Stereotypic movement disorder



Stereotypic Movement Disorder 921
Photo by: Piotr Marcinski

Definition

Stereotypic movement disorder is a disorder characterized by repeated, rhythmic, purposeless movements or activities such as head banging, nail biting, or body rocking. These movements either cause self-injury or severely interfere with normal activities. Until 1994, the American Psychiatric Association referred to stereotypic movement disorder as stereotypy/habit disorder.

Description

Stereotypic movements were first described as a psychiatric symptom in the early 1900s. Since then, they have been recognized as a symptom of both psychotic and neurological disorders. They may also arise from unexplained causes. These movements may include:

  • head banging
  • nail biting
  • playing with hair (but not hair pulling, which is considered the separate disorder of trichotillomania )
  • thumb sucking
  • hand flapping
  • nose picking
  • whirling
  • body rocking
  • picking at the body
  • self-biting
  • object biting
  • self-hitting
  • compulsive scratching
  • eye gouging
  • teeth grinding (bruxism)
  • breath holding
  • stereotyped sound production

The precise definition of stereotypic movement disorder has changed over the past 20 years. Today, it limits the disorder to repetitive movements that cause physical harm or severely interfere with normal activities. These movements cannot be better described by another psychiatric condition such as anxiety disorder, a general medical condition such as Huntington's disease, or as the side effect of a medication or illicit drug (for example, cocaine use).

Stereotypic movements occur in people of any age, including the very young, but they are most prevalent in adolescence. People may exhibit only one particular stereotyped movement or several. The movements may be slow and gentle, fast and frenetic, or varied in intensity. They seem to increase with boredom, tension, or frustration, and it appears that the movements are self-stimulatory and sometimes pleasurable. The root causes are unknown.

Stereotypic movements are common in infants and toddlers. Some estimates suggest that 15–20 percent of children under age three exhibit some kind of rhythmic, repetitive movements. Certainly thumb sucking and body rocking are common self-comforting mechanisms in the very young. This type of repeated movement is temporary, and usually ends by age three or four. It is not the same as stereotypic movement disorder.

Causes and symptoms

Causes

Stereotypic movements can be caused by:

It has also been suggested that inadequate caregiving may cause the disorder. Although many situations can give rise to stereotypic movements, the root cause of stereotypic movement disorder is unknown. Different theories propose that the causes are behavioral, neurological, and/or genetic. Although there are many theories to account for this disorder, no hard evidence clearly supports one line of reasoning or specific cause.

Symptoms

Symptoms of stereotypic movement disorder include all the activities listed above. It should be noted that many of these activities are normal in infants. They usually begin between five and 11 months, and disappear on their own by age three. In fact, about 55% of infants grind their teeth. These passing phases of repetitive movement in infants are not the same as stereotypic movement disorder. They do not cause harm, and often serve the purpose of self-comforting or helping the child learn a new motor skill.

People with stereotypic movement disorder often hurt themselves. They may pick their nail cuticles or skin until they bleed. They may repeatedly gouge their eyes, bite or hit themselves causing bleeding, bruising, and sometimes, as in the case of eye gouging or head banging, even more severe damage. Some people develop behaviors such as keeping their hands in their pockets, to prevent these movements. In other cases those who hurt themselves appear to welcome, rather than fight, physical restraints that keep them safe. However when these restraints are removed, they return to their harmful behaviors.

Demographics

Stereotypic movement disorder is most strongly associated with severe or profound mental retardation, especially among people who are institutionalized and perhaps deprived of adequate sensory stimulation. It is estimated that 2–3% of people with mental retardation living in the community have stereotypic movement disorder. About 25% of all people with mental retardation who are institutionalized have the disorder. Among those with severe or profound retardation, the rate is about 60%, with 15% showing behavior that causes self-injury.

Stereotypic movements are common among children with pervasive developmental disorders such as autism, childhood degenerative disorder, and Asperger's disorder . These movements can also be seen in people with Tourette's disorder or with tics. Head banging is estimated to affect about 5% of children, with boys outnumbering girls three to one, although other stereotypic behaviors appear to be distributed equally between males and females. Despite its association with psychiatric disorders, there are some people with normal intelligence and adequate caregiving who still develop stereotypic movement disorder.

Diagnosis

Stereotypic movements are diagnosed by the presence of the activities mentioned above. Young children rarely try to hide these movements, although older children may, and the first sign of them may be the physical harm they cause (bleeding skin, chewed nails). Often parents mention these repetitive movements when the physician takes a history of the child.

The difficulty in diagnosing stereotypic movement disorder comes from distinguishing it from other disorders where rhythmic, repetitive movements occur. To be diagnosed with stereotypic movement disorder, the following conditions must be met:

  • The patient must show repeated, purposeless motor behavior.
  • The patient must experience physical harm from this behavior or it must seriously interfere with activities.
  • If the patient is mentally retarded, the behavior must be serious enough to need treatment.
  • The behavior must not be a symptom of another psychiatric disorder.
  • The behavior must not be a side effect of medicinal or illicit substance use.
  • The behavior must not be caused by a diagnosed medical condition.
  • The behavior must last at least four weeks. The disorder may be classified as either with self-injurious behavior or without self-harm.

This definition of stereotypic movement disorder rules out many people who show repetitive movement because of autism or other pervasive developmental disorders. It also rules out those with obsessive-compulsive disorder, where movements are apt to be ritualistic and follow rigid rules or patterns. In addition, specific disorders such as trichotillomania (hair pulling) do not fall under the diagnosis of stereotypic movement disorder, nor do developmentally appropriate self-stimulatory behavior among young children, such as thumb sucking, rocking or transient pediatric head banging.

Treatments

There are few successful treatments for stereotypic movement disorder. When the patient harms himself, physical restraints may be required. In less severe situations, behavioral modifications using both rewards and punishments may help decrease the intensity of the behavior. Drugs that have been used with some success to treat stereotypic movement disorder include clomipramine (Anafranil), desipramine (Norpramin), haloperidol (Haldol) and chlorpromazine (Thorazine).

Prognosis

Stereotypic movements peak in adolescence, then decline, and sometimes disappear. Although behavior modification may reduce the intensity of the stereotypic movements, rarely does it completely eliminate them. Stress and physical pain may bring on these movements, (which may come and go for years), especially among those patients with severe mental retardation.

Prevention

Stereotypic movement disorder cannot be prevented. Interventions should be done to prevent self-injury.

Resources

BOOKS

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. text revised. Washington DC: American Psychiatric Association, 2000.

Hales, Robert E., Stuart C. Yudofsky, and John A. Talbot. The American Psychiatric Press Textbook of Psychiatry. 3rd ed. Washington, DC: American Psychiatric Press, 2000.

Sadock, Benjamin J. and Virginia A. Sadock, eds. Comprehensive Textbook of Psychiatry. 7th ed. Vol. 2. Philadelphia: Lippincott Williams and Wilkins, 2000.

Tish Davidson, A.M.



User Contributions:

Joe
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Aug 12, 2009 @ 10:10 am
I met someone who says she rocks. She has good intelegence, motor function, no signs of injury and no history of self injury she will admit to. She admitted to having some ocd activities as a child; i.e. checking to make sure all doors in the house were locked and secured before she could fall asleep. She is 21 and has sinse grown out of the ocd activities. Will she grow out of the rocking? She is aware of the rocking and says it makes her feel good and that's why she doesn't want to stop. She says she can stop but will think about it if she makes herself stop. She is taking some anxiety medicine. I don't know too much about her past but she said she grew up in a place where her family were not too supportive and her county is one of the largest meth areas in her state. Her ex boyfriend died from this. Does her rockking and anxiety sound environmental or nerological? I hate to ask but people with this disorder, are they at risk of snapping one day and completely going off the reservation and causing injury to others? She seems very nice but I am not sure if I want to date her.

thank you!
Mary Ann
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Aug 24, 2009 @ 9:21 pm
Hi Joe,
You could be writing about me! I believe my family has a genetic disposition for the movement disorders that we have. My sister and myself rock when lying down (I've done it as long as I can remember). I can stop when thinking about it, but will start again, not realizing I started until someone tells me. I have Restless legs and when put on medicine for it (sinamet) it has worked wonders, I can finally sleep through the night. Interestingly in our family my sister, my dad and I, we all have a thyroid disorder, my brothers do not and they do not have the movement issues that we have.
dolphin
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Dec 25, 2011 @ 11:23 pm
HI, I LOST WEIGHT DOWN TO 79BLS AND I SLOWLY GAIN WEIGHT, I HAD EPIDSODE OF HEARTBURN AND TOOK ZANTAC 14 DAYS, FELT BETTER. THEN 2 WEEKS AFTER, I WENT TO THE DOCTOR AND I WAS GIVING OMEPRAZOLE CAPSULE: half of week one i started having a weird headache and it was like my brain being pressed on in different areas with on and off of rocking back and forth. Second week i had fast heartbeat, faster repetitive rocking movement uncontrolable, my right leg would jump with the heartbeat, and with the headache muscle pressure. Im better than before and i slightly rockback and forth but now i slow down i have the eye shifting slight and my nerves through the leg i can feel it move like a sway can you help me understand what is this?
Laura
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Jul 29, 2013 @ 9:09 am
Hi,
I have a 4 year old daughter who has normal development and has hit all of her milestones, but she had been hand flapping when she gets over simulated. There is no self harm with this behavior. not sure what to make of it..

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