Table of Contents
- What is Non-Destructive Self-Inflicting Damage (NDSID)?
- How do youth engage in self-damaging acts?
- How widespread is self-damaging behavior?
- What are the causes of NDSID?
- What triggers self-damaging behavior in youth?
- Why do wounds escalate in severity and intensity?
- Does self-damaging behavior impact the daily lives of young people?
- What role does social media play in the emergence of NDSID?
- How can NDSID be identified?
- Why should self-damaging behavior be addressed promptly?
- What steps to take if one suspects someone is engaging in self-damaging behavior?
- What treatment options are available for NDSID?
- What changes should parents make in the external environment?
- Parental Guidance when a Child Self-Harms: Proper Actions and Missteps to Avoid
Initial self-damaging acts often begin mildly: Knotting a shoelace around a finger to cut off circulation, causing it to turn white. Burning hair with a lighter or pulling out a few strands. For many young people in Germany, this form of self-harm happens at least once in their lives. However, for some, it evolves into a persistent problem. Wounds become more severe, pain more intense, and scars form. Sometimes, these injuries can even be life-threatening.
What is Non-Destructive Self-Inflicting Damage (NDSID)?
|"Young people generally do not aim to end their lives; instead, they use pain as a coping mechanism for emotional and physical stress," says Simone Pfeuffer, Chief Physician for Child and Adolescent Psychiatry and Psychotherapy at Schoen Clinic Roseneck in Prien am Chiemsee. Medical professionals refer to this behavior as Non-Destructive Self-Inflicting Damage (NDSID, or Non-Destructive Self-Inflicting Damage in English). It is typically a symptom of an emotion regulation disorder and not a disease, but rather an indication of an underlying psychological disorder (such as anxiety disorders, depression, eating disorders, or emotional instability personality disorder). Only rarely does self-damaging behavior occur in isolation.
Emotion
Emotion |NDSID is a relatively common but severe issue, primarily affecting young people and young adults. Between the ages of 15 and 16, the risk is highest. And interestingly, it appears to be a "German issue," with Germany leading compared to other European countries.
Auslöser
Trigger |How do youth engage in self-damaging acts?
Handlungsimpuls
Action urge |Initially, self-damaging acts are usually harmless: Youth bite their arms, scratch themselves with scissors and knives, pull out individual hairs, or repeatedly pick at their nail beds. Over time, the self-damaging acts can become more severe: Teenagers cut themselves with razor blades on their arms, legs, and stomachs, burn themselves with cigarettes or lighters, or scald themselves with boiling water. "Boys and young men often use so-called masculine self-damaging techniques: They hit themselves or bang their heads against the wall," says Simone Pfeuffer. Sometimes doctors even witness that those affected consume corrosive liquids or continue to scratch at already healed wounds until they become inflamed.
Entgegengesetztes Verhalten
Opposite behavior |How common is self-damaging behavior?
Evidence |Taking a survey of students, 25 to 35 percent reported having experienced self-damaging behavior, with 12 percent frequently cutting or burning themselves. "Girls are 1.5 times more likely to be affected," says Simone Pfeuffer. "However, the prevalence of self-damaging behavior is also increasing among boys." Adults, on the other hand, seem to rarely engage in cutting, hitting, or burning themselves – in a sample, only 0.3 percent reported participating in self-damaging behavior.
Ärger
Anger |What are the reasons for NDSID?
Grenzüberschreitung
Exceeding Limits |Self-damaging acts often provide relief for those affected, helping them deal with negative emotions. Self-damaging acts serve as a sort of drug, providing a high, as it temporarily distracts from psychological problems and releases endorphins, happy hormones. "Cutting and burning provide temporary relief and allow individuals to feel pain more intensely," explains child and adolescent psychiatrist Simone Pfeuffer. "Moreover, those affected feel they regain control over their body." Some describe cutting, picking, hitting as "calming" and "liberating." However, this does not change the underlying issue.
Angriff
Motivation |What are the reasons for NDSID?
Situation verlassen
Escape |The causes of NDSID are complex, often stemming from difficulty regulating emotions. Self-damaging acts are a cry for help, a way for adolescents to relieve significant psychological pressure. Often, past traumas in childhood are the root cause:
|* Conflicts in childhood and adolescence* Sexual abuse* Physical abuse* Neglect* Psychological problems such as borderline disorder, depression, anxiety, or eating disorders
Angst
Fear |Risk factors also include having alcoholic parents, untreated ADHD, excessive self-criticism, lack of structure, and being conscientious. Many keep their NDSID hidden, engaging in self-damaging acts in places that can't be seen or by wearing long sleeves. Those affected often feel they deserve the self-damaging acts and can only free themselves from their mental anguish through self-damaging behavior.
Bedrohung
Threat |Why do self-damaging acts become more severe and extreme?
Flucht
Struggle not all individuals intensify their wounds. "Usually, it's just a plea for aid: See me, I'm struggling," explains specialist Pfeuffer. "But sometimes, it escalates without mental health treatment." The reason: The body is accustomed to certain wounds and pain, so the affected individuals no longer view them as something "out of the ordinary" or "liberating." Therefore, cuts worsen, injury methods grow more extreme, and the desire to self-harm increases.
Konfrontation
Conflict |Does self-harm impact the daily life of adolescents?
The urge to self-harm often takes over. Over time, it's often seen as the only way out of a hard situation. "Those affected often lose the ability to manage difficult situations or deal with them in other ways – such as through relaxing activities like a walk, meditation, or sports," says expert Pfeuffer. "Self-harm is seen as the only solution, and those affected also avoid an important confrontation with the underlying issue."
Trauer
Grief |In real life and on social media, friend circles can mainly "infect" - bring youth with non-suicidal self-injurious behavior into contact. "Whether someone continues depends on self-esteem or the psyche," says Simone Pfeuffer. Certain youth groups also seem to self-harm more frequently.
Verlust
Retreat |How can non-suicidal self-injurious behavior be recognized?
Rückzug, Trost suchen
Typically, there are numerous injuries on one body part, such as the arms, legs, chest, or abdomen. The scars align, sometimes in geometric shapes, letters, or even words. However, adolescents are usually excellent at concealing the scars. Therefore, family members or friends should be extremely observant and look out for specific signs:
Aktivität, Ablenkung
Activity, Distraction |* The teenager wears long sleeves and long pants even in summer and ensures they don't ride up.* They spend a lot of time in the bathroom and disengage from other activities: they no longer want to pursue hobbies and also don't want to join family vacations.* They don't want to show their naked body and don't go swimming or to the beach.* In their room, they hide disinfectants, bandages, and other first aid materials. There might also be objects used for self-harm: lighters, knives, candles, razor blades.* If an outsider discovers the cuts, the affected person cannot rationalize them properly.
|Why should self-harm be treated quickly?
Scham
For parents or friends, it's often challenging to recognize non-suicidal self-injurious behavior because adolescents feel ashamed and hide the signs of injury. Usually, it stays that way, with youth trying self-harm once. "However, self-harm can become ingrained and worsen over time, so it's crucial to react early," says psychiatrist Pfeuffer. "Then, healthier coping mechanisms can be learned to alleviate negative feelings." Also, there's usually an underlying mental health issue that needs treatment.
Makel
Scars |How should one react if they suspect someone is self-harming?
Im Erdboden versinken
Even if it's a shock for parents to discover their child is self-harming, it's important to stay calm and not panic. "The key is to stay in contact with the child and maintain that connection," says psychiatrist Simone Pfeuffer.
Sich zeigen
Showing Up |* Approach your child carefully in a quiet moment and express your suspicion that they are self-harming.* Avoid making accusations or applying pressure.* Don't set an ultimatum to stop self-harming; instead, offer your support and show your love.* Make it clear that you understand the situation and that help is always available: "We can get through this, I'm here to help!"* If your child doesn't want to talk about self-harm with you, don't be disappointed or make accusations. Instead, suggest other sources of support: friends, counseling services, psychologists or psychiatrists, a chosen clinic. Often, it's easier to open up to strangers.* Don't blame yourself; you haven't done anything wrong if your child is self-harming - but support them in their journey to treat the underlying mental health issue.
Treatment Options |What treatment options are available for non-suicidal self-injurious behavior?
A child and adolescent psychiatrist or psychotherapist can intervene effectively at an early stage. After an extensive intake conversation, they can treat various psychological disorders with different therapeutic measures. "Cognitive behavioral therapy is particularly effective, providing adolescents with new coping strategies for stressful situations to better control their emotions," says Pfeuffer from Schoen Clinic Roseneck.
In a so-called skills training, those affected learn strategies that help regulate feelings in highly tense and emotional situations, but do not cause harm. Skills work on different levels (source: Psychotherapeutic Consultation Center Mainz):
Behavioral Skills for Impulses
- Physical distraction: Exercise, craft, write, play an instrument, etc.
- Opposite behavior: Show behavior opposite to the original action impulse to reduce emotional response
Physical Skills for Strong Physical Responses
- Intense sensory experiences: such as taking a cold shower, munching on spicy peppers, savoring sour candies or fizzy vitamin tablets, squeezing a stress ball, or snapping a rubber band on your wrist
- Physical activity: like jogging, climbing stairs, swimming, chopping wood, hitting a punching bag, or tearing paper
- Relaxation methods: like visualization exercises, mindfulness, muscle tension release, deep breathing routines, and sauna sessions
Cognitive Strategies for Negative Thinking
- Diverting attention: through brain teasers, guessing games like "20 questions," or counting backwards in sevens
- Thought disruption: by interrupting negative thought patterns with the phrase "HALT" and shifting focus to something else, or switching to a different task
- Designated worrying time: allocating a specific period each day (about 30 minutes) in a peaceful setting (like a quiet room) to productively analyze thoughts
The Westphalia Clinic proposes assembling an emergency pack. Components: a stress ball, spicy peppers for chewing, Fisherman's Friend lozenges, an awareness audio CD, and an essential phone number to contact during emergencies, which may be a friend or a crisis counseling service, such as the "Number against Sadness."
What modifications should parents consider in external circumstances?
Bullying in school or at work is a prevalent cause of NSSV, and transferring to a new school or job might be a solution. If the home environment is perceived as stressful, family counseling can be beneficial. During therapy, individuals learn to identify triggers and manage them promptly. This skill can be extensively worked on in a day clinic like the Schoen-Klinik Roseneck on Chiemsee, but spots are limited and waitlists are long. Relaxation techniques like yoga, deep breathing, and progressive muscle relaxation also reduce stress levels. In severe cases exposed to an underlying mental health issue, psychotropic medications can also prove effective. To decrease the embarrassment from scars, these can be minimized using topical scar creams, laser therapy, dermabrasion (removing the skin's surface layer), or micro-needling (introducing small needles into the skin's surface layer).
The intense pain and severe wounds from self-harming behaviors can sometimes be life-threatening. This escalation in severity and intensity often indicates a persistent problem, as previously harmless acts become more extreme over time.
Often, past traumas such as physical or sexual abuse, neglect, or psychological problems are the root causes of self-damaging behaviors. These experiences can lead to difficulty regulating emotions and a cry for help.
