Cutting in Adolescence

The following is not meant to invoke fear, though it may, but rather, inform you as to a trend starting in early adolescence that has existed for decades in the dark. There is a plethora of means to self-harm, such as anorexia, or starving / restricting food intake; bulimia, or purging / vomiting up food soon after consumption; and so on. However, the form of self-harm briefly discussed here falls within the realm of self-mutilation, known as cutting. Burning oneself is also included as another form of self-mutilation. The information to follow may be difficult to read, though awareness is necessary. Take breaks in reading this article if need be and do not continue reading until you feel more settled.

Emerging adolescence is an extremely challenging time developmentally, emotionally, psychologically, culturally, and socially. As such it is not uncommon for adolescents to experiment with various means, such as sex, drugs, and alcohol, as well as exercise, and academia, to sooth their plight. Another means is cutting. Often cutting involves the straight, parallel, mild to severe, incisions to the skin. In addition, words, patterns, and symbols may present. These injuries are commonly located on the outer and inner forearms, biceps, shoulders, and the outer and inner thighs. Cutting has been also known to occur, in even more severe instances, on the hips, in the nooks and crannies of the palms, under the feet, between the fingers and toes, on the breasts, as well as on other genitals for females, and for males. Though cutting is significantly more common in young girls and older women, cutting definitely occurs among clusters of young boys and older men as well. In fact, cutting has become increasingly popular among male youths.

Commonly, cutting is an isolative and secretive experience in terms of the action itself, and in concealing the outcome. In general, adolescents hide their more risky behaviours, and, in general, we adults tend not to see the extent of those behaviours. Thus cutting may occur for many months, or years, or may never be discovered. Though few who cut wear their injuries like a badge, most hide their wounds with thin, long-sleeve tops and jeans, even in extreme heat, and insistently avoid shorts, dresses, short-sleeve tops, and the like. More seasoned self-mutilators will knowingly wear shortened clothing to avoid suspicion, and cut on the fewer hidden areas. The point here is to be aware of unusual behaviour and potential warning signs, and not to assume self-mutilation when faced with fashion choices we simply do not understand or we outright dislike.

Self-mutilation or cutting may occur with almost any implement, for example, kitchen knives, forks, pocket knives, scissors, razor blades, glass, paperclips, paperclip removers, nails, keys, box cutters, bottle openers, barbwire fencing, thorny bushes, open canned-food lids, nail clippers, paint peelers, and the like. The list is essentially endless. It is impossible to eliminate all items that may be used for cutting; however, one may take note of implements that are oddly located, stained with dried blood, missing, and so on. In addition, note whether plasters, tape, bandages, cloths, gauze, and/or disinfectants, are empty frequently, or inexplicably. Furthermore, note whether blood-stained clothing is placed in the wash, even within, or under other clothes; and/or whether clothes have ‘disappeared’ at a highly unorthodox pace. Those clothes may have had dried blood on them, and so, discarded.

The reasons behind cutting as a means of coping or self-soothing are far too vast to explore in-depth here, however, briefly, most cutters tend to self-harm to anesthetise, ‘zone-out’, distract from, or numb feelings, such as despair, helplessness, self-hatred, emptiness, frustration, rage, hopelessness, regret, guilt, shame, and so on. In contrast, cutting also may be used in order to shift from a state of numbness to a place of feeling, such as feeling in control, free, special, accepted, joyous (usually from an endorphin or adrenalin rush), powerful, focused, calm, relieved, and so on. Though this is a general description in understanding self-mutilation, it is important that the individual cutter become aware of their idiosyncratic reasons for doing what they do. Despite the myth, once an adolescent has found cutting as a means of coping or self-soothing, it is generally quite difficult to just simply stop the behaviour, and relapses or re-occurrences are expected, even in treatment. The hope is to reduce the frequency and severity of the cutting over time until it becomes needless and purposeless. Use the analogy of an alcoholic and his or her alcohol to grasp the difficulty involved. In that, it is always important to keep a complete and unexpired first aid kit regardless of whether cutting occurs or not.

It is important that adolescents are approached calmly and gently when engaged by his or her worried, panicked, frustrated, confused, angry, and/or saddened parent or caregiver, upon questioning, or discovery, of any cutting or self-mutilating behaviours. As stated earlier, adolescents tend to not fully disclose their thoughts, feelings, and behaviours to their caregivers. As such, adolescents who are unable to talk about, or even articulate, their cutting to their parents or caregivers, should be referred to their nearest or most trusted healthcare professional, such as a psychiatrist and/or psychologist. In more severe instances, visits and/or admission to the nearest medical or psychiatric hospital or treatment facility may be most opportune. In that, though cutting itself differs from an actual suicide attempt, accidental death may occur in certain circumstances, and in a few severe instances, suicide attempts may co-occur. It is then better to err on the side of caution, than avoid, dismiss, or ignore. In terms of understanding cutting better, two excellent books to read are Marliee Strong’s (1998) A Bright Red Scream: Self-Mutilation and the Language of Pain; and Steven Levenkron’s (1998) Cutting: Understanding and Overcoming Self-Mutilation.