Article Text

Download PDFPDF
Self injurious behaviour in Tourette syndrome: correlates with impulsivity and impulse control
  1. C A Mathews1,
  2. J Waller1,
  3. D Glidden2,
  4. T L Lowe3,
  5. L D Herrera4,
  6. C L Budman5,
  7. G Erenberg6,
  8. A Naarden7,
  9. R D Bruun5,
  10. N B Freimer8,
  11. V I Reus9
  1. 1Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
  2. 2Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
  3. 3Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of California, San Francisco, San Francisco, CA, USA
  4. 4Departments of Psychiatry and Pediatrics, University of Costa Rica School of Medicine, San José, Costa Rica
  5. 5Department of Psychiatry, North Shore University Hospital and New York University School of Medicine, Manhasset, New York, USA
  6. 6Department of Neurology, Cleveland Clinic Foundation, Cleveland, OH, USA
  7. 7Department of Neurology, University of Texas Southwestern Medical School, Dallas, TX, USA
  8. 8Departments of Psychiatry and Human Genetics, University of California, Los Angeles, Los Angeles, CA, USA
  9. 9Department of Psychiatry, University of California, San Francisco, CA, USA
  1. Correspondence to:
 Dr C A Mathews Department of Psychiatry
 University of California, San Diego, 9500 Gilman Dr, 0810, La Jolla, CA 92093-0810;


Background: Self injurious behaviour (SIB), the deliberate, repetitive infliction of self harm, is present in a wide variety of neuropsychiatric disorders, including Tourette syndrome (TS). Although SIB occurs in up to 60% of individuals with TS, and can cause significant clinical impairment and distress, little is known about its aetiology.

Objective: This study examined the relationship between SIB and other behavioural features that commonly co-occur with TS in nearly 300 subjects with TS participating in three genetic studies. SIB, obsessions, compulsions, tic severity, attention deficit hyperactivity disorder related impulsivity, risk taking behaviours, and rages were systematically assessed in all subjects.

Methods: Using logistic regression, a best fit model was determined for both mild to moderate SIB and severe SIB.

Results: Mild/moderate SIB in TS was correlated with the presence of obsessive and compulsive symptoms such as the presence of aggressive obsessions or violent or aggressive compulsions, and with the presence of obsessive−compulsive disorder and overall number of obsessions. Severe SIB in TS was correlated with variables related to affect or impulse dysregulation; in particular, with the presence of episodic rages and risk taking behaviours. Both mild/moderate and severe SIB were also correlated with tic severity.

Conclusions: This study suggests that mild/moderate and severe SIB in TS may represent different phenomena, which has implications for clinical management of these symptoms.

  • ADHD, attention deficit hyperactivity disorder
  • ASP, affected sibling pair
  • PGM, population genetic mapping
  • SIB, self injurious behaviour
  • TS, Tourette syndrome
  • TSA, Tourette Syndrome Association
  • YGTSS, Yale Global Tic Severity Scale
  • YSRF, Yale Self Report Form
  • Tourette Syndrome
  • self injury
  • psychiatric comorbidity

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Competing interests: none declared