Naltrexone for Severe Self-Harm Behavior: A Case Report

To the Editor: Naltrexone is an opioid receptor antagonist approved by the Food and Drug Administration for alcohol and opioid dependence. Case reports have noted efficacy in impulse control disorders and self-injury, particularly in populations with developmental delay (1). Newer research suggests that response to naltrexone may be predicted by elevated beta-endorphin levels following self-injurious behavior (2). We report on a case of severe treatment-resistant self-mutilating behavior successfully treated with naltrexone.

This case highlights the potential efficacy of naltrexone in self-injurious behavior resistant to multiple psychopharmacological and behavioral interventions. Utilization of this treatment may allow for tapering or discontinuation of atypical antipsychotics and mood stabilizers that have significant metabolic side effects, including weight gain and diabetes. Although previous reports have described similar effects, the magnitude of the response, the medical comorbidities, and the resistance to treatment in this patient demonstrate a need to consider naltrexone sooner in treatment algorithms. Our group has also used naltrexone to treat an autistic man with sexually violent behavior and an elderly man with dementia and sexually inappropriate behavior, with resolution of symptoms and no adverse events. Large-scale randomized placebo-controlled trials are necessary to provide further evidence for the use of naltrexone in refractory cases of impulse control disorders.