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Cutting and Self-Mutilation

Cutting is a form of self-mutilating behavior that involves intentionally harming oneself with a sharp object. It belongs to a larger group of behaviors, known collectively as self-injury or self-harm, which most commonly appear in teenagers. Despite the violence involved, people who engage in these behaviors are not typically trying to kill themselves. Instead, they have strong emotions – such as anger, rage, frustration or pain – they feel they can’t adequately express in other ways. Some doctors classify cutting and other forms of self-mutilation as impulse control disorders, and self-injurers sometimes have additional mental health problems such as depression or an eating disorder.

The Basics

People who engage in cutting use sharp objects to scratch or gouge their skin severely enough to draw blood. Common areas on the body subjected to this treatment include the arms, legs, wrists and stomach. Other closely related forms of self-injury include deeply scratching the skin with fingernails, piercing the skin, and carving symbols or words into the flesh. Additional forms of self-harm include biting the skin, burning the skin, head banging, punching, intentional hair pulling and intentional bone breaking. Some people engage in only one form of self-injury, while others injure themselves in two or more ways.

In some cases, self-injury only occurs a few times or in limited circumstances. In other cases, the impulse to harm the self continues for longer periods of time and becomes repetitive or chronic. In the immediate aftermath of their behavior, people who self-injure commonly report a sense of relief or a decrease in their tension levels. However, these effects don’t last for long, and the anxiety that led to their behavior will usually build up again over time.

Causes and Risks

While no one knows precisely why cutting and other forms of self-injury occur, they typically appear in people who haven’t developed the mental tools needed to cope successfully with psychologically painful emotions. In some cases, self-injurers blame themselves for their feelings and seek some form of punishment. In other cases, they blame others and use their behavior as a form of manipulation or attention seeking. Although most self-injurers are teenagers, the phenomenon also appears in pre-teens and adults. Additional known risks for self-harming behaviors include being female; having friends or peers who intentionally injure themselves; having a history of sexual, emotional or physical abuse; having a history of any other form of childhood neglect; and abusing drugs or alcohol.

People who self-injure also frequently lack adequate problem-solving abilities or “act out” through impulsive behavior. In addition to eating disorders and depression, mental health issues sometimes associated with self-injury include borderline personality disorder, post-traumatic stress disorder (PTSD) and various anxiety disorders.

Signs and Symptoms of Self-Injury

People who cut themselves or engage in other forms of self-mutilation frequently try to cover their damaged skin by wearing long-sleeved shirts or pants, even when those clothing choices are inappropriate for a given activity or climate. Other common potential signs or symptoms of self-injuring behavior include repeatedly having forms of skin damage such as cuts, burns or bruises; explaining frequent injuries as “accidents;” frequently describing oneself as "clumsy" having frequent or recurring bone fractures; having a fascination with sharp objects; having problems forming or maintaining relationships; and having a tendency to withdraw from social contact.

Self-Injury Risks

Most people who engage in self-injury don’t mean to seriously or permanently harm themselves. However, self-harming behaviors can still lead to consequences that include signficant blood loss and infection. What’s more, in some cases, self-injurers mistakenly cut themselves too deeply and create severe health problems or even endanger their lives. In addition to the potential for unwanted physical consequences, repeated self-harm can alter normal behavioral responses in the brain and lead to compulsive, uncontrollable urges to commit further injury. Since self-injury only masks emotional pain for brief amounts of time, these urges can’t possibly lead to a lasting resolution of any underlying emotional problems.

Self-Injury Treatment

Doctors commonly treat cutting and other forms of self-mutilation with various forms of group and individual psychotherapy. While specific approaches vary, the overall goal of this form of treatment is identification and ongoing management of the underlying issues that lead to self-harming behaviors. Other approaches sometimes used include psychiatric hospitalization and the use of medications designed to treat specific mental disorders. Typically, self-injurers can actively participate in the recovery process by sticking to their established treatment plans, fully reporting any behavioral lapses, and seeking appropriate medical attention for any injuries.

If you believe your child is involved in cutting or any other form of self-injury, do what you can to avoid any type of confrontational reaction. In many cases, confrontation damages your relationship with your child, and also makes self-injuring behaviors harder to detect by driving them further underground. As an alternative, seek the help of an experienced therapist or doctor who can direct you to the appropriate treatment resources.

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