The British Journal of Psychiatry 172: 381-384 (1998)
© 1998 The Royal College of Psychiatrists

Self-injury and violence in people with severe learning disabilities

S Read

BACKGROUND: Psychiatry in severe and profound learning disability is essentially behavioural psychiatry. Some clinical and research observations of disorders of behaviour in this group are summarised in this study. METHOD: After inspection of the literature, I postulated a clinical syndrome of violence and self-injury in the severely learning disabled. A check-list of behavioural symptoms was developed and used in a community survey. RESULTS: Behaviour, assessed by the check-list, supported the existence of organic behaviour disorder, as did small- scale psychophysiological testing. CONCLUSIONS: Self-injury is strongly associated with violence, and with severe and profound learning disability. Pathophysiology of violence and self-injury may include high levels of psychophysiological arousal demonstrated by unstable EEGs. Reduction of arousal by antipsychotic medication is associated with clinical improvement in violent and self-injurious behaviours.