Mind Help

Cutting

Cutting

Nonsuicidal self-injury, often simply called self-injury, is the act of deliberately harming your own body, such as cutting or burning yourself. It’s typically not meant as a suicide attempt. While self-injury may bring a momentary sense of calm and a release of tension, it’s usually followed by guilt and shame and the return of painful emotions. Although life-threatening injuries are usually not intended, with self-injury comes the possibility of more serious and even fatal self-aggressive actions.

What Is Cutting?

Cutting refers to the practice whereby an individual deliberately harms his/her body in a non-suicidal manner. It is a form of self-injury where the concerned person performs small cuts on his/her body, usually the arms and legs. This type of self-injury is a painful way to deal with emotional pain, extreme anger, and frustration.

Cutting is the most prevalent form of physical self-harm. Like other forms of self-injury practice, cutting is not a suicidal act but rather, an unhealthy coping technique people use to alleviate stress” says the experts at Minds Help. The common tools used to self-harm via cutting are knives, paper clips, razors, or any other sharp object that will help induce the pain. It must be noted that this phenomenon or practice is a faulty cycle connected with anger, sadness, and neglect, followed by a quick mental relief from cutting. Upon the completion of the act, the individual starts experiencing feelings of guilt and shame, which then again turns to anger and sadness, thus repeating the cycle again.

Individuals with a past or recent history of abuse, shock, low self-esteem, family dispute, bullying, and sexual identity conflicts often suffer from extreme stress and negative feelings. In order to deal with such uncontrollable emotional turmoil, people sought the practice of cutting to relieve the stress and such negative emotions. Many individuals who engage in self-harm observe this practice as a psychological release. They consider it a way to unravel their deep underlying negative emotions and thoughts.

According to a 2010 study 1 , non-suicidal self-injury is defined as ”intentional, direct damage to one’s body tissue without suicidal intent”. Other terms that have been applied to describe this behavior are deliberate self-harm, self-wounding, superficial-moderate self-mutilation, and parasuicide. Such behavior is mainly exhibited through skin-cutting, scratching, burning, and self-banging or hitting.

”Self-injury is prevalent among patients diagnosed with anxiety, substance abuse and dependence, eating, and psychotic disorders, as well as each of the personality disorders, and especially borderline personality disorder” says the study. While self-injury is relatively common in clinical settings, it can also be found in non-patient populations. The study states that nearly 4% of individuals from large community samples have reported a history of self-injury. Lifetime rates appear to be particularly high in adolescents and young adults, where approximately 15–17% report a history of self-injury.

Cutting At A Glance 

  1. Cutting refers to the practice whereby an individual deliberately harms his/her body in a non-suicidal manner.
  2. Nonsuicidal self-injury, often simply called self-injury, is the act of deliberately harming your own body, such as cutting or burning yourself.
  3. People who engage in self-harm in the form of cutting generally go through a lot of trouble hiding the fact.
  4. Cutting, just like other self-injuring habits, is a developing condition, especially among adolescents and adults.
  5. While the exact reason behind causing self-harm or cutting is not yet known, the causes usually stem from unhappy emotions.

Prevalence Of Cutting & Other Self Harm

A 2005 study 2 comprised 4,205 adolescents aged 13-18 years. In this study, background circumstances, social relationships, alcohol and substance abuse, self-harm, and self-cutting were assessed by a structured questionnaire. As per the results, the lifetime prevalence of self-cutting was 11.5% and of other self-harm 10.2%. The prevalence of current self-cutting was 1.8%. Self-cutting was associated with the female gender and other adverse psychosocial background variables.

According to another study 3, a national interview survey suggested that in Great Britain, between 4.6% and 6.6% of people engaged in self-harmed In a school survey, 13% of young people aged 15 or 16 reported having self-harmed at some time in their lives.

As per another 2006 study 4, a survey conducted in U.S. community samples of young adults and adolescents estimates self-injury prevalence from 4% to 38%. Larger studies in Britain consider that approximately 10% of youth within 11 to 25 years of age self-injure. As per another study, skin cutting is the most common form of causing self-injury, accounting for 70-90% of cases.

Causes Of Cutting

While the exact reason behind causing self-harm or cutting is not yet known, the causes usually stem from unhappy emotions. These generally include low self-esteem or self-hatred. One may feel angry, guilty, sad, anxious, numb, lonely, or unconnected to the world due to some incident. Such emotions can slowly build up in an individual which he/she may not know how to turn off later. Thus, self-harming in the form of cutting may become the only way to cope up with such problems while alleviating emotional turmoils. Therefore, it is not a way to seek attention but a sign of emotional distress.

According to a study, brain chemicals play their part in motivating one into self-injury. ”Youth experiencing chemical imbalances within the brain may injure to release endorphins or experience a high”, says the study. Just like drug use, a person may also develop yearnings for these brain chemicals and eventually experience a form of addiction.

Additionally, the study 5 also mentions that neurotransmitters such as serotonin have also been linked to self-injury. Serotonin levels control emotions such as depression, emotional distress, and aggression. However, a self-injurer with typically low levels of serotonin attempts to increase serotonin levels upon injury. ”As a result, they instantly experience relief and regulation of the aforementioned emotional issues”.

Other factors that may influence one into self-injury are cutting are:

1. Social Causes

Social factors commonly cause emotional distress in people who self-harm. These include may include:

  • Troubled relationships with friends or partners
  • Problems at school or doing poor academically
  • Challenges at work
  • Being bullied, either at home, school, or work
  • Concerns about money
  • Alcohol or drug misuse
  • Facing challenges with one’s own sexuality when he/she thinks himself/herself gay or bisexual
  • Coping with cultural expectations, for example, an arranged marriage

According to a study 6 , self-harm occurs in all sections of the population but is more prevalent among individuals with poor socio-economic terms and among those who are single or divorced, live alone, are single parents, or have a severe lack of social support. Life events are strongly assumed to be linked with self-harm in two ways. First, there is a strong relationship between the likelihood of self-harm and adverse events in that person’s life. Second, life events, particularly relationship problems, can foster the act of self-harm.

2. Trauma

Self-harm could also sometimes be a way of coping with a traumatic experience. Such experience may include:

  • Sexual, physical, or emotional abuse in the form of domestic abuse, rape, etc.
  • The loss of a close family member or friend
  • Suffering a miscarriage

A study 7 states that child sexual abuse is associated with self-harm along with other mental health problems in adolescence and adulthood, particularly in females. In one review of 45 studies about childhood sexual abuse, immediate and long-term signs of severe mental torture were typical. It included anxiety, substance misuse, depression, self-destructive behavior, suicide, self-harm, and re-victimization. Prevalence rates for child sexual abuse were high, 20% to 30% for women and 10% for men while 25% of women (and their children) experiencing domestic violence. Underlying this are high rates of physical abuse.

Read More About Post Traumatic Stress Disorder Here

3. Psychological Causes

In some cases, psychological reasons may also lead to self-harming. For example:

  • One may hear voices telling him/her to self-harm
  • Individuals may have repeated, compelling thoughts about self-harming
  • One may lose touch with himself/herself and the surroundings, thus engaging in self-harm
  • It can also be a symptom of borderline personality disorder

According to a study 8 , most individuals who attend an emergency department following an act of self-harm tend to meet the criteria for one or more psychiatric diagnoses at the time when they are assessed. ”More than two-thirds would be diagnosed as having depression although, within 12–16 months, two-thirds of these will no longer fulfill diagnostic criteria for depression” says the study. In one British survey, people with symptoms of a mental disorder were up to 20 times more likely to report having harmed themselves in the past. Certain mental characteristics are more common among such populations including impulsivity, poor problem-solving, and hopelessness. Also, people who self-harm more often have interpersonal difficulties.

Read More About Depression Here

What Are The Symptoms Of Cutting?

People who engage in self-harm in the form of cutting generally go through a lot of trouble hiding the fact. People who cut themselves may:

  • Constantly criticizing themselves
  • Dealing with troubled relationships
  • Questioning their personal identity or sexuality
  • Dealing with emotional instability
  • Having an impulsive nature
  • Experiencing feelings of guilt, hopelessness, or worthlessness
  • Often having fresh cuts, particularly on the arms and legs
  • Injuries from previous cuts
  • Keeping sharp objects like razor blades and knives in reach
  • Always wearing clothes covering their skin, even in hot weather
  • Justifying cuts and scars that just don’t ring true

Additionally, such individuals may also engage in other self-harm behaviors such as:

  • Scratching or picking at wounds
  • Burning themselves with cigarettes, candles, matches, or lighters
  • Pulling out their hair

Who Is At Risk Of Inflicting Self-Cutting?

It must be noted that engaging in self-cutting is popular mostly among teenagers and young adults, although people in other age groups may also engage in the act. Self-injury usually begins in the preteen or early teen years, when emotions are more unpredictable and teens encounter increasing loneliness, peer pressure, and conflicts with parents or other authority figures. Factors that may increase the risk of self-injury are:

  • Staying with friends who also practice the act of self-injury.
  • Dealing with life issues such as feeling neglected, sexual, physical, or emotional abuse, or other traumatic life events. Additionally, the person might have grown up in an unstable family environment, or they may be young people questioning their personal identity or sexuality.
  • People suffering from certain mental health conditions such as borderline personality disorder, anxiety, depression, post-traumatic stress disorder, and eating disorders.
  • Alcoholism or substance misuse may also influence one into cutting themselves.

Read More About Alcoholism Here

Complications Associated With Cutting

Self-injury or cutting can cause an array of complications, including:

  • Aggravated feelings of guilt, shame, and low self-esteem
  • Infection developing from injuries or from sharing tools
  • Permanent scars
  • Severe, possibly fatal injury
  • Severe underlying issues and disorders, if not well treated
  • Increased risk of suicide

Diagnosis Of Cutting

Any form of self-injury including cutting generally is recognized by family members, friends, or a doctor during the routine medical examination. However, there is no formal diagnostic test for self-injury. Diagnosis is generally performed via physical and psychological evaluation. The person may be asked to consult a mental health professional for treating self-injury for evaluation. The mental health professional may further evaluate the person for other mental health disorders that may be linked to self-injury, such as depression or personality disorders.

According to a study, non-suicidal self-injury (NSSI) has historically been considered a symptom of borderline personality disorder. Diagnostic and Statistical Manual of Mental Disorders, 4th ed (DSM-IV) had considered self-harm under the aforementioned diagnostic criteria. However, practitioners had stated that the current diagnostic criteria were wrong for many self-injurious clients. As a result, experts called for a precise and a more accurate diagnosis within the DSM-5. In response, the American Psychiatric Association placed NSSI in a new section of the Diagnostic and Statistical Manual of Mental Disorders entitled, “Conditions for Further Study.” Thus, the proposed criteria in this section require additional study and are not intended for clinical diagnosis. NSSI may also look similar to other disorders such as trichotillomania or another disorder such as borderline personality disorder, eating disorders, or substance abuse. To further complicate diagnosis, the DSM-5 states there must be an absence of suicidal intent in order to meet the criteria for NSSI.

Treatment Of Repetitive Self-Mutilation

There’s no precise way to treat the act of cutting. However, treatment of this condition is sometimes based on other specific issues along with other related mental health disorders that the person might be facing. As we mentioned earlier, since cutting or self-injury is associated with other mental health disorders, the treatment is planned in a way to focus on that of the disorder along with the condition. Here are a few ways to treat the act of cutting or self-injury in an individual.

1. Psychotherapy

Also known as talk therapy or psychological counseling, psychotherapy can help a person the following way.

  • To learn to boost self-image
  • Help develop abilities to improve relationships and social skills
  • Learning to manage stress better
  • To identify and control underlying issues
  • To learn how to regulate one’s emotions
  • Help develop sound problem-solving skills

There are different types of individual psychotherapy that may be helpful. These are as follows.

A. Mindfulness-Based Therapies

The main advantages of mindfulness-based therapy are:

  • Enables one to live in the moment
  • Fosters appropriate understanding of the thoughts and actions
  • Reduces anxiety and depression for better well-being

A 2018 study 9 states that the most widely researched Mindfulness-Based Interventions (MBI) to treat psychiatric disorders is mindfulness-based cognitive therapy (MBCT). According to a meta-analysis, MBCT decreased the risk for relapse and recurrence of the major depressive disorder when compared to treatment as usual (TAU) or placebo control groups. The relapse rate among MBCT+TAU patients was 32% relative to 60% for the TAU control group. Moreover, MBCT is as useful as a maintenance antidepressant medication in preventing major depressive disorder relapse

B. Dialectical Behavior Therapy

Dialectical behavior therapy is a type of CBT that helps one develop behavioral skills to endure distress, manage or regulate emotions better while improving relationships with others. In a clinical study, two groups compared. In one group, females aged 18–45 yrs with parasuicidal borderline per­sonality disorder (PBPD) were treated using DBT, and in another group, females with PBPD underwent treatment as usual in the community. Results showed that there was a striking decrease in the frequency and medical risk of parasuicidal behavior among patients who received DBT compared to those who received usual treatment. DBT efficiently retained patients in therapy. Additionally, the number of days of inpatient psychiatric hospital­ization had notably reduced as well.

C. Cognitive-Behavioral Therapy (CBT)

CBT first helps one to discover harmful, negative beliefs and behaviors and then replacing the same with sound, adaptive ones. A 2011 study 10 states that CBT is effective when it comes to the treatment of depression and may act as a good alternative to antidepressant medications (ADM). CBT may also prove to be effective along with medication for bipolar patients, however, there aren’t many studies to support the same. Additionally, CBT has shown lasting effects on such patients. Thus, it prevents succeeding relapse and recurrence, following the end of active treatment, something that cannot be claimed for medications.

Read More About Cognitive-Behavioral Therapy (CBT) Here

2. Medications

There are no medicines specifically curated to treat self-injuring behavior like cutting. However, if one is diagnosed with a mental health condition, such as depression or anxiety, the doctor may suggest antidepressants or other medicines to treat the related disorder with cutting.

Read More About Antidepressants Here

Prevention Tips For Cutting

While people can help their loved ones from inflicting self-injury by cutting their skin, it must be noted that there is no sure way to prevent the same. However, one can come up with strategies with the help of the person’s parents, family members, teachers, school nurses, coaches, or friends to prevent this condition from aggravating. Here are to steps to prevent cutting.

Step 1: Identify the Victim

Start by understanding whether someone is at the risk of developing self-injuring behavior and offer help to that person. The person who is still at risk can be taught to control his/her urge along with healthy coping skills before the habit becomes out of control.

Step 2: Expand Socialisation

The person at risk tends to feel isolated, lonely, and disconnected. Thus, it is wise to help that person connect with someone who will discourage the person from self-injuring himself/herself while improving the relationship and communication skills.

Step 3: Raise Awareness

As a helper, one must identify the warning signs of self-injury and learn what to do when one suspects it.

Step 4: Encourage to Seek Help

Encourage the victim to seek help rather than maintaining secrecy about their developing behavioral pattern.

Lifestyle & Home Remedies To Prevent Cutting

In addition to professional treatment, one can also indulge in self-care through home homely remedies. These are as follows.

  • The person must stay committed to his/her treatment plan, attend therapy sessions on a regular basis along with taking prescribed medications on time.
  • Upon understanding the triggering factor of the habit, one must look for ways to soothe or distract him/herself. He/she can also get support from the near ones.
  • Seek help, be it from a professional, friend, family, or partner.
  • One must practice physical activity and relaxation exercises and add them to his/her daily routine. Additionally, one must eat healthy food and seek professional help in the case of sleep troubles.
  • Avoid alcohol and recreational drugs.
  • The person must take good care of his/her wounds caused due to cutting or seek medical treatment if needed.

Coping Techniques

Coping tips if someone self-injures himself/herself include:

  • Staying in contact with people who will stop the victim from feeling lonely and to whom, the person can reach out for help in times of stress.
  • The person must stay away from websites that support or glorify self-injury. Instead, one must look for places or websites that encourage recovery efforts.
  • The person must express his/her emotions in a positive way. He/she must engage in activities that will keep him/her happy like regular workouts, relaxation techniques, or participating in dance, art, or music events.

Think Positive, Embrace Good Company & Seek Help When Needed

Cutting, just like other self-injuring habits, is a developing condition, especially among adolescents and adults. It is also linked with other mental impairments most of the time. Research and examinations around this area have grown with time, resulting in an ongoing debate about its separate diagnosis. Cutting, however, is a manageable condition. One must support the victim to express his/her feelings, provide a stable environment, help seek professional treatment, and provide persistent care to help the victim overcome this condition over time.

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References:
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  2. Laukkanen, E., Rissanen, M. L., Honkalampi, K., Kylmä, J., Tolmunen, T., & Hintikka, J. (2009). The prevalence of self-cutting and other self-harm among 13- to 18-year-old Finnish adolescents. Social psychiatry and psychiatric epidemiology, 44(1), 23–28. https://doi.org/10.1007/s00127-008-0398-x []
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  6. National Collaborating Centre for Mental Health (UK). Self-Harm: The Short-Term Physical and Psychological Management and Secondary Prevention of Self-Harm in Primary and Secondary Care. Leicester (UK): British Psychological Society; 2004. (NICE Clinical Guidelines, No. 16.) 2, Introduction to self-harm. Available from: https://www.ncbi.nlm.nih.gov/books/NBK56398/ []
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