“I hurt myself today, to see if I still feel. I focus on the pain, the only thing that’s real. The needle tears a hole, the old familiar sting. Try to kill it all away, but I remember everything.” – Trent Reznor and Nine Inch Nails

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

To briefly review, purposely cutting or scratching your body with a sharp object, enough to break the skin and cause bleeding, is called “cutting”.  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.  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 in an attempt to cover up the scabs and scars from cutting as they are themselves embarrassed by what they have done.

Some of the complications of cutting behavior include:

• Worsening feelings of guilt and shame – Although cutting can provide people with a brief respite from the horrible emotional pain they are experiencing, it is not an effective way to obtain relief.  The escape does not last, and the problems that led to the cutting in the first place remain.
• Life threatening problems – People do not usually mean to keep cutting once they start, and they do not intend to permanently harm themselves.  However, both can and have happened.  Cutters can misjudge how deeply they are cutting leading to a significant loss of blood and the possibility of cutting arteries.  Many times requiring stitches, or in extreme cases hospitalization.
• Infection – Cuts can become infected if the person uses non-sterile or dirty cutting tools (razors, scissors, sharp edge of a soda can tab, etc.).
• Accidental suicide – The vast majority of people who cut have no intention whatsoever of committing suicide.  It is typically the individual’s attempt to feel better, not end their life.  However, they may unintentionally inflict a fatal injury, especially if they cut while under the influence of illicit drugs or alcohol.  Under the influence these people are also at greater risk of deliberately taking their own life as a result of the emotional pain at the root of their cutting in the first place.
• Permanent scars or disfigurement
• Cutting can be habit forming (addicting) – Cutting can become a compulsive behavior in that the more a person cuts, the more she or he feels the need to do so.  What ends up happening is the brain begins to connect the false transient feeling of relief from the emotional and psychological pain to the actual cutting, and as such will begin to crave this same escape the next time the emotional pain develops.  Once it becomes an addictive compulsive behavior the urge itself becomes overwhelming difficult to resists.  Some researchers have theorized that people who cut may have the strong continued drive to do so as a result of the body’s natural “feel good” chemicals (known as endorphins) which are released in the body as a result of cutting (or other forms of tissue damage).  These endorphins produce a natural “high” feeling which, in itself, can become addictive.  Ironically, a behavior initially attempted in order to help the person feel more in control is now controlling the person.

There are some clearly identified factors that may increase the likelihood of cutting behavior.  These include:

• Age – The vast majority of people who cut are teenagers.  Cutting, and other self-injuring behaviors, typically start during the early teens when children are faced with increasing peer and school pressures, parental and other authority conflicts, and their emotions are the most unstable.
• Drug and alcohol abuse – Many who demonstrate cutting behaviors do so while under the influence of drugs and/or alcohol.
• Mental health problems – Cutting is commonly associated with certain mental illness diagnoses including: borderline personality disorder; post-traumatic stress disorder; eating disorder; depression; anxiety disorders; and, substance abuse disorders.  They are also more prone to being impulsive and have rather limited problem-solving abilities.
• Having friends who cut – Individuals whose friends cut themselves are more likely to do so.

If someone close to you is cutting it can be very emotionally confusing and frightening, and difficult to know what to do.  You can start by learning more about cutting and other self-injuring behavior.  Doing so will hopefully assist you in understanding why it happens and help you form a firm and compassionate approach to helping them.   It is vital to remember that you cannot force anyone who cuts themselves to stop doing so.  Getting frustrated or angry at the person, begging them to stop, lecturing them, or rejecting them, does not help.  Rather, letting them know you are there for them, that you care, that everyone is worthy of happiness, and that they do not need to suffer with their problems alone, sets the foundation for them progressing from this state of despair.  Let them know gently that there are other options to dealing with the emotional pain.  Suggest that they talk to someone, anyone, that they trust be it a teacher, school counselor, parent or another adult.  You can encourage them to seek medical and psychiatric treatment as well.  There are professionals who know how to effectively work with individuals who self-injure.  If your friend refuses to reach out for help you need to take the very difficult step of letting someone know what is happening.  I understand that you will likely feel as though you are betraying your special friend, worry that she may reject you for doing so, but cutting behavior may be too huge a problem for them to deal with alone.  Tell your parents, your teacher, or any responsible adult who can take the information you give them and find the help your friend needs.

If you are cutting yourself, even in just a small way now, or if you have thoughts of acting on other types of self-injuring behavior, reach out for help to anyone you can.  I understand there will be feelings of shame and embarrassment about the behavior, but there is caring support available to you that will not sit and judge you.  So, please try to work up the courage to let someone know.  People who have stopped cutting very often site that the first step of talking about the cutting is the most difficult.  If talking about it is still too big a challenge, write a note.  Admitting what you have been doing  will often bring with it an almost immediate sense of relief in that you are now sharing the burden, and as such the burden no longer feels quite so heavy.  If you are not taken seriously by the first person you share with, or do not get the type of help you need to stop the cutting behavior, go and talk with someone else.  Sometimes adults, even those with the best of intentions, really do not understand the profound nature of many teenage problems.

Try to identify and understand the underlying problem(s) that sets off your cutting behavior.  We know that cutting is an unhealthy way of reacting to severe emotional tension.  So, trying to figure out what sort of situations, and the feelings associated with them, trigger the behavior will help you develop ways to more effectively adapt.  Some people can figure this out for themselves, and for some it takes the help of a mental health professional.  Either way, it is a critical step in learning how to control your cutting behavior.

Although difficult, the pattern of cutting behavior can be broken.  People with the sort of deep emotional turmoil that leads to cutting most often need to get professional counseling help to prevail over this illness.  Doing so does not in any way mean the person is crazy or weak.  It just means they need help to sort through the intense feelings and learn more effective ways to cope with their life stresses.  Mental health professionals are trained to help people discover their inner strengths that can help them cope with their problems.

There really is no one best way to treat cutting behavior.  Treatment needs to be customized to the specific issues at the heart of each individual’s behavior along with any other mental health conditions which may be present.  Treating cutting behavior can take a long time and requires a load of hard work.  Some of the demonstrated effective treatment interventions include:

• Psychotherapy: Whether it be in the form of Cognitive-Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), or more traditional counseling therapy, can assist you in acquiring new coping skills, improve you self-image and self-esteem, better help you learn to regulate your emotions, and improve your problem-solving skills.  Beside individual therapy sessions, group and/or family counseling can be of notable benefit.
• 12-Step programs:  These programs may be of benefit in treating cutting behavior as an addiction.
• Medication:  Although there are no specific medications for the treatment of cutting or other self-injuring behaviors, certain antidepressants and other psychiatric medications can definitely help in treating the depression and anxiety often associated with cutting.  By lessening the anxiety and depression the urge and impulse to continue to cut can be dramatically reduced.
• In-patient hospitalization:  This may be necessary if the cutting behavior is of such an extreme nature that the patient’s life is at risk.  Hospitalization provides a safe and structured environment which can be tremendously beneficial.

Door of Hope 4 Teens is a national organization dedicated to helping teens who cut.  So, if you do not have anyone you feel you can reach out to for help you can contact their national hotline number by calling 615-746-7319 or go to www.doorof4teens.org.

Getting the help you need will lead to learning healthier ways of dealing with your problems, ways that will not leave you with emotional or permanent body scars.  Everyone has problems, and learning healthy ways to deal with them is the only real lasting solution.