1. Self mutilation may result in scarring of the mouth region.
2. Patients are susceptible to aspiration pneumonitis.
3. Abnormal adrenergic responses and decreased monoamine oxidase activity have been reported (Larson & Wilkins 1985).
4. Atlantoaxial instability has been described in two brothers.The 5 year old had neck pain and progressive quadriplegia, and CT scan showed fracture of the odontoid tip and forward subluxation of the atlas.The 16-year-old brother was screened and had similar findings, but without quadriplegia (Shewell et al 1996).
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