Childhood-onset multiple self-injurious behaviors in Gilles de la Tourette syndrome

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.