What is cutting?
“Cutting” is one of the most common methods of self-injury. As the name implies, it involves cutting one’s body-usually in places that can’t readily be seen or are easily covered up – with sharp items such as razor blades, knives and scissors.
Self-injury goes by many names including self-mutilation, self-harm, and parasuicide. It is not meant as a suicide attempt although this does accidentally happen on occasion.
Rather, self-injurious behavior is an unhealthy approach to dealing with the pain of strong emotions, intense pressure, or anger and frustration. The mental health profession has only recently discovered that cutting is not a “cry for help” and is not a suicide attempt.
In fact, most cutters are not suicidal and do not want to be found out. That is why they wear long sleeves (so no one will see their wrists) or cut on their upper inner thigh where nobody will look.
Cutting, and other self-injurious behavior like burning oneself with matches, can be dangerous but also can become addictive. It is a self-perpetuating cycle that is hard to break: a teenager feels emotional pain so cuts his or herself, feels release from the tension, followed by negative feelings of guilt or shame, which in turn causes emotional pain and the cycle continues.
With each additional episode, the chances are greater of inflicting serious injury, infection, permanent disfigurement or even death (example: from blood loss if the cutter accidentally cuts a major vessel or artery).
Self-injury is frequently an impulsive act. The person becomes upset and has a sudden, strong urge to hurt herself. Some professionals prefer to view it as an impulse-control behavior problem and tackle treatment accordingly.
Many of the individuals who self-injure do it only a few times and stop. For others, it can become a cycle that leads to compulsive, repetitive behavior as noted in the above paragraph.
Cutting appears to be more prevalent now than it was in the 1990’s. Research at that time suggested rates of 3% or lower. Recent studies, however, have current rates of 20% to 56% depending on the study.
Researchers at Yale University indicated that 56% of girls they interviewed, 10 to 14 years of age, reported injuring themselves-with 36% reporting they had done so in the past year.
Most studies put the figure at approximately 1 in 5 for females (no recent figures were available for males). This self-destructive behavior was previously thought to be more common in females than males, but recent studies refute that and report the behavior affecting both sexes equally.
Adolescents are more prone to cutting themselves although self-injury occurs at all ages.
People with the following disorders have a higher risk factor for self-mutilation: depression, eating disorders, substance abuse, anxiety disorders, post-traumatic stress disorder and borderline personality disorder.
Cutting and other methods of self-injury are often kept secret, so it can be hard to spot these signs or symptoms:
- Scars from burns or cuts
- Fresh cuts, scratches, bruises or other wounds
- Broken bones
- Keeping sharp objects on hand
- Spending a great deal of time alone
- Relationship troubles
- Wearing long sleeves or pants, even in hot weather
- Claiming to have frequent accidents or mishaps
Other forms of self injury
Cutting is the most common form of self-injury, but people who self injure may use more than one method. Other common methods include:
- Severe scratching
- Self-poisoning or overdosing
- Branding; carving words or symbols on the skin
- Breaking bones (using a hammer or similar object)
- Hitting or punching
- Piercing or stabbing the skin with sharp objects
- Head banging
- Pulling out hair
- Interfering with wound healing (re-cutting or picking at scabs)
What causes them to do it?
Self-injury is an unhealthy coping mechanism in response to strong painful emotions, intense pressure or upsetting relationship problems. There are countless reasons behind this self-destructive behavior.
They may not have developed healthier ways to cope or their coping skills are overpowered by emotions that are too intense. If emotions aren’t expressed in a healthy way, they tend to build up creating extreme tension.
Cutting may relieve that tension, even if it is temporary. For others, cutting seems like a way of feeling in control in situations that are otherwise uncontrollable.
Cutting can be triggered by strong feelings that the person is unable to cope with like anger, hurt, shame, frustration or alienation. A cutter may engage in self-injury to find relief from the pain of a relationship break-up or to alleviate feelings of rejection.
Sometimes cutting is a symptom of other mental health disorders that contribute to their emotional tension. Cutting is sometimes (not always) associated with depression, bipolar disorder, eating disorders, obsessive thinking, compulsive behaviors or difficulty with impulse control.
It is not uncommon to find cutters that have significant problems with drug or alcohol abuse.
Yet others use cutting to cope with the emotions that were caused by a traumatic experience such as abuse, violence, or disaster. For them, cutting feels like a way to wake-up from a sense of numbness after the experience. It can also be a means to express anger toward the experience or try to get control of it. The mix of emotions that trigger self-injury is complex and often multi-faceted. In general, cutting is the result of an inability to use healthy coping skills to deal with psychological pain.
Intervention can be accomplished through therapy, medication, or a combination of the two. However, identifying and treating people who cut is difficult due to their tendency to hide the signs of self-mutilation. Self-injury also appears to be addictive, which further complicates treatment. The positive feeling that is generated by cutting may be due to the release of endorphins (“endogenous opiates”) which mimic a “high” and are pain killers as well.
Psychotherapy can help recognize and manage underlying issues that may elicit self-injury. It can also teach the individual coping skills to better tolerate stress, regulate their emotions, increase self esteem and better handle relationship problems.
Cognitive behavioral therapy, dialectical behavior therapy and psychodynamic psychotherapy have been particularly helpful in addressing the issues of self-injury.
A physician may recommend medication to help improve depression, decrease anxiety or help with other mental disorders commonly associated with self-injury. There are no medications for specifically treating cutting or self-injury.
Cutting is serious. The condition needs to be treated by medical or mental health professionals as its addictive and cyclical nature makes it almost impossible for a cutter to stop without help.