Stereotypic Movement Disorder DSM-5 307.3 (F98.4)

Stereotypic Movement Disorder DSM-5 307.3 (F98.4)

DSM-5 Category: Neurodevelopmental Disorders


Stereotypic Movement Disorder is a condition that is typified by a variety of repetitive and uncontrolled movements for a period of no less than four weeks. Stereotypic Movement Disorder manifests itself in children and adults but is most common in male children with neurological disorders of the brain or nerves, developmental retardation; or mental retardation that is sometimes labeled as an intellectual disability (Singer, 2011). Additional tentative causes can be traced to head injuries or the introduction or abuse of stimulants such as cocaine or amphetamines. In some cases the origin of the disorder cannot be determined. Finally, these repetitive motions may also increase with the presence of anxiety or frustration, boredom or stress and may exacerbate learning difficulties.

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) also recommends that the diagnosis be further refined according to whether or not the behavior is self-injurious; associated with a known medical or genetic condition and its severity (American Psychiatric Association, 2013). Moreover, the DSM-5 emphasizes Stereotypic Movement Disorder is differentiated from body-focused repetitive behavior disorders.

Symptoms of Stereotypic Movement Disorder

Antisocial behaviors exhibited in cases of Stereotypic Movement Disorder include body rocking, head banging, nail biting, tics, self-mutilating actions such as self- hitting or picking at one’s skin, hand waving or wringing, and mouthing an object; all interfere with normal activity and are potentially harmful. New behaviors are also regularly being considered for inclusion in this disorder including ‘cheek biting’ (Sarkhel, Praharaj, & Akhtar, 2011).


Family members and significant others will likely recognize the behaviors common to Stereotypic Movement Disorder as out of the ordinary in the course of everyday life and are urged to seek medical intervention at the earliest possible opportunity. Unfortunately there are no specific tests to identify this condition. Instead, diagnosis begins when a qualified physician conducts a complete medical history and physical examination of the patient. Then the process continues as the medical professional may rely on the results of a variety of results from blood tests, neuroimaging and more physiological analytical tools to rule out the possibility of other pathologies while pinpointing Stereotypic Movement Disorder as the offending agent. There are multiple disorders whose symptoms mimic those of Stereotypic Movement Disorder including chorea or tic disorders, obsessive compulsive behaviors or autism spectrum (Freeman, Soltanifar & Baer, 2010); therefore a correct diagnosis is essential to proper treatment.

Psychologist Based Treatment for Stereotypic Movement Disorder

There are several general rules to follow upon diagnosis of Stereotypic Movement Disorder; the first being that treatment should be tailored according to the patient’s age, presenting symptoms and cause(s) of the condition. For example, children who acquire Stereotypic Movement Disorder as co-morbidity of stress and developmental retardation would require a different therapy regimen than an adult who exhibits the disorder due to excessive cocaine use.

In general, however, the first step is to ensure that the patient is functioning in a safe environment due to the tendency towards erratic movements. This may mean that the child or adult’s surroundings are adjusted to reduce injury risks and vulnerability. A good example of a safety remedy may be the use of a helmet to prevent injury in instances of ‘head banging’; until such time as the behavior can be brought under control or eradicated.

Behavioral therapy is the most common psychologist-based treatment applied as a prescriptive remedy. For example, behavior modification techniques have been found to be moderately successful in diminishing, suppressing and/ or reversing habitual behaviors in some patients (Ricketts, E.; Bauer, C.; Van der Fluit, F.; Capriotti, M.; Espil, F,; & Snorrason, I., 2013). In fact, over time there have been a full range of behavioral strategies implemented for the treatment of this disorder through classic conditioning techniques unique to behavioral therapy including systematic desensitization and ‘aversion’ therapy.

Pharmacological Treatment for Stereotypic Movement Disorder

Drug treatments are often – but not always and not automatically - considered only after behavioral and psychotherapeutic treatment plans have been exhausted; particularly in the case of children who present with symptoms. However, when pharmaceuticals are deemed appropriate the most commonly used include antidepressants such as Zoloft, Prozac or Luvox. These are known in medical circles as SSRIs or selective serotonin reuptake inhibitors and have been found to ease symptoms of depression. Another antidepressant common in treatment is Anafranil. Naltrexone is a medication that is used for other condition-related symptom reductions. Caregivers are encouraged to understand the full scope of the benefits and side effects of all medication in advance of its use.


It is important to note that it is generally not possible to prevent Stereotypic Movement Disorder but immediate medical intervention may help to bring it under control or eradicate symptoms in time. Much of this depends on the cause(s) precipitating the condition. For example, in the case of an individual who exhibits stereotypical movement disorder due to drug use or abuse; the cessation of behaviors may subside as the drugs leave their system. If the cause is traced to a head injury then there are contributing factors that will determine the likelihood the disorder will disappear. Too, if it is a co-factor of a neurological or developmental disorder then patience and repeated therapy may be the best hope for controlling the behaviors; total remedy is on a case-by-case basis.

Functioning with Stereotypic Movement Disorder

When Stereotypic Movement Disorder is expected to be experienced by the patient at some level over a long period of time (perhaps lifelong) then it is incumbent upon caregivers and loved ones to develop coping mechanisms that will ensure optimal functioning at home, in school and in society. First, create and maintain a daily schedule to avoid stress; therapy and medication should occur at the same time daily or weekly. Safety-proof the house so there is less chance of an accident. Use trained caregivers to provide for personal time; a stressed family member increases the stress of the afflicted. Be consistent in expectations and responses to stereotypic motor behaviors. For example, if you regularly remove a child’s hands from their mouth for nail-biting always respond in this manner. Finally, stay positive and remain current in your understanding of new treatments.


American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). Washington, DC: Author.

Freeman, R.; Soltanifar, A.; & Baer, S. (2010). “Stereotypic movement disorder: easily missed”. Developmental medicine and child neurology; Vol. 52, Iss. 8, pp. 733 – 738.

Ricketts, E.; Bauer, C.; Van der Fluit, F.; Capriotti, M.; Espil, F,; & Snorrason, I. (2013). “Behavior Therapy for Stereotypic Movement Disorder in Typically Developing

Children: A Clinical Case Series”. Cognitive and Behavioral Practice; Vol, 20, Iss. 4; Pages 544–555.

Sarkhel, S.; Praharaj, S.; & Akhtar, S. (2011). “Cheek-biting disorder: another stereotypic movement disorder?” Journal of anxiety disorders; Vol. 25; Iss. 8, pp. 1085-1086.

Singer, H. (2011). Handbook of Clinical Neurology. Vol 100, pp. 631 - 639

Help Us Improve This Article

Did you find an inaccuracy? We work hard to provide accurate and scientifically reliable information. If you have found an error of any kind, please let us know by sending an email to, please reference the article title and the issue you found.

Share Therapedia With Others