The Unkindest Cut

People who discover that relatives or friends are in the habit of furtively cutting themselves often react with horror. It can be frightening. But, as Saturday Early Show family and adolescence counselor Mike Riera explains, such behavior is usually a sign of great inner pain.

Cutting usually begins during puberty and lasts 5 to 10 years. But it can go on much longer if left untreated.

Many cutters also have eating disorders or were sexually abused. Usually, people cut themselves on the arms or legs because it is easier to hide the wounds with clothing.

Experts estimate that nearly 1 percent of the population are self-injurers, and the primary means of injury is through cutting, although other behaviors include burning,
aggressive and intentional scab picking so as to interfere with healing, and hair pulling.

How common is cutting? Who does this to themselves?

More females than males, to begin with. The typical person is middle- to upper-class with average to above-average intelligence and low self-esteem. Many also report having been physically or sexually abused during childhood, too.

A typical victim is hypersensitive to rejection and often is chronically angry, with no outlet for that anger.

Overall, general neglect by family is the best predictor of self-injurious behavior later on. Especially vulnerable are those who cannot remember feeling special or loved as a child.

Author and psychologist Dusty Miller says: "Men act out. Women act out by acting in." Generally, self-cutting is not an attempted suicide; rather, a means of coping with painful feelings.

Some feel it's about control; others, that if you were abused as a child, you learned to devalue yourself and therefore, to punish yourself. Most do not report the cutting as painful.

Here is the vicious cycle of cutting: The act makes the person feel powerful, in control, and alive. Then, they quickly feel guilty and ashamed of themselves for having cut themselves. This makes them anxious and sets the stage for more cutting.

Self-cutting quickly calms the body.

What are the signs that someone is cutting? How should you respond if you think a friend or child is cutting?

Wearing long sleeves or long pants all the time, even on hot summer days. Confront them nonjudgmentally, and get them to a professional.

How is this condition treated?

The cutting temporarily elieves stress and anxiety. So part of solution is to find other means of resolving stress. Some past sufferers report drastic interventions, once they have committed themselves to stopping: taking a cold bath, biting into a strongly favored food (lemon, hot pepper, garlic), something as intense as the cutting.

Often, this kind of behavior is symptomatic of another sort of psychiatric disorder: depression, manic depression, borderline personality. This must be treated in conjunction with the cutting behavior.

Most effective treatments involve a combination of face-to-face therapy and medication. The medication helps break the cycle of behavior, and the talk therapy helps the patient to address the underlying issues. One hopes this leads to new coping behaviors and eradicates the need for medication.

Especially important: The person under treatment needs to feel accepted by family members and not judged for their behavior.

©MMI, CBS Worldwide Inc. All Rights Reserved