People Who Cut Themselves and Why

Cutting with razors and other sharp objects is a troubling trend among women, especially teenagers. Disney starlet Demi Lovato sought treatment for the disorder earlier this year, along with bulimia and bipolar disease. Why do young women engage in such self-destructive behavior, and are these disorders connected? One of the nation’s top psychiatrists, Mark Hyman Rapaport, M.D., explains people who cut themselves and why…

Often, people who cut themselves hide their injuries out of shame and embarrassment.

But some of that stigma faded in January, when fresh-faced teen singer and actress Demi Lovato, then just 18, admitted she has wrestled with cutting and bulimia since she was 11 years old.

"It was a way of expressing my shame on my body," she told "20/20," ABC’s newsmagazine.

"There were times where my emotions were just so built up, I didn't know what to do,” she says. “[Cutting was] the only way I could get an immediate release."

While undergoing treatment last winter at an Illinois rehabilitation center, Lovato was also diagnosed with bipolar disease. Now she is speaking publically about all these issues.

We decided to dig deeper to understand why a beautiful young woman like Lovato – who seems to have it all – would engage in such self-destructive behavior. So we turned to Mark Hyman Rapaport, M.D., chairman of the department of Psychiatry and Behavioral Neurosciences at Cedars-Sinai Medical Center in Los Angeles.

In this exclusive interview, Rapaport explains self-harm and cutting and what may cause these painful disorders.

Why would someone engage in self-harm or cutting behavior?
It can be [a sign] of someone under tremendous pressure and distress. They’ve found this sort of dysfunctional behavior releases that.

It’s also a behavior that some people outgrow.

Are bipolar disorder, bulimia and cutting connected?
There are certainly adolescent people who have bipolar disorder and manifest it by a variety of different behaviors, but cutting doesn’t mean somebody has bipolar disorder. It can be a sign of a variety of different dysfunctions.

How can parents spot signs of self-harm or cutting?
The first thing is to have a good enough relationship with your children that you know they’ve got a problem. [It's] important that there’s enough trust that the child is willing to work both with the family and outside experts to get help.

That’s very difficult with adolescents – to have an open and non-judgmental relationship so they can come to you when they’re in distress.

Should parents nose around more in their children's lives?
More than nosing around, [we should develop] the best relationship we can with our children and not take things for granted.

Our lives are all so busy [that] it’s easy to say, ‘There has been a change in my child’s behavior, but since it’s not creating a problem within the family now, I don’t have time to deal with it.’

We need to address [the problem].
What are the top warning signs of people who cut themselves? What questions should parents ask?

1. Has there been a precipitate change in this person’s friends, the types of people they’re hanging out with? Have they withdrawn from them?

2. School performance and grades: Has that person also withdrawn from activities they used to enjoy and be part of? Have they gotten out of playing in the band. Are they no longer interested in participating in theater at school? Has there been a change in those activities and behaviors?

3. [Has there] been a change in their sleep-wake cycle, eating patterns [or other] day-to-day behaviors?

4. Is the child much more withdrawn, aggressive or assertive? Are we seeing more angry outbursts or tearfulness?

These are all [behaviors] that suggest that children are drifting [toward trouble] – whether it’s mood, eating or alcohol- or substance-use disorders.

Why is it so difficult for children and teens to talk about cutting?
Many times, kids, by nature, want to try and handle it on their own. They feel ashamed about it, and don’t want to be controlled by their parents at this point. They’re trying to be more independent.

That’s why open communication and acceptance is good.

What happens to people who cut themselves if you don’t deal with it head on?
Other [harmful] behaviors are experimentation with drugs and alcohol. It's a major problem [that] can begin as early as junior high school and increase in high school.

Frequently, there are issues around eating disorders, particularly with young women. That was the case [with Lovato]. She had been teased about her weight and developed eating disorders.

If teen girl has bulimia, is she more likely to practice self-harm or cutting?
One frequently sees [an array] of behaviors when someone has an eating disorder. It’s not just either binging or purging, food restriction or over exercising. It can be more basic or primitive behaviors, such as cutting.

Is peer pressure a cause?
We really don’t know how much of it is [due to] the pressure these young children are under – the pressure to grow up faster, to succeed in school [or] act more [grown up] than they may be developmentally ready to do.

How tough is it for people who cut themselves to accept their diagnosis?
For anyone to come to grips with this – let alone an adolescent whose body is changing, and who still doesn’t have the wisdom or experiences adults have had – is tough.

Healing takes a long time. A young person needs to get used to the fact that they have a chronic disease.

That is a tremendous burden to bear suddenly. Your friends don’t have a disease, but you do. You feel very different [and] stigmatized.

How can adults minimize the shame people who cut themselves feel?
It’s important to realize that these are disorders of circuitry in the brain. They’re the same types [disorders] we see in the rest of the body. They just manifest differently.

The brain is the most complex system in the body. The mind and the body are connected – that’s why God made the neck.

What sort of treatment is best for people who cut themselves?
Intervention, whether through psychotherapy, medication or a combination of those approaches.

Can doctors treat people who cut themselves without medication?
Yes, sometimes, it can be very effectively treated by psychotherapy, depending on the reasons for the cutting, because – remember – cutting is a symptom. It’s not necessarily a disorder.

What kind of psychotherapy is most effective for people who cut themselves?
[Dialectical behavioral therapy or DBT] can be a very effective treatment for these types of destructive impulses. [DBT uses cognitive-behavioral techniques and meditation to teach patients to cope with stress, regulate emotions and improve relationships.]

Have there been advances in drug and other treatments for these disorders?
We’ve made tremendous progress and will continue to make it. Not just in terms of new compounds and medications, but even more importantly, we’re beginning to understand the basic biology behind [such self-destructive behavior].

What have you learned?
We’re beginning to understand the role of stress and early-life trauma in [the development of] brain disorders later in life. We’re beginning to understand the role of chronic perceived stress in triggering events and changing the biology of people.

Through our works in genetics and epigenetics [the study of how environment and choices can influence genes], we're learning individual factors that put someone at greater risk or resilience. This will allow us eventually to better tailor treatments.

Should we be optimistic about the future of treating brain diseases?
I want to emphasize the importance of hope. Just because somebody has a symptom of something like cutting or a brain disorder, it’s not necessarily going to negatively impact the rest of their lives. Many people with brain disorders have wonderful lives.

What do people who cut themselves need to know most?
If they’re cutting, they shouldn’t be ashamed – they should realize people understand that it’s because they’re in distress. They need to know it’s OK to get help.

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