Deep Cuts: What’s Happening Inside Youth Who Self-Harm

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Real Life, Part One
“I’m going to be suspended, ain’t I? Did you really have to call my parents? I’m so embarrassed! This is the worst day of my life!” Sheri angrily shouted at me as she sat in my office, hysterical and bawling her eyes out.
Sheri was a tenth-grade student at the local high school where I was working as a school counselor. One of her friends informed her science teacher that she had been cutting. Her teacher confronted her and verified this to be the case; one thing led to another and here she sat.

Her eyes were red and puffy, and her voice was hoarse because she’d been crying so much. I told her the reason I called her parents was that self-mutilation, or cutting, as it’s typically called, can be a very serious habit that follows a person well into adulthood if it’s not dealt with when it starts.
I asked to see both her arms and she rolled up both the long sleeves of her shirt and pull-over (in May, in Georgia!) to reveal ten to twelve, one-inch long red and inflamed cuts—all in various levels of healing. This meant that she had been doing this for a while.

She admitted that she’d been stressed out about her relationship with her boyfriend, her science grade and her father just got laid off from his job…man, was she stressed out! She gave me the contact information for the counselor she sees and told me that she started seeing her counselor due to problems with depression and anxiety and coping skills following dealing with an eating disorder at the beginning of her Sophomore year. She said that her counselor was helping her a lot and that her eating disorder was under control since late in her Sophomore year, but she hadn’t seen her in two weeks because money was tight.

Sheri said that she’d been cutting herself with a razor blade and a pin since last year, when she heard about it from a friend. She said that when she first did it, that it actually made her feel a lot better—for a while, at least, but she eventually found that to get rid of her feelings of stress and anxiety, she needed to continue doing it. She said that she got to the point where she realized that she didn’t want to keep “damaging my body and looking like somebody had whipped me.” She’d tried to stop doing it for a long time and knew that it hurt her body. She admitted that she didn’t realize how addictive her habit had become. I talked with her about some coping skills and then called her mother.

What’s the Problem?
Self-injury, also called self-harm, self-mutilation, or simply “cutting,” is defined as any intentional injury to one’s own body. Usually, self-injury leaves marks or causes tissue damage.
While self-injury may bring a momentary sense of calm and a release of tension, it’s usually followed by guilt and shame and the return of painful emotions. This is an ineffective way to cope with problems and with self-injury comes the possibility of more serious and even fatal self-aggressive actions.
Because self-injury is often done impulsively, it can be considered an impulse-control behavior problem. Self-injury may be linked to a variety of mental disorders, such as depression, eating disorders and borderline personality disorder.
People who injure themselves usually hide the cuts and marks and sometimes no one else knows.

By the Numbers
In the USA:
• Each year, 1 in 5 females and 1 in 7 males engage in self injury
• 90 percent of people who engage in self harm begin during their teen or pre-adolescent years
• Nearly 50 percent of those who engage in self injury activities have been sexually abused
• Females comprise 60 percent of those who engage in self injurious behavior
• About 50 percent of those who engage in self mutilation begin around age 14 and carry on into their 20s
• Many of those who self injure report learning how to do so from friends or pro self injury websites
• Approximately two million cases are reported annually in the U.S.

What You Need to Know
Are People Trying to Kill Themselves?
Cutting typically isn’t meant as a suicide attempt. Rather, self-injury is an unhealthy way to cope with emotional pain, intense anger and frustration.

Why Do People Cut?
Cutting is an outside (external) way of letting others know how much you’re hurting on the inside (internal).
Self-injury usually occurs when people face what seem like overwhelming or distressing feelings. It can also be an act of rebellion and/or rejection of parents’ values and a way of individualizing oneself. Sufferers may feel that self-injury is a way of:
• Temporarily relieving intense feelings, pressure, or anxiety.
• Being a means to control and manage pain – unlike the pain experienced through physical or sexual abuse or trauma.
• Providing a way to break through emotional numbness (the self-anesthesia that allows someone to cut without feeling pain).
• Asking for help in an indirect way or drawing attention to the need for help.
• Attempting to affect others by manipulating them, trying to make them care, trying to make them feel guilty, or trying to make them go away.
• Punishing themselves for having strong feelings that they were usually not allowed to express as children. They also may be punishing themselves for somehow being bad and undeserving. These feelings are an outgrowth of abuse and a belief that the abuse was deserved.

Other Forms of Self-Harm
• cutting
• burning
• interfering with wound healing (picking or reopening wounds)
• punching or hitting oneself or other objects
• inserting objects into the skin
• purposely bruising or breaking one’s bones
• certain forms of hair pulling
• drinking harmful liquids like bleach or other cleaning fluids
• carving
• branding
• marking
• biting
• head banging
• bruising
• hitting
• tattooing
• excessive body piercing

Warning Signs/Symptoms
• a preference for wearing concealing clothing at all times (like long sleeves in hot weather)
• an avoidance of situations where more revealing clothing might be expected (unexplained refusal to go to a party or swimming)
• unusually frequent complaints of accidental injury (for example, a cat owner who frequently has scratches on their arms)
• the appearance of lighters, razors, or sharp objects that one would not expect among a person’s belongings.
• low self-esteem.
• difficulty handling feelings.
• relationship problems.
• poor functioning at work, school, or home.
• scars, such as from burns or cuts
• fresh cuts, scratches, bruises or other wounds
• broken bones
• spending a great deal of time alone
• persistent questions about personal identity, such as “I’m uncertain about my gender”, “Who am I?”, or “What am I doing here?”
• behavioral and emotional instability, impulsivity and unpredictability
• tatements of helplessness, hopelessness or worthlessness

Risk Factors
People who are at greatest risk of self-injury are:
• People who struggle with knowing their gender (gender dysphoria)
• Adolescent females. Females are at greater risk of self-injuring than males are.
• People who have a history of physical, emotional, or sexual abuse
• People who also have problems of substance abuse (drugs and alcohol), obsessive-compulsive disorder, borderline personality disorder, depression, anxiety disorders, post-traumatic stress disorder and eating disorders.
• Individuals who were often raised in families that discouraged expression of anger
• Individuals who lack skills to express their emotions and lack a good social support network
• Age. Most people who self-injure are teenagers and young adults, although those in other age groups also self-injure. Self-injury often starts in the early teen years, when emotions are more volatile and teens face increasing peer pressure, loneliness, and conflicts with parents or other authority figures.
• Having friends who self-injure. People who have friends who intentionally harm themselves are more likely to begin self-injuring.
• Excessive alcohol or drug use. People who harm themselves often do so while under the influence of alcohol or illegal drugs.

Worse Stuff aka Complications
Self-injury can cause a variety of complications, including:
• Worsening feelings of shame, guilt and low self-esteem
• Infection, either from wounds or from sharing tools
• Life-threatening problems, such as blood loss if major blood vessels or arteries are cut
• Permanent scars or disfigurement
• Difficulty finding and keeping a good job/career
• Severe, possibly fatal injury, especially if you harm yourself while under the influence of alcohol or illegal drugs
• Worsening of underlying issues and disorders, if not adequately treated

What the Bible Says
Cutting ultimately needs to be solved by deciding first to change your mental and emotional focus from that of on your problems, to God.
Focusing on the following Scriptures will help counteract these negative feelings you may have:

Feeling: This is my body. I can do anything I want with it. Truth: Your body isn’t yours and belongs to Jesus because He paid for it with His own blood and ultimately, His very life (1 Cor. 6:19-20).

Feeling: I need to be punished. Truth: When Jesus allowed Himself to be beaten, mocked and nailed to a cross to die, he paid the price for any wrongs. He bled (so that I don’t have to) and gave me grace, love and forgiveness (1 Peter 2:24).
I have been made righteous because of a faith in Jesus, and he has freely given me His grace in spite of my sin (Romans 3:21-26).

Feeling: God has abandoned me. Truth: Because God loves me, He promises to never leave me or forsake me. His love for me is everlasting; it will never stop, disappear or grow cold. Nothing can separate me from His love—not even myself. He won’t ever leave me but will provide mercy and grace when I am in need (Hebrews 13:5, Jeremiah 31:3, Romans 8:35-39 and Hebrews 4:16).

Feeling: Things are never going to get better. Truth: God promises me of a future and a hope. I can’t see it right now, and I don’t know how He is working it out. Still, I choose to trust Him, and while He is working out my problems, I will wait on Him (Jeremiah 29:11, Psalm 27:14).

Feeling: I’ll never be able to change. Truth: When I came to Christ, He made me a new creation. It will take time to renew my mind, body and spirit, but He has promised to change me, no matter how I feel (John 15:15, 2 Corinthians 5:7, Colossians 2:7, Philippians 1:6).

Feeling: I’m unlovable. Truth: When Jesus died on the cross, He demonstrated the ultimate act of love for me. He did this because I am chosen and dearly loved (Romans 5:6-11, Colossians 3:12).

Feeling: I’m unacceptable. Truth: Because God created me, and Christ died for me, I am acceptable to Him; before the world was created, He made the choice to adopt me as His own (Ephesians 2:13, I Peter 2:9, Ephesians 1:5).

Feeling: I feel like God won’t forgive me. Truth: Despite how I see myself, God sees me as blameless and holy because of what Christ did on the cross. It’s hard to imagine, but God has completely forgiven me. When I confess anything that I have done wrong, He is more than willing to forgive and cleanse me from sin, no matter how many mistakes I make (Colossians 1:22, Colossians 1:13-14, 1 John 1:9).

Remember, change takes time, but if you accept the truth of what God says, and seek professional help, you will discover better life coping skills.

What Omar Says
Generally, I try to stay away from giving my personal perspective on any issue, however, I have seen so, so many lives ruined by body modification that I want to share my opinion, and here it is: God don’t make no junk!
In my experience, when people modify their bodies (cut, tattoo, or pierce), at their core their behavior is screaming to God and to the world: “I’m not happy with who God made me to be. I believe that God made a mistake. I’m not happy with who I am. I wish that I was somebody else! I have shame! I hate myself…and because I hate myself, I need to punish myself or I need to change myself.”

Now again, in my experience, 100% of the time, people who cut, tattoo, or pierce, come from family backgrounds littered with abuse and trauma! The connection is very powerful and very real! And I believe that all body mutilation stems from unresolved trauma. So, if this is the case, what is needed is consistent connections with: God, a solid Christian counselor, and godly friends. Again, these are just my perspectives and observations from my own life and almost 30 years in the field of adolescent mental health.

What a Good Christian Community Say and Does

God calls us to live in light of His grace, knowing the infinite cost God paid to save us. Through the Holy Spirit we glorify God in our minds, bodies and spirits. We are called to be a godly people who think, feel and act in harmony with the principles of heaven. For the Holy Spirit to recreate in us the character of our Lord we involve ourselves only in those things which will produce Christlike purity, health and joy in our lives. . . .It also means that because our bodies are the temples of the Holy Spirit, we are to care for them intelligently. Along with adequate exercise and rest, we are to adopt the most healthful diet possible and abstain from the unclean foods identified in the Scriptures. . . .we are to engage in whatever brings our thoughts and bodies into the discipline of Christ, who desires our wholesomeness, joy and goodness. . . .”

What the World Says
The world sees that cutting or self-mutilation is a problem as well, although they say to plug into your self or counselors, friends and family as your power source. However, as Christians, we know that the ultimate power lies in a personal relationship with Jesus as our Lord and Savior and only through His Holy Spirit giving us the power and motivation to make effective life changes.

Related to the other forms of body modification (tattoos and piercings), they tend to perceive people as “brave” or “courageous” because they’re choosing to “live their truth.” I don’t know about you, but I’ve seen some extreme examples of body modification (people who no longer look human—and brag about it!), and frankly, plastic surgery falls into the definition of body modification as well. In this present culture of acceptance and tolerance, nothing…nothing is seen as weird or strange or extreme. In fact, the more novel the better! After all, people are just living their truth and no one can tell them they’re wrong.

What Can I Do?
Many people say that cutting is the problem, but actually it’s just the fruit (the result of a much deeper problem, issue, or stressor). Anyone who is cutting needs to begin to deal with the root (the problem/stress that’s causing the urge to cut).

You can help people who cut by:
• Getting appropriate help for him or her from a qualified mental health professional
• Remaining calm and caring
• Accepting him or her even if you disagree with the behavior
• Knowing that this represents a way of dealing with emotional pain
• Listening with compassion
• Avoiding panic and overreaction
• Do not show shock or disgust (judgment) at what they’ve done
• Do not use threats in an attempt to stop the behavior
• Do not allow him or her to recount the self injury experience in detail as it may trigger another incident

The only way to truly solve the real problem is to start to talk about it—first and foremost with God and then with someone such as a counselor, psychologist, psychiatrist, teacher, pastor, parent. This is really the most effective way of dealing with what’s going on, but first things first. Saying something is the best way to start the process going.

• Psychotherapy: Counseling can be used to help a person stop engaging in self-injury.
• Dialectical Behavior Therapy (DBT): DBT is a group- and individually-based treatment program that helps people gain greater mastery over self-destructive impulses (such as self-injury), learn ways to better tolerate distress, and acquire new coping skills through techniques such as mindfulness.
• Post-Traumatic Stress Therapies: These may be helpful for self-injurers who have a history of abuse or incest.
• Group therapy: Talking about your condition in a group setting to people who have similar problems may be helpful in decreasing the shame associated with self-harm, and in supporting healthy expression of emotions.
• Family therapy: This type of therapy addresses any history of family stress related to the behavior and can help family members learn to communicate more directly and openly with each other.
• Self-Relaxation Therapies: These approaches are helpful in reducing the stress and tension that often precede incidents of self-injury.
• Medications: Antidepressants. Low-dose antipsychotics, or anti-anxiety medication may be used to reduce the initial impulsive response to stress.

It’s My Problem!
• Talk to somebody immediately! Don’t wait. Find a trusted adult like a parent, teacher, youth pastor, Pathfinder leader or counselor.
• Talk to God about it. Confess and repent of your behavior and let God forgive you and empty you of all your self-anger, shame, guilt, stress and anxiety.
• Recognize the situations or feelings that might trigger your desire to self-injure. Make a plan for other ways to soothe, distract or get support for yourself so you’re ready the next time you feel that urge.
• Connect with others who can support you so that you don’t feel alone. For example, reach out to a family member or friend, contact a support group or get in touch with your doctor.
• Learn to express your emotions in positive ways. For example, to help balance your emotions and improve your sense of wellbeing, become more physically active, practice relaxation techniques, or participate in dance, art or music.
• Learn to cope in positive and effective ways. Learn how to include physical activity and relaxation exercises as a regular part of your daily routine.
• Avoid alcohol and illegal drugs. They affect your ability to make good decisions and can put you at risk of self-injuring.
• Accept, recognize & remind yourself of your God-given status. The Bible clearly tells you that you are valued, valuable, and important. Jesus knows you, loves you, and sees you. Remember: Jesus died for you. For you! You don’t need to tattoo or pierce yourself to feel that you are loved, valued, and recognized.
• Avoid websites that support or glamorize self-injury or tattoos or piercings. Instead, seek out sites that support your recovery efforts.
• Take appropriate care of your wounds if you do injure yourself or seek medical treatment if needed — call your relative or friend for help and support.
• Never share instruments used for self-injury, which raises the risk of infectious disease.

Real Life, Part Two
When her mother called back, I informed her and asked both her and Sheri’s permission to inform the rest of Sheri’s teachers of her cutting. Sheri’s mom agreed and thanked me, but Sheri reluctantly agreed stating that she felt embarrassed and was afraid that word would get out and that others would tease and bully her. She also admitted that she was very angry at her friend for informing their teacher in the first place. She asked me to meet with her and Sheri. During the meeting both Sheri and her friend were able to talk respectfully and honestly about what had happened.
Sheri ultimately apologized both to her mother and her friend for her behavior and set up a plan to see me once a week for a “check-in” and more times weekly when she couldn’t see her regular counselor. She also made her mother, her friend (who initially turned her in) and her youth pastor three of her accountability partners to help her not to cut again.

She also admitted that she had a lot of low self-esteem problems and had a difficult time talking about how she felt when she dealt with sudden or overwhelming stressful situations. She began a Bible study with her youth pastor specifically focused on dealing with her low self-esteem and she stated that this has helped her a lot. She also has begun to journal daily and keeps her journal with her. She stated that her relationship with God has gotten stronger through her dealing with all of this—in fact, she told her youth pastor that she wanted to talk with her youth group about this issue and through her telling her story and putting herself “out there,” two other teens admitted to her and her youth pastor that they were also cutting.
Sheri told me “I’m glad that God used my story to be a blessing to others and to help them out. I learned a lot about how to deal with my problems and God’s faithfulness. I never ever want to cut again.”

Additional Resources
You need to know that this is a complicated and highly sensitive issue and a lot of people tend to become very emotional and have strong feelings—for and against. I tried to find resources that would clearly represent a wide variety of perspectives—not just my own. Whatever you decide, before you make a decision to modify your body in any way, shape, or form (cut, tattoo, or pierce), please value your present and future enough to pray, think, and discuss these issues with several people whom you trust, and who don’t always agree with you; you need to make sure that you hear all the perspectives—even those that you may not necessarily like or agree with. Don’t damage your life because you cancelled someone who was trying to help you. With that being said, check out these resources.

1. Pastor Steve Case’s perspective on tattoos & piercings:
2. 8 Principles of Wellness:
3. Adolescent Injury Foundation:
4. National Suicide Prevention Lifeline:
5. Healthy Place:
6. WebMd:
7. Mayo Clinic:
8. Adolescent Injury Foundation:
9. TeensHealth:



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