Many things happen behind closed doors and in private, sometimes going completely unnoticed or unimaginable. One of those things is self-harm, such as cutting, which occurs much more often than people would expect.
Every year, one in five females and one in seven males engage in self-injurious behavior. About 90 percent of those who participate in self-harm began during their pre-teen or teenage years.
Approximately two million cases are reported annually in the U.S. Imagine how many cases there actually are, since a majority of the cases go unreported.
When cutting occurs, it usually manifests as horizontal scars across the lower arms (as in the picture) and upper thighs. These are both areas that can easily be covered with clothing.
Cutting isn’t the only form of self-harm that can be done. Other types of harm that can be self-inflicted and warning signs to look out for include:
- Picking at or reopening wounds
- Punching or hitting oneself
- Inserting objects into the skin
- Purposely bruising or breaking one’s bones
- Pulling out one’s hair
There are several myths about cutting and other forms of self-harm, which are important to recognize, understand, and even debunk.
First, cutting isn’t considered an attempt at suicide. According to the Diagnostic Manual of Mental Disorders (DSM-5), the authoritative guide for doctors, cutting is considered a non-suicidal self-injury disorder.
Second, it is not a mental illness. Cutting is a behavior indicating a lack of coping skills for emotional pain, intense anger and frustration. Even though self-injury brings a brief feeling of calm, it is usually followed by guilt, shame, and the return of painful emotions. This destructive cycle can become addictive to the point that it becomes a compulsive behavior and difficult to stop.
There are a great many reasons why people engage in cutting. It can be triggered by someone’s social environment. An overwhelming amount of stress can lead someone to feel like there’s no way out or to feel so empty that the only emotional release is through inflicting pain.
What you can do:
In order to help prevent someone from harming themselves, it helps to understand the risk factors and to be aware of red flags of secretive behavior. Risk factors include, but are not limited to:
- Age (teenagers and young adults most common, although it can happen at any age)
- Having friends who self-injure
- Abuse (sexual, physical or emotional)
- Social isolation/ loneliness
- Mental health issues (i.e., borderline personality disorder, eating disorders, depression, anxiety disorders, substance abuse, conduct, and oppositional defiant disorders)
Common signs and symptoms might include:
- Parallel linear scars on the arms
- Fresh cuts, scratches, bruises or other wounds
- Possession of sharp objects, like a razor
- Difficulties with relationships
- Persistent questions about personal identity, such as “Who am I?” and “What am I doing here?”
- Emotional and behavioral instability, impulsivity and unpredictability
- Statements of helplessness, hopelessness or worthlessness
Each of us has a responsibility to look out for friends, family and acquaintances for any signs or suspicions of self-harm and to offer help and support during whatever is compelling someone to hurt themselves. If you have a friend, loved one or acquaintance who is self-injuring or has revealed thoughts about self- harm, you must take it seriously.
You may feel shocked, scared, or even feel you’re betraying their privacy. However, this is too big of a problem to ignore, and their safety and well-being are the most important considerations.
If you know anyone injuring themselves, suggest they reach out to someone they trust, such as their parents, friends, teachers, a counselor, a physician or spiritual leader. Furthermore, always keep the suicide hotline number close by: 1-800-273-TALK (1-800-273-8255). If you find yourself in an emergency situation, this requires a quicker but, most importantly, calm response by calling 911 or other local emergency numbers.
Do not condemn or criticize anyone who has cut themselves for their behavior. What they need most is support and healthy coping skills rather than added negativity.
Preventing self-harm should be the utmost goal. There’s no fool-proof way to do so, but there are various avenues that can be taken to curtail it, including many seemingly small things anybody can do to look out for others and make a real difference.
Help is available
If you have ever harmed or currently harm yourself in any way, or if you’ve had suicidal thoughts, remember one thing: You can overcome almost any challenge. If you have injured yourself and believe your injury is life-threatening in any way, immediately call 911 or the suicide hotline.
Most importantly, reach out to somebody, anybody. If you can’t talk to your family members, talk to your doctor. If the doctor is not available, there is always help available at the hospital’s emergency room. Be it family, friend, minister or doctor, there is always someone there to help you. Please reach out.
By Charles E. Crutchfield III, MD and Alexis E. Carrington
Alexis E. Carrington is a senior medical student at St. George’s University School of Medicine and a graduate of Pepperdine University. She is currently applying for a dermatology residency and research fellowship.