Why do people cut themselves?
There are as many reasons for this as there are people who cut themselves. It is not indicative of one specific mental or physical illness, but rather a symptom that may accompany a wide variety of issues. Sometimes the behavior comes from deep-seated emotional problems that may or may not be rooted in physiological mental health concerns. We begin, therefore, not with a description of the causes explaining why do people cut themselves, but rather with a description of the syndrome itself.
Cutting as part of NSSI spectrum
There are many actions directed against oneself that while not intended to be suicidal are harmful to bodily health and integrity of the practitioner. These are called Non-Suicidal Self Injuries, or NSSI in abbreviation: deliberate, self-inflicted destruction of body tissue, not intended to cause deathbut carried out on purpose. Cutting is the most common form of this behavior, but it can also include intentional burning (as with a cigarette), scratching, causes bruises, or even breaking bones. The National Institutes of Health (NIH) say that approximately one in every one hundred Americans has engaged in NSSI, more common among women than men, and more common among young people than among mature adults.
It is the use of a sharp object to make marks or cuts on the body on purpose, deep enough to break the skin and cause bleeding. Usually the area of choice will be the forearms , thighs, or bellies: places that are easyto cover up. The implement used might be a knife, razorblade, scissors, the tab from a soda can, a nail file: almost anything you can imagine that will penetrate the skin.
Almost always, secrecy and a sense of social shaming accompanies the cutting. Most who have taken these kinds of actions hide the results and make up excuses to explain their existence; a few individuals on the other end of the spectrum may try to draw attention to them.
Understanding the psychology of NSSI cutting
Cutting often begins as an impulse, after the afflicted person has been exposed to it through a peers or through the media. But many discover that once they start to cut, it becomes addictive: they do it more and more, and have trouble stopping. Thus it is a very risky behavior, not only because of the possibility of infection or serious injury, but also because of the compulsive and overwhelming pattern of its occurrence. People who self-injure report that cutting provides relief from other deep painful emotions. If it works for them, they tend to repeat it again and again.
- A struggle with powerful emotions that they do not know how to express elsewhere and which they feel they cannot withstand by themselves: a loss of love, a divorce, grief. Very often, no one else knows about their feelings, or at least does not imagine the overwhelming power of them. Sometimes it is the pressure to be perfect. Sometimes it is the harm of harsh treatment or neglect by adults. Sometimes it is about feeling unloved and depressed.. Cutting is a way of testing whether they can still “feel” pain, whether they can escape from feeling the numbness of their position.
- Physical pain is visible and specific, and thus to be preferred to the vagueness and inexpressibility of emotional pain. The act of cutting gives the practitioner a sense of control and relief in that they know where the pain is coming from. It is a symbol for the deep inner pain that is hard to acknowledge, confide in others, or verbalize.
- Many cutters describe relief when they are in the act of cutting. It is possible that the relief they describe is related to the release of endorphins, the “feel-good” hormones that the body releases during intense exercise. It is also possible relief is experienced just a temporary distraction from the overwhelmingly painful emotions. It is also a visible “proof” of how much pain they are truly experiencing.
- Cutting is addictive, habit-forming. The more someone cuts, the more he/she feels the need to do it. As with many other kinds of compulsion, the brain connects the temporary relief with the physical act; and when tension builds, the brain craves that relief/release. The practice is VERY difficult to give up without help, because the urge to cut is very strong when psychological pressure is intense.
- Peer pressure can be the initial impetus. It might be an individual friend or boyfriend who wants company in the practice. Or it might be part of a group ritual which a teen is pressured to join.
Serious mental health problems are not always indicated in a person who is addicted to cutting, but they are a distinct possibility. Some cutters are struggling with other obsessions and compulsive behaviors, and may be diagnosed with obsessive compulsive disorder or OCD. Others may have wide fluctuations in mood that they cannot control, indicative of being depressed or having bipolar disorder. Some with personality disorders can find themselves unable to cope with disappointment or loneliness or anger. Alternately, a personality disorder can be responsible for compelling a person toward risky behavior, including self-destructive acts. Still others may have experienced terrible abuse as children and are now in the midst of posttraumatic stress, or PTSD. Substance abuse is another frightening dual diagnosis. Consulting with a physician well-versed in psychology ought to be considered.
Discovery of the cutting
A few of those who cut may do so to call attention to themselves and get help as a result. If medical attention is sought for severe injury, that can also be a way of discovering that a loved one or friend is practicing this kind of risky relief. However, many people can cut for a long time before they are discovered. They wear long-sleeves and other cover-ups so that no one can see the scars. Some of them may eventually confide in someone who will help them to get help although they may fear being misunderstood, or worry about others being disappointed or angry.
If a family member or trustworthy friend suspects the behavior, confrontation is a good idea. Different people will respond differently. Some may deny or refuse help; others may be relieved to know that someone cares and will help. For those who may have a more entrenched psychiatric conditions, a hospital stay may be necessary.
Some people are able to stop cutting on their own, if they can find within themselves a motivation. The first step is for the person to realize that their behavior is connected to deep unshared emotions, and then he/she will recognize that they need to find an alternate way to deal with their problems and their pain. They need to learn how to regulate feelings that seem to be overwhelming through practices like talk therapy or meditation. It will take courage and strength and support from others to break the habit.
When a friend or loved one self-injures
If you are the one who has discovered that a friend or a loved one is injuring themselves, you may not know what to do. In fact, perhaps looking on line for answers is the first place you have turned. First of all, know that it IS important to take self-injury seriously even if it does not at first appear to be life-threatening. It is a risky behavior that becomes increasingly dangerous, not only because of the possibility of injury but also because of the escalation of the feelings that led to the behavior itself. Although you may worry about tattling on something that your friend has asked you to keep in confidence, it is too big a problem for you to hold by yourself. Here are some things you can do.
If the victim is your child…
Begin with talking with your pediatrician or family doctor. If your child is willing, make an appointment for an initial evaluation and if needed, referral to a mental health specialist. Do not yell at, cry or accuse your child. Remain calm, listen, and invite them to see the doctor.
If it is your friend/peer
It is hard, of course, not to be considered a tattler. The best way around this is to talk with your friend and suggest a friendly, sympathetic adult with whom they might speak. Hopefully this might be one of their parents, grandparents, or uncle or aunt. If not, help them think of another adult who could help: a school counselor, teacher, coach, or pastor.
If it is another adult
Listen for as long as it takes, and then firmly persuade your friend to seek appropriate help with a doctor or mental health professional.
If there are no direct discernible causes for cutting behavior, what are the factors that increase risk for it?
- Being female. As we have already said, females are statistically more likely to cut than males.
- Being young. This is most common among young people
- Having peers/friends who self injure.
- Larger life issues. Many people who self-injure have been neglected or abused as children. They may still be in the same unstable home environment, questioning their identity and/or their sexuality.
- Mental health issues. Cutters are likely to be impulsive, explosive, and self critical. The behavior itself is often associated with more serious mental health disorders, such as borderline personality, being depressed, anxiety, eating disorders, and post-traumatic stress disorder (PTSD).
- Excessive alcohol or drug use. Those who harm themselves often do so while under the influence of alcohol or illegal drugs.
Coping tips for the helper or loved ones
First of all, educate yourself. Learning more about NSSI will help you understand why this self-destructive behavior occurs. More knowledge will help you to be compassionate but also firm in helping the person to stop the behavior and to seek help. It is important for you to try not to judge or criticize, especially by raising your voice. That may actually lead to more of the behavior. Make sure they understand that you love them and care about them no matter what and that you are always available to listen and to talk and to work with them to find help and create non-injurious coping methods. Give them ideas about how you yourself cope with stress, and offer to teach them how to implement it. And lastly, find support for yourself: talk with other parents or friends who have dealt with this, especially if you can find a support group through references from your local health providers or through NAMI or other mental health organization. Make sure to take care of yourself while you are caring for your loved one: get exercise and rest.
What are some alternate ways of relieving stress and balancing emotions?
Again, there are as many alternatives as there are individuals. One important process to put into motion is helping the afflicted person use their words instead of their actions. Perhaps that sounds like advice for a raging toddler, but in fact, learning to talk openly with others and/or writing in a journal is an important first step in learning how to cope with strong emotions. Another important learning is that exercise –moving the body and taking in extra oxygen to the lungs – will increase feelings of well being. Singing works well in this regard, and/or vigorous participation in their art form or sport of choice: playing a musical instrument, dancing, painting, sculpting, etc. The hope is that eventually the cutter will find ways to use self-reflection to explore and cope with the range of human emotions that seem to come under control.with the cutting behavior.