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Cutting is a form of self mutilative behavior which refers to a patient causing self injury usually by using an object that causes pain or wound.
Many different patients do cutting behavior. It may be more prevalent with
adolescent females or patients with a trauma history.
Typically patients will do cutting behavior on their arms or legs, although it can occur on any body part.
You will want to pointedly ask your patient if they are engaged in behaviors of self harm during the risk assessment portion of your intake.
You may see that a patient has scars on their arms or legs in view, although this is unusual. A patient will typically attempt to hide the evidence of this behavior.
Why do people do cutting behavior?
Most patients report that they either have overwhelming feelings that they cannot handle or they feel emotionally numb.
Doing the cutting allows them to be able to feel again.
Likely the behavior releases some type of neurochemical response that is soothing to the individual for some reason.
This creates almost an addictive type attraction to the behavior. For this reason, secrecy around the behavior needs to be broken down.
Cutting may or may not be related to more serious forms of self harm such as suicidal behavior which requires a more drastic intervention. ALWAYS, ALWAYS, ALWAYS!!!! Assess for all potential types of self harm behavior.
Cutting is a coping mechanism for the person who finds satisfaction in the behavior.
When a patient reveals this behavior, develop a safety plan with the patient. The safety plan needs to include telling other people so that the secrecy is lifted.
The patient should agree to get rid of the item used for the cutting if they have it stashed somewhere. The patient should also identify 3-5 quick coping skills they can use as an alternative before the next appointment.
The primary focus of counseling might be to develop other coping skills which might not be as easy or effective as the cutting behavior. As one of the initial homeworks, the patient will need to identify a list (I suggest a 20 item list) of coping skills that they find soothing.
Coping skills require practice to become second nature, so assign the patient’s practice of these skills as homework as well.
Another technique for managing these urges to cut is to have the patient use an ice cube and rub it on the area usually cut. This provides a lot of sensory stimulation, a tactile sensation close to
pain and again diverts the patient from the more harmful cutting.
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and let’s work together to Make the Counseling World a Better Place!
Licensed Mental Health Counselor
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