Self Injurious Behaviour and Autism

Causes

It can be difficult to be sure why an individual self injures although, in practice, that behaviour may arise from, and then be maintained (kept going), by a range of different factors.

Some people on the autism spectrum may be more at risk of self injury than other people.  However, the fact that one or more risk markers are present does not necessarily mean that a specific person will self injure, it just makes it more likely.

Internal risk markers

Internal risk markers are those to do with the person themselves, irrespective of what is going on in their current environment, or the people with whom they are interacting. They include

• Severity of autism, including core features such as restricted and repetitive behaviours and difficulties with social communication and social interaction
• Diagnosis of a learning disability and the severity of that learning disability
• Specific genetic conditions, such as Lesch–Nyhan syndrome, fragile X syndrome and Prader–Willi syndrome
• Physiological problems, such as difficulties with sensory processing and arousal/motor control (the physiological activation of the body)
• Medical problems, such as migraine (severe headache), otitis media (inflammatory disease of the ear) and reflux (heartburn)
• Mental health problems, such as anxiety and depression
• Irregularities in neurotransmitters (brain chemicals), such as dopamine, glutamate and endorphins
• An existing history of self-injury or the presence of other challenging behaviours, such as hyperactivity and impulsivity

Interpersonal risk markers

Interpersonal risk markers are those involving relationships between two or more people. They include

• Learnt behaviour, where the person injures themselves in response to the reactions of other people around them. For example, other people may give them desirable items such as snacks in order to stop them injuring themselves. However, over time this may actually have the opposite effect, causing the person to injure themselves in order to get those desirable items. 
• Inappropriate behaviour by other people. For example, other people may not listen to what they are trying to say, they may tell them off or shout at them, or they may treat them like children
• Deliberate mistreatment by other people. For example, other people may be bullying or abusing them (as happened at the residential care home, Winterbourne View).

External risk markers

External risk markers are those in which the person is not central. They involve what is going on around the person but the person generally has little or no control over them. They include

• Having a lack of control within their living environment. For example, they may have little or no choice about where they live, who they live with, and who supports them; they may have no control over what goes on in their home; they may have no control over some of the ‘systems’ they have to cope with
• Use of inappropriate interventions.  For example, some medications may increase self injurious behaviours in some people on the autism spectrum.

Updated

02 Nov 2017