Healed scars from prior self-harm, Author James Heilman, MD (CC BY-SA 4.0 International)
Mental health issues including drug abuse and suicide are known to be long-term consequences of child abuse [1A][3]. Non-Suicidal Self-Injury (NSSI), more commonly known as cutting, is another [1B][4A].
Definition
NSSI is defined as the deliberate damaging of the surface of the skin – whether by scratching, cutting, piercing, or burning – but without suicidal intent [1C][2A].
“After I’d seen the blood, it was like a release of anger or some sort of release. I can’t really explain the feeling, but it was just a release.”
-Alex [6]
According to the Mayo Clinic, this type of self-harm is a maladaptive means of coping with profound emotional pain, anger, or frustration [2B].
Cutting (in whatever form) acts to distract from internal turmoil; restore a sense of control (at least over the body, if not the underlying situation); inflict punishment; and communicate distress to the world [2C].
Though cutting may bring temporary relief, calm is generally followed by guilt and shame [2D][7A]. Soon enough, the troubling emotions return. More-serious (even fatal) harm can follow.
Prevalence
Studies have shown cutting to be extremely common among adolescents. Over 20% of adolescents are now thought to self-harm at some point [7B]. Approximately 18% continue into adulthood [1D]. This does not make the practice benign.
Causes
Emotional abuse and neglect seem to play a particularly powerful role in cutting [1E]. Physical and sexual abuse have a more indirect effect, by way of depression and anxiety [1F][10].
Cutting can happen at any age, but often begins between the ages of 12 and 15 [7C][8A].
Teens may cut themselves to be part of a peer group, which is why their choice of friends is important [7D]. Alcohol and drugs, an eating disorder, poverty, unemployment, and psychiatric illnesses like borderline personality or schizophrenia can, also, be contributing factors [2E][4B][9].
Signs and Symptoms
NSSI can occur anywhere on the body, but is most common on the hands, wrists, stomach, and thighs [8B]. Cutters are, however, secretive [8C].
The signs and symptoms of cutting include [2F][5][8D][11]:
Cuts/Burns, Etc.
- Fresh cuts, burns, bruises, bite marks, and/or other wounds;
- Scars (frequently in patterns, with linear cuts particularly common);
- Excessive rubbing to create a burn;
- Frequent reports of accidental injury, with implausible explanations.
Disguise
- Frequent use of wristbands, large bracelets, or oversize watches;
- A preference for long sleeved shirts and/or slacks, despite hot weather;
- Unwillingness to participate in activities such as swimming which reveal the body.
Instruments of Injury
- A habit of keeping razor blades, needles, or other sharp objects readily at hand.
Blood Evidence
- Frequent use of bandages;
- Blood stains on clothing;
- Presence of bloody tissues in a child, tween, or teen’s room.
Problems
- Relationships difficulties, including school bullying victimization;
- Instability, impulsivity, and unpredictability, e.g. risky behavior or sudden outbursts of anger;
- Statements of helplessness, hopelessness, and/or low self-esteem.
Treatment and prevention will be discussed in the conclusion of this series.
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[1A through 1F] BMC Psychiatry, “The impact of child maltreatment on non-suicidal self-injury: data from a representative sample of the general population” by Rebecca Brown et al, 6/8/18, https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-018-1754-3.
[2A through 2F] Mayo Clinic, “Self-injury/cutting”, https://www.mayoclinic.org/diseases-conditions/self-injury/symptoms-causes/syc-20350950 and https://www.mayoclinic.org/diseases-conditions/self-injury/diagnosis-treatment/drc-20350956.
[3] Cornell Research Program on Self-Injury and Recovery, Bronfenbrenner Center for Translational Research (BCTR), Cornell University, “The relationship between self-injury and child maltreatment” by Margaret Fleming and Lauren Aronson, http://www.selfinjury.bctr.cornell.edu/perch/resources/the-relationship-between-self-injury-and-child-maltreatmentfinal-1.pdf.
[4A and 4B] National Center for Biotechnical Information, US National Library of Medicine, National Institutes of Health, “Repeat deliberate self-harm: a link with childhood sexual abuse?” by HM Yeo and WW Yeo, September 1993, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1285981/.
[5] Hindawi, “The Association between Deliberate Self-Harm and School Bullying Victimization and the Mediating Effect of Depressive Symptoms and Self-Stigma: A Systematic Review” by Maria Karanikola et al, 2018, https://www.hindawi.com/journals/bmri/2018/4745791/.
[6] The Conversation, “Cutting to numb the pain of sex abuse: interviews with young women in drug treatment” by Kathryn Daly, https://theconversation.com/cutting-to-numb-the-pain-of-sex-abuse-interviews-with-young-women-in-drug-treatment-62096.
[7A through 7D] Lifespan, Bradley Hospital, “Self-Cutting and Adolescents”, 2020, https://www.bradleyhospital.org/self-cutting-and-adolescents.
[8A through 8D] U Lifeline, “Cutting”, 2020, http://www.ulifeline.org/topics/135-cutting .
[9] Psychiatric Times, “Treating Self-Harm in Children and Adolescents” by Donald Greydanus MD, 4/28/11, https://www.psychiatrictimes.com/view/treating-self-harm-children-and-adolescents.
[10] British Journal of Psychiatry, “Childhood sexual abuse and non-suicidal self-injury: meta-analysis” by David Klonsky and Anne Moyer, 1/2/18, https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/childhood-sexual-abuse-and-nonsuicidal-selfinjury-metaanalysis/32656A88888D805C6BC1F96BBEA453F8.
[11] NSPCC, “Signs of self-harm in children and teenagers”, https://www.nspcc.org.uk/keeping-children-safe/childrens-mental-health/self-harm/.
This series will conclude next week.
Wishing You All a Happy Thanksgiving!
FOR MORE OF MY ARTICLES ON POVERTY, POLITICS, AND MATTERS OF CONSCIENCE CHECK OUT MY BLOG A LAWYER’S PRAYERS AT: https://alawyersprayers.com
ANNA WALDHERR A Voice Reclaimed, Surviving Child Abuse 
It’s ao sad to know that people go through this.
Thank you for sharing this. I look forward to reading the cure for NSSI
Thank you for reading, Adeleke. I felt it was important to pass the information on.
Thanks again. Be blessed and stay safe.
You too, Adeleke.
This is a hard topic. I did some of that when I was a teenager.
My heart goes out to you, Linda. Unfortunately, the practice is all too common. ❤
God bless the victim.
So right.
Wishing you a Happy Thanksgiving, back. We are very thankful for the awareness on these issues that you so clearly bring forward.
Thank you for your kind heart, Marilee. Have a wonderful Turkey Day! ❤
Great post Anna. Communication has become a huge problems where people often children are not allowed or do not know how to talk or tell others what is upsetting them in their lives so they resort to harming often hidden but really they are wanting to draw attention to themselves. We have become a harmful society even though so many believe we live in good and caring times, if this is so then why so much abuse.
Yes, communication is essential. Whatever our material prosperity, our society is lost without Christ. Little wonder that our children harm themselves.
I have a granddaughter that’s 3. I hate to even think how much worse it can get. We as a society seem to have given up on family values and God.
That is exactly where we lost our way, Brian. It is a blessing to your little one that she has a loving grandfather who will share his faith w/ her. The Father of us all will stand by you both, whatever the future may hold in store.
Children should be taught about Jesus Christs loving ways.
Absolutely right, Nanette. ❤
Another very interesting and valuable post Anna. I saw many cases of this back in my police days, out in the streets and even inside. It is a big problem and one that must be tackled carefully and professionally. Take good care and all the best,
F.
Before researching this topic, I had no idea the problem was so widespread. It reflects the pain and isolation in our society. But God remains a steadfast source of comfort and strength. I pray we and our children will once again turn to Him. You take good care, too, Francisco. I wish you all things good, my friend. A.
Thank you very much Anna, and I wish you likewise and like you I pray for that. All the best,
F.
I can understand that need to release inner pain which can feel unbearable at times. However, it is very sad that so many people feel this is the only, or the most effective, way of dealing with inner torment. It leaves me feeling very sad for those who feel they can’t talk about the struggling with.
We are failing people (and especially young people) if they don’t feel they can safely open up to their family, friends, teachers, and others in positions of leadership.
You are so right.
Thank you for highlighting the important issues here, Anna.
Thank you for stopping by, Kally.
Thank you for sharing this information with us, Anna. The world needs to know how broken some of our adolescents are. Talking about the problem is always the first step to resolving a pressing issue.🙌
Thank you for your concern, Muzhinga. I fully agree.
Thanks for this, Anna, painful as it is to read. Sometimes one has no language but a cry.
That is certainly what happens to me, Allan.
The Body Keeps the Score, Chapter 6, excellently describes this coping mechanism as well. Keep up this great work, Anna.
Thank you for the information, Jodie!
Of course! You had a lot, too. Xoxoxo
As a youth pastor I ran into cutting, it was the “in” thing to talk about at that time in the schools. Unfortunately it became a way to gain attention with many girls “cutting” themselves then talking about it publicly as if it was a badge of honor. One of my youth would talk about being caught cutting her inner thighs but, when asked about wearing a bikini and why there were no marks, said her mom got her a cream that healed up the marks quickly even though she claimed deep cutting for a prolonged period of time. It seemed to be an “out do the other person” thing rather than a cry for help. It became difficult to tell the difference between the real cutters and the attention seekers. I was left with the dilemma of how to help, who to report because they were in danger and who was looking for attention. In the end the rate of cutting in the youth group was low and possibly none but the need to appear to be cutting was high because it gained attention. I saw the same thing with depression. Once the school talked about depression everyone got it in youth group and had to tell everyone else. It’s so hard to help those who really need help when this happens. I felt so helpless as a pastor.
I do have a question that maybe you can help me with or even address in a future blog. Is there another level of self harm between suicide and cutting or is self injury like punching one’s self in the head, legs etc., repeatedly in frustration or anger by a person who suffered abuse, a different mental health issue?
Genuine self-harm (unlike the teen trend you describe) is a symptom of profound emotional distress.
The essential difference between NSSI and suicide is intent. NSSI is meant to relieve distress, so that life may continue. Suicide is meant to end distress permanently. But an individual who engages in NSSI as a temporizing measure may, also, be suicidal. NSSI should, therefore, be viewed as a danger signal.
Those who have survived abuse may not actually cut, bruise, or burn themselves but still seek out ways to harm themselves. This is not always conscious. Self-destructive behavior can include compulsive gambling, sexual addiction, substance abuse, and eating disorders.
The label placed on such behavior is less important than an understanding that it reflects inner turmoil — is how victims express the anger and self-hatred they often feel, as a long-term consequence of abuse. The behavior is both self-punishment, and an a misguided attempt at self-comfort.
The anger and self-hatred are, of course, misplaced. They would more appropriately be directed against the predator.
I hope that answers your question.
very helpful – it is amazing how different each response can be from person to person and the fact that the road to ending it all can start in the NSSI response is scary – I am no longer a youth pastor but my son is – I do not envy the difficulty of his position
Informative for me to read about this as a pastor of young people
I am grateful to know you found the post helpful.
Yes helpful