Confessions of a Cutter

I recently became aware of a friend who cuts herself to make her feel better. She asked me to keep her identity private because she is a highly regarded professional in the community in which we live. Can you imagine inflicting pain upon oneself in order to relieve pain? As strange as it sounds, a Teens Health webpage explains that the purpose of cutting may be "a way some people try to cope with the pain of strong emotions, intense pressure, or upsetting relationship problems. They may be dealing with feelings that seem too difficult to bear, or bad situations they think can't change" (www.kidshealth.org). The more I thought about this, the more I began to understand that my friend felt this was one area in which she had control. I asked her why she cuts and her response was simple. "I cut", she said, "because I decide how much, how deep, how long, and no one else has this influence over my decisions. I know there are better ways to cope like exercise, or hell, even smoking would be better maybe." Now, I don't know if smoking is a recommended alternative, but in more literature reviews uncovered in my search to understand this phenomenon, I did find out more information.

For those of you who have never heard of cutting, it is another term for self-injury or self- mutilation. According to Wikipedia, "Self-injury (SI) or Self-harm (SH) is deliberate injury inflicted by a person upon his or her own body without suicidal intent. These acts may be aimed at relieving otherwise unbearable emotions, sensations of unreality and numbness. It is listed in the DSM-IV-TR as a symptom of borderline personality disorder and is sometimes associated with mental illness, a history of trauma and abuse, eating disorders, or mental traits such as low self-esteem or perfectionism. There is a positive statistical correlation between self-injury and emotional abuse" ^{[1] [2]} (Wikipedia definition). I need to remind you that I am not an expert on this subject and only reviewed some of the literature available on this subject. This truly was not an exhaustive search or review.

Recurrent themes, ideas, and information I found through literature reviews and interviews with my friends, colleagues and other field professionals revealed some interesting insight of which I wanted to share. The intent of this is to more enlighten and give direction to people needing more information. We will start with the five Ws: Who, what, where, when, and why. The 'why' actually may be the most fascinating of the five. It is, to me, because this method of handling emotion delves deeply into one's ability to cope and handle stress, tension and pressure.

Who: In most of the literature, cutting or SI is more common among girls, but some guys self-injure, too. As kids hear about cutting, they may feel curious about it and may be willing to try it because it seems a forbidden, like underage drinking or smoking. Some younger teens may think that cutting might make them seem more grown up or that people will think they are tough. Younger teens are more likely to cut, but this isn't limited to the younger group. We would like to think that older teens and young adults have developed better ways to cope, but sometimes this group is dealing with the most pressure in their lives.

What or How: Making scratches or cuts on your body, enough to break the skin and make it bleed, is called cutting. Other types of self-injury include burning their skin with the end of a cigarette or lighted match. Extreme forms of this include digging, gouging, even amputation.

Where: People may cut themselves on their wrists, arms, legs, or bellies and usually hide the cuts and marks and sometimes no one else knows.

When: When emotions don't get expressed in a healthy way, these emotions can build up to a point of unbearable pressure. Cutting is believed to be an attempt to relieve that pressure. It is often a way of feeling in control of something in their life. See Why.

Why: Cutting is believed to be a way for people to cope with the pain of strong emotions, intense pressure, or upsetting relationship problems. They may be dealing with feelings so overwhelming or with situations they feel cannot be changed. Some people cut because they want to relieve these feelings. Some may not know how to cope with emotional pain or life's pressures. Teens and young adults may be mainly affected because this is the most intense time of their lives in trying to figure out who they are, where they fit in, and how to handle the prospect of being an adult or being on their own. The urge to cut may be triggered by strong feelings like anger, hurt, shame, frustration, or depression. People who cut say sometimes they cannot express their feelings, feel they don't fit in, or believe that no one understands them. Additionally, some people who self-injure sometimes have other mental health problems associated with depression, bipolar disorder, eating disorders, obsessive thinking, or compulsive behaviors. Unfortunately, it is also entirely possible for teens to do it because they want to emulate someone else or because their friends do it too.

Obviously there are risks to cutting. Although it may provide some temporary relief from a terrible feeling, the relief doesn't last and the troubles that triggered the cutting remain. From cutters that I have spoken with, most said that they don't intend to hurt themselves permanently when they cut and don't intend to continue cutting. They did say, however, that both can and have happened. For example, it is possible to misjudge the depth or location of a cut, making it so deep that it requires stitches or even hospitalization. Some cuts can become infected if a person uses non-sterile objects such as razors, scissors, pins, or even the tab on a can of soda.

Cutting can be habit forming and become a compulsive behavior. According to the literature reviewed, the brain connects the false sense of relief to the act of cutting, then craves this relief the next time anxiety builds. When cutting becomes a compulsive behavior, it seems impossible to stop and becomes an addiction of sorts. The urge to cut seems too hard to resist and the person develops a behavior that started as an attempt to feel more in control. Unfortunately, this behavior seems to end up controlling the person.

What is the answer you ask? There are so many variables in why a person cuts that this article cannot even begin to explore them all to find an answer. And, one answer will not solve the problem. One thing, however, that cutters and the literature seemed to allude to was to tell someone, get help in figuring out what the trouble is that triggers the need to cut, ask for help, and work on stopping the behavior. Just as starting behavior was a slow, progressive process stopping it is considered to be the same. One thing to remember in dealing with someone who is a cutter (especially if it is your child, a close friend or family member) - you can't force them to stop. Try not to get mad, reject, lecture, or beg them to stop. This won't help and could potentially exacerbate the situation. Simply let them know you care, that they deserve to be happy and healthy, and that they don't need to endure their problems alone. So listen to your loved one, help to figure out why the cutting is occurring, and help your loved one to find ways to deal with their feelings in healthy alternatives to cutting like exercise, dance, art, counseling or other methods that work for that person.