The thin criss-cross line of scars on her arms and the thickened scars along the base of her thumbs were a visible reminder of the many years of self-cutting that my patient felt compelled to do. She was here for a follow-up visit and I was pleased that she hadn’t cut herself in months. She is one of a handful of patients in my practice that have “deliberate self-harm syndrome” or DSHS. She (and I) simply refer to this behavior as “cutting” and in the vernacular, she is known as a “cutter”.

DSHS is also known as superficial self-mutilation, self-injurious behavior, self-wounding and even parasuicide but it is not an attempt to commit suicide. Statistics on the number of people who engage in self-mutilation are not well known because much of the behavior goes underreported. We do know that females are more likely to report this behavior than males and that it crosses all social, economic, and racial backgrounds. It tends to start in adolescence.

My patient is under the care of a therapist and psychiatrist but despite the help she receives, there is no known treatment for the behavior. Cutters do not fall under one particular personality disorder such as obsessive compulsive, depression, bipolar or borderline personality disorder but one study published in the American Journal of Psychiatry reported that self-harmers were more often characterized as anxious rather than depressed. They cut to reduce their anxiety.

When I asked my patient what her triggers were for cutting, she replied that painful memories had been prompts in the past and that she cut to forget – in other words when she needed to pull herself back from the abyss, cutting brought her back into the present moment.

As one publication put it, self-harm provided temporary, rapid relief from psychological distress and was a coping mechanism, albeit, an extreme one. This same report indicated that in many cases self-harming tended to run a natural course over a 5-10 year period. It is not clear what the psychological burden is for the patient once the cutting stops. This is where therapy to learn less destructive coping mechanisms is likely to be on-going.

There is a paucity of information about deliberate self-harm syndrome but this link provides further information.

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