For some adolescents, the cutting begins as an impulsive act; they react emotionally to a difficult event and impulsively scratch their skin with fingernails or a pencil or paperclip either to distract themselves or act out their anger on themselves. For others, the cutting may be a learned behavior; cutting, much like bulimic and anorexic behaviors, can precipitate a copycat phenomenon and spread quickly within a peer group. In either case, the cutter may find that the physical pain of cutting provides temporary distraction and relief from emotional pain, pain that they are ill-equipped to express or manage in constructive ways. For these young people, cutting can evolve into a habit, a compulsion, and even an addiction.
Many cutters are discreet and attempt to hide their scratches and wounds under long sleeves or pants. Some even cut thumb loops in long-sleeved shirts so that their sleeves do not inadvertently creep up, exposing their wounds. Many compulsive cutters desperately want help addressing this addiction but don’t know where to turn. Like most addictions, talking to someone-both about the addiction itself and also about the feelings that drive the behavior-is the first step toward healing. If you know someone you suspect may be cutting, it can be helpful simply to ask, as long as your query is direct, compassionate, and non-judgmental.
Others who cut or otherwise self-harm may do so, at least in part, as manipulative or attention-seeking behavior. These young people may dramatize their cutting in order to act out anger toward parents or others by creating shock value; others may manipulate those around them by using the threat of cutting to get their way. Still, others may find the attention and nurturance their cutting garners to be itself soothing, which reinforces the self-harming behavior. Even attention-seeking cutting, however, often has the escapist and addictive roots of more discreet cutting and should not be judged solely as a manipulation.
Most cutting is not suicidal or life-threatening, but overly zealous or unsanitary cutting can cause serious injury and infection. When cutting co-occurs with a dissociative disorder, the cutter may be unaware of the depth of her cutting and can risk arterial injury and death. Cutting that accompanies suicidal ideation, psychosis or extreme attention-seeking can also be life-threatening and should be taken very seriously. Hospitalization and residential care may be critical for the safe care of young people whose cutting is compounded by these issues. If your child or friend exhibits what seems to be life-threatening self-harming behaviors, call 911 immediately.
For typical chronic cutters, however, many therapies have proven effective. Helpguide, a non-profit that provides a wide range of valuable mental-health content (www.helpguide.org), suggests the following therapies, most of which can be pursued in either an outpatient or residential setting:
- Because a history of abuse or incest may be at the core of an individual’s self-injuring behavior, therapies that address post-traumatic stress disorder such as EMDR may be helpful (see Helpguide’s article on Eye Movement Desensitization and Reprocessing)
- Hypnosis or other self-relaxation techniques are helpful in reducing the stress and tension that often precede injuring incidents (see Helpguide’s article on Yoga, meditation, and other relaxation techniques)
- Group therapy may be helpful in decreasing the shame associated with self-harm, and help to support healthy expressions of emotions
- Family therapy may be useful, both in addressing any history of family stress related to the behavior and also in helping other family members learn how to communicate more directly and non-judgmentally with each other
- In cases of moderate to severe depression or anxiety, an antidepressant or anti-anxiety medication may be used to reduce the impulsive urges to self-harm in response to stress, while other coping strategies are developed.
- In severe cases, an in-patient hospitalization program with a multi-disciplinary team approach may be required
- Cognitive-behavioral therapy may be used to help the person learn to recognize and address triggering feelings in healthier ways