Self Injury – Cutting – Self Mutilation

I wrote my thesis on SIB (Self Injurious Behavior) – it’s a topic close to my heart.  No, I’ve never been a “cutter.” But I love someone who engages in this behavior.  Cutters are on the increase.  I am a Family Therapist and 90% of my adolescent clients currently cut, or have experimented with it.  Yep.  What do they look like?  They look like kids you would see at your local coffee shop.  They are “A” students, varsity sport players, church youth leaders, and high achievers.  They typically abstain from recreational drug use.  So, WHY?  Why do these seemingly all-American kids cut themselves?

First, the data suggest most cutters are female, however, this may be significantly under-reported.  And, there is a very strong positive correlation between self-injury and sexual abuse – in other words, up to 77% of cutters have a positive history of sexual abuse.  The remainder come from “invalidating” home environments; e.g., neglect, emotional abuse, or a poor parent-child relationship fit.  How does sexual abuse and/or an invalidating home environment contribute to the urge to cut?

Cutters typically report an increasing urge or impulse to self-injure.  They often attempt to refrain, but the impulse is too strong and they find themselves with whatever sharp instrument is available (most cutters use one specific device regularly).  This urge often manifests after a trigger event – an argument, or a flashback to sexual abuse, or some cutters report “I don’t know why I did it – I just couldn’t stop myself.” Cutting their flesh is the only way to help them ease their emotional suffering.  Most cutters do not feel any pain.  This is attributed to a dissociative experience – they’re not totally emotionaly present.  This skill is what enabled them to survive earlier sexual abuse.  However, after a cutting episode, cutters become fully aware again, and the physical discomfort of their tissue trauma is now felt.

I knew a woman who cut her inner forearm about 12 inches long down to the tendons.  She didn’t know how serious she cut until after she came “back” to her body.  A family member found her and took her to the emergency room where the attending physician sutured her wound without anesthesia to “teach her a lesson.”  That doctor should have been sued.

Cutters are typically not attention-seeking.  They go to great lengths to hide their twisted and mutilated flesh.  They feel shame at their inability to resist their pathological impulse.  This behavior is very different than body piercings, tattoos, or body modifications as part of a cultural or religious purpose.  These people are private prisoners of their own impulse to self-injure because it is the only way they know to purge their pain.  If you or someone you know engages in self-injury, be gentle with them, listen, do not judge, try to avoid being horrified at any wounds they show you.  And lastly, help them find a compassionate therapist who has experience with this population.