Self-injurious behavior (SIB) is a serious and moderately prevalent problem behavior among developmentally disabled persons, and it frequently leads to treatment with psychotropic medication. The empirical literature relating to the efficacy of pharmacological intervention is comprehensively reviewed. The rationales for using some "newer" agents, such as serotonin reuptake blockers, opiate blockers, and beta-adrenergic blockers are described. In general there are insufficient data to draw conclusions about specific agents. Evidence for a possible role in managing SIB is strongest for thioridazine, lithium carbonate, and the opiate antagonists. However, further research is needed to define the specific indications, if any, for each of these. Impediments to past research are discussed, possible refinements are offered for future research, and recommendations for treatment are offered.