People who self-injure present a major challenge to services and carers. The behaviour can cause negative emotions in observers. Even experienced clinicians can find themselves conflicted.
Tsiouris et al. (2003) have reservations that the behaviour as manifested by people with intellectual disabilities (ID) can be considered an Axis I psychiatric diagnosis in the context of DSM IV (American Psychiatric Association, 1994). Favazza and Rosenthal (1993) classified self-mutilation in general into three basic types: major, superficial and stereotypic. They claim that the stereotypic type is most commonly seen in institutionalized people with ID, although the authors admit that not all self injury in people with ID is of this type.
Indeed, we know that people with ID can show myriad forms of self injury. It can be resistant to treatment. Kahng et al. (2002) in reviewing the literature on behavioural intervention stated that, though there is much research ‘the disorder persists’. Self-injurious behaviour can be responsible for much medical, psychological and social morbidity.
Variations in the definition make comparison between epidemiological studies difficult. The definitions used generally include the requirement that the actions cause tissue damage. Oliver et al. (1987) reported that the ‘tissue damage’ criterion proved robust when judging the ability of different informants to agree on caseness.
Definitions also vary according to the frequency and severity of the self-injury (e.g. Borthwick-Duffy, 1994 vs. O'Brien, 2003).