A friend of mine cuts himself with razors as a way of relieving depression.  Sound a little strange?  Well, a lot of people do it, and no, it's not a healthy form of release.  If nothing else, he has an awful lot of scars on his upper arms that look horrible, which is a shame, because he's generally a pretty good looking guy.

It can be hard to understand, but people who cut themselves sometimes do it because it actually makes them feel better. They are overflowing with emotions - like sadness, depression, or anger - that they have trouble expressing.  My friend tells me that by cutting himself he can feel the pain flowing out of his body along with the blood.

You can probably recall a time when you've experienced intense emotions. Maybe a grandparent or a pet that you loved died, or maybe you had a bad argument with a friend. You may remember how your whole body felt different. Your body may have felt tense, as if it were getting ready for action. Maybe you relieved that tension by crying about your loss or by shouting angrily at your friend. These physical actions probably helped you to release the tightness in your body and let it return to a more relaxed state.

People who cut themselves are often full of intense emotional pain, but they have difficulty relieving the tension this causes in the usual ways. They may think that they have to be strong, and so they may not allow themselves to cry. They may have been taught as children that expressing emotions is wrong. But the tension inside their bodies and their minds becomes almost unbearable, and they find that cutting themselves somehow relieves that tension. It's as if the physical pain releases the emotional pain they've been feeling. It actually calms them, at least for a short time. It helps them feel as if they are in control of their situation and their moods.

Some people who have trouble coping with strong emotions feel numb or as if what's happening to them isn't real. Some people say that they feel like they're watching themselves in a TV show or movie. When this feeling of numbness and unreality gets too strong, they may cut themselves as a way of "waking up" from this state. Cutting may make them feel alive and grounded in reality.

Cutting isn't the only form of self-injury. People hurt themselves in other ways like burning themselves, hitting themselves with objects or their fists until they bruise themselves or break their bones, or picking at scabs and preventing sores on their bodies from healing. Cutting and other self-injurious behavior isn't confined to a particular group, either - self-injurers can be male or female, any race, and any age (although most are in their teens, 20s, and 30s and more girls than guys injure themselves).

No one knows for sure why some people injure themselves. Research suggests that it could be a combination of several factors. These include low levels of a chemical called serotonin (pronounced: ser-uh-toe-nin) in the brain, which has also been linked todepression and anxiety. Family background may play a role; people who self-abuse may have been discouraged from expressing their feelings as children. A history of physical and sexual abuse may also be associated with self-abuse.

Self-abusers don't usually intend to hurt themselves permanently. (In fact, many would say that cutting helps them relieve the depression that might lead to suicide.) But many theorists believe cutting is an addictive behavior and that self-injurers will need to make more and deeper cuts as time goes on to relieve the pain they're feeling. This can lead to serious medical complications.

You may be wondering why your friend's cat has suddenly turned vicious and is "scratching" her all the time. You may have a friend who frequently has cuts on his legs, and when you ask him why, he just mumbles something about getting caught in a sticker bush near his house. Both of these friends may be isolating themselves socially and may wear clothing that covers up their arms and legs, even in hot weather. (Most self-cutters feel ashamed of what they're doing and try to hide it from their friends and families.) You may know someone who has a bad cut and is constantly picking at the scab or playing with it so much that it repeatedly reopens the wound.

If you have a friend who's going through a tough time, you might want to watch for signs of this behavior.  My friend who cuts himself has a pattern of self-destructive romantic relationships, feels estranged from his family (even though they have been more than willing to help him), is living with friends rather than having a home of his own, is badly in debt, and recently lost his job.  This kind of pressure can easily contribute to someone hurting himself.

Everyone gets hurt accidentally from time to time, but you should suspect self-cutting if your friend has a continuing pattern of unexplained (or poorly explained) cuts or scratches that never seem to heal. If you see this happening, you should seek help.

Although self-cutters don't intend to hurt themselves permanently, they are at risk each time they injure themselves. They may misjudge the depth of a cut and require stitches (or, in extreme cases, hospitalization). Cuts can become infected because the person uses dirty cutting instruments (a self-cutter may use razors, scissors, pins, or even the sharp edge of the tab on a can of soda). If two people who are self-injurers cut themselves and share the cutting instrument, they risk spreading illnesses such as HIV disease and hepatitis.

I got a call one morning at 5am that my friend was in the hospital.  His roommate had come home and found blood everywhere.  He called an ambulance, and the police also came.  My friend ended up in a psychiatric ward strapped down to the bed.  They let him out without any sort of follow-up.  This happened over a year ago, and he still cuts himself.

Self-cutters often indicate that what they are doing makes suicide less likely because it relieves their depression. Sadly, though, those who cut themselves are more likely to commit suicide later if they don't get help with their underlying problems.

People who cut themselves often have other problems, too, like eating disorders, bipolar disorder, or drug or alcohol abuse. They're often trying to find ways of numbing their emotional pain and avoiding the problems that are behind their self-destructive behaviors.  My friend who cuts himself also does drugs and takes money from family members.

If you have a friend who is cutting, you can't force them to stop. But you can let them know that you're there to help. It can be tough to remain calm when talking about it because it's such an upsetting subject, but it's very important to let your friend know that you care and that you don't think they're a bad person for doing this.

Find an adult whom your friend can trust. If your friend can't speak directly to the adult, maybe they can write about what they're doing in a letter or a journal that the adult can read. The important thing is to encourage them to talk to someone who can help them stop the behavior and deal with the underlying problems. Ultimately, your friend will need to be assessed by a professional counselor or therapist who can recommend the best treatment plan. This may include a combination of behavioral therapy, medication such as fluoxetine or sertraline, and specialized treatment of associated problems such as eating disorders.

Some people have also found that using other means of relieving stress - like relaxation and breathing techniques, yoga, meditation, hypnosis, exercise, or art therapy - helps them to fight the urge to injure themselves.

Although cutting can be difficult to stop, it is possible. Once the self-abuser gets help in solving the problems that are at the root of the behavior, chances are good that they'll be able to stop hurting and lead a healthier, happier life.

Adapted from TEENS HEALTH.