Nicht-suizidales selbstverletzendes Verhalten – Einblicke in ein wenig bekanntes plastisch-chirurgisches Patient*innenkollektiv

Zusammenfassung

Hintergrund und Fragestellung Nicht-suizidales selbstverletzendes Verhalten (NSSV) ist trotz einer hohen Prävalenz bei Jugendlichen und jungen Erwachsenen ein außerhalb der Psychiatrie nur wenig bekanntes Krankheitsbild. Auch aus diesem Unwissen heraus erfahren Betroffene von medizinischem Fachpersonal oft Unverständnis für ihr Handeln, Ablehnung und Diskriminierung. Dies behindert einen dauerhaften Abschluss mit dem selbstverletzenden Verhalten und den Aufbau einer von Vertrauen geprägten Arzt-Patienten-Beziehung und kann zu einer erneuten Traumatisierung der Betroffenen führen. Wir möchten mit dieser Arbeit interessierte plastisch-chirurgischen Kolleg*innen anhand unseres Patient*innenkollektivs über das Krankheitsbild des NSSV informieren und damit eine Hilfestellung für den Umgang mit betroffenen Patient*innen geben.

Patienten und Methoden Von 600 Patient*innen mit Narben aus NSSV aus unserer plastisch-chirurgischen Narbenspezialsprechstunde der letzten 5 Jahren wurden die erhobenen Daten bei Erstvorstellung ausgewertet und mit der aktuellen Literatur verglichen.

Ergebnisse 95 % der Patient*innen waren weiblich, 5 % männlich. Im Mittel waren 8,4 Jahre zwischen letzter Selbstverletzung und Erstvorstellung in unserer Sprechstunde vergangen, die Patient*innen waren bei Erstvorstellung im Mittel 26 Jahre alt. Am häufigsten war durch NSSV-Narben der linke Unterarm (48 %) betroffen, gefolgt von beiden Unterarmen (40 %), dem linken Oberarm (20 %), beiden Oberarmen (15 %) und beiden Oberschenkeln (14 %). Bei 57 % der Patient*innen war dabei nur eine Körperregion betroffen. Die von NSSV-Narben insgesamt betroffene Körperoberfläche betrug im Mittel 380 cm² mit hohen Schwankungen. Häufige Nebendiagnosen waren Schilddrüsenfehlfunktionen und Depressionen. 21 % der Patient*innen befanden sich zum Zeitpunkt der Erstvorstellung in psychiatrischer, psychologischer oder psychotherapeutischer Behandlung.

Schlussfolgerung Unsere hier gezeigten Daten geben Einblick in ein großes Kollektiv von Patient*innen mit Narben aus NSSV, die sich zur Korrektur derselben in unserer plastisch-chirurgischen Spezialsprechstunde vorstellten. Die Patient*innen waren meist weiblich, die Narben am häufigsten an den Unterarmen lokalisiert und das letzte NSSV im Mittel mehr als 8 Jahre vergangen. Unsere Daten sollen einen faktenbasierten Zugang zu einer Gruppe von Patient*innen ermöglichen, mit einem in chirurgischen Disziplinen wenig bekannten Krankheitsbild, das aufgrund seiner hohen Prävalenz und lebenslangen Folgen stärker in den Fokus gerückt werden sollte.

Abstract

Background Despite its high prevalence in adolescents and young adults, non-suicidal self-injury (NSSI) is poorly known and understood in areas other than psychiatry. Due to this lack of knowledge, affected patients often face a lack of understanding as well as rejection and discrimination when seeking help from medical professionals. This not only hampers a lasting improvement of NSSI and the development of a trustful physician-patient relationship but may also lead to traumatisation of affected patients. Based on our patients’ data, this article aims to inform interested plastic surgeons about NSSI and thus to support the treatment of affected patients.

Patients and methods 600 patients with scars from NSSI presenting to our outpatient clinic for the first time during the past five years were enrolled in this study. Extensive data collected during the first contact was analysed and compared with the current literature.

Results 95 % of the patients were female; 5 % were male. On average, patients presented 8.4 years after the last NSSI event and with a mean age of 26 years. NSSI scars were most often located on the left forearm (48 %), followed by both forearms (40 %), the left upper arm (20 %), both upper arms (15 %) and both thighs (14 %). In 57 % of patients, scars were only present on one side. A mean of 380 cm2 of the body surface was affected by NSSI scars. 47 % of patients reported having at least one additional diagnosis, with thyroid dysfunction and depression being the most common. 21 % of patients had ongoing psychiatric or psychological therapy at the time of their first consultation in our clinic.

Conclusion Our data provides first insight into a large population of NSSI patients seeking treatment options for their NSSI-associated scars in a plastic surgery outpatient clinic. Most patients were female with scars located on their forearms. A mean of more than 8 years had passed between their last NSSI and their first presentation to our clinic. Our findings offer a data-based approach to a group of patients with a disease pattern that is largely misunderstood in surgical disciplines and needs more attention, especially in the light of its high prevalence and life-long consequences.

Schlüsselwörter

Selbstverletzung - Borderline-Persönlichkeitsstörung - Narben - NSSV - Stigmatisierung

Key words

Scars - borderline personality disorders - NSSI - non-suicidal self-injury - stigmatisation

Publication History

Received: 02 July 2021

Accepted: 18 January 2022

Article published online:
13 April 2022

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