Although all behavior that causes tissues damage should be assessed for lethality, the intent of self-mutilating behavior is one of reaffirming life. So no, it is not a suicidal act and the person should not be treated as if they had attempted to end their life. Adolescents and adults who self-injure generally do not have the words to express the emotions that underlie the behavior. “Cutting” is an active way for them to express their emotions visually. Cutting also, by its very nature communicates a very profound anger. It may also convey self-hatred, but the self-mutilation does not equate with permanent self-destruction.
Self-mutilation generally is scratching, cutting, hitting oneself, or burning. The locations where adolescents self-mutilate are: wrists, forearms, legs, etc. Most of the tissue damage is not severe enough to cause much bleeding. The problem, however, is that many adolescents are unaware of the location of arteries or of the depth of cuts that might create problems. Research supports the tendency for a self-mutilator to use a different method to commit suicide than the one they use to self-harm. They might use poison to try to kill themselves, where they used a razor blade as a means to draw blood.
Scars and open wounds normally are covered or hidden. When open wounds are visibly apparent, the self-harmer may be attention seeking, may be trying to manipulate another, or may even by crying for help. However here the likelihood of a suicide attempt is exponentially increased as this is much more of a dramatic show staged with the intent of letting others know their pain. The term for this type of behavior is more appropriately deemed “para-suicidal”.
Oftentimes friends and family of those who know “cutters” try to force them to stop their acting out. Usually self-mutilation is a result of their discomfort. Until the self-injurer has an increased emotional vocabulary and has developed new coping methods of their own, trying to force them to give up cutting is counterproductive. Be supportive by listening and trying to truly understand what they have to say. Suggest therapy if they are not going to counseling. Finally work through your own emotions that the “cutter” has brought up and seek counseling yourself if necessary.
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Author: Evelyn Wenzel, LCSW, CAP