Cutting and other forms of self harm

Cutting is a form of deliberate self harm. It can be thought of as a physical manifestation of psychological distress. Cutting is a way of coping as much as a means of communication. It should always be taken seriously and viewed as a sign of genuine distress. Most self harm is undertaken by young people, with girls most likely to use cutting.

Cutting provides one of the clearest examples of self harm in that it is unambiguous. Some acts of self harm are more difficult to spot and may appear like clumsiness; bruising is one such example. There are many other mechanisms. The list includes, scalding, burning, scratching, hair pulling, self-strangulation, stabbing (with pins or sharp objects), drug and alcohol misuse.

We are starting to understand that the causes of cutting and other forms of self harm are complex and diverse. People who cut report a whole variety of emotions and causes. They may feel depressed, angry, frustrated or trapped. They may feel emotionally numb. They may be frightened due to emotional, physical or sexual abuse. They may be the victims of bullying. They may feel lonely, misunderstood or uncared for. They may be experiencing inner turmoil about their sexual orientation. Other sexual behaviors may make them feeling ashamed, guilty and a bad person.

The act of cutting frequently follows a period of turmoil and emotional upset such as an argument. If the family structure is rejecting or abusive the risks of self harm increase.

Cutting is fairly easy to hide. The most common areas are the arms and legs but sometimes the stomach or other parts of the body are targets. Clothing readily covers these parts of the body. However, self harm is nearly always accompanied by changes in mood. As cutting is generally carried out in privacy it is behavior and content of speech that may alert adults or friends to the fact that something is wrong.

Teens, as everyone knows and recognizes, are prone to moodiness. But even here the pattern tends to be predictable. Behaviors to look out for are changes in appetite, insomnia, lack of interest in activities previously enjoyed. Also be aware of verbal comments such as praising death or suicide, of feeling worthless, or of life being trivial and pointless. Yes, I know some of these sound like the 'typical teen', but the emphasis here is change in behavior and in the tone and context of the behavior or speech. The risk of suicide is estimated to be 100 times greater for those who self-harm than the general population (British Journal of Psychiatry, 1998).

Support and genuine interest in the concerns of young people is a vital component in assuring their well-being. The concerns of young people may sound quite mild, or they may be expressed in such an oblique way as to be easily overlooked. For this reason it is important for adults not to beat themselves up if they later discover that signs were missed. Young people are sometimes too self-conscious or embarrassed to put across the true depth of their feelings. They sometimes make an attempt, but lack the verbal repertoire or social skills to achieve the desired effect. However, the consequence for them may be a feeling of deep rejection and humiliation.