A lot of people are shocked and horrified at the thought of self-mutilation and for many years “cutting” was categorized only as a symptom of Borderline Personality Disorder. BPD, as you may know, has symptoms of unstable personal relationships, impulsivity, and extreme mood changes (different from Bipolar disorder as they can change on a dime and swing wildly).
The new issue of the American Psychiatric Association’s Diagnostic and Statistical Manual, Fifth Edition or DSM-5, includes it as a separate diagnosis of Non-Suicidal Self-Injury (NSSI). Research has suggested that NSSI can occur independently of BPD but is also often a co-existing or co-morbid illness, occurring alongside BPD, Bipolar Disorder, one of the many anxiety disorders or with other disorders such as anorexia or bulimia.
I am the mother of pre-adolescent children – who are beginning to believe they know all about people who act “weird” or do “weird” things (their words, not mine). My daughter has recently talked about the “EMO” kids – which as a dumb mom, I had to figure out was a social group of kids who were “emotionally dark.” She includes in her description of an “EMO” as “you know, like kids who are cutters.” It is stereotypical to think that they all wear black clothing and heavy eyeliner – as some may – but many do not.
Some people who have the disorder would never be suspected of such – but then we are also sometimes surprised when someone who seems to have everything commits suicide, only to find that under the polished exterior was extreme anguish. Often, cutting will be dismissed as a “stage” and it may be a “stage” – but often it is not. Many patients – have arms or hips full of patterned scars – proving that it is often a condition all to itself.
Self-mutilation most often starts in the early teen years when adolescent emotions are at their height – but often extends well into adulthood. The majority of “cutters” are female – but not all. There is often a co-existing mental illness and may have a family history component – but also often occurs following events of abuse – including sexual, physical or emotional abuse. Sudden life changes such as unemployment or divorce – and isolation may trigger an occurrence.
People who “cut” often express a desire to “feel” as if they cannot truly attach to their own emotions. Others will say they “cut” to kill the pain – this is because the act of producing pain also causes the body to release endorphins (the body’s natural painkiller) that makes them feel better. Unfortunately, even though the action may induce temporary euphoria – it is often followed by guilt and a return of the negative feelings.
NSSI is defined as:
• 5 or more days of intentional self-inflicted damage to the surface of the body without suicidal intent – in the past year.
• Patients must be intending to:
o Seek relief from negative feelings or thoughts and/or
o Resolve interpersonal problems and/or
o Induce a positive emotional state
• The behavior must be associated with 1 of:
o Interpersonal problems
o Negative thoughts or feelings
o Ruminating on injury (obsession)
NSSI includes not only “cutting” but also burning, hitting or punching, head banging, biting, non-aesthetic piercing or carving of skin (tattoos and body piercing don’t apply), pulling out hair or other “topical” mutilation. If a patient has expressed suicidal thoughts or shows suicidal tendencies – it is not classified as NSSI as the intent of a person with NSSI is not to commit suicide.
NSSI should be first viewed as a serious medical condition that truly requires treatment. It may be resolved by treating an existing co-morbid psychiatric condition – but likely it will also require psychotherapy to resolve some of the underlying issues.
Definition of Self-injury/cutting (Mayo Clinic)
If you see signs of NSSI or “cutting” in a child, teen, or adult that you know – encourage them to seek help.