How do I stop beating myself

Young, injured - and tired of life?

Nearly every fifth young person has already intentionally inflicted injuries on himself, for example with razor blades or cigarettes. Are these boys and girls suicidal? In most cases not, says our author. Psychological help should use them anyway.

Text: Joana Straub
Pictures: Getty Images

A teacher called me last month. She no longer knew what to do: she had a student who had been regularly on her forearm with a for a good year and a half razor bladechink. 15-year-old Pia * kept the injuries secret for a long time by always wearing long sleeves. But one day a schoolmate discovered the wounds in the locker room before physical education class and turned to the teacher with concern, asking if she could help Pia.

The teacher immediately sought a conversation with the girl, had the injuries shown and asked why. Pia explained: "By hurting myself, I can better deal with negative feelings and inner tension. " She didn't want to tell more. The teacher feared that Pia could cut herself so deep that she would die in the process.

It is a typical situation in many ways. According to international surveys, the majority of educationalists and school social workers feel insecure when dealing with young people who injure themselves. Mostly they react with horror, often with compassion and sympathy, but sometimes also with aversion, disgust and incomprehension.

Many wonder whether the self-harm is an indication of an impending suicide. According to their own statements, they often do not know how best to get into conversation with the young people and how to support them. Only in the rarest of cases do members of the professions mentioned have one concrete training for dealing with such children. Almost all of them come into contact with those affected at some point.

Self-injurious behavior in adolescence is a quite a common phenomenon. Worldwide, 18 percent of under 19-year-olds, i.e. almost one in five, report having deliberately inflicted physical harm on themselves at least once in the past year. This is done much less regularly. In Germany, around four percent of young people said they had repeatedly injured themselves in the past twelve months (for the situation in Switzerland, see the interview with Marc Schmid). For example, they use razor blades or cigarettes or spray the skin very closely with a deodorant spray, which can lead to cold burns. Some boys also say that they hit a wall with their hand until it bleeds and then feel relief. However, behind all of these behaviors there is no intention of killing yourself - the technical term is therefore: non-suicidal self-harming behavior, or NSSV for short.

Thoughts of suicide are common

The trust teacher's fear that Pia might commit suicide cannot be dismissed lightly: young people are far more concerned with the thought than one might assume. In a comparative study in 17 European countries from 2012, every third student in Germany stated that they had already thought about suicide at least once. Around a third of this group, in turn, talked about concrete plans to put an end to their own lives. Around two thirds of them try to put this into practice.

Boys report that they hit a wall with their hand until it bleeds - and then feel relief.

It actually represents suicide the second leading cause of death in adolescents with four times more boys than girls taking their own lives. But how are self-harming behavior and suicide related? According to studies, the majority of those who harm themselves are not suicidal. It is true that if it happens repeatedly, the NSSV a risk factor for attempted suicide. But experts see it primarily as one Coping strategythat makes it possible to better deal with negative emotions such as stress and inner tension. Only a fraction of those affected say that it helps them to distract themselves from suicidal thoughts. However, if a student is injured more deeply and in more unusual places (such as the trunk), the risk of suicide appears to be greater. The constant injuries increase the pain threshold over time and thus the risk of life-threatening self-harm.

There are many likes for pictures of scratches

In any case, the young people need psychological help. But how can educators even recognize affected students? Most self-harming children, like Pia, do so for the first time around the age of 13-14. From the age of around 17, the numbers decline, as a study published in 2015 by researchers led by Paul Plener from Ulm University Hospital showed. Inexplicable scratches and wounds as well as inappropriate clothing - for example long sleeves in summer - can be clues.

Occasionally, teachers can also find sharp objects such as razor blades and knives, or they notice that a student often withdraws from everyday school life and disappears again and again into the toilet. Some young people also produce clear texts or drawings. And it is not uncommon for NSSV to spread like an epidemic among friends: As the team around Paul Plener observed in 2016, those affected reap for their in social networks posted pictures of scratches many likes and sympathy.

The non-suicidal hurtful behavior is primarily a possibility for the young person Stress reduction. Ideally, as a helper you shouldn't react in shock or panic, but rather approach the student calmly and compassionately, in the spirit of a respectful curiosity. Be sure to make the student feel that you value them as a person, even if you don't approve of the scratching yourself. In conversation, it helps to adapt to the young person's expressions by taking on board their choice of words. The tutor Pia could ask: "How does it help you when you hurt yourself?"

In addition, she should make it clear to the girl that other people - such as her classmates - care for her. Without putting her under pressure, the teacher should emphasize that Pia is from another side support expect: "I may not be the one you want to talk to, but I can help you find someone." If the girl declines to speak to a child and adolescent psychotherapist, the teacher could call in a school psychologist or social worker who is familiar with the method of "Therapeutic assessment" is trained. These are special ones Conversation Techniqueson the one hand to determine whether there is a need for treatment and on the other to help motivate those affected to seek therapy. It is also advisable not to pay too much attention to the scratching itself, as this may reinforce the behavior. The teacher should also ask Pia to keep the injuries covered and not to discuss them with classmates.

Reduction of bad feelings

The concrete risk of suicide it is not easy to assess. Many young people who harm themselves report problems within the family such as a divorce between their parents, anger among friends and bullying, lovesickness or school difficulties.

Psychological stress triggers strong feelings such as sadness, anger and excitement. Most self-harming adolescents, like Pia, say it helps them, such reduce bad feelings. Some want to punish themselves or they hope that others will see their plight and stand by them. Some also report that only the pain enables them to feel themselves or their own limits. Less often do they explain that they are looking for that "Kick" - which in the end is often an attempt to escape a feeling of inner emptiness or numbness.

Students who are tired of life often suffer from excessive demands

If one compares the data collected in various studies on NSSV with those of adolescents at risk of suicide, parallels can be seen. “Tired of life” pupils feel even more often and to a greater extent confronted with a multitude of stresses that they cannot cope with on their own. Around 90 percent of those who do actually commit suicide have had one before diagnosed mental disorder

Some want themselves
punish, others hope that their plight will be recognized and supported.

The risk of suicide increases when a young person feels socially isolated because they have no friends or other people they can trust, or when they are troubled by a serious event such as the death of a loved one. Likewise, a suicide or mental illness in one's own family seems to increase the risk.

The supervisor asked Pia during the next interview: «You said that scratching helps you to deal with negative feelings. Do you have any ideas what might trigger this? " It turned out that Pia had been arguing with her mother a lot more since her father moved out two years ago. She also said that she don't have a really good girlfriend and therefore often feel very lonely. The teacher advises Pia to entrust herself to a child and adolescent psychotherapist. This could also give her better advice on how to deal with classmates, teachers and parents.

When is the risk of suicide increased?

According to studies, the risk of suicide is increased when adolescents report persistent, hardly controllable thoughts of harming themselves and express a strong desire to die themselves. The same applies if a suicide attempt has already taken place in the past or if the person concerned has forged corresponding plans earlier or is currently doing so. The rule here is: If he considers the other person to be suicidal, the therapist should ask about it directly.

You might think that asking a young person about suicidal thoughts is what gives them the idea. However, this fear has been dispelled in controlled studies such as that by Madelyn Gould and colleagues at Columbia University on more than 2,300 students. Boys and girls who were questioned in detail about suicidal ideation were no longer concerned with it two days later. On the contrary: Adolescents with depressive symptoms or suicidal ideas - classified as high-risk persons - actually felt better psychologically afterwards.

Determine the risk of suicide

A psychotherapist could ask Pia: "Does everything get too much for you every now and then, so that you sometimes thought it might be better not to be alive?" And should the girl answer in the affirmative, she should ask: "Have you ever thought about how you would do that in concrete terms?" Or: "Have you already tried to take your life?" The more openly, calmly and naturally you ask about these aspects, the higher the probability that the person concerned will honestly answers and opens accordingly. Many young people report that in retrospect they felt primarily relieved by such questions.

The concern that the question of suicidal ideation will give a young person the idea is unfounded.

By taking all of these factors into account, it is possible to determine whether the risk of suicide is low, medium or high. The assessment However, specialists such as licensed child and adolescent psychotherapists or child and adolescent psychiatrists must carry out the work. When there is a high risk of suicide, there is usually both acute stressors and a mental disorder that requires treatment. In this case, the therapy may have to take place in a child and adolescent psychiatric clinic. If, on the other hand, the young person credibly insures that he will not harm himself, he or she can be treated on an outpatient basis, for example in a practice for child and youth psychotherapy or psychiatry.

The trust teacher managed to convince Pia that she needs the support of other people and especially her parents. With the girl's consent, she therefore holds talks with the mother and father. In it, she explains that Pia still feels very burdened by their separation, especially when they carry out their disagreements about their daughter. Together with her mother, Pia finally decides to meet with a child and adolescent psychotherapist on a trial basis. This sees no acute risk of suicide. Pia likes the therapist and so she agrees to visit her once a week.

Pia's readiness for therapy is not an exceptional stroke of luck. According to surveys, around half of those who harm themselves actually want to give up the behavior - so offers of help should fall on fertile ground with them. The individual triggers are identified during therapy. For example, if a student reports bullying, this problem would again have to be tackled together with the teachers. However, because of the “risk of infection”, the NSSV itself should never be discussed in front of the class. Class-level interventions should only address more general issues such as: "How do I deal with stress and strain?"

Frequent relapses

In the next step, the therapist and the adolescent can consider which so-called Skills he or she could use instead of self-harming behavior. These are skills that are effective in the short term without causing harm in the long term. These include mindfulness exercises, relaxation techniques such as autogenic training, distraction - listening to music, jogging, playing the Playstation - and sometimes something like biting into a chilli pepper when an intense stimulus is required.

Around half of those who harm themselves actually want to give up the behavior.

Because everyone responds differently to the various skills, a few variants often have to be tried out before the right one is found. Relapses occur more frequently, especially in difficult times, which should not demotivate helpers or those affected. Rather, it is more important to take a close look at the triggers together and consider how the young person will react differently and which alternative coping strategy he could try next time.

For example, Pia comes with the Relaxation exercises not right, she just can't get rid of her negative thoughts. As she is athletic, the therapist advises her to put on her jogging shoes after a stressful argument at home and "run the rage off her mind". Studies have long shown that this recommendation also makes sense from a medical point of view: after a short time, physical activity sets processes in motion in the body that improve mood.

* Name changed.

This article first appeared in the magazine “Brain + Spirit”.

Self-harm - what to do? A quick guide for educators

  • If the wounds are fresh, seek medical care first.
  • Don't be shocked. The self-harm is usually not a suicide attempt, but a short-term effective coping strategy against mental pain.
  • Connect with the young person: listen, take their feelings seriously, express appreciation for them as a person, not patronize or evaluate their behavior. Do not promise absolute secrecy.
  • In no case ask the student to stop self-harming behavior immediately, as this could overwhelm them.
  • Build hope for emotional support, offer help in finding a therapist.
  • Consult a school psychologist, social worker, or other professionals.
  • See books for advice, e. B. in: Tina In-Albon et al., Self-harming behavior. Hogrefe 2015.

"Parents are not allowed to look the other way"

Self-harming behavior always has one root cause and should addressed says Marc Schmid, senior psychologist in the child and adolescent psychiatric research department at UPK Basel.

Interview: Evelin Hartmann

Mr Schmid, how many young people in Switzerland show self-harm

We investigated this in the child and adolescent psychiatric research department at UPK Basel. There are many young people here who say that they have injured themselves before. About 4.5 percent did this at least four times in the past six months. In child and adolescent psychiatric clinics it is as much as 50 percent and in adolescents who live in socio-educational residential groups, 38 percent.

What is the function of this behavior?

The most common cause of self-harm is the ending of intense tension, uncomfortable feelings or circling around negative, stressful thoughts. Severe states of tension are also associated with a loss of body awareness. With the help of self-harm, those affected feel themselves again and calm down.

It is known that girls are affected more often than boys. Which age group is particularly at risk?

Self-harm usually begins after puberty and usually only after the first menstruation. In this phase of life, difficulties often arise with the regulation of emotions, the body feeling and one's own body structure change. In addition, self-esteem is more unstable in this development phase and critical self-evaluation processes occur more frequently. Contact with people of the same age is very important at this age. The feeling of rejection by other people has been identified in several studies as a trigger for self-harm. In addition, adolescents and young adults are much more susceptible to group dynamics.

Does that mean that some learn self-harming behavior from others?

So to speak. However, it is important to understand that no young person simply hurts himself because others are doing the same, but that behind it there are very central needs such as belonging. For overcoming self-harming behavior, it is much better to work out these needs and take care of them.

Which factors increasingly lead to self-harm?

Risk factors are stress in the family, stressful life experiences, little social contact in the class. Factors that protect against self-harming behavior, on the other hand, are good social integration, positive leisure activities, especially involvement in sports clubs or music groups. These all seem to be protective factors. Good self-esteem and a high expectation of self-efficacy, i.e. the belief that you can solve problems, are also associated with a lower risk of self-harm.

How do I, as a mother or father, know whether my child is at risk?

Parents should worry if their child withdraws a lot, often appears depressed and irritable, loses interest in hobbies, withdraws from friends and avoids the parents. One should listen carefully if it repeatedly devalues ​​itself and expresses itself negatively. Of course, it is also very noticeable when young people only wear long-sleeved clothes in midsummer and avoid seeing legs and arms by, for example, no longer going swimming.

How should parents react when they observe this behavior or even discover injuries in their child?

It is very important not to look away and not to pretend not to notice anything. It is also important not to reproach the child, but to express their concern, to stick with it, to make and maintain an offer of a relationship, even if the person concerned cannot accept it immediately.

However, clearing away dangerous objects such as knives or scissors is not very promising. Affected teenagers always find something to hurt themselves with if they really want to. It is much better to make binding agreements with the person concerned about what to do when the tension and the scratching pressure increase, and to offer help.

As a mother or father, when should I seek professional help? What could this look like?

It is certainly good to motivate young people who have injured themselves more than once to seek professional help. In this conversation, it makes sense to emphasize that you are concerned and want him or her to get help and to accompany the search for help as a parent with the necessary presence. All successful therapies, regardless of the therapeutic school, have in common that they start with the self-perception of feelings and interaction patterns and help adolescents to better perceive their feelings and needs and to express themselves better even in difficult social interactions.

Read more about psychological problems in adolescents:

  • Depressed or not in the mood?
    The puberty is a time of change. Mental illness like depression occur more frequently. On which first signs should parents pay attention to?
  • When teenagers think about suicides. Call two to three teenagers who are suicidal Every day at the Pro Juventute emergency number 147. What drives adolescents to kill themselves? And how can suicides be prevented?
  • Back to life through the clinic. If a child suffers from mental disorders, often only treatment in a protected setting will help. The Clienia Littenheid is a private clinic for psychiatry and psychotherapy. She is taking care of Young people who have lost their emotional balance to have.