Physical acts committed
against one's self, mostly the skin, have often been referred to by
commentators on radio, television, and print as the "anorexia of today".
These comments suggest that this is a new disorder. Not true. Anorexia was considered a new disorder in 1978 when Hilda Bruch published The
Golden Cage, and I published The Best Little Girl in the World.
The comments in 1978 were as misleading as the comments about
self-mutilation are today. Once again we have an "epidemic of
disclosure" rather than a new disorder. Self-mutilation has, like
anorexia before 1978, been one of the best kept secret psychological
disorders outside of psychiatry and emergency room medicine, where it
has always been plentifully documented. Perhaps very few doctors and
patients found it "attractive" to discuss. It was associated with severe
mental disorders and confined to the netherworld of "crazy",
Now with new web sites,
chat rooms for the initiated, and self-help groups springing up almost
daily, we can welcome its victims (estimates of one-in-two hundred
adolescents and older) into the category of "disorders worthy of study
and treatment". Downsizing this disorder from that or arcane,
non-understandable, and untreatable is important. Defining these
behaviors characteristic of individuals who suffer from alienations,
mistrust, loneliness, self-hatred, hopelessness, and an impoverishment
of reflective language for their emotional pain, permits us to see them
as persons seeking relief from these feelings by the use of physical
pain. This technique goes back to the reformation at least, when
Catholics lost faith in their pope and the men publicly beat themselves
with chains, though the Vatican archives stated that women did
self-harming behavior "in private".
Family backgrounds will
vary from tragic-ridden, to over-worked, to anxious, to malevolent.
Hereditary personality traits and chemical disorders causing depression
and anxiety will play a role as to who is predisposed to this disorder.
In my novelized case study,
The Luckiest Girl in the World, (1997,
Scribner/Penguin Paperback), I have characterized a girl and her family
in the middle of that spectrum. In
Cutting, Understanding and Overcoming Self-Mutilation
(1998, W.W. Norton), I presented a variety of personalities, family
structures, and treatment strategies included in this heartbreaking
I see 90 percent of
self-mutilators give up the self-harming behaviors within one year of
treatment. This is followed by much longer period of time in therapy to
heal the underlying causes of these behaviors.