A systematic review of studies on the association between physiological parameters and self-harm.
Heart-rate and other body signals are not yet reliable predictors of self-harm in clients with intellectual disability.
01Research in Context
What this study did
The team hunted for a body signal that warns when a person with intellectual disability might self-harm. They read every paper that linked heart rate, skin sweat, or other body measures to self-injury in this group.
After the search, they kept only studies that watched real people and tracked both body data and self-harm moments.
What they found
No single body measure showed up again and again as a clear warning sign. The only faint clue was low heart-rate variability while the person calms down.
Even that clue was weak, so the authors say we still lack a reliable red flag.
How this fits with other research
McCabe et al. (2023) ran small lab tests and also found heart rate useless for predicting destructive behavior. Together, the two papers warn BCBAs not to buy heart-rate watches hoping for a magic alert.
Neely et al. (2025) tried wrist accelerometers instead of heart rate and caught self-hits during functional analyses. Their early data suggest movement sensors may do what heart-rate sensors cannot.
Meyns et al. (2012) and Vos et al. (2013) did show that heart rate and skin temperature track emotions in severe ID, but emotions are not the same as self-harm risk. The new review widens the lens and shows the jump from emotion to prediction is still too big.
Why it matters
If you hoped a cheap fitness band could give you an early-warning text, this review says save your money. For now, lean on functional assessment, caregiver reports, and direct observation. You can still trial wearables that track movement, like the ones Neely et al. (2025) used, but treat them as extra data points, not crystal balls.
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02At a glance
03Original abstract
BACKGROUND: Self-harm is common in people with intellectual disabilities and is associated with multiple adverse consequences for the client engaging in self-harm, other clients and caregivers. Self-harm is related to emotional dysregulation according to both observational and self-report data. Measures of the autonomic nervous system might provide additional insight in this relationship. METHODS: The current systematic review systematically summarized a broad spectrum of studies on the association between self-harm and physiological parameters. The search identified 2400 articles, 46 were included. RESULTS: In most studies, which compared electrodermal activity and heart rate in people with and without self-harm, no clear indications for a relation between physiology and self-harm was found. Studies on heart rate variability showed indications for lower heart rate variability during recovery, which could imply emotion dysregulation, findings which were supported by results from imagery studies (heart rate and skin conductance). No consistent findings were found when self-harm was studied before, during or after actual occurrences of self-harm, although this was examined by very few studies. CONCLUSIONS: Although wearable technology has improved, the majority of studies to date are lab-studies. Future research should focus on measuring physiology in daily life before, during and after self-harm, in people with intellectual disabilities, study different types and functions of self-harm separately, and test multimodal prediction models. This knowledge could improve the understanding, prevention and assessment of this debilitating behaviour.
Research in developmental disabilities, 2025 · doi:10.1016/j.ridd.2025.105010