I have made a mistake. I am so angry with myself. God, why am I so stupid? How can I be so bad? I am so worthless. I don't deserve to be happy. I want to punish myself. I am a bad person. I want to cut myself.

Many of us kick ourselves after making a mistake or when we feel angry and upset about something. Eventually, time heals these emotions, and we go on with our lives. We learn ways to cope with struggles and overcome the negative feelings.

According to Focus Adolescent Services, approximately 1 percent of the U.S. population uses physical injury, such as cutting, bruising or burning, as a way of dealing with overwhelming feelings or situations. An alarming trend is seen among adolescents, particularly teenage girls, to the point where guidance counselors around the country are seeking training and education on how to identify cutters and how to best help their students get out of this vicious cycle.

Cutting is one of the most common forms of self-injury, which is formally defined as, "…the commission of deliberate harm to one's own body. Acts that are committed with conscious suicidal intent or are associated with sexual arousal are excluded."1

According to Vijai P. Sharma, Ph.D, a few months prior to her death, Princess Diana confessed that the strain of her marriage had caused her to cut herself with razors, penknives and lemon cutters. Other celebrities, such as Angelina Jolie and Christina Ricci, have also talked about periods in their lives where they turned to physical injury. Why would those who are clearly admired by many, turn upon themselves and assault their bodies in this manner? Princess Diana explained it in an interview with the British Broadcasting Company (BBC), "You have so much pain inside yourself, you try and hurt yourself on the outside because you need help." The Princess felt that an act of self-injury was a cry for help. Many self-injurers confirm this view. They see cutting as an outlet for anger and self-loathing.

Teenage girls are the most common group of cutters. Some of these girls have had an experience in their past that has led them to associate physical pain with an eventual reward. Others simply feel inadequate, unworthy and undeserving of any happiness. They are unable to assert themselves constructively, and their negative feelings are often exacerbated by a conflict about body and body image.

This unhealthy association has led to a need for cutters to feel physical pain in order to experience emotional calm. What cutters may not realize is that the act of cutting is only a temporary fix because they have, in fact, avoided the process of working through issues that triggered the need to cut.

Often those who cut are unable to cope with their emotional pain. By transferring emotional pain to physical pain, they feel a sense of release and relief. They become markedly calmer immediately following the act of self-injury.

The relationship between pain and comfort has somehow formed an unrealistic association for cutters that cannot be easily explained.

Cutters are able to bypass their own physical pain, block it out as it were, in order to accomplish emotional relief after the pain. In a "US Magazine" interview, Christina Ricci explains, "You get this endorphin rush...it takes a second, a little sting and then it's like you really don't feel anything. It's calming actually."

In spite of the relief felt immediately after hurting themselves, cutters know their actions are wrong; hence, the process of hiding their scars becomes an important part of their cycle. Cutters are usually careful not to cut in areas that cannot be easily hidden. They also typically engage in the cutting behavior when no one is around to witness the act. They are very much aware of the negative connotations their actions have on others.

Treatment for cutters is multifaceted. A therapist must first address the underlying causes of the behavior such as depression or anxiety, simultaneously teaching ways to control the actual behavior of cutting. Some psychiatrists and therapists have specialized experience in treating this condition.

Although there is no one specific treatment for cutting, a combination of psychotherapy and medication can be highly effective in eliminating the behavior and restoring an individual's sense of balance and control.

Gary Litovitz, a board certified psychiatrist, is the Medical Director of Dominion Hospital, a private psychiatric hospital in Falls Church, Va. He directs the inpatient and day treatment programs at the hospital. Dr. Litovitz also maintains an outpatient practice of psychiatry in Vienna, Va., treating anxiety disorders, mood disorders, eating disorders and other psychiatric conditions.

¹ Winchel and Stanley, 1991.