RECURRENT SELF-INJURIOUS BEHAVIOR IN FORENSIC PATIENTS Marc Hillbrand, Ph.D., John L. Young, M.D., and John H. Krystal, M.D. A high prevalence of self-injurious behavior has been reported in the forensic psychiatric population and the correctional psychiatric population. Severely and recurrently self-destructive patients pose great therapeutic challenges. The pre- sent study examined forensic patients who engaged in multiple acts of self-in- jury while hospitalized and compared them to forensic patients who engaged in a single act of self-injury. The groups did not differ on demographic or di- agnostic measures, but the recurringly self-injurious patients were more fre- quently and more severely aggressive against others (verbally as well as physically), and required longer hospitalization. The results are interpreted to suggest that the high cost of recurring self-injury in human and financial terms may be reduced by a strategy of early and vigorous intervention. Several clinical distinctions have proven useful in understanding the challenging problem of self-destructive behavior. Self-destruc- tive behavior may be conceptualized as being either direct (e.g., Dr. Hillbrand is Unit Director, Intermediate Treatment Unit, Whiting Forensic Institute, and Assistant Clinical Professor of Psychiatry, Yale University School of Medicine. Dr. Young is Service Chief, Intermediate Treatment and Diagnostic Units, Whiting Forensic Institute, and Associate Clinical Professor of Psychiatry, Yale University School of Medicine. Dr. Krystal is Director of the Schizophrenia Biological Research Project, West Haven V.A. Medical Center, and Associate Professor of Psychiatry, Yale University School of Medicine. Address correspondence to Dr. Hillbrand at Whiting Forensic Institute, PO Box 70, Middletown, CT 06457. PSYCHIATRIC QUARTERLY, Vol. 67, No. 1, Spring 1996 0033-2720/96/0300-0033509.50/0 9 1996 Human Sciences Press, Inc. 33