Self-damage is defined as intentional injury of the own body. Patients with this disorder often consult and deceive surgeons. In case of factitious disease the diagnosis of self-injurious behavior can be difficult.A literature review on self-injuring behavior was done with special emphasis on its clinical presentation in surgical departments, its psychodynamic background and the therapeutic consequences.Self-damaging behavior is most frequent in adolescent females. Both a disturbed relation with the own body and with fellow-beings is the problem of all patients. Deprivation, physical or sexual abuse are common in the biography of these patients. The feelings of internal emptiness and unbearable psychic tension are the immediate psychodynamic causes of the self-damaging act. Psychotherapeutic strategies are aimed at learning to express emotions in a better way, to care for the own body, and to establish confidential and stable relationships.The knowledge of the psychodynamic background facilitates the therapeutic approach to patients with self-injuring behavior.