Observing signs of pain in relation to self-injurious behaviour among individuals with intellectual and developmental disabilities.
Self-injury can hurt even when clients cannot say so—check for moment-to-moment pain cues instead of assuming numbness.
01Research in Context
What this study did
Storch et al. (2012) watched adults with intellectual and developmental disabilities during times they hurt themselves.
The team looked for face, voice, and body cues that can mean pain.
They wanted to see if pain signals show up right before or during self-injury.
What they found
Some people did grimace, moan, or guard a body part just before they hit or bit themselves.
Other people showed no clear pain signs at all.
The mix of results means we cannot say this group feels less pain across the board.
How this fits with other research
Bromley et al. (1998) built a simple body-map and color scale that adults with ID can use to point to where and how much they hurt.
Their tool gives us a way to double-check what we think we see, instead of trusting only faces or sounds.
Oliver et al. (2002) say challenging behavior often spikes when stress is high and attachment feels shaky.
Put together, pain may be one more stressor that feeds self-injury, not proof of a numb nervous system.
Why it matters
If you treat self-injury like it never hurts, you might miss ear infections, reflux, or broken bones.
Pause to scan for individual pain signals each time the behavior starts.
Use the body-map from Bromley et al. (1998) if the client can point, or watch for small shifts in movement, breathing, or facial tension.
Document what you see and share it with the medical team so real pain gets fixed instead of masked.
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Join Free →During the next self-injury episode, start a 30-second timer and tally any grimace, gasp, or body guarding you see—note the pattern before you intervene.
02At a glance
03Original abstract
BACKGROUND: Self-injurious behaviour is a chronic condition among people with intellectual and developmental disabilities for which there is no known cure. The pain hypothesis suggests that individuals who engage in self-injury have altered or diminished pain perception. The purpose of the present study was to assess how frequently individuals diagnosed with an intellectual and developmental disability who engage in chronic self-injury displayed non-verbal signs of pain in relation to their self-injury. METHODS: We videotaped four participants (aged 28-50 years) in their homes during times when they were likely to engage in self-injury. Using continuous recording measures, we coded videotapes for the frequency and duration of self-injury and expressions of non-verbal pain-related behaviours. Sequential analyses were conducted to identify temporal relations between pain-related behaviours and self-injury. RESULTS: Our data suggest that the existing measures of pain may be systematically related to instances of self-injury. The relationships, however, appear to vary depending on the person who engages in self-injury, the environmental contexts in which the self-injury occurs, and perhaps, the type of self-injury in which the person engages. CONCLUSIONS: These results support some of the findings of Symons et al. and they raise questions about the blunted nociception hypothesis of self-injury.
Journal of intellectual disability research : JIDR, 2012 · doi:10.1111/j.1365-2788.2011.01492.x