroeder SR, Mulick JA, Rojahn J. The definition, taxonomy, epidemiology, and ecology of self-injurious behavior. J Autism Dev Disord. 1980 Dec;10(4):417–432. [PubMed]

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