While writing my latest novel, HIGH FLYING, I wanted to create a complex, self-debasing character that struggles with her past and self-image and, at the same time, recognizes her inability to connect with others. Throughout her adolescence, she longs to be “normal” like other people, but self-harm becomes her vice and the quickest, most effective way to deal with the negativity in her life…until she finds a powerful solution.
In the course of researching this subject, I discovered that cutting is a common form of deliberate self-harm and may co-occur with other self-injurious behaviors such as skin-burning, hair-pulling, and anorexia, and that people who cut themselves often use razors, knives, or other sharp objects. However, cutting is not typically an attempt at suicide or long-term self-harm. Rather, it is an immediate reaction to stress that provides release for the person who cuts. They may accidentally sever a vein or artery, which can be life-threatening, but this behavior is not listed in the DSM-IV as a mental health disorder. Instead, it is related to other impulse control conditions such as pyromania (obsession with fires), kleptomania (persistent stealing), and/or pathological gambling.
Self-harm can also be a symptom of borderline personality (BPD), as well as factitious disorders, which occur when a person fakes an illness or believes he or she has a disease they haven’t truly contracted. People who cut themselves may also suffer from depression, anxiety, post-traumatic stress, obsessive-compulsive disorder, and other stress-related conditions.
Outpatient therapy using a variety of methods, particularly cognitive behavioral therapy, can be highly effective at teaching people more effective skills for coping with stress. However, unless treated, cutting is a behavior that tends to escalate, resulting in more severe and frequent cutting over time. People who have been cutting for an extended period of time may require inpatient treatment, which involves group therapy, individual therapy, and when necessary, psychotropic medication to help mitigate the psychological factors that contribute to cutting.
Often therapy for treating this disorder involves redirection–a sort of reprograming mechanism, for dealing with stressful situations. This might involve various forms of self-expressive art, tennis, boxing, or other activities as a means for releasing pent-up emotions, tension and anxiety. Support, compassion and understanding by friends, family members and anyone aware of this condition is also very important. Society as a whole needs to understand that anyone who has a history of cutting or other obsessive disorders is fully capable of leading a healthy, normal life, if given the chance to do so.