Stereotyped self-injurious behaviors include, but are not limited to, repetitive head banging, face slapping, eye poking, and biting of hands, lips, or other body parts. Eye poking is particularly concerning; it occurs more frequently among children with visual impairment. Multiple movements may be combined (e.g., cocking the head, rocking the torso, waving a small string repetitively in front of the face). If the behaviors cause self-injury, this should be specified as part of the diagnostic description.


Stereotypic Movement Disorder With Self-Injurious Behavior 

The repertoire of behaviors is variable; each individual presents with his or her own individually patterned, “signature” behavior. Examples of non-self-injurious stereotypic movements include, but are not limited to, body rocking, bilateral flapping or rotating hand movements, flicking or fluttering fingers in front of the face, arm waving or flapping, and head nodding; mouth stretching is commonly seen in association with upper limb movements.


Stereotypic Movement Disorder Without Self-Injurious Behavior

The severity of non-self-injurious stereotypic movements ranges from mild presentations that are easily suppressed by a sensory stimulus or distraction to continuous movements that markedly interfere with all activities of daily living. Self-injurious behaviors range in severity along various dimensions, including the frequency, impact on adaptive functioning, and severity of bodily injury (from mild bruising or erythema from hitting hand against body, to lacerations or amputation of digits, to retinal detachment from head banging).

Current Severity of Stereotypic Movement Disorder

The DSM-5-TR outlines a few specifiers to help specify the condition of Stereotypic Movement Disorder for each individual case. These specifiers are as followed: Self-injurious, not self-injurious and severity

Michigan State University

Stereotypic movement disorder is diagnosed when an individual has repetitive, seemingly driven, and apparently purposeless motor behaviors, such as hand flapping, body rocking, head banging, self-biting, or hitting. The movements interfere with social, academic, or other activities. Motor stereotypes are among the diagnostic characteristics of autism spectrum disorder

Stereotypic Movement Disorder

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed., Text revision). https://doi.org/10.1176/appi.books.9780890425596

DSM-5-TR

The essential feature of stereotypic movement disorder is repetitive, seemingly driven, and apparently purposeless motor behavior. These behaviors are often rhythmical movements of the head, hands, or body without obvious adaptive function. The movements may or may not respond to efforts to stop them.


Diagnostic Features of Stereotypic Movement Disorder

Specifiers for Stereotypic Movement Disorder

Young children who are typically developing frequently make simple stereotypical movements (such as rocking; in the US and UK, this ranges from 5% to 18%). Complex stereotypic movements are substantially less frequent (happening in 3%–4% of cases). In samples from high-income nations, between 4% and 16% of people with intellectual developmental disorder (intellectual impairment) engage in stereotypy and self-harm. People with severe intellectual developmental disorders are more at risk. 10% to 15% of people with intellectual developmental disorders who dwell in residential facilities may also self-injure and have stereotypic movement disorder.  In children with severe intellectual developmental disorders, repetitive and constrained behaviors and interests may be risk factors for the onset of self-harm, violence, and destructive conduct.


Prevalence of Stereotypic Movement Disorder 

Onset is in the early developmental period. Stereotypic movements typically begin within the first 3 years of life. Simple stereotypic movements are common in infancy and may be involved in acquisition of motor mastery. In children who develop complex motor stereotypes, approximately 80% exhibit symptoms before age 24 months, 12% between 24 and 35 months, and 8% at 36 months or older. In most typically developing children, the severity and frequency of stereotyped movements diminish over time. Onset of complex motor stereotypies may be in infancy or later in the developmental period. Among individuals with intellectual developmental disorder, the stereotyped, self-injurious behaviors may persist for years, even though the typography or pattern of self-injury may change.


Development and Course of Stereotypic Movement Disorder 

Risk and prognostic factors of Stereotypic Movement disorder include:

Environmental
Genetic and physiological


Risk and Prognostic Factors of Stereotypic Movement Disorder 

Diagnostic issues of Stereotypic Movement disorder include:

Culture-related diagnostic issues

Related Diagnostic Issues of Stereotypic Movement Disorder

Differential Diagnoses to Stereotypic Movement Disorder include
Normal development
Autism spectrum disorder
Tic disorders
Obsessive-Compulsive related disorders
Other conditions

Differential Diagnoses to Stereotypic Movement Disorder 

Common comorbidities in children with chronic motor stereotypes include attention-deficit hyperactivity disorder, motor coordination problems, tics/Tourette’s disorder, and anxiety.

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