ADULT HEAD-BANGING AND STEREOTYPIC MOVEMENT-DISORDERS

Stereotypic movement disorders (SMD) such as head-banging, which are c ommon among children with mental retardation or pervasive developmenta l disorders, may also occur in intellectually normal adults. We report a 27-year history of daily head-banging with self-injury in a 49-year -old man with normal cognition. The patient had no personal or family history of Tourette's syndrome, tic disorder, obsessive-compulsive dis order (OCD), or mental retardation. The frequency of his stereotypical head-banging increased with anxiety, loud noises with startle, and bo redom. He reported a sense of pleasure from his head-banging, and the frequency of this behavior decreased when he was treated with the opio id antagonist naltrexone. Although not diagnostic, the self-stimulator y or pleasurable component of head-banging, body-rocking, thumb-suckin g, and other SMD may help distinguish them from ties, Tourette's syndr ome, OCD, and deliberate self-harming behavior. This report reviews th e disorders associated with SMD and discusses the potential mechanisms for these behaviors. The treatment of SMD includes drugs that work th rough opioid, serotonergic, or dopaminergic systems.