Cutting

Once or twice a month, I see patients with distinctive scars, mostly, but not always, confined to their arms. A recent patient prompted this post. The photo and text are presented with her approval as she feels her story needs to be told.

The patient is a 66 year old insulin dependent diabetic who presented with a dermatitis of the abdomen. It had non-specific features and was KOH negative. Most likely a xerotic eczema or an irritant contact dermatitis. Linear scars were noted on her arms and I questioned her about this. She had been the object of sexual abuse for many years as an adolescent and cutting was her outlet.

Cutting is a form of self-injury (aka nonsuicidal self-injury - NSSI). In my, albeit limited, experience, most cutters are or have been victims of abuse, often sexual abuse. These patients usually are receptive to discussion about their cutting and its causes. Viewing these lesions may be an opportunity to show compassion and understanding for these patients.

Cutting, almost always, is a sign of "Adverse Childhood Experiences." These, ACEs have negative impacts on one's health as an adult and are well described in a New Yorker article, "The Poverty Clinic."

For more on cutting:
Wikipedia
Why People Hurt Themselves
The Poverty Clinic by Paul Tough. There is a full text pdf online which I can not link here.

If you encounter a person with acute cutting, Brief Therapy Heals Trauma in Children, by Jane Brody, is worth reading.