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Physical Causes SIB ID — MRCPsych Paper B MCQ

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ModerateIntellectual DisabilityPhysical Causes SIB IDMRCPsych Paper B

A 28-year-old man with severe intellectual disability and limited verbal communication has developed frequent head-banging and hand-biting over the past week. This is a marked change from his usual behaviour. He has no established psychotic disorder and is not acutely medically unstable. Which is the most appropriate initial clinical approach?

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Correct answer: B — Assess for physical illness or discomfort and review medication, including adverse effects

The correct answer is B. New self-injurious behaviour in someone with intellectual disability and limited communication may be an expression of pain, discomfort or physical illness. Assessment should actively consider causes such as dental pain, infection, constipation, gastro-oesophageal reflux and medication adverse effects. This health review forms part of a broader biopsychosocial and functional assessment rather than implying that all behaviour has a physical cause. Functional analysis is important, but option C risks diagnostic overshadowing by omitting health assessment. Epilepsy or psychosis should be investigated when supported by relevant features, not assumed to be the leading explanation. Medication should be reviewed systematically rather than stopped indiscriminately.

Reference: National Institute for Health and Care Excellence. Challenging behaviour and learning disabilities: prevention and interventions for people with learning disabilities whose behaviour challenges. NICE guideline NG11, recommendations 1.2.1, 1.5.5 and 1.10.1, 2015. https://www.nice.org.uk/guidance/ng11/chapter/recommendations