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Joyce Boaz & Dr. Frank Ochberg, M.D.

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Cutting & Self Harm

Q: Dear Frank, One of our members said they would like to know why you believe some people cut themselves, referred to as self harming. The member said that the only kind that she struggles with is picking at unhealed wounds from time to time. Mostly on her face. She also struggled with it as a teen. Is it linked to childhood sexual abuse? What are some of the coping mechanisms?

A: Dear Joyce, Thank you for passing on this interesting and important question. There are many compulsions related to early abuse and many theories advanced to explain the connection. Obviously, a habit of picking scabs or pulling hair or cutting skin is not good for health, appearance, self-esteem or social acceptance. But it may ward off something worse - a terrible memory, a sense of utter helplessness, a belief of being dead inside - so the habit serves a purpose. There are names for these conditions, and with a name there is a website (often more than one) and with a website there is an on-line support group.

Let's identify a few of those names:

dermatillomania is the term for "skin picking" and Google lists nearly 100,000 sites for this compulsion. Compusive skin picking (to the point where it is considered "self-injurious") affects 1 to 2 % of our population. A good one page outline can be found at http://childadvocate.net/skin-picking-and-self-injurious-behavior/ .

Trichotillamania is the medical term for compulsive hair pulling and there are over 500,000 sites on Google for this condition. See http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0060480/ for a quick and accurate outline. 4% of our American population qualify for the diagnosis, and it is a recognized DSM diagnostic entity, in the section on impulse control disorders. Women are affected 4 times more than men and the peak years are during childhood.

Compulsive cutting has over a million Google references (although not all are for the self-injurious behavior we are discussing here--in fact, one site helps with cutting back on web-surfing, an obvious addiction of mine!). Here is a very helpful website: http://www.helpguide.org/mental/self_injury.htm . On this site some myths are dispelled. For example, cutting does not usually signify psychosis (although serious mutilation may be part of delusional behavior). Cutting is not necessarily suicidal (although deep cuts may be deadly and must be taken seriously). Cutting is not usually a cry for help (although self-help is, in my opinion, always indicated).

The facts explained in this website, facts that I endorse, include:

"You may find yourself more likely to self-harm after an overwhelming or distressing experience, or series of experiences. It's possible that you never learned how to identify or express difficult feelings in a healthy way. Understanding your emotions and how they may make you want to self-harm can be another important step toward recovery."

And the list of remedies include this:

"Finding an alternative to self-injury goes hand-in-hand with why you self-injure in the first place. The following are reasons you may self-harm and things to do instead of hurting yourself.

  • Deal with anger. Try running, dancing fast, screaming, punching a pillow, throwing something, or ripping something apart.
  • Cope with emotional numbness. Squeeze ice cubes, hold a package of frozen food, take a very cold shower, or chew something with a very strong taste, like chili peppers, raw ginger root, or a grapefruit peel.
  • Calm yourself. Take a bubble bath, do deep breathing, write in a journal, draw, or practice yoga.
  • See "blood." You can draw a red ink line where you would usually cut yourself, in addition to the other suggestions above."


In sum, there are various forms of compulsive injurious behavior and some are more dangerous than others. Compulsions are not necessarily a product of child abuse, but may related to trauma suffered as a youngster. When that is the case, the picking or pulling or cutting was discovered during periods of isolation and neglect, it restored a sense of autonomy, it created a sense relief, and it became a habit. Once the habit is well established it is very difficult to change, and it carries a burden of shame and secrecy. There may also be a sense of loneliness, as though no one else understands, cares or can help. This is certainly not the case. There are millions of others out there with similar conditions and the outlook is actually quite good. Professional therapists are familiar with the pattern. The web is full of resources. And Gift From Within joins all these providers of information and encouragement to thank you for getting information, whether it is to help a friend, a family member, or yourself.

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Page created on 29 March 2011
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