Cutting and Self-Harm

Cutting and self-harm are intentional self-injury to the body. There are many different types of self-injury, but scratching or superficial cutting of the skin that causes bleeding is a form of self-harm that is particularly widespread among young people.

Cutting and self-harm are the deliberate injuring of one's own body tissue. The arms, wrists, legs, and stomach are frequent targets. The methods and severity of self-injury vary, but include:

Cutting and self-harm are complex behaviors that occur for a variety of reasons. They often start impulsively without forethought, and the pain may provide a sense of emotional release. People may cut or self-harm when facing a specific problem or as a means of dealing with intense pressure, relationship problems, rejection, sorrow, shame, alienation, rage, or feelings of emptiness or desperation. People who bottle up strong emotions sometimes injure themselves to relieve feelings of emotional numbness. Teens often claim that they are distracting themselves from anger, loneliness, or hopelessness, or are seeking a sense of control over their strong emotions. Some teens cut or self-harm as a form of risk-taking, rebellion, attention-seeking, or rejection of parental or societal values, or as an expression of their individuality. Paradoxically, injuring oneself may stimulate the release of endorphins—brain hormones that reduce pain and improve mood. Sometimes cutting or other forms of self-harm are associated with body image; for example, some people derive pleasure from the appearance of the cuts and cut again in the same place when the wounds start to heal. Cutting and self-harm are often practiced by people who are suffering from a combination of depression * , impulsivity * , and rapid, intense mood swings. Eating disorders, such as anorexia * or bulimia * , and drug or alcohol abuse are themselves forms of self-harm as well as conditions that can contribute to other types of self-harm such as cutting. Furthermore, using alcohol or drugs while engaging in self-harm can lead to more serious injury than intended.

Cutting and self-harm are not generally considered suicidal behaviors or forms of mental illness, although they can sometimes be expressions of suicidal thoughts; rather, most people who cut or self-harm are seeking temporary emotional relief and do not intend to continue the behavior or permanently harm themselves. Cutting and self-harm indicate a lack of coping skills, especially in people who have not learned to deal with their emotions or who have been taught to hide their emotions. Although children who occasionally self-harm may outgrow the behavior, continued cutting and self-harm can have serious consequences. They can intensify distress, hurt, anger, fear, and hate, and cause shame and guilt. This can lead to a dangerous cycle wherein self-harm results in negative feelings that people try to relieve with further self-harm. It can become a compulsive behavior or long-term habit, in which the brain associates self-injury with a false sense of relief. Some people create rituals around their self-harming behaviors. Many people find it difficult or impossible to stop on their own, similar to an addiction. Nevertheless, most people who harm themselves realize that the relief is not long-lasting, that the underlying problems remain, and that self-harm is not a productive way to deal with problems. Cutting and self-harm sometimes accompany a mental illness, such as depression, psychosis * , bipolar disorder * , eating disorders, anxiety disorders * , obsessive-compulsive disorders * * (PTSD) from abuse, violence, or a disaster. Children with intellectual disabilities and/or autism spectrum disorder, * as well as abused or abandoned children, sometimes engage in self-harm.

Cutting and other forms of self-injury have been viewed in various ways and pursued for various purposes in different cultures and by different groups within societies. However, cutting and self-harm as means of coping with psychological pain or to relieve emotional turmoil appear to have become increasingly widespread, with an estimated overall incidence of about 1 in 100 people. A 2012 study found that 9 percent of U.S. teens reported having self-injured in the previous year, with almost 20 percent having self-harmed at some previous point. Another 2012 study found that, on average, 8 percent of third-, sixth-, and ninth-graders reported self-harming without suicidal intent, including 19 percent of ninth-grade girls. Earlier studies reported rates of non-suicidal self-injury ranging from 14 percent to 21 percent among high-school students and up to 38 percent among college students. The percentages are even higher among institutionalized youth, such as those in residential treatment or detention facilities, and among those who have had mental-health diagnoses and/or treatment. Some experts blame the apparent increase, at least in part, on the pervasiveness of social media that prevent teens from ever escaping social pressures. They argue that cutting has become the coping strategy of 21st-century adolescents. However, it is difficult to determine whether cutting and self-harm are truly on the increase or whether there is greater awareness of the problem, with more teens and parents seeking help.

Cutting often begins during early adolescence and is most common in teens and young adults, although it also occurs among older people. Cutting and self-harm are more common in females and in people who have experienced abuse, neglect, or trauma. People who binge drink or use drugs, which reduces self-control, are also at greater risk. However, cutting and other forms of self-harm are practiced by males and females from all socioeconomic backgrounds, by both good students and struggling students, and by people who appear to be emotionally and psychologically healthy as well as those with obvious emotional and psychological issues. Most teens cut themselves only once or twice, and those who continue the practice usually outgrow it in their 20s. However, some people continue self-harming for years and are unable to stop on their own.

Cutting and self-harm can spread among teens by a process called social contagion * through peer pressure and social media. Cutting appears to have lost some of its social stigma, and teens may discuss it openly. Some teens report that they cut themselves because other teens are doing it, and they want to be accepted or to appear unafraid. Because of potential social contagion, teens in group therapy sessions may be prohibited from showing off their scars or talking about acts of self-harm.

Unlike certain mental disorders in which people may be unaware that they are injuring themselves, people engage in cutting and self-harm with full awareness and intention, even if they are unable to stop themselves. However, they may go to great lengths to hide their behaviors. Signs that people are cutting or self-harming may include:

People who are suspected of cutting or self-harm should not be directly confronted about their behavior; rather, they should be asked about their feelings or other symptoms of emotional distress and listened to carefully, even if their answers are uncomfortable or difficult to understand. They should be supported and reassured that their emotions are serious and that cutting and self-harm are common, and they should be encouraged to seek treatment. The behaviors should never be dismissed as attempts to garner attention and illicit a response. Cutting and self-harm may indicate a lack of coping skills or may be a symptom of a more serious mental disorder.

A psychiatrist or other mental-health professional will conduct diagnostic interviews, in which patients are asked about their health and life histories. Diagnosis requires revealing and understanding the underlying causes of emotional distress, such as social problems, feelings of hopelessness, low self-esteem, or poor impulse control. It may take multiple sessions before patients are willing to discuss their self-injuring behaviors. Nevertheless, early intervention is important, because some self-harming behaviors can escalate into riskier activities.

In addition to addressing cutting and self-harm and providing coping strategies, the treatment plan must address family relationships, communication and problem-solving skills, and any mental-health issues. Underlying mental-health problems may be treated with medications such as antidepressants. For severe symptoms, a short period of hospitalization can provide a safe environment.

Although most people who cut or self-harm are not suicidal, they are at increased risk for suicidal thoughts or behaviors. Some teens who cut or self-harm develop borderline personality disorder * as adults. Cutting and self-harm also carry a risk of serious accidental injury, such as wounds that require stitches or even hospitalization, infection, permanent scarring, serious health problems, or even death. Sharing cutting tools poses a risk of infectious diseases such as HIV/AIDS and hepatitis. Finally, people who self-injure may find it hard to stop and are less likely to develop healthy ways of coping with emotions.

Prevention of cutting and self-harm includes learning to:

See also Anorexia Nervosa • Anxiety and Anxiety Disorders: Overview • Bulimia Nervosa and Binge Eating Disorder • Depressive Disorders: Overview • Eating Disorders: Overview • Post-Traumatic Stress Disorder (PTSD) • Suicide

* depression (de-PRESH-un) is a mental state characterized by feelings of sadness, discouragement, and despair.

* impulsivity is behavior in which people do not think through consequences before acting.

* anorexia (an-o-REK-see-a) is an emotional disorder characterized by dread of gaining weight, leading to self-starvation, dangerous loss of weight, and malnutrition.

* bulimia (bu-LEE-me-a) is a serious eating disorder that primarily affects young women and is characterized by compulsive overeating, followed by selfinduced vomiting or the use of laxatives or diuretics.

* psychosis (sy-KO-sis) is a mental disorder in which people's sense of reality is so impaired that they cannot function normally and may experience delusions (exaggerated beliefs that are contrary to fact), hallucinations, incoherent speech, and agitated behavior.

* bipolar disorder is a recurrent mood disorder (previously called manic-depressive disorder) in which patients have extreme mood swings from depression to mania or a mixture of both.

* anxiety disorders (ang-ZY-etee dis-OR-derz) are a group of conditions that cause people to feel extreme worry or fear, sometimes accompanied by symptoms such as dizziness, chest pain, or difficulty sleeping or concentrating.

* obsessive-compulsive disorders (OCD) are a spectrum of conditions in which people become trapped in patterns of repeated, unwanted thoughts, called obsessions (ob-SESH-unz), and repetitive behaviors, called compulsions (kom-PUL-shunz).

* post-traumatic stress disorder (PTSD) is a psychological response to a highly stressful event; typically characterized by depression, anxiety, flashbacks, nightmares, and avoidance of reminders of the traumatic experience.

* autism spectrum disorder (AWtih- zum) is a range or spectrum of developmental disorders in which people have difficulty interacting and communicating with others and usually have severely limited interest in social activities.

* social contagion is a condition that is spread through social interactions or social media.

* dialectical behavior therapy (DIE-ah-lek-ti-kal be- HAY-vyuh-rul THAIR-uh-pee) (DBT) is a more formalized type of cognitive-behavioral therapy originally designed to treat borderline personality disorder.

* borderline personality disorder is a serious mental illness characterized by unstable moods, poor self-image, and unhealthy interpersonal relationships along with an inability to regulate emotional responses.