Cutting Signals Need for Emotional Help
By Teresa Novellino
Originally published by ABC News, March 16, 2001
It's a secret, painful and compulsive behavior that you might not have heard of, even though experts estimate that two to three million Americans do it. They are "cutters," people who slice their own skin as a means of coping with pain.
Lisa Bayens was only 12 when she started cutting her own arms and stomach with a razor. Now 20, she is finishing therapy, where she confronts the inner demons that first drove her to cut herself.
"I felt so much anger inside and I was so upset that I wanted to have my feelings expressed," she said. "I couldn't discuss them with somebody, so I felt like I had to put a mark on my body. I felt so relieved afterwards that I continued the behavior every time I was sad or angry, upset or depressed."
Bayens' behavior may seem bizarre, but it's not unusual.
Researchers say 2 to 3 million Americans—and more worldwide—cut themselves on purpose.
Those who cut themselves are often turning their anger on themselves because they are afraid to let their feelings out, says Good Morning America parenting expert Ann Pleshette Murphy.
"This can be a way to express painful feelings and avoiding having to express them out loud," says Murphy. "The philosophy behind it is not very different from girls who starve themselves."
'Physical Expression of Anger'
In recent years, the secret impulse has gone public.
Princess Diana admitted in a 1995 BBC interview that she cut her legs and arms because she was unhappy about her marriage, for example.
Experts say cutters inflict pain on themselves to deal with worthlessness and self-hatred.
Most of these self-injurers are female, 50 percent were sexually abused and many also have eating disorders.
"It's a physical expression of anger," says author and clinical psychologist Wendy Lader, co-founder of the Self-Abuse Finally Ends (S.A.F.E) program. "You might see guys who are angry hit a wall, or kick something and they feel better. For these girls, they hurt themselves."
Journalist Marilee Strong interviewed more than 50 "cutters" for her book, A Bright Red Scream. The group included foster children, prisoners, doctors, lawyers, nurses and Sunday-school teachers. "Self-injurers," she says, "are often bright, talented, creative achievers-perfectionists who push themselves beyond all human bounds, people-pleasers who cover their pain with a happy face."
Often the cutting episode begins on impulse: A cutter grabs a sharp object to cut themselves, or they nick themselves shaving their legs and just keep cutting.
Many cutters describe relief and solace in watching themselves bleed, as though their pain and fear is seeping away.
"Basically there's a belief that when one cuts," says Lader, "there may be naturally occurring opiates that produce an analgesic effect."
The First Cut
Doctors often misdiagnose cutting as attempts to commit suicide. Self-injurers, however, view the behavior as a way to survive, to show themselves they are still alive and capable of feeling pain.
Bayens says she cut herself as an angry reaction to a neighbor who had abused her since she was 5 years old—something she never revealed to her parents.
"I did not want them to know about the past sexual abuse … so I could not bring the self-injury up to them," says Bayens. "I did not want to hurt them."
Instead, she went to S.A.F.E., a 30-day inpatient treatment program at MacNeal Hospital in Berwyn, Ill. The program accepts 10 patients at a time. Almost all of them end up being white females; many are adolescents.
When Lader and Karen Conterio co-launched S.A.F.E. in 1984, they received 1,250 letters a year from those seeking help. Today they get 5,000 letters each month.
They have seen girls who have amputated parts of their body, girls who have cut themselves to the point where they require hundreds of stitches to re-seal their flesh, girls who have carved words like "fat" or "ugly" into their skin.
The therapy that S.A.F.E. patients go through emphasizes that they alone can help themselves.
"Our program puts the responsibility squarely with the client," says Lader. "To recognize that they do have control. That this is a choice."
A No-Harm Contract
S.A.F.E. patients sign a contract promising not to hurt themselves during their 30-day stay. There are no restraints to keep the girls from hurting themselves and they are not kept away from potentially self-injurious weapons such as scissors.
Instead the focus is on new behaviors: group therapy to discuss feelings, not their injuries, taking anti-depressants if needed, and writing in impulse control logs to help them pinpoint the emotions that lead to the cutting.
"The self-injury isn't the problem," says Lader. "It's the feelings that lead to it, the anger and the abandonment."
And addressing those feelings appears to help, at least in Bayens' case. "The jump is so frightening between where I am and where I want to be," she says. "I am learning to live a full life."
