Ellie is a well-liked, sociable girl of 14. A high achieving ninth grader, she takes several advanced placement courses in her new high school. She generally participated in at least two extracurricular activities each year as well. Soccer and art classes are always her first choices. Lately, however, Ellie has found it difficult to maintain her interest in and motivation for her many activities. Her parents are divorcing, and she often feels “pulled” between her mother and her father. Worse yet, she feels overwhelmed and saddened by her little sister’s response to these events--she tearfully informed me, during our first visit--that her sister was often so distraught that she had trouble remaining at school for the day.
Ellie ended up in my office when her father noticed a number of faint but nonetheless distinct markings on her arm--they looked like deep, healing scratches. When he questioned Ellie about the marks, she initially attributed them to scratches from the family cat. Undeterred, her father queried her further, and Ellie eventually broke down and admitted that she had been cutting the insides of her arms--and her legs as well--with a razor blade. She stated that she did not understand it herself, but knew that afterwards, she felt a sense of deep relief, and she was able to sleep.
Sheryl, a spunky 15-year-old with attention deficit hyperactivity disorder, visited me occasionally when she needed some tools or suggestions for dealing with her disorder. One day recently, she requested a session but admitted at the outset of our hour that she was “really here to talk about my friend.” She stated that Nancy, her best friend since kindergarten, had begun to act rather strangely. Sheryl noted, for example, that Nancy had taken to wearing long-sleeved shirts all the time, even when they went to the beach; that she seemed more secretive, and that she no longer seemed to be interested in long confidential gab sessions. Sheryl felt as though she was missing her friend, even though they continued to spend time together. One day recently, Sheryl was certain she saw what looked like fresh cuts on Nancy’s upper arms as Nancy unthinkingly removed her long sleeve shirt and headed for the shower. Nancy adamantly denied that she had self-inflicted these wounds, and tried to explain them away as a skin condition. Sheryl felt perplexed and even more concerned about her friend than she had been previously. She asked me what I thought she should do.
In both of the scenarios described above, young teenage girls have begun a process known as “cutting.” Cutting is a self inflicted wound, a form of self-abuse in which the afflicted person cuts herself because it actually makes her feel better--it is essentially a form of release from what is experienced as overwhelming, unmanageable emotion (s). In the first case scenario above, there was a clear precipitant to the onset of cutting--a traumatic event (divorce) and overwhelming affect. In the second case, no clear precipitant was described. Often, cutting occurs without such a clear, preexisting cause. We do know quite a bit which can help, however. The following article will attempt to provide the reader with an understanding of this often frustrating and sometimes heartbreaking condition.
We haven’t heard much about cutting until recently, but Dr. Charles Goodstein (ref. 1) states that he encountered it as a resident back in the 1950’s. He quotes statistics including the fact that something like (1) in every (200) adolescent girls between the ages of 13 and 19 regularly cut themselves. The disorder affects some boys as well.
Cutting isn’t the only form of self-injury. People hurt themselves in other ways, like burning themselves, hitting themselves with objects or their own fists, or scratching themselves and preventing the sores from healing. Cutting has been called the “New Age Anorexia,” perhaps in part because it is a form of self-injury that is easier to hide than others.
Teenagers who cut often share this information with no one, not even their closest friend. It is secretive and shameful to most teens. During the winter, it is easy to cover up. During the summer, however, people notice the cuts and the scars. When a teen’s cutting is first uncovered, people often wonder if the teen is seeking attention. This is generally not the case.
There is no single, simple answer to this question. As noted above, many afflicted teenagers describe a tremendous sense of relief--they actually state that they feel much better--after cutting. Very often, these teens are literally overflowing with emotions--often anger, depression or sadness--which they feel unable to express. Some teenagers state that they feel “numb, not quite alive,” and that cutting reassures them that they are alive. Most often, the unifying answer is that cutting represents a release from overwhelming tension. Often, the physical pain is described as “releasing” the emotional pain they have been carrying.
Cutting, or any form of self-injury, must always be viewed as within the context of a larger problem. Not every cutter is a cutter for the same reason. But in virtually all cases, there is an inability to formulate a more constructive approach to problems. In some cases, cutting and other self-injurious behaviors are associated with anorexia; sometimes with depressive disorders; and very often, with a borderline personality disorder. Some research suggests that it could be a combination of several factors which predisposes a teen to cutting. These may include low levels of serotonin; family background; or a history of physical or sexual abuse. Cutting must always be understood as one component of a larger picture.
Adolescence is perhaps the most vulnerable period in the human being’s lifespan. There are rapid changes, some of which are hormonal and growth-related, and which result in great tension. For the individual who may be predisposed, the discovery that cutting relieves some of the tension may be irresistible.
Not usually. While cutting is likely to become a repetitive behavior, it is typically not suicidal. Most of the injuries from cutting are superficial--delicate cutting that leaves faint scars. Some people believe that one of the dangers associated with cutting, however, is that it is an addictive behavior. As such, cutters may need to make more and deeper cuts as time goes on to relieve the pain they are experiencing. This can lead to infections and serious medical complications.
Cutters are masters at hiding their behavior. They learn where to cut to minimize the chance of discovery. They avoid athletics, and they shower or dress out of the range of others.
Parents often don’t want to face the fact that their child may be engaging in self-injurious behaviors. When faced with their child’s denial, most parents want nothing more than to believe that there is a “logical” reason for what they have seen.