Cutting & Self-Injury

Most of us know about cutting — using a sharp object like a razorblade, knife, or scissors to make marks, cuts, or scratches on one's own body. But cutting is just one form of self-injury. People who self-injure also might burn, scratch, or hit themselves; bang their head; pull their hair; pinch their skin; pierce their skin with needles or sharp objects; or insert objects under their skin.

People who cut or self-injure often start doing it as young teens. Some continue to do it into adulthood.

Why Do People Hurt Themselves?

It can be hard to understand why people harm themselves on purpose. But it's a way some people try to cope with the pain of strong emotions, intense pressure, or upsetting relationship problems. They may be dealing with feelings that seem too difficult to bear or bad situations they think can't change.

Some people do it because they feel desperate for relief from bad feelings. People may not know better ways to get relief from emotional pain or pressure. For some, it's an expression of strong feelings like rage, sorrow, rejection, desperation, longing, or emptiness.

There are other ways to cope with difficulties, even big problems and terrible emotional pain. The help of a mental health professional might be needed for major life troubles or overwhelming emotions. For other tough situations or strong emotions, it can help put things in perspective to talk problems over with parents, other adults, or friends. Getting plenty of exercise also can help put problems in perspective and help balance emotions.

But people who self-harm may not have developed ways to cope. Or their coping skills may be overpowered by emotions that are too intense. When emotions don't get expressed in a healthy way, tension can build up — sometimes to a point where it seems almost unbearable. Cutting or another self-injury may be an attempt to relieve that extreme tension. For some, it seems like a way of feeling in control.

The urge to cut might be triggered by strong feelings the person can't express — such as anger, hurt, shame, frustration, or alienation. People sometimes say they feel they don't fit in or that no one understands them. A person might self-harm because of losing someone close or to escape a sense of emptiness. It might seem like the only way to find relief or express personal pain over relationships or rejection.

People who cut or self-injure sometimes have other mental health problems that contribute to their emotional tension. Cutting is sometimes (but not always) associated with depression, bipolar disorder, eating disorders, obsessive thinking, or compulsive behaviors. It can also be a sign of mental health problems that cause people to have trouble controlling their impulses or to take unnecessary risks. Some people who self-harm have problems with drug or alcohol abuse.

Cutting and other types of self-harm often begin on an impulse. It's not something the person thinks about ahead of time. Some people who cut have had a traumatic experience, such as living through abuse, violence, or a disaster. Self-injury may feel like a way of "waking up" from a sense of numbness after a traumatic experience. Or it may be a way of reliving the pain they went through, expressing anger over it, or trying to get control of it.

What Can Happen to People Who Self-Injure?

Although it may provide some temporary relief from a terrible feeling, people who self-harm tend to agree that it isn't a good way to get that relief. For one thing, the relief doesn't last. The troubles that triggered it remain — they're just masked over.

People don't usually intend to hurt themselves permanently. And they don't usually mean to keep cutting or doing another type of self-harm once they start. But both can happen. It's possible to misjudge the depth of a cut, for example, making it so deep that it requires stitches (or, in extreme cases, hospitalization). Cuts can become infected if a person uses nonsterile or dirty cutting instruments — razors, scissors, pins, or even the sharp edge of the tab on a can of soda.

Most people who self-injure aren't attempting suicide. It's usually a person's attempt at feeling better, not ending it all. Although some people who self-injure do attempt suicide, it's usually because of the emotional problems and pain that lie behind their desire to self-harm, not the behavior itself.

Self-injury can be habit forming. It can become a compulsive behavior — meaning that the more a person does it, the more they feel the need to do it. The brain starts to connect the injury to the false sense of relief from bad feelings, and it craves this relief the next time tension builds. When self-harm becomes a compulsive behavior, it can seem impossible to stop. So it can seem almost like an addiction, where the urge to do it can seem too hard to resist. A behavior that starts as an attempt to feel more in control can end up controlling you.

Getting Help

There are better ways to deal with troubles than cutting or other self-harm — healthier, long-lasting ways that don't leave a person with emotional and physical scars. The first step is to get help with the troubles that led to the behavior in the first place. Here are some ideas for doing that:

1. Tell someone. People who have stopped self-injuring often say the first step is the hardest — admitting to or talking about it. But they also say that after they open up about it, they often feel a great sense of relief. Choose someone you trust to talk to at first (a parent, school counselor, teacher, coach, doctor, or nurse). If it's too hard to bring up the topic in person, write a note.
2. Identify the trouble that's triggering it. Cutting and other types of self-harm are ways to react to emotional tension or pain. Try to figure out what feelings or situations are causing you to do it. Is it anger? Pressure to be perfect? Relationship trouble? A painful loss or trauma? Mean criticism or mistreatment? Identify the trouble you're having, then tell someone about it. Many people have trouble figuring this part out on their own. This is where a mental health professional can really help.
3. Ask for help. Tell someone that you want help dealing with your troubles and the self-harm. If the person you ask doesn't help you get the help you need, ask someone else. Sometimes adults try to downplay the problems teens have or think they're just a phase. If you get the feeling this is happening to you, find another adult (such as a school counselor or nurse) who can make your case for you.
4. Work on it. Most people with deep emotional pain or distress need to work with a counselor or mental health professional to sort through strong feelings, heal past hurts, and learn better ways to cope with life's stresses. One way to find a therapist or counselor is to ask at your doctor's office, at school, or at a mental health clinic in your community.

It can take time to overcome cutting or other kinds of self-injury. But therapists and counselors are trained to help people get through it and find inner strengths that help them heal. Then they can use those strengths to cope with life's problems in a healthy way.