Understanding Why People Cut Themselves, Hide It, and How to Help

People cut as a coping mechanism, according to Cornell University’s Self-Injury and Recovery Research and Resources (SIRRR). Self-harm can be a way for a person to feel something when experiencing numbness or to distract themselves from depression or anxiety. Some people cut to create a wound that can symbolize their emotional pain, while others use cutting as a way to avoid telling loved ones about their feelings.

There can be a link between self-harm and childhood trauma like physical abuse, sexual abuse, and neglect. Other links include mental health issues like:

• borderline personality disorder (BPD)
• suicidality
• anxiety
• depression

The Journal of the American Board of Family Medicine estimates that 1 to 4 percent of adults and approximately 15 percent of teens in the United States engage in self-harm. College students appear to be the group at the greatest risk with rates ranging from 17 to 35 percent.

But self-harm isn’t limited to a group, gender, or age. Psychologist Dr. Vijayeta Sinh, PhD, owner of NYC Family Therapy, says children as young as 9 and 10, teens, college students, and even adults in their 40s and 50s cut.

Kirsten began cutting when she was 13 years old after her father made an insensitive comment about her acne. Her self-esteem, she says, was already low. Although she hasn’t cut in six months, she’s still struggling with the issue.

There’s not always a timing or pattern to self-harm

Penny, 36, first cut herself when she was 15 years old as a way of dealing with the emotional pain of having been raped by a family friend. She cut when she was depressed and would shut down emotionally. She says she’d tell herself, “See, you’re still alive, you still feel, you still bleed.” She stopped cutting just over a year ago.

SIRRR reports that self-harm can be cyclical. Someone may cut frequently and then stop for long periods before relapsing. That has been 31-year-old Brandy’s experience. After suffering physical and verbal abuse at the hands of her older brother, she cut herself from ages 11 to 25. “It happened so sporadically that there wasn’t really an ‘often,’” she says. “Sometimes I could go several years without cutting.”

Self-injury can mirror substance addiction because it’s a form of self-medication that someone may crave and may have trouble stopping. People who cut often describe a specific type of high, relief, connectedness, or sense of calm.

The euphoria Brandy describes may be attributed to endorphins the body releases when we get injured.

“Endorphins energize us so we can take actions to avoid the hurt and discomfort,” Dr. Sinh explains. “This impacts not just the physical pain we experience but also the emotional pain.”

Another woman we spoke to, Ariel, 21, started cutting when she was 17 years old. She’d just lost her brother, people were bullying her, and she’d been assaulted.

“It became a normal habit,” she says. “I cut myself because I was curious. I cut myself because I was bored. I cut myself because I was happy and didn’t trust the feeling of happiness … I cut myself for any reason I could think of. I justified my reasons and came up with excuses because I loved it.”

Self-harm isn’t a trend that’s come about in recent decades. An NPR article reports that cutting dates back to ancient Greece as a coping mechanism. Researchers also agree that rates of NSSI have increased over the last decade and a half, but studies on the topic are somewhat new and rates are hard to assess.

Cutting can also affect younger children. Dr. Sinh says, “Younger children are more suggestive and may see it as an appropriate or typical thing to do, if they know other adults or older kids who frequently cut themselves or punch walls or pull their hair when they are angry or dysregulated.”

Although Penny hid her own wounds and scars, her daughter began cutting a few years ago at age 13. “Fortunately, she talked to me about it,” she says. “I taught her some coping techniques and some of the diversion therapy I have learned. I didn’t chastise her, but I also did not allow her to believe that was the best or only option.”

Movies and television shows may also play a role in the possible increased rate of cutting. Their portrayals may spread the idea that this is normal behavior. Although she knows everyone who cuts is different, Ariel says shows and movies rarely create an accurate picture of what self-harm is like.

“I absolutely think everything I’ve seen with cutting on TV or in movies romanticizes it,” she says. She references “American Horror Story: Murder House,” where the character Violet cuts herself. “When she did, she looked in the mirror and they zoomed in on her pupils widening from doing it.”

The stereotype on film and television depicts a troubled white suburban teen girl crying out for people to notice. This also bothers Flora, 18, who always took precautions to hide her cuts and now her scars. She began cutting at 13 but recently found art as a new way to cope and distract herself when she’s upset. “It’s portrayed as attention seeking, which is extremely detrimental,” she says. “There’s no such thing as being beautifully broken. There isn’t a misunderstood beauty in your scars. It doesn’t make you stronger.”

NSSI is now listed as a disorder in the fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The reasoning behind this, according to an NPR article, is to differentiate self-harm methods like cutting from suicide attempts because the treatments for the two are very different.

“I never wanted to kill myself any of the times I cut,” Brandy says, even though her first time she took a scissor to her left arm and “laid open the flesh.” People who cut are seeking something different rather than a permanent end to their turmoil.

A journal article in Child Adolescent Psychiatry and Mental Health reports that, on average, a person engages in NSSI for a period of 2 to 4 years before stopping. This is where therapy can be beneficial and help people working through personal issues to determine what cutting means to them.

Dr. Sinh often employs two different types of therapy, depending on the person:

• Dialectical behavior therapy (DBT), a form of cognitive behavioral therapy (CBT), may give someone the tools to cope with and work through distress.
• Psychodynamic therapy helps someone look at any past experiences that might have an effect on their behavior and identify issues of low self-esteem, perfectionism, or anger management.

“It was extremely difficult,” Flora says of quitting. “Once I started therapy in 2015, I started learning how to reach out for help more, and self-harm became less of a problem once I had a more stable outlet and better coping mechanisms.” She’s now in college majoring in psychology and plans to pursue a doctorate.

If you need immediate support to help stop cutting, call the self-injury hotline at 1-800-DON’T CUT. If you’re looking for therapy, visit S.A.F.E. Alternatives for some guidelines on how to find a professional who’s a good fit for you or your loved one. In the event of an emergency, your local hospital may require an evaluation at a psychiatric emergency room to ensure your safety.

Jennifer Chesak is a Nashville-based freelance book editor and writing instructor. She’s also an adventure travel, fitness, and health writer for several national publications. She earned her Master of Science in Journalism from Northwestern’s Medill and is working on her first fiction novel, set in her native state of North Dakota.