Dr. Charles Goodstein, clinical associate professor of psychiatry at New York University School of Medicine, offers the following advice and guidance for families who are struggling with cutting, a disorder that appears to be epidemic in the United States.

Q: How long has "cutting" been going on and who is affected by it?

A: It's been going on a long time. I first encountered it as a resident - it goes back to the 50s, and probably before then. Some people phrase it the "new-age anorexia." The statistics are something like one in every 200 adolescent girls between the ages of 13 and 19, regularly cut themselves. Even though it's basically teenage girls, the disorder also affects boys. The disorder can continue through adult life.

Q: Why don't you hear much about this disorder?

A: It's a secret and a great shame. Some patients never bring it up. It's very probably beyond what people would report in their practices. Most of the time you would think that people would pick it up, but not necessarily. It's very rarely picked up during the winter because clothing can disguise the syndrome. Once you get into summer though, people start to see the scars. In many cases, people mistakenly think these kids are seeking attention. But they're very often very shameful of what they've done.

Q: Is cutting the result of some other disorder?

A: Yes, it's always associated with a component of a larger problem, but you can't say every cutter is a cutter for the same reason. In some cases, it's associated with anorexia; sometimes with depressive disorders, and very frequently it's associated with borderline personality disorder. So, cutting should be understood as part of a larger picture.

Q: Why do people cut themselves?

A: There's not necessarily a uniform explanation. Some people say until they cut themselves, they're not sure they're alive. They feel so numb, so out of touch that somehow the slicing sort of validates them. It helps them release overwhelming tension - tension that stems from intense feelings that can't be communicated. The cutting seems to produce a release and there's almost a pleasure in that release. In many cases, cutting correlates with a history of sexual abuse. Cutting is a form of self-punishment by people afflicted by ongoing feelings of guilt who can't cope with it. Cutters learn how rapidly they can gain release and almost look forward to it. Once it becomes this, it's something that's done repeatedly - out of the view of others.

Q: Do cutters intend to commit suicide?

A: While cutting is likely to become a repetitive behavior, it's typically not suicidal. The injuries are sort of superficial - delicate cutting that leaves scars.