Naltrexone as a treatment for repetitive self-injurious behaviour:an open-label trial

Repetitive self-injurious behavior (SIB) is a dangerous and often treatment-refractory syndrome encountered frequently in clinical practice. The authors sought to determine if oral naltrexone could decrease SIB in a sample of adult psychiatric patients.

Seven female patients with SIB accompanied by analgesia and dysphoria reduction were administered oral naltrexone (50 mg/day) in an open-label trial. All patients demonstrated persistent and clinically significant SIB prior to receiving the drug. Mean follow-up period was 10.7 weeks.

SIB in six of seven patients ceased entirely during naltrexone treatment. Two patients who discontinued naltrexone briefly experienced the rapid resumption of SIB, which again ceased after resumption of naltrexone therapy. One patient exhibited superficial cutting on two occasions while receiving naltrexone, a rate that reflected a significant reduction of SIB.

These preliminary observations are consistent with the hypothesis that the endogenous opioid system is involved in cases of SIB that are accompanied by analgesia and dysphoria reduction. Additional placebo-controlled studies that explore the effectiveness of naltrexone in treating patients with this syndrome are warranted.