Q. I'm a 21-year-old male. In the past few months I've started cutting and scratching the inside of my calves with a razor when I get depressed (nothing really deep, just enough so that it bleeds). I don't know what made me start, but I always feel much better afterwards. I've heard that only suicidal people do things like this. I don't consider myself suicidal by any means. Just because I occasionally cut myself, does it mean I'm suicidal?

A. When people cut or otherwise injure themselves (self-injurious behavior or SIB), it may stem from many different reasons. Not all such individuals are suicidal, as you correctly suspect. However, SIB is a risk factor for eventual suicidal behavior, and definitely deserves professional evaluation NOW!

You say that you feel much better after cutting yourself, and this effect is sometimes reported in those who engage in SIB. For some, the act of cutting or scratching may relieve tension, or serve as a kind of release valve for repressed anger. For others, SIB relieves some type of inner urge or compulsion.

SIB probably does not indicate a wish to die, in the majority of cases--but it may be a kind of cry for help. After all, you are writing to me. You must have some reasons for not wanting to keep this to yourself...what might those reasons be? You say that you cut yourself "...when I get depressed...". To me, this suggests you may be trying to self-manage a potentially serious mood disorder. There are far more constructive ways to deal with depression, and again, I would urge you to get professional help right away.

You may also want to contact your local chapter of the Depression and Bipolar Support Alliance (<http://www.dbsalliance.org> or call 800-826-3632); they can often provide helpful suggestions for dealing with the feelings you are now handling by cutting or scratching. The book, "Feeling Good", by Dr. David Burns, may also be of help to you--but it is not a substitute for professional help.

If you need a referral, try calling the Alliance, or ask your family doctor. Please don't keep this all to yourself!

Other Resources:

• More Questions on Self Destructive Behavior

December 2003

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