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Forum Name: Psychiatric Topics

Question: cutting - phase or lifetime problem?


 dnflgmn - Fri Jan 05, 2007 10:35 pm

Sorry this post got longer than I meant it to be so I'll post the question here so as not to hog your time and if you want more background you can read below: Are people who cut themselves likely to "relapse" (in cutting or other mental health problems), even after successfully committing and wholeheartedly desiring not to?

I'm an 18 year old female who feels very happy, mentally healthy, emotionally stable, etc. When I was 14 I used to cut myself and I was also very depressed and suicidal. I never saw a therapist/psychiatrist about this or took any medication so I can't say for sure I was "depressed" but anyway I felt horrible emotionally. When I was 14 I decided I wanted to change and stop cutting and for the most part did though I continued occasionally but now I am 18 and have not cut myself in over a year. I am happy and love myself and usually feel like a completely different person than the person I was and can't imagine wanting to cut myself. Rarely, I feel like I am 14 again and have the same negative thoughts ("everyone is wondering why you are here," "everyone thinks you don't belong," etc.)/outlook that I associate with that phase of my life/cutting. (These sort of recurrences were frequent when I was 14-16 and have become less frequent, briefer, and less severe as I have gotten older so that I have only felt this way maybe once or twice in the four months I have been at college and only lasting for maybe 2 days at a time). Are people who cut themselves (or have the type of depressed/suicidal feelings I described) likely to "relapse", even after committing to and succeeding at being happy, healthy, stable, and not cutting for a long time? (This seems like kind of a stupid question I know, but the thing is I feel great about my life now and I've resolved any issues I may have had (not just covered them over) so it seems pointless to see anyone professionally now (and I feel better if I just separate myself from who I was), but because I love my life so much now I worry that some day I will lose control and throw it all away and I don't want that. You may say if I'm happy why do I worry about that? 2 reasons- 1) my life right now is excellent- I have great, supportive friends, I'm in an academic environment where people are very nice, no one I am close to has died recently, etc. and I know that can't last forever and 2) I have seen relatives relapse into drug/alcohol problems after recovering and committing to a different lifestlye, eventually ending in their overdose, suicide, etc.- I want to know if I'm going to have to struggle with this my whole life or if I can stay mentally healthy/stable/"normal" -the way I feel now-for the rest of my life). I was also wondering if cutting is associated with any particular mental illnesses (I did read the previous posts on cutting and went to the link MaryAnn RN provided on selfinjury.com but I don't think I have any of the disorders they listed.) and if from reading what I have written you think I might have any. If it helps, I have always had a very stable/supportive family life, and outside of my immediate household I have a family history of depression, suicide, drug and alcohol abuse.
 Dr. K. Eisele - Sat Jan 06, 2007 2:56 am

User avatar dnflgmn:

Cutting, as you must have observed, is addictive. There's an old saying: "once is never enough, and once is too many."

That simply means that you must never cut again, because if you do, you may indeed throw it all away, as you so aptly put it. Time away from the source of addiction, in your case, cutting, is positively correlated with success. However, it is important not to become complacent.

Complacency is what happens when alcoholics go for years without a drink, successfully, but then they are faced with a situation, for example, in which others are drinking and they feel they should also just to fit in. They think to themselves that "one won't matter." They go ahead and have that drink, and guess what? They are very likely to "fall off the wagon" and drink to excess again.

I think it would be wise for you to file the cutting in the back of your mind, but don't hide it away, or put it away so well that you cannot find it again easily. You should think about it just enough to figure out what kinds of feelings and/or situations trigger those feelings that seem to have caused that desire to cut in the past. Once you have done that, stay as far away from those triggers as possible. If you cannot stay away from them, you must have a very low tolerance for "smelling trouble" and getting into therapy.

The mental illness most closely associated with non-suicidal cutting is Borderline Personality Disorder. Even though we consider this kind of cutting "non-suicidal," it must be taken extremely seriously because some people who self-injure do end up making a mistake, and dying without intention.

Best wishes.
 dnflgmn - Wed Jan 10, 2007 8:11 pm

Thanks for the response. I looked at some websites about borderline personality disorder. One said that there were 9 criteria for borderline personality disorder, and 5 needed to be met for a diagnosis. When I think of myself when I was 14, I solidly met 4 of the criteria, and possibly 1 other (I didn't totally understand it), but when I think of myself now, I definitely don't fit any of the criteria. Hypothetically, if I did meet 5+ of the criteria then (and not now), would this mean that I had borderline personality disorder then and it went away? that I never had it? or that I still/will always have it?
 jrlpc - Thu Jan 11, 2007 4:58 pm

nflgmn:

I agree with Dr. Eisele. Cutting is very addictive and the longer you stay away from it, hopefully the easier it will be for you to come up with other alternatives to cope.

I have two different stances I can take with this topic. The stance of a therapist, and the stance of a previous cutter myself. I'll try my best to be short and sweet with a response from both sides.

As a previous cutter, I can tell you that it is hard to find other alternatives. However, it IS possible. As I (and Dr. Eisele) stated before, time is of the essence. There are many times when you will get upset and the first thing that you think of is cutting. However, the longer you go without cutting, the easier it is to come up with other alternatives. As with any addiction, sometimes the addiction itself (in this case, cutting) is always the first choice. With help, time, and outside support systems you can come up with ways to push your first thought aside and then do something else instead.

As a therapist speaking it is very important for you to find out what it is that triggers these thoughts for you. Once you find a trend then it is often possible to really put something into place that will help you out when trying to find other mechanisms for dealing w/ whatever it is that is triggering you to cut.

with any cutter, i have to say that you need to seek help for this somehow. Cutting can be dangerous at times, especially if you have a tendency to disassociate or black-out while cutting. It is very possible to accidentally cut too far or too deep and die by mistake. Please make sure that if you do, by any means, end up harming yourself in any way, call 911, or go to the nearest hospital. Also, make sure you take care of your cuts (even old ones) because they can easily get infected.

Best wishes.

JR, B.S., M.S Community Counseling
 Dr. K. Eisele - Thu Jan 11, 2007 11:40 pm

User avatar dnflgm:

jrlpc gives really good advice. I agree that therapy is essential.

About the diagnosis, though, there is an age requirement involved with all personality disorders. In general, I do not diagnose personality disorders in individuals less than 25 years of age, and at that age, I am very cautious. The reason for this reluctance is because personality disorder diagnoses can stick to someone like fingernail glue. Diagnosing a personality disorder is not the same as diagnosing an Axis I disorder (mood disorder, psychotic disorder, affective disorder). It is always understood that the Axis I diagnosis is a working diagnosis, meaning that it is someone's opinion at the time the diagnosis is made. Psychiatrists do make educated opinions, of course, so Axis I disorders tend to stick. For some reason, though, I am much less reluctant to change this kind of disorder than I am an Axis II (personality disorder) diagnosis.

Having said all that, the reason we wait until the individual has reached emotional maturity to diagnose personality disorders, is that personality hasn't yet fully developed. When you were fourteen, and when anyone is 14, you could potentially be diagnosed with all personality disorders if it were not for the age requirement.

So, in my professional opinion, you do not have any personality disorders, because you are not yet old enough.

I hope that answers your questions.

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