Cutting

What Is Cutting?

Someone who cuts uses a sharp object to make marks, cuts, or scratches on the body on purpose — enough to break the skin and cause bleeding. People typically cut themselves on their wrists, forearms, thighs, or belly. They might use a razorblade, knife, scissors, a metal tab from a soda can, the end of a paper clip, a nail file, or a pen. Some people burn their skin with the end of a cigarette or lighted match.

Most people who self-injure are girls, but boys do it too. It usually starts during the teen years and can continue into adulthood. In some cases, there's a family history of cutting.

A sense of shame and secrecy often goes along with cutting. Most teens who cut hide the marks and if they're noticed, make up excuses about them. Some teens don't try to hide cuts and might even call attention to them.

Cutting often begins as an impulse. But many teens discover that once they start to cut, they do it more and more, and can have trouble stopping. Many teens who self-injure report that cutting provides a sense of relief from deep painful emotions. Because of this, cutting is a behavior that tends to reinforce itself. Cutting can become a teen's habitual way to respond to pressures and unbearable feelings. Many say they feel "addicted" to the behavior. Some would like to stop but don't know how or feel they can't. Other teens don't want to stop cutting.

Why Do Teens Cut?

Teens cut for many different reasons. For most, cutting is an attempt to interrupt strong emotions that seem impossible to tolerate. Most of the time, cutting is not a suicide attempt. But sadly, people often underestimate the potential to get seriously sick or hurt through bleeding or infections that go along with cutting.

Powerful overwhelming emotions. Most teens who cut are struggling with powerful emotions. To them, cutting might seem like the only way to express or interrupt feelings that seem too intense to endure. Emotional pain over rejection, lost or broken relationships, or deep grief can be overwhelming for some teens. And many times they're dealing with emotional pain or difficult situations that no one knows about. Pressure to be perfect or to live up to impossible standards — their own or someone else's — can cause some teens unbearable pain. Some teens who cut have been deeply hurt by harsh treatment or by situations that have left them feeling unsupported, powerless, unworthy, or unloved.

Some teens have experienced trauma, which can cause waves of emotional numbness called dissociation. For them, cutting can be a way of testing whether they can still "feel" pain. Others describe cutting as a way of "waking up" from that emotional numbness.

Self-inflicted physical pain is specific and visible. For some, the physical pain of cutting can seem preferable to emotional pain. Emotional pain can feel vague and hard to pinpoint, talk about, or soothe. When they cut, teens say there is a sense of control and relief to see and know where the specific pain is coming from and a sense of soothing when it stops. Cutting can symbolize inner pain that might not have been verbalized, confided, acknowledged, or healed. And because it's self-inflicted, it is pain the teen controls.

A sense of relief. Many teens who cut describe the sense of relief they feel as they're cutting, which is common with compulsive behaviors. Some people believe that endorphins might add to the relief teens describe when they cut. Endorphins are the "feel-good" hormones released during intense physical exertion. And they can be released during an injury. Others believe the relief is simply a result of being distracted from painful emotions by intense physical pain and the dramatic sight of blood. Some teens say they don't feel the pain when they cut, but feel relieved because the visible SI "shows" emotional pain they feel.

Feeling "addicted." Cutting can be habit forming. Though it only provides temporary relief from emotional distress, the more a person cuts, the more he or she feels the need to do it. As with other compulsive behaviors, the brain starts to connect a momentary sense of relief from bad feelings with the act of cutting. Whenever the tension builds, the brain craves that relief and drives the teen to seek relief again by cutting. So cutting can become a habit someone feels powerless to stop. The urge to cut — to get relief — can seem too hard to resist when emotional pressure is high.

Other mental health conditions. Cutting is often linked to — or part of — another mental health condition. Some teens who cut are also struggling with other urges, obsessions, or compulsive behaviors. For some, depression or bipolar disorder can contribute to overwhelming moods that may be difficult for a teen to regulate. For others, mental health conditions that affect personality can cause relationships to feel intense and consuming, but unsteady. For these teens, intense positive attachments can suddenly become terribly disappointing and leave them feeling hurt, anger, or despair too strong to cope with. Other teens struggle with personality traits that attract them to the dangerous excitement of risky behavior or self-destructive acts. Some are prone to dramatic ways of getting reassurance that they are loved and cared about. For others, posttraumatic stress has had an effect on their ability to cope. Or they're struggling with alcohol or substance problems.

Peer pressure. Some teens are influenced to start cutting by another person who does it. For example, a teen girl might try cutting because her boyfriend cuts. Group peer pressure can play a role, too. Some teens cut in groups and might pressure others to cut. A teen might give in to group pressure to try cutting as a way to seem cool or bold, to belong, or to avoid social bullying.

Any of these factors may help to explain why a particular teen cuts. But each teen also has unique feelings and experiences that play a role. Some who cut might not be able to explain why they do it. Regardless of the factors that may lead a teen to self-injure, cutting isn't a healthy way to deal with even the most extreme emotions or pressures.

Confronting Cutting

Some teens call attention to their self-injury. Or if the SI requires medical attention, that might be a way others find out. But many teens cut for a long time before anyone else knows. Some teens eventually tell someone about their self-injury — because they want help and want to stop, or because they just want someone to understand what they're going through.

It can take courage and trust to reach out. Many teens hesitate to tell others because they fear being misunderstood, or worry that someone might be angry, upset, disappointed, shocked, or judgmental. Some teens confide in friends, but ask them not to tell. This can create burden and worry for a friend who knows.

If confronted about the cutting, teens can respond in different ways, depending partly on the teen and partly on the how they were approached by it. Some might deny the cutting, while others might admit to it, but deny that it's a problem. Some might get angry and upset or reject efforts to help. Some teens are relieved that someone knows, cares, and wants to help.

Bringing a Halt to Cutting

Whether or not anyone else knows or has tried to help, some teens cut for a long time before they try to stop. For teens whose cutting is part of another mental health condition, prefessional help is usually necessary. Sometimes cutting or another symptom leads to a teen's admission to a mental health hospital or clinic. Some teens have more than one hospital stay for self-injury before they feel ready to accept help for cutting or other problems.

Some teens find a way to stop cutting on their own. This might happen if a teen finds a powerful reason to stop (such as realizing how much it hurts a friend), receives needed support, or finds ways to resist the powerful urge to cut. To stop cutting, a person also needs to find new ways to deal with problem situations and regulate emotions that feel overwhelming. This can take time and often requires the help of a mental health professional.

It can be difficult to stop cutting and a teen might not succeed at first. Some people stop for a while and then start cutting again. It takes determination, courage, strength — as well as support from others who understand and care — to break this powerful habit.