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.
As a concerned and loving parent, discovering your son or daughter has been cutting can be quite a shock. No matter what your personal feelings or concerns are at this stage it is important to put negative emotions like anger, fear, indignation or guilt aside. This is the very last thing your child needs and it may simply add to the problem. Remember that your child already feels a good deal of shame and guilt about cutting so they may resent this new intrusion by becoming angry and dismissive. The first step in helping may be a very practical one. Do cuts need treating or stitching? Have they become infected? Thereafter, you may want to seek out some psychological support in the form of counseling or possibly cognitive therapy. Your family doctor should be able to offer guidance as to what services are available in your area.
As the person who cuts, or who uses other forms of self harm, the evidence to date suggests you are unlikely to resolve your problems by yourself. Even if you stop cutting it doesn't mean your problems are solved. You may simply turn to some alternative form of self harm.
Everyone's circumstances are different and some have a more pressing need for immediate professional help. As a general rule I think it's safe to say that it will be enormously helpful to you if you can talk to a trusted person. This may be a friend, teacher, counselor, priest, doctor or some member of your family. You'll need to be able to explore the reasons why you cut and think of alternative ways of coping. The person you talk to may not feel equipped to help and they may suggest you seek specialist help. They are probably right, but moving beyond what is often a secretive and destructive period in your life is important. If you can only talk to someone and reassure them you aren't expecting any more than this, it will be a very important first step. Then, when you feel ready, it might be time to seek out more professional help.