Despite summer's hot temperatures, Leslie* dresses herself in pants and long sleeve shirts while her friends wear fashionable low-riding shorts and midriff-baring tops. Leslie keeps her body covered to hide her freshly marked and permanently scarred skin. No, she hasn't recently been in an accident, she is actually responsible for the wounds. She has been self-mutilating, also known as cutting, for almost a decade.
What is cutting?
According to the Cornell Research Program on Self-Injurious Behavior (CRPSIB), cutting, also known as self-injury or self-mutilation, encompasses a variety of behaviors in which an individual intentionally inflicts harm on his or her body for purposes that are not socially acceptable and are not with suicidal intent.
Though cutting or carving the skin is the most common self-injury, research has documented over 16 forms of self-mutilation in the college population, including burning, biting, ripping or pulling skin or hair, swallowing toxic substances, subdermal tissue scratching, self-bruising, sticking the body with sharp pins, and even breaking bones. Excessive body piercing and tattooing can also be a form of self-harm, but not everyone with body piercing or tattoos are cutters.
Several studies have shown that the number of forms of self-mutilation used by a single individual varies significantly, from 1 to over 10. Self-injury can be and is performed on any part of the body, but most often occurs on the hands, wrists, stomach and thighs. The severity of the act can vary from superficial wounds to those resulting in lasting disfigurement.
Because many people who self-injure conceal their injuries and do not seek treatment, accurate statistics are unavailable. Some sources suggest one percent of Americans engage in self-injury and that 10 percent of college students have at some point intentionally harmed themselves. Self-mutilation is becoming more recognized and has even gotten mainstream media attention (Carrie Bradshaw on Sex and the City is an admitted emotional cutter).
Why does a person engage in self-mutilation?
It is natural to assume if someone deliberately hurts themselves, it can be a preempt for suicide. That would almost make more sense. However, that is not the case.
John Eckenrode, professor and director of the Family Life Development Center at Cornell's College of Human Ecology, says "The underlying motivation for self-injury is not to attempt suicide, but rather to cope with stress, emotional pain, numbness and isolation. For many it is self-medicating; it creates a palpable calm - that's what makes it potentially addicting."
There are many reasons why people will cut themselves, says David Rosen, M.D., director of Teenage and Young Adult Medicine and clinical associate professor of the Department of Pediatrics and Communicable Diseases at the University of Michigan Health System. Some do so to express how terrible they feel.
Cutting is this tangible, real form of feeling pain that helps the cutter make his or her emotional pain more real. Some people cut because they feel empty or numb and the physical pain helps them feel more alive. Others cut because they don't have any other way of expressing what they feel.
Leslie, who began silently chewing her knuckles when she was a young girl as a way to cope with her parent's divorce, found solace in hurting herself. She wouldn't allow herself to deal with her emotions and eventually went from knuckle biting to cutting her body with paper clips, safety pins, knives and razor blades. "I wanted to get rid of the pain that was inside me, so I would cut myself to release that pain," says Leslie. "The physical pain from the razors was far easier to deal with than the emotional pain that I felt."
Research also indicates that cutters self-injure to feel in control of their bodies and minds, to purify themselves, to reenact a trauma in an attempt to resolve it, and to protect others from pain. Some cutters report that self-mutilation feels good or provides a "rush."
Regardless, experts say self-injury is best understood as a maladaptive coping mechanism that works in the short term in relieving anxiety but it is not a long-term solution. Healthier coping mechanisms are needed to better deal with stress and emotions, ideally, coping mechanisms that will become life long and involve self-care, not self-injury.
Stress is commonly cited as impetus for a person to self-harm and research has shown a strong link between self-injury and childhood abuse, especially childhood sexual abuse. Self-injury typically begins in adolescence but it is reported to be on the rise in college populations and it can also begin later in life, though onset in youth is more common. In addition, self-injury is linked to eating disorders, substance abuse, post-traumatic stress disorder, borderline personality disorder, depression, and anxiety disorders.
What are the treatments for cutting?
Self-injury can be treated and people do get better. The University of Michigan Health System recommends a multidisciplinary approach. Once a person is diagnosed, a treatment plan is proposed that encourages patients to attend therapy sessions with trained mental health professionals.
Patients learn how to accept their lives and how to make the present moment more tolerable. In addition, patients are counseled to identify their emotions and talk them over instead of acting on them by self-mutilation.
Over time, patients learn how to handle emotional situations and how to control their own self-injurious impulses. Medications, such as anti-depressants, are often prescribed in conjunction with therapy. "People who cut themselves do get better," says Rosen. "If we provide people with great support and treatment and sometimes medicine, we see people improve."
The key to getting better is understanding that self-mutilation is not a long-term coping mechanism and that it can lead to infections and life-long scarring. If you or someone you know engages in self-injury, get help so you can learn how to effectively deal with your stressors and emotions and stop hurting yourself. Check your local listings for a mental health professional or organization.
The CRPSIB is looking to expand their resources to help people who self-mutilate as well as their loved ones. Visit their website to contribute your experience with cutting and to get more information on putting an end to self-injury.
May is Mental Health Month, be sure to visit Mental Health America or the National Institute of Mental Health for information on taking care of your mental health.
For an in-depth perspective on cutting, visit Cut: The Movie.