“You bleed just to know you’re alive.”  –Unknown

A dear friend, and long time reader of Healthy Mind – Healthy Future, wrote to me the other day sharing with me her own experience of helping “dear family friends whose daughter was recently hospitalized because she’d been cutting herself.”  She asked that I consider sharing this frightening, and all too common behavior, especially amongst teenage girls, with my readers.  She added, “I think by the time a cutter is showing someone their cuts, they might know they need help and just might not know how to ask for it…this hit close to home…So, so sad, and so very scary.”…Indeed.

In Part 1 of this two-part series the reader will be presented an overview of cutting behavior, its causes and prevalence, and how to identify cutting behavior in a family member or friend.

Purposely cutting or scratching your body with a sharp object, enough to break the skin and cause bleeding, is called “cutting”.  The cutting is usually accomplished with sharp objects such as knives, razors, broken glass, needles, and others.  The more common body sites where people cut include: arms, thighs, wrists, lower legs and ankles.  Other, more hidden locations may include the abdomen, feet, genitals, and under the arms or breasts. Cutting, a form of self-injury, is a deliberate act of harming your own body without the intent of suicide (although some accidently kill themselves as a result).  Rather, people cut in an unhealthy attempt to stop their emotional pain, intense pressure, anger and frustration.  It can be very hard to understand why a person would cut themselves on purpose.  I can tell you that after years, decades actually, of working with teenagers that cut themselves there is no doubt that they do so in an attempt to stop the intense psychological and emotional pain they are experiencing as well as to express strong feelings of rage, rejection, shame, desperation, sadness or emptiness.  Some people who cut have experienced severe trauma, such as violence or abuse, and feel that cutting is the only way they can escape from the pervasive numbness they experience.  Many do not have the knowledge or tools to get the relief they seek from their emotional pain or pressure.  For them, cutting provides them with a momentary feeling of calm and a release of tension.  However, it is most often then followed by intense feelings of shame and guilt, and a return, once again, of the painful emotions.  There are, of course, much more effective coping mechanisms, but individuals who cut often have not developed these.  Or, their more effective skills may be overpowered by the intensity of emotion they are experiencing.  For some, it gives them the sense of being in control of otherwise out of control feelings.

Cutting is not a new phenomenon, but it most definitely appears to be increasing in frequency.  Most of the people who cut are females, but males have been known to cut as well.  And, by far, most who cut are teenagers.  Cutting behavior may also accompany other mental illnesses such as depression, bipolar disorder, obsessive-compulsive disorder, borderline personality disorder, and eating disorders.  One myth about cutting is that people do so in order to get attention.  In actuality, this is the furthest from the truth.  Most teens who cut will wear clothing (long-sleeved shirts, sweaters, etc.) in an attempt to cover up the scabs and scars from cutting as they are themselves embarrassed by what they have done.

There are many many forms of self-injury.  One of the most common however is by cutting.  Other forms of self-injury include:

• Burning
• Punching or hitting
• Head banging
• Biting
• Pinching
• Pulling out hair
• Carving symbols or words into the skin
• Poisoning
• Piercing the skin with sharp objects
• Breaking bones

People who self-injure often use more than one method of harming themselves.

Many will self-inflict injury only once, or maybe just a few times, and then stop.  Sadly, however, for others it becomes a longstanding recurring behavior.  Although any area of the body can be used by far the most frequent areas of the body targeted for cutting are the arms (particularly inside of the forearms), legs and chest as these areas are most easily reached and can be easily hidden by clothing.

Cutting behavior often begins as an impulse, not something the person thinks much about or considers ahead of time.  As one patient noted, “It all started when something really upset me, and I didn’t know how to talk about it or what to do.  But, I couldn’t stop thinking about it and feeling all upset about it.  It was turning my body into a knot of emotional pain.  The next thing I knew I was cutting myself.  I don’t know how it happened.  Then, the next thing you know you’re in a different place and the pain is so much better.  Then, the next time you feel awful about something you try it again, and again the pain is better.  Then slowly it just becomes sort of a habit I guess.”

To following underscores the severity of the problem amongst teenagers today:

• It is estimated that 1 in 200 girls have cut themselves.
• 13% of 15 to 16-year-olds have deliberately harmed themselves.
• 1% of the US population engages in self abusive behavior.
• For 3 million Americans cutting is a serious problem.
• Cutting occurs most often with girls/women between the ages of 13 and 30.
• Cutting usually starts when the cutter is between 10 and 16 years old.
• Most parents don’t have a clue that their teenager is cutting.

Because those that self-injure often go to great lengths to hide it, it can be quite difficult to identify the signs and symptoms of someone suffering from this.  Some of the signs to watch for include:

• Wearing long sleeves and/or long pants even when the weather is hot
• Fresh cuts/scratches, bruises or other types of wounds
• Numerous scars from cutting or burning
• Claiming to have frequent accidents leading to physical injuries
• Broken bones
• Spending a lot of time alone
• Keeping sharp objects around on a regular basis

In Part 2 of this two-part series I will discuss the complications of cutting behavior, what to do if your friend is cutting, what to do if you are cutting on yourself, and the treatment options available to help treat this dangerous and potentially lethal behavior.