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Cutting: The New-Age Anorexia?

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.

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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.

Q: Why does cutting begin in adolescence?

A: Because adolescence is a vulnerable time - a time of rapid changes and difficulty in coping with these changes. It's a very tumultuous time - a time of great tension and of course, the kids discover that by cutting themselves they're able to release some of that tension.

Q: You have to wonder how these kids can keep cutting themselves without their parents' knowledge?

A: There's a degree of denial, where the parents don't want to know. It's too much to bear when you know your kid is doing something like that. You don't want to face that. Parents who do catch on and bring it to their child's attention are sometimes faced with denials, which may make them feel like they've intruded too much. It makes it difficult for parents when their kids become defensive. The other thing to note is that these kids become proficient at disguising their behavior. They learn where to cut, how to cut, and they avoid athletics. They shower or dress in such a way that no one will notice. They're careful about revealing themselves - they look to see who's around.

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Q: What do you recommend parents do if they discover their child is cutting?

A: Persist gently. Teaching them that cutting is not a good thing to do is not valuable. I can't imagine a case when something like this is not a call for more intensive treatment. Many parents might conceptualize it as a phase, mistakenly thinking that their child will outgrow it. But it's a sign - a very important sign and one a parent has to recognize even though it's very shocking, disfiguring and has medical implications. It's important to realize that cutting is a symptom of a more serious underlying problem. You can try and curb it by taking away sharp objects, but a cutter will turn from one thing to another. If you leave matches around, they'll burn themselves. It's not simply stopping the cutting. Parents need to recognize that cutting might be a symptom of major depression and/or a borderline personality. If a parent suspects his child is cutting, he should talk to his primary care physician to seek out a mental-health professional who can help.

Q: Does the problem ever go away?

A: Cutting has lifelong psychological implications, but with treatment, the cutting behavior can stop. The treatment process, however, is not simply 12 sessions and out, or medication therapy. It's a combination of individual and family therapy and medication. What you hope would happen with such a kid is that they'd get involved with a therapist who they trust, who is helpful and who can see them for a sustained period of time. In the course of therapy they can learn how to tolerate intense feelings - how to soothe themselves in ways that do not include cutting.

Dr. Goodstein, who practices in Tenafly, N.J., also is president of the Psychoanalytic Association of New York.

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