Cracks - causes, therapy, symptoms

Ritzen - Why do people hurt themselves??
Self-injurious behavior (SVV, colloquial "scoring") refers to actions in which individuals destroy body tissues for targets that are not aesthetically or socially established, such as piercings, brandings, or scarvings. Sections in the subcutaneous tissue are by far the most common form of these self-inflicted wounds. Colloquially, the destructive behavior is also referred to as "scratches".

contents

• definition
• The story of self-injury
• initiation rites
• Symptoms of self-injury
• causes
• Warning signs for self-injury
• Childhood abuse
• suicide
• Schizophrenia, psychosis and depression
• Borderline personality disorder
• Eating disorder
• alcoholism
• treatment
• psychotherapy
• Dialectical Behavior Therapy (DBT)
• medication
• family therapy

definition

"It makes no friends to cut into my own hand, to see red tears forming a small trickle, leaving me. The only way to avenge me, to atone for what I spoke and did. Without having acted consciously. It feels like I've never laughed, never cried. "Affected

Cracks: The deliberate injury of the arms and legs. Other body parts can be affected as well. TwilightArtPictures - fotolia

Those affected injure (scratch) themselves on every part of the body, but mostly on the arms and wrists. The severity of the actions varies from superficial wounds to those that leave permanent disfigurement.

Sufferers usually start scratching in late teens or early adulthood. Some of them only inflict wounds a few times, while others establish this behavior as part of everyday life and they feel bad when they stop it temporarily.

Immediately after scratching, sufferers feel how (mental and physical) pressure is easing. When this feeling subsides, shame and guilt take their place, followed by the return of the tormenting emotions that drove people to hurt themselves in order to escape them.

The afflicted Eni writes about the scars:

"Long red lines that I hide under a long sweater Lines that say more than 1000 words Lines that scream louder than any scream Lines that draw my arms Lines that destroy my soul Lines that I will never forget Long red lines that write life. "

People who hurt themselves in this way do not want to kill themselves, but feel better by distracting themselves from the emotional stress they suffer from. The behavior thus shows a high degree of emotional suffering, which in turn can lead to suicide attempts.

The wounds on one's own body can also be dangerous: the fewest affected have a medical education, they can wound more seriously than intended, cause infections or other medical problems - from abscesses to badly healed scars.

People of all walks of life are nicking, but it is more prevalent among the socially disadvantaged, singles and divorced, single and single parents, and those who receive little support from their families.

People who hurt themselves have often been victims of abuse or are otherwise powerless and helpless in the midst of dire circumstances. Self-abuse often appears as a burst of overwhelming feelings of isolation, fear, murder or madness. Some who hurt themselves declare that these actions give them the feeling of control in a world that they can not control. But they can also physically express their emotional pain.

The self-injuries bring peace for a moment, but then the painful feelings return. Although life-threatening wounds are usually unintentional, the risk of more severe and even fatal acts increases.

In general, self-harm among women is more prevalent than among men - but it's unclear. Some studies suggest that women use their bodies more often in this way, but others conclude that both sexes equally wound themselves.

The point is that the reasons for men and women to "take the knife" are different, as are the favored methods. Some scientists suggest that men inflict more bruising than women. They hit objects like stones, hammers or metal tools. The self-made wounds of women are therefore easier to recognize, because they rather scratch or cut.

However, men also cut themselves and women attack with blunt objects. Sophia, suffering from borderline syndrome, sores herself to feel her body. She started beating her head against stone or maltreating herself with blunt objects because it left more pain and thus helped her dissociative states.

The story of self-injury

Gaps are not new, but have been known for centuries, and in all cultures - although the explanations and patterns differ. Some religious leaders glorify self-harm as a way to purify oneself of sins. Believing that people suffer less from God's punishment by punishing themselves is an explanation why some religions glorify self-injury.

Such religions preach active self-harm, asceticism, as a way to get closer to God. Early Christians asked for mercy from God by fasting, not touching alcohol, and renouncing sex.

Modern asceticism is usually associated with monks, nuns or priests. Self-chosen poverty or celibacy are ways in which a priest lives asceticism. Hinduism, Buddhism, Islam and shamanism also represent ascetic behavior.

Physical humiliation is a more extreme form of self-harm to purify oneself spiritually or spiritually. Humans who physically humiliate, cut, burn or whip themselves. In early Christianity, as well as Judaism and Sufism, some believers wore a shirt made of animal hair, which scratched the bare skin very much.

initiation rites

In some cultures, painful procedures serve to mark stages of life, such as puberty. Genital mutilation, the removal of the clitoris and the foreskin, marks the beginning of adolescence in some cultures of Africa, Arabia and Australia. Although those affected often undergo these acts "voluntarily", conditioned by their socialization and community pressure, some are forced by their tribal members.

Symptoms of self-injury

Individual self-injury without ideological superstructure follows similar patterns as alcohol or drug addiction, the affected also develop solid rituals and cover up their behavior. As with other addictions, the behavior follows a circle: for example, a person feels fear, then comes the impulse, the resistance, the excitement and the relaxation; it sounds like shame, and ann returns.

While he or she often knows that he or she is destroying the behavior, he feels there is no alternative to cutting, burning, and other acts of physical pain right now.

Anyone who hurts themselves sometimes fakes accidents to explain the wounds or bruises. The victims wear clothing that conceals their injuries, for example, long sleeves even in summer.
They seem confused, carry sharp objects in their personal belongings without having a reason for doing so, and look for long periods in which they are alone. Those who have wounded themselves often have difficulty functioning in the workplace or at school and have little self-esteem. However, symptom and cause go hand in hand.

Typical of teenagers who scratch are the following points:

1) They usually scratch at home.

2) They use scissors, screws, staples or fingernails

3) They scratch especially in the forearm and wrist

4) Other teenagers give them the idea

5) The scratches emit adrenaline and endorphins, the affected feel a sense of happiness

6) As with other addictions, the longer the last chink, the greater the pressure, and the sufferer will have to cut more and more.

7) Those affected are ashamed of what they do.

causes

People who scribble typically report feelings of hopelessness, anxiety, and social rejection; they lack self-esteem, and they despair of events in their lives. Often they have not learned to openly express their feelings to other people.

They say that they do it to relieve stress or pressure, to reduce emotional pain, to punish themselves for the guilt they feel, to avoid letting others know how they are - or about themselves to gain control over their lives. Conscious self-harm can also be a symptom of an underlying mental illness that requires professional care.

Scoring is a hallmark of borderline disorder. Such people are emotionally unstable; they can not bear contradictions and separate the world into black and white, they feel empty inside, they can not endure their inner conflicts, they idealize or demonize other people, they can not control impulses and they have an intense and changing relationship.

Social factors favor SVEs, especially among adolescents: Those affected by friends who often scribble often imitate their behavior. Often the scratching even spreads like a fashion, similar to smoking in the toilet. If the adolescents are particularly impulsive, extremely self-critical, with a negative self-image, or are struggling with other mental disorders, then they are in great danger of hurting themselves.

The social environment is added: A stressful home or the consequences of a trauma can cause a person to harm themselves to cope with these experiences.

Warning signs for self-injury

Many people treat their self-injuries as a secret. Adolescents hide their wounds from teachers, friends and family, adults from partners, friends and colleagues like their children.
Some sufferers have one or two close friends who know about the secret, but most of the time, friends and family only suspect that something is happening to their family member or suspect nothing at all.

Childhood abuse

Nearly half of those affected report physical and / or sexual abuse during their childhood, and almost all tell that they were not allowed to openly express feelings when they were children - especially anger and grief.

Excited teens feel that self-harm releases suppressed emotions, or they punish themselves when they are disappointed. Such a self-injury is a cry for help.

We can not express our emotions from birth and deal with them - we learn from our parents, siblings, friends and teachers - from everyone in our lives. One factor that shapes those affected is devaluation. They were taught at a very early age that their interpretations and feelings about the things around them were bad and wrong. They learned that certain feelings are not allowed.

In homes with abuse, they were severely punished for expressing thoughts and feelings that were undesirable. At the same time they lacked positive roles that they could imitate. Someone can not learn to deal effectively with stress when growing up with people who can not.

Often a story of abuse is among those affected, but not everyone who scratches suffered one. Sometimes the devaluation and lack of role models is enough, especially if the brain chemistry of those concerned sets the course to overcome problems in this way.

suicide

Affected people usually do not want to kill themselves. The behavior of suicides differs significantly from self-harm in their phenomenology, their characteristics and their intentions, although they share some psychosocial risk factors.

Those affected are not necessarily at risk of committing suicide, because many of them never try and, secondly, have no suicidal thoughts. Suicide is one way to end one's life, but for many people, self-harm is a way of coping with life and being able to continue living despite their emotional difficulties.

Sometimes people die as a result of self-injury. This happens, for example, if they cut too deeply and bleed to death before help comes, or if they poison themselves and take too high a dose. When scribing in the subcutaneous tissue, the risk of dying is low.

Conversely, the risk of suicide even increases if those affected are prevented from injuring themselves. As bizarre as it may seem to outsiders, self-harm is sometimes the safest option - when the alternative is to end life. So it's dangerous to stop someone from hurting themselves without having realistic mechanisms to get their problems under control.

Studies have shown that people who hurt themselves are not only more apathetic than non-affected and less loyal to their families, but also less fearful of suicide and more willing to try it. Therefore, it is essential to examine the motivation of those affected to see whether thoughts of suicide play a role, as well as the psychiatric symptoms that occur during therapy.

Schizophrenia, psychosis and depression

Schizophrenics violate themselves, not to deliberately punish themselves, but to silence the hallucinatory voices whispering instructions to them. They feel obligated to eliminate these voices, ghosts, or demons, or are so desperate that they do anything to erase the voices. Or they hurt themselves to distract themselves from the voices.

Often affected by this disorder also delusional believe that they would have to hurt themselves - God wants it that way, or they could stop something terrible, or they do it because they think they are possessed by evil spirits.

Similar to schizophrenia, drug-induced psychoses also lead to self-injury. Often, self-mutilation arises from physical illusions, and patients try to remove something from their skin: parasites, worms or demons.

In depression, self-injury is an attempt to regulate negative moods - similar to borderline people. It can also be suicide attempts. In the case of depressives, the destruction of one's own body is the expression of nihilistic illusions, which suggest that something terrible happens - for example, the belief that their eyes belong to the devil and that they therefore have to remove them.

Such delusions are not typical for all disorders of the depressive type, but occurred mainly in major depressive disorder. These usually arise in the third decade of life, last at least two weeks and are associated with extreme feelings of hopelessness, value and meaninglessness.

Borderline personality disorder

This disorder is characterized by unstable relationships, self-images and affects as well as uncontrolled impulses. It usually begins in adolescence or early adulthood. Patients try everything to fight the feeling of abandonment. They express this in a recurring suicidal and / or self-injurious behavior. Emotions of emptiness, intense anger, dissociation and paranoia are typical.

Some of those affected hurt themselves because they think they have to punish themselves and think they deserve to be abused. This belief is often due to the fact that they suffered psychological and / or physical violence as children. Now they uphold the pattern of abuse by repeatedly doing it on their own body.

Many of the patients have trouble expressing anger in a healthy way. Instead, they hurt themselves so others feel bad for something they said or did. Borderliner manipulate thus actively and passively with their own suffering, and this goes up to recurring games with suicidal behavior.

Self-punishment and punishment of other people are two main reasons why Borderliners hurt themselves. A third is difficult to understand for outsiders: as a result of their trauma, borderline people find it difficult to access their feelings, and their emotions and memories are perceived as splinters that appear to be nightmares in sleep or as wakefulness irritations; they dissociate and lose the sense of space and time. The wounds make them feel good: the body is now producing painkillers called endorphins. These endorphins act like morphine and reduce pain and stress. The emotionally unstable borderliners can better control their emotions and feel better.

One affected person writes about the scribe: "I know that I want it partly because I want to punish myself because I'm such a bad person. I need it to show that I'm feeling sick, because no one else is aware of me (I walk long-sleeved in summer and winter and also with cuffs) ... crazy? "

Eating disorder

People who suffer from eating disorders are highly susceptible to self-harm: self-destructive behavior is one of the symptoms of eating disorders, as is self-induced vomiting or excessive exercise with the intent to inflict pain on oneself.

Probably 25% of all dyslexics hurt themselves, especially those with bulimia. For many of them, self-harm and eating disorder exist side by side, others replace a eating disorder by scratches. If someone tries to change their behavior without being psychologically ready (for example, to please someone else), then another self-destruction easily takes their place. This is because this behavior serves the individual to deal with intense emotions, eliminate them and avert them - anger, shame, grief, loneliness or guilt. Those affected must first be able to identify these feelings and find ways to deal with them, leading them out of the circle of self-harm.

For some people, self-mutilations and eating disorders are a form of punishment and express hatred of one's own body. If someone has a bad self-image and is suffering from a eating disorder, then that person loses his sense of self, which leads to a lack of respect for his body. That opens the door for self-mutilation. In the world of someone with a eating disorder, especially in a form based on routine and control, self-harm can also become a ritual of punishment because that person does not comply with self-imposed rules.

Cracks, borderline and eating disorders are not strictly separated. As one sufferer who suffers from borderline syndrome wrote: "I've been scratching myself with some interruptions for ten years now and sometimes I'm getting burns. If I'm not SV, I'm drinking or I'm not controlling my eating habits, but I always pity myself. No matter how long I do not hurt to do it again and again it comes to me and I start all over again. Meanwhile, I do not fight it anymore, but still I would like to get rid of the tension that the SVV triggers - only how? No relaxation practice has helped so far, and until now, skills have only infuriated me, which in the end has made the SVV worse. "

alcoholism

Aloholm abuse is not primarily an individual or psychological phenomenon, but a sociological that goes hand in hand with psychic structures that also apply to suicidality. The relationship between alcoholism and self-destruction is complex and different between the sexes, cultures and countries.

Problematic alcohol consumption burdens social relationships and family life, and it does not only pose risks to the individual, but also to conflicting relationships and family destruction.

Alcohol often leads to a long-term risk of self-harm, such as financial and social ruin, domestic violence and negative feelings. In the short term, it increases the risk of impulsive and destructive behavior, even in people with a chronic alcohol problem who are used to alcohol.

Self-injury or suicide can put an end to an alcoholic career, but a significant number of alcohol abusers use self-harm to escape the negative effects of alcohol.

Conversely, the alcohol intoxication is dangerous for people who are already scratching because they can lose control of the depth of the cuts. A person concerned reported: "... when I was drunk at a party, I was scratched very blatantly, so that my whole left pant leg was soaked in blood. It is well known that alcohol in the blood no longer has all the senses together. So I also believe that the scratching is no longer under control. I am less sensitive to alcohol in my blood. Alcohol and scratching is a dangerous thing. "

Another writes: "Alcohol stuns, so when I drink Alk I'm not in control of the scratches anymore - it's like a dream. I can not remember pain, just blood, blood everywhere. "

In some cases there is a borderline disorder. Image: Photographee.eu - fotolia

Alcohol reinforces the feelings, after heavy consumption especially the negative ones. For someone who injures himself to escape the stressful emotions, it has fatal consequences. One sufferer writes, "When I get drunk and fall on my bed, I get so bad that I'd like to kill myself! In the meantime, it almost happened, by this shit alcohol! I have a third of my really thick scars only from the Alk! So if you drink and come home, take yourself to safety by including everything in the forefront. "

treatment

A treatment promises little success, if the victims only replace a self-damaging behavior or scratches by another. Then sometimes they feel even worse. So one person writes: "If I replace the cutting by alcohol, food or the like, I feel really shit, because it is a shift for me but unfortunately not the solution of the basic problem. I only take psychopharmaceuticals, if they can not help it, they only cause side effects, and some of them are not without it. I sometimes feel like this tension, which leads to the SVV, as delivered. Sometimes I can postpone it all, but after a few hours it will not work anymore. My Gednaken then only revolve around, and only when the tension is gone, I can continue normally. "

Affected themselves suggest the following alternatives to scratching:

- run through nettles

- listen to music

- Write down feelings

- To draw

- write a letter to the person causing the suffering

- Melt ice cube in hand

- Run cold water over legs and arms

- Draw lines on your arm with a red pencil, or run colored water over the areas to simulate blood.

Others report that they avoid cutting

- beat against pillows

- call or chat

- talk to somebody about it

- cry if you can

- sleep

- to do sports

- Tie a rubber band around your arm

- singing aloud

- scream out loud

- bite into a pillow

- to take a cold shower

- meet friends

- Play video game - transfer the apartment

- tear a newspaper

- work in the garden

- throw a pumice on the wall

Self-harming behavior is often difficult to detect, diagnose and treat. Often it shows a underlying mental disorder - but that does not have to be. When cracks mate with addictive behavior, it is even harder to treat. The affected then need a special therapy that addresses both problems at the same time.

psychotherapy

Scarring is associated with low self-esteem, self-hatred and inadequacy. A psychotherapist specializing in SVV will discuss these feelings with those affected, identify the cause of the emotional pain, and develop strategies to reduce and control the pain.

Trauma therapy as an aid to "scratches". Image: Photographee.eu - fotolia

The therapist can also do mindfulness exercises with the sufferer, and meditation as well as creative expression can help the patient master excitement in the future, without the impulse to cut oneself.

Dialectical Behavior Therapy (DBT)

Dialectical behavior therapy, the dialectical behavioral therapy developed Marsha Linehan in the 1970s to handle the borderline disorder in adults.

DBT serves to help with extreme emotional instability - the inability to manage intense emotions. This lack of control leads to self-destruction and self-injury. DBT teaches techniques to understand these emotions without judging them, as well as providing the tools to change behavior in ways that improve the lives of the sick. But this requires the willingness of those affected and is a long and hard way.

The central goal is to change the problematic behavior. This is attempted as patients focus on controlling their thoughts and feelings that lead to injurious behavior as well as solving problems that cause these feelings, thoughts and self-harm.

medication

Psychiatric meditation for SVV is uncommon, but people who scrit often need medications for comorbidities such as depression or bipolarity. If the sufferer has no other disorders, medications are not recommended, because they hide feelings that people have to deal with to stop the self-injury.

family therapy

Almost all people who scratch themselves, especially teenagers, turn away from friends and family, but at the same time reveal this first. Then they seek help over the internet. The next address is psychologists.

Decisive for relatives is to realize that the person who scratches is still the same person, and the scratching just not in the center of the discussions with him. Parents are well advised to treat them as "normal", ie not to introduce additional constraints that will not stop the scratch anyway, but not to deal with it like a raw egg. The relatives should not let the SVV into their lives. This behavior exerts enormous emotional power and the family should block off here.

Family therapies are designed to help patients and their families recognize how scratching affects family dynamics. The therapy is also used to educate the family about SVV and to show them ways to deal with it.

It becomes more difficult when the family itself is the trigger for the disorder. Cold-hearted mothers, beating dads, an upbringing that constantly blames the child for everything, drug abuse and lack of communication are core factors that cause a chink. Such parents are unfortunately rarely willing to admit their mistakes. Relatives can find help, for example, on the website www.rotelinien.de or on www.svv-community.net
(Somayeh Khaleseh Ranjbar, translated and supplemented by Dr. Utz Anhalt)
Specialist supervision: Barbara Schindewolf-Lensch (doctor)