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Scribing - causes, therapy, symptoms

Scribing - causes, therapy, symptoms


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Cracks - Why Do People Hurt Themselves?
Self-injurious behavior (SVV, colloquially “scratching”) describes actions in which individuals destroy body tissue for goals 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-made wounds. Colloquially, the destructive behavior is also referred to as “scratching”.

Definition

“It makes me no friends to cut into my own hand, to watch red tears that form a small trickle, to leave me. The only way to avenge myself, to atone for what I said and did. Without acting consciously. I feel like I've never laughed, never cried. ” A victim

Sufferers injure themselves (scratches) 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 disfigurements.

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

Immediately after scratching, those affected feel how (mental and physical) pressure subsides. When this feeling subsides, shame and guilt take its place, followed by the return of the excruciating emotions that drive people to hurt themselves to escape them.

Affected Eni writes about the scars:

“Long red lines, lines that I hide under a long sweater, lines that say more than 1000 words, lines that scream louder than every cry, 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 are suffering from. So the behavior shows a high degree of mental suffering, which in turn can lead to suicide attempts.

Wounds on your own body can also be dangerous: very few sufferers have a medical education, they are more likely to get wounded than intended, causing infections or other medical problems - from abscesses to poorly healed scars.

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

People who hurt themselves are often victims of abuse or are otherwise powerless and helpless amid terrible circumstances. Self-abuse often appears as an outbreak of overwhelming feelings of isolation, fear, murder, or madness. Some who hurt themselves explain that these actions give them a sense of control in a world they cannot control. You can also use it to express your emotional pain physically.

The self-harm brings a moment's rest, but then the painful feelings return. Even though life-threatening wounds are usually not intended, the risk of increasingly serious and even fatal actions increases.

In general, self-harm is more common among women than among men - but whether that is true is unclear. Some studies suggest that women abuse their bodies more often in this way, but others conclude that both sexes twist themselves equally.

The consensus is that the reasons for men and women to "pick up the knife" differ, as do the preferred methods. Some scientists suspect that men bruise more often than women. They deal with objects such as stones, hammers or metal tools. As a result, women's self-made wounds are easier to recognize because they are more likely to scratch or cut.

However, men also cut themselves and women attack themselves with blunt objects. Sophia, who has borderline syndrome, inflicts wounds on herself to feel her body. She started banging her head against stone or maltreating herself with blunt objects because it left her in greater pain and thus helped against her dissociative conditions.

The story of self-harm

Cracks are not new, but have been known for centuries, and in all cultures - although the explanations and the patterns differ. Some religious leaders glorify self-harm as a way to rid themselves of sins. The belief that people suffer less from God's punishment when they punish themselves is an explanation of why some religions glorify self-harm.

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 refraining from 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 cleanse yourself mentally or spiritually. People who physically humble themselves, cut, burn or whip themselves. In early Christianity, Judaism and Sufism, some believers wore an animal hair shirt that scratched the bare skin.

Initiation rites

In some cultures, painful procedures are used to mark phases of life, for example puberty. Genital mutilation, the removal of the clitoris and foreskin, marks the beginning of adolescence in some cultures in Africa, Arabia and Australia. Even though those affected often voluntarily submit to these files due to their socialization and community pressures, some are forced by their tribe members.

Symptoms of self-harm

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

He or she often knows that he or she is destroying himself with the behavior, but feels that there is currently no alternative to cutting, burning and other acts of physical pain.

Those who injure themselves sometimes pretend accidents to explain the wounds or bruises. Those affected wear clothes that hide their injuries, for example long sleeves even in summer.
They look confused, carry sharp objects in their personal belongings without a reason and look for long phases in which they are alone. Those who wound themselves often also have difficulties working at work or school and have low self-esteem. However, symptom and cause go hand in hand.

The following points are typical for young people who scratch:

1) You usually scratch at home.

2) You use scissors, screws, staples or fingernails

3) They scratch mainly in the forearm and wrist

4) Other young people give them the idea

5) The scratching releases adrenaline and endorphins, those affected feel a feeling of happiness

6) As with other addictions, the longer the last scratch is made, the greater the pressure, and those affected have to cut themselves more and more.

7) Those affected are ashamed of what they do.

Causes

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

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

Scribing is a key symptom of borderline disorder. Such people are emotionally unstable; they cannot stand contradictions and separate the world in black and white, feel empty inside, cannot endure their internal conflicts, idealize or demonize other people, cannot control impulses and lead relationships that are as intense as they are changing.

Social factors favor SVV, particularly among adolescents: those with friends who scratch themselves often imitate their behavior. Scribing often spreads like fashion, comparable to smoking in the toilet. If the adolescents are particularly impulsive, extremely self-critical, associated with a negative self-image or if they are struggling with other mental disorders, then they are very at risk of injuring themselves.

There is also the social environment: a stressful home or the consequences of a trauma can lead a person to harm themselves in order to cope with these experiences.

Warning sign of self-harm

Many people treat their self-harm 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 the secret, but most of the time, friends and family only suspect that something is happening to their family member or have no idea.

Childhood abuse

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

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

We cannot express and deal with our emotions from birth - we learn from our parents, our siblings, friends and teachers - from everyone in our lives. One factor that affects 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 abused homes, they were severely punished for expressing thoughts and feelings that were not wanted. At the same time, they lacked positive roles that they could imitate. Someone cannot learn to deal effectively with stress when growing up with people who cannot.

A history of abuse is common among those affected, but not everyone who scratches has suffered one. Sometimes the devaluation and the lack of role models are enough, especially if the brain chemistry of the affected person sets the course for dealing with problems in this way.

Suicide

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

Affected people are not at risk of committing suicide because, firstly, many of them never try and secondly have no thoughts of suicide. Suicide is a way to end your life, but for many people, self-harm is a way to cope with life and to be able to continue living despite their emotional difficulties.

Sometimes people die as a result of self-harm. This happens, for example, if they cut too deeply and bleed to death before help arrives, or if they poison themselves and take an excessive dose. If you scratch the subcutis, the risk of dying is small.

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

Studies have shown that people who hurt themselves are not only more apathetic than those who are not affected and have less attachment to their families, but are also less afraid of suicide and more willing to try it. It is therefore essential to examine the motivation of those affected to determine whether thoughts of suicide play a role and also to consider the psychiatric symptoms that occur during therapy.

Schizophrenia, psychoses and depression

Schizophrenics hurt themselves, not to consciously punish themselves, but to silence the hallucinal voices that whisper instructions to them. They feel obliged to eliminate these voices, ghosts or demons or are so desperate that they do everything to extinguish the voices. Or they hurt themselves to distract themselves from the voices.

Those affected by this disorder also often delusionally believe that they should hurt themselves - God wills it, or they can stop something terrible, or do it because they think they are possessed by evil spirits.

Similar to schizophrenia, drug-induced psychoses lead to self-harm. Self-mutilation often results from physical illusions, and patients try to remove something from their skin: parasites, worms or demons.

With depression, self-harm is an attempt to regulate negative moods - similar to borderliners. It can also be suicide attempts. In the case of depressed people, the destruction of their own bodies is an expression of nihilistic illusions that suggest that something terrible is happening - 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 rather occurred mainly in major depressions. These usually arise in the third decade of life, last for at least two weeks and are associated with extreme feelings of hopelessness, worthlessness and senselessness.

Borderline personality disorder

This disturbance characterizes unstable relationships, self-images and affects as well as uncontrolled impulses. It usually begins in adolescence or early adulthood. Patients try everything to combat the feeling of abandonment. They express this in a recurring suicidal and / or self-harming behavior. Feelings of emptiness, intense anger, dissociations 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 often comes from the fact that they suffered psychological and / or physical violence as children. Now they maintain the pattern of abuse by repeatedly performing it on their own bodies.

Many of the patients have problems expressing anger in a healthy way. Instead, they hurt themselves so that others feel bad for something they said or did. Borderliners manipulate actively and passively with their own suffering, and that goes as far as repetitive games with suicidal behavior.

Self-punishment and other people's punishment are two main reasons why borderliners hurt themselves. A third is difficult for outsiders to understand: as a result of their trauma, borderliners find it difficult to access their feelings; their emotions and memories are felt as fragments that appear as nightmares during sleep or as irritations when awake; they dissociate and lose their sense of space and time. The wounds make them feel good: The body now produces pain killers called endorphins. These endorphins act similarly to morphine and reduce pain and stress. The emotionally unstable borderliners can control their emotions better and feel better.

One affected person writes about the scratching: “I know that I want it for myself partly because I want to punish myself because I am such a bad person. I need it to show that I'm feeling bad because no one else notices me (whereby I run long sleeves in summer and winter and also with gauntlets) ... Not crazy? ”

Eating disorder

People who suffer from eating disorders are highly susceptible to self-harm: self-harm is one of the symptoms of eating disorders, as is self-induced vomiting or excessive exercise with the intention of causing pain to yourself.

Probably 25% of all people with eating disorders injure themselves, especially those with bulemia. For many of them, self-harm and eating disorders exist side by side, others replace eating disorders with scratches. If someone tries to change their behavior without being psychologically ready (for example, to please someone else), then another self-destruction easily takes the place. This is because this behavior serves the individual to cope with, switch off and avert intense feelings - anger, shame, sadness, loneliness or guilt. Those affected must first be able to name these feelings and find ways to deal with them that lead them out of the circle of self-harm.

For some people, self-mutilation and eating disorders are a form of punishment and express hatred of your own body. If someone has a bad self-image and suffers from an eating disorder, then that person loses his feeling for himself, which leads to a lack of respect for his body. That opens the door to self-mutilation. In the world of someone with an eating disorder, particularly in a form based on routine and control, self-harm can also become a ritual of punishment for not adhering to the self-imposed rules.

Cracks, borderline and eating disorders cannot be strictly separated. As one affected person, who suffers from borderline syndrome writes: “I've been scratching myself with a few breaks for ten years now and partly causing myself burns. If I don't do SV V, I drink or I don't have my eating behavior under control, but I always harm myself, no matter how long I can't hurt myself, it always happens and I start all over again. I don't fight it anymore, but I would still like to get rid of the tension that the SVV triggers - just how? No relaxation exercise has helped so far, and until now, skills have only made me angry, which ultimately made the SVV worse. ”

Alcoholism

Alcohol abuse is not primarily an individual or psychological phenomenon, but rather a sociological one that goes hand in hand with psychological structures that also apply to suicidality. The relationship between alcoholism and self-destruction is complex and differs between genders, cultures and countries.

Problematic alcohol consumption puts a strain on social relationships and family life and means risks not only for the individual but also for relationship conflicts and family destruction.

Alcohol often leads to a long-term risk of self-harm, for example through 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-harm or suicide can end an alcoholic career, but a significant number of alcoholics use self-harm to escape the negative effects of alcohol.

Conversely, alcohol intoxication is dangerous for people who are already scratching because they can lose control over the depth of the cuts. One affected person reports: “.. when I was drunk at a party, I scratched very badly, so that my entire left leg was drenched with blood. It is well known that alcohol in the blood no longer has all of the senses. so I also believe that you can’t control the scratching anymore. I am less sensitive to pain with alcohol in the blood. Alcohol and scratching is a dangerous thing. ”

Another writes: “Alcohol is numb, so when I drink alcohol I have no more control over the scratching - it's like a dream. I can't remember pain, just blood, blood everywhere. ”

Alcohol increases feelings, especially negative ones after heavy consumption. For someone who hurts themselves to escape the stressful emotions, this has fatal consequences. One of those affected writes: “If I am drunk and let myself fall on my bed, I will become so depressed that I would like to kill myself! Lately, it almost happened because of that shit of alcohol! I only have a third of my really thick scars from alk! So if you drink and come home, then bring yourself to safety by including everything beforehand. ”

Treatment

Treatment promises little success if those affected simply replace self-harming behavior or scratching with another. Then they are sometimes even worse. One affected person writes: “If I replace cutting with alcohol, food or the like, I feel even more shit because it is a relocation for me, but unfortunately not the solution to the basic problem. I actually only take psychiatric drugs if there is no other way, they only trigger side effects, and some of them are not without. I sometimes feel like I am at the mercy of the tension that leads to the SVV. Sometimes I can postpone the whole thing, but after a few hours it doesn't work anymore. My thoughts then only circle around it, and I can only continue normally when the tension is gone. ”

Those affected themselves suggest the following alternatives to scratching:

  • walk through nettles
  • listen to music
  • Write down feelings
  • To draw
  • write a letter to the person who is causing the suffering
  • Let ice cubes melt in your hand
  • Let cold water run down your 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 to avoid cutting

    • hitting pillows,
    • phone or chat,
    • talk to someone about it,
    • cry when you can
    • sleep,
    • To do sports,
    • tie a rubber band around your arm,
    • sing out loud
    • scream out loud,
    • bite into a pillow,
    • to take a cold shower,
    • Meet friends,
    • Play video game - move the apartment around
    • tear up a newspaper,
    • work in the garden,
    • throw a stick on the wall.

    Even hurtful behavior is often difficult to identify, diagnose and treat. It often shows a mental disorder behind it - but it doesn't have to be. If cracks are paired with addictive behavior, it is even more difficult to treat. Those affected then need special therapy that addresses both problems at the same time.

    Psychotherapy

    Scoring is associated with low self-esteem, self-loathing and inadequacy. A psychotherapist who specializes 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.

    The therapist can also perform mindfulness exercises with those affected, and meditation as well as creative expression can help patients cope with exciting situations in the future without feeling the impulse to cut themselves.

    Dialectical Behavior Therapy (DBT)

    Dialectical behavior therapy, the dialectical behavior therapy developed Dr. Marsha Linehan in the 1970s to treat adult borderline disorder.

    So DBT serves to help with extreme emotional instability - the inability to manage intense emotions. This lack of control leads to self-destruction and self-harm. DBT teaches techniques to understand these emotions without judging them, which also gives the tools to change behavior in a way that improves the lives of the sick. However, this requires the willingness of those affected and is a long and hard road.

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

    Medication

    Psychiatric meditation for SVV is unusual, but people who scratch often need medication for comorbidities like depression or bipolarity. If the affected person has no further disorders, medication is not recommended because it hides feelings that people have to deal with in order to stop self-harm.

    Family therapy

    Almost all people who scratch themselves, especially teenagers, turn away from friends and family, but at the same time reveal themselves to them first. Then they look for help on the Internet. The next address is psychologists.

    It is crucial for relatives to make it clear that the person who scratches himself has remained the same person and that the scratching is not the focus of discussions with him. Parents are well advised to treat him as "normal", so neither introduce additional constraints that do not stop the scratching anyway, but also do not treat him like a raw egg. Relatives should not let the SVV into their lives. This behavior has enormous emotional power, and the family should block here.

    Family therapies are designed to help patients and their families understand how scratching affects all family dynamics. The therapy also serves to educate the family about SVV and to show them ways how they can best deal with it.

    It becomes more difficult when the family itself triggers the disorder. Cold-hearted mothers, beating fathers, an education that constantly blames the child for everything, substance abuse and a lack of communication are core factors that lead to scratching. Unfortunately, such parents are rarely willing to admit their mistakes. Relatives can find help, for example, on the website www.rotellinien.de or www.svv-community.net
    (Somayeh Khaleseh Ranjbar, translated and supplemented by Dr. Utz Anhalt)

    Author and source information

    This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

    Dr. phil. Utz Anhalt, Barbara Schindewolf-Lensch

    Swell:

    • The online family handbook is published by the State Institute for Early Education (IFP): www.familien Handbuch.de (accessed: August 17, 2019), Ritzen - why does my child hurt itself?
    • Paul L. Plener; Thorsten Sukale; Rebecca C. Groschwitz; Emanuel Pavlic; Jörg M. Fegert: "Rocking instead of scratching", in: Psychotherapist, Volume 56 Issue 1, 2014, Springer Link
    • Franz Petermann; Dennis Nitkowski: "Self-harming behavior: characteristics, diagnostics and risk factors", in: Psychotherapy, Psychosomatics and Medical Psychology, Volume 61 Issue 1, 2011, Thieme Connect
    • Kathleen Seifert: scratching as a problem of self-injurious behavior in girls in adolescence. Limits and Possibilities of School Intervention, Grin Verlag, 2005
    • Ulrich Sachsse: Self-harming behavior, Vandenhoeck & Ruprecht, 2008
    • Franz Petermann; Sandra Winkel: Self-harming behavior: manifestations, causes and possibilities for intervention, Hogrefe Verlag, 2005


Video: Introduction to Anatomy of the Shoulder and Common Causes of Shoulder Pain: David Epstein, MD (May 2022).


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