Brief overview
- Description: Self-injurious behavior (SVV) in which sufferers deliberately injure themselves (e.g., by scratching the skin on their arms).
- Causes: Usually a long-lasting psychological stress (e.g. conflicts within the family) or illness (e.g. borderline disorder, depression) is the reason for the behavior.
- Symptoms: For example, wounds, stings, burns on the body (mostly on the arms and legs), bruises, scars, sleep disorders, mood swings
- Treatment: The doctor first treats the wounds, then investigates the psychological causes and selects appropriate psychotherapy. In some cases, the doctor prescribes psychotropic drugs.
- Diagnosis: Discussion with the doctor, physical examination (e.g. assessment of the wounds and scars).
What is self-injurious behavior?
Self-injury – also self-injurious or autoaggressive behavior or autoaggression (self-aggression) or artifact action – describes various behaviors and actions in which affected persons intentionally repeatedly injure themselves or inflict wounds on themselves.
So-called scribing – scoring or cutting the skin of forearms or legs with sharp objects such as knives, broken glass, or razor blades – represents the most common method of self-injury. These are not life-threatening wounds, but small to moderate injuries to the skin or tissue surface of the body.
In ICD-10, the International Classification of Diseases and Health Problems, self-injurious behavior is not classified as a separate disease. It is considered “intentional self-harm in an unspecified manner.”
Self-injurious behavior can often be attributed to prolonged emotional distress and often occurs in conjunction with other mental illnesses, such as borderline personality disorder or depression. According to research, one in four adolescents will self-injure at least once by the time they turn 18.
“Scribing” is often used as a synonym for self-injurious behavior because it is the most common method of self-injury.
What are the causes of self-injury?
Self-injurious behavior usually occurs because of prolonged emotional stress, such as a problematic parent-child relationship or frequent conflicts with peers. Less often, the behavior occurs during acute emotional stress, such as parental divorce, separation, or school problems.
- Borderline personality disorder
- Depression
- Eating disorders such as bulimia nervosa (bulimia) or anorexia nervosa (anorexia)
- Post-traumatic stress disorder (PTSD)
- Obsessive-compulsive disorder
- Substance abuse
- Anxiety disorders
- Social behavior disorder
Autoaggressive behavior usually begins in adolescence between the ages of twelve and 15, although in some cases it begins much earlier. Less commonly, autoaggression occurs in adults. With most concerning it is a valve, in order to release strong internal tension. By self-harming, they feel a sense of relief.
Or, the self-injuries serve as self-punishment because sufferers are angry at themselves. Some become “addicted” to this state over time and hurt themselves again and again.
Self-injury (“self-mutilation”) causes an interruption or relief of the intensely unpleasant emotional state. Self-injurious behavior thus serves as a kind of coping strategy for those affected. It is not uncommon for self-injurious behavior to be “learned” and imitated by other adolescents (e.g., friends or classmates): adolescents adopt self-injurious acts from others.
The role of the Internet should be noted here. Here, those affected exchange information on self-injurious behavior among themselves. This can lead to social acceptance and “normalization” of the behavior.
Who is particularly affected?
Adolescents (less frequently also young children) with mental health problems are most often affected by autoaggression. In Germany, about 25 percent of adolescents self-injure once in their lives; worldwide, about 19 percent of the adolescent population is affected by self-injurious behavior.
Girls and young women between the ages of twelve and 15 in particular have an increased risk of developing self-injurious behavior. This is due in part to the fact that girls tend more often to direct negative feelings inward, against themselves. They are also more often affected by depression and anxiety, which increases the risk of self-injurious acts.
How does self-injurious behavior manifest itself?
Self-injurious behavior and associated symptoms manifest themselves in many ways. The most common type, however, is “scratching” or “cutting.” This involves repeatedly cutting one’s own body with sharp objects such as razor blades, knives, needles or broken glass.
But there are many other types of self-injury, such as stubbing out burning cigarettes on one’s arm, touching hot stove tops, or cutting off certain parts of the body. It is not uncommon for sufferers to use multiple self-injurious methods that change over time.
These include:
- scratching themselves sore or bloody
- @ scratching or cutting themselves with sharp objects
- hitting or striking themselves against hard objects
- pinching yourself
- bite yourself
- burn themselves
- burn themselves (e.g. with acids)
- pulling out hair
- excessive fingernail biting
- strangulation of certain parts of the body
- Attempts to break the bones
- Intentionally ingesting harmful substances (e.g., spoiled food or cleaning products)
The most commonly injured areas of the body are:
- Forearms
- Wrists
- Upper arms
- Thighs
Less frequently, the chest, abdomen, face, or genital area are injured. In addition, the injuries are usually of the same depth, grouped, in parallel rows or symmetrically visible on the skin surface (also in the form of letters or words). It is not uncommon for these wounds to result in scars, which are called self-injury scars or SVV scars.
Often, people with SVV have sleep disorders. They withdraw and neglect contact with friends and also hobbies that they used to do. Often, those affected try to hide their wounds and injuries on their bodies out of shame.
- Frequent locking in the room or bathroom
- Neglecting one’s own interests (e.g. meeting friends)
- Storing razor blades, knives, or other sharp objects
- Cuts on the body (usually on the forearm)
- Burns or stitches (e.g., from needles)
- Bruises on the body
- Abrasions (especially on the knees or elbows)
How does the doctor make the diagnosis?
Self-injurious behavior is a symptom that can occur in connection with various mental disorders, but also independently of them. If self-injurious behavior is suspected, the general practitioner is the first point of contact. If necessary, he or she will refer the patient to a specialist.
A specialist in psychiatry or child and adolescent psychiatry will assess whether the behavior is based on a mental illness.
The doctor then examines the injured parts of the body and looks for any abnormalities (e.g., are the wounds the same depth, grouped, in parallel rows, or symmetrically visible on the surface of the skin?).
If you suspect that a friend or loved one is self-harming, contact your primary care physician, a mental health professional, or a psychotherapist.
What can be done about autoaggression?
Treatment of the wounds
First, the doctor treats the person’s wounds. A cut or burn wound always needs immediate medical treatment. Here, the risk of the wound becoming infected is very high. The doctor also cleans and treats superficial injuries (e.g. by disinfecting the wound, applying a wound dressing).
If you are affected yourself, do not be afraid to go to the doctor with wounds so that he can take care of them and they do not become infected.
Psychosocial treatment
Cognitive behavioral therapy, for example, has been shown to be particularly effective. Here, people with autoaggression learn new coping strategies to better react to stressful situations and control their emotions. Those affected learn to analyze possible triggers for self-injurious behavior in order to recognize and react to them in time.
Relaxation techniques such as yoga, breathing exercises or progressive muscle relaxation help those affected in therapy to relieve pressure.
If the self-injurious behavior is based on a serious mental illness (e.g. depression, borderline personality disorder), the doctor may prescribe psychotropic drugs in addition to psychotherapy. Especially in the case of adolescents, parents and other caregivers should be involved in the treatment. If they also use behavioral therapy measures, this usually contributes significantly to successful treatment.
Scar removal
Depending on how deep or large the wound is, scars remain that are more or less visible. These remind the affected person again and again of their former behavior, for which they are often ashamed. For this reason, many of those affected have their scars removed by a doctor.
Various methods can be used for this purpose, such as dermabrasion (abrasion of the upper skin layer), micro-needling (light needle punctures in the upper skin layer), serial excision (gradual surgical reduction of the scar) or laser treatment.
Special scar ointments or creams from the pharmacy also help to reduce the visibility of scars to some extent. However, scars usually do not disappear completely with all these methods.
The effect of these home remedies on scars is not sufficiently proven scientifically.
What can be done to prevent scars?
Skills training” has proven to be an effective measure, in addition to extensive education of the affected person and their parents: Here, the affected person practices strategies by which he or she replaces the self-injurious behavior, for example, the use of strong sensory stimuli such as placing ice cubes in the neck or on the wrists, biting into chili peppers, kneading a hedgehog ball, drinking pure lemon juice, hitting the bed or pillow, taking a cold shower, or the like.
Distraction through intense concentration on physical or mental activities (e.g., playing soccer, jogging, writing a diary, or doing crossword puzzles) also comes in handy here.
What can relatives do?
Self-injurious behavior is definitely to be considered a distress signal and should be taken seriously. However, it is often difficult for parents and relatives to recognize signs of self-injurious behavior. Adolescents are often ashamed of their behavior and do not actively seek help.
For friends and siblings of those affected, the following therefore applies: Do not hesitate too long at the first signs, but be sure to talk about it with parents or another trusted adult.
Tips for parents and caregivers
- Address the problem calmly and openly.
- Do not criticize or judge the behavior.
- Help affected child or adolescent understand what triggers the behavior in others (e.g., worry, fear, etc.).
- Take the child’s or adolescent’s feelings seriously.
- Do not put pressure on the child if he or she does not want to talk about it.
- Help the child to recognize the problem himself.
- Don’t spend too long trying to manage the problem yourself; get professional help as early as possible.
