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Originally Published: April 18, 1995 - Last Updated / Reviewed On: February 27, 2009

Dear What's normal?,

Your concern is definitely warranted. Although more people have turned to "cutting" lately, their reasons for doing so aren't necessarily new. Mental health professionals agree that "cutters" usually have some psychological disturbance that leads them to injure themselves. This, however, doesn't mean that helping your friend is a lost cause — there's good evidence to suggest that people who self-mutilate who decide to seek treatment are able to stop cutting and move on with their lives.

To start off, it might help you to know more about cutting in general as you try to understand what your friend is going through. Cutting is a type of self-mutilation or self-injury that occurs mostly among young people, and there are three times as many women who do it than men. Although your friend self-injures by scratching her skin with a sharp object, there's a range of ways to self-mutilate. For instance, others intentionally cut or burn themselves, jab themselves with needles, rub glass into their skin, or pull out their head and body hair. People who self-mutilate are at increased risk for drug and alcohol misuse and disordered eating. They are also often quiet survivors of sexual and/or physical abuse.

Some people who self-injure say they feel numb, unable to feel or experience anything. They might admit that self-mutilation is an attempt to feel something in their lives — a check-in that they're still alive. For others, self-mutilation is a way of temporarily coping with emotional pain that seems to go away as they see blood flow from their self-inflicted wounds.

It's really likely your friend could benefit from speaking with someone, not only to help heal her visible wounds but her invisible ones as well. The thing is, it's ultimately her decision to seek help. You could consider telling her that you're concerned and you've done research, and see where she takes the conversation. She may see your genuine concern as just the type of support she needs to make the next move toward recovery. Unfortunately, it's also possible she'll brush your attempt off the first time. If she does, you could keep her on your radar and check in with her later. All the while, you'll be sending the message that you care. When she's ready to look for help, your willingness to understand and support her might be just what she needs.

When she's ready, it could be helpful to offer her some resources. You can start by referring her to the Self-Abuse Finally Ends (S.A.F.E.) Alternatives information line at 1.800.DON'T.CUT (1.800.366.8288). If she's interested (or becomes interested) in counseling, you can point her in the direction of mental health services. At Columbia, there's counseling at Getting Help: Locate Services for more information on finding a counselor nearby. If your friend has health insurance, her plan may have a list of counselors and a procedure for connecting with services. That information should be on their web site or brochure. She could also call the company to get more guidance.

Now that you know more about self-injury, you'll be better able to understand your friend's situation. With some luck and finesse, a supportive conversation with her might nudge her toward seeking the help she needs. You seem like a genuine, concerned friend that anyone would be lucky to have!