Gualtieri C T
Psychopharmacol Bull. 1989;25(3):358-63.
Self-injurious behavior (SIB) is sometimes presented as if it were a unitary behavioral entity. It is this assumption that leads to impunity in clinical trials of SIB patients, who are thought to be a homogeneous group. In fact, nothing could be further from the truth. SIB is no more than the occasion for a neuropsychiatric differential diagnosis; first to consider environmental and medical circumstances that may induce SIB; then specific, diagnosable conditions from neurology and psychiatry; then specific syndromes like Lesch-Nyhan and Cornelia de Lange; and then for "idiopathic" cases, the alternative neuro-chemical hypotheses. The goal of differential diagnosis is not only to guide treatment, but also to improve subject homogeneity in clinical trials.
自伤行为（SIB）有时被呈现为好像它是一个单一的行为实体。正是这种假设导致了在针对SIB患者的临床试验中出现有罪不罚的情况，这些患者被认为是一个同质群体。事实上，事实远非如此。SIB只不过是进行神经精神科鉴别诊断的契机；首先要考虑可能诱发SIB的环境和医学情况；然后是来自神经学和精神病学的特定的、可诊断的病症；接着是像莱施-奈汉综合征和科妮莉亚·德朗热综合征这样的特定综合征；然后对于“特发性”病例，要考虑替代性的神经化学假说。鉴别诊断的目的不仅是为了指导治疗，也是为了提高临床试验中受试者的同质性。
