Affiliations: Institute of Neurology, Queen Square, London,
UK | Department of Neurology, Amedeo Avogadro University,
Novara, Italy | University of Turin Medical School, Turin,
Italy | Department of Psychiatry, Brighton and Sussex Medical
School, Brighton, UK
Note: [] Correspondence: Andrea E. Cavanna, MD, Sobell Department of
Motor Neuroscience and Movement Disorders, Institute of Neurology, Queen
Square, London WC1N3BG, UK. E-mail: A.Cavanna@ion.ucl.ac.uk
Abstract: Self injurious behavior, i.e. the deliberate, non-accidental,
repetitive infliction of self harm, has been reported in a wide range of
neuropsychiatric conditions. Clinical and epidemiological studies have shown
that self-injurious behavior can occur in up to one third of patients with
Gilles de la Tourette syndrome, a neurodevelopmental disorder, characterized by
the presence of multiple motor tics and at least one vocal/phonic tic. This
paper describes the case of a patient diagnosed with Gilles de la Tourette
syndrome who presented with severe multiple self injurious behaviors since
early childhood. On physical examination, we documented a few self-injurious
behavior signs including scars in the forehead resulting from repetitive
head-banging and bald patches on the scalp due to trichotillomania.
Characteristically, self-injurious behaviors were distressing and resistant to
treatments (both pharmacotherapy and cognitive behavioral therapy), and were
associated with comorbid obsessive-compulsive disorder. This case illustrates
the complex nature and difficult management of severe self-injurious behavior
in the context of Gilles de la Tourette syndrome and obsessive-compulsive
disorder.
Keywords: Gilles de la tourette syndrome, self-injurious behavior, obsessive-compulsive disorder, self-mutilation
