Cutters

Someone recently confided to me about the difficulties he was having with his fifteen year old daughter. After telling me quite a bit about her psychological history and conduct issues, I asked him if she was a "cutter." He looked astonished that I had figured that out without his saying anything about it.

Cutters are difficult cases with complicated origins and iffy outcomes. As a GAL, these children are very tricky to work with. They do not make good reporters, are frequently at a difficult age and often have the characteristics of borderline personality disorder. Their tendency to self injury can sometimes lead them to serious suicide attempts. Frequently they have been the victims of abuse, sometimes in the family. At the same time, their reports are ofttimes unreliable so keeping them safe is a challenge.

Cutters, particularly those who also suffer from borderline personality disorder (BPD), tend to be emotionally unstable and prone to compulsive behavior that can take the form of binge eating, drug abuse, sexual acting out, etc. I've seen a number of lovely young ladies from loving homes who are intelligent and with all the potential in the world engage in prostitution, indiscriminate drug use, petty thievery and blackmail. Their lives read like a bad novel.

Their fear of abandonment, coupled with emotional volatility and aggression aimed towards family and friends (you only hurt the ones you love) make the family dynamics painful and hard to manage. Exceptionally strong parents can set appropriate boundaries and maintain their composure. Many parents can only do this periodically, if at all. In families where a parent (almost always the mother) also has borderline personality disorder, it is even more difficult to keep these kids safe. With the risk of injury so high, a strong therapist is a must.

Most cutters do pretty well with therapy. They tend to follow a two steps forward, one step back pattern which can be frustrating, but they do frequently make progress and many are very motivated and successful.

One of my most horrific cases involved a cutter who also suffered from BPD. She periodically ran away from home and would run with strangers, often hooking at parties for food and drugs. She was an exceptionally beautiful girl and we later learned that she specialized in some pretty kinky behavior. She had made a number of contacts while out on the street. She would contact them to subsidize her when she'd periodically run off. Or when she was bored. Highschool student by day, whore by night. She seemed to enjoy the dichotomy.

On time, however, was different. She ran away and her frantic parents searched for her for three weeks. One day, a younger sibling heard a sound in her room and looked under the bed. There she was - she just grinned as the sibling shrieked in shock. She'd been hiding in the house all that time and would come and go when the rest of the family members were asleep or absent. She thoroughly enjoyed spying on her family and listening to them agonize over what might be happening to her. She flitted through the house like a ghost at night, taking pleasure in moving things and, in her words, "messing with their minds." She wanted them to think she'd died and that her ghost was haunting them. She maintained that charade for weeks. When the family reacted with understandable shock and dismay to what she'd been doing, she dissolved into tears and insisted that they didn't love her. The younger sibling (age eleven), had feared her big sister was dead and was a wreck - especially after thinking that she'd run across some sort of demonic ghoul under the bed.

Eventually, at age 17, the young lady was sent to a bootcamp type treatment center. The program was structured so that if they kids want to go to school, stay warm, earn privileges, etc., they had to chop their own wood (they lived in tents even in the winter and it was in the mountains), cook their own food, keep the camp clean, dig latrines, etc. Part of the reason for placing her in the program was to put her someplace where she was away from an urban center (the other part was that other treatment programs hadn't worked or kept her safe and we were at our wit's end). She promptly ran away into the woods, got lost but was found within two hours.

Her parents nearly divorced over the situation. The mother was beside herself to think of her child in the camp. The father just wanted her to be safe. The child manipulated her mother into smuggling in contraband on a regular basis and this caused all sorts of commotion and derailed her progress. It also undermined the progress the other girls were making. Instead of learning to appreciate simplicity and self reliance, she continued to play the puppeteer.

Most kids, especially the boys, thrive in these programs if they are run correctly. They develop empathy and leadership skills. Some of these kids have just been cut adrift by their parents and the community and the program helps them to find themselves and a higher purpose in their lives. They gain a sense of self respect and self discipline, and a respect for authority and their peers. This particular girl, however, continued to manipulate her peers into doing most of the work and nothing seemed to reach her. Once when she volunteered to cook, she claimed that she added feces to the mix just for the fun of it (she didn't eat any, herself, but I suspect she didn't actually add anything - she just was messing with them). Telling them what she'd done after the fact seemed to give her a thrill. She left the program as a result. By that time, she was eighteen and we ended up closing the case, relieved that she'd made it to adulthood.

Obviously, she had significant problems well beyond being a cutter. I don't want anyone to think that simply because this post is entitled "Cutter" that I am suggesting that cutters typically behave this way because they don't.

The last I heard from her, she was twenty-one years old and had been arrested for prostitution several times. The good news was that she was still in therapy and had stopped cutting. She was going to school. And she was still alive (for two years, I periodically would lay in bed at night worried that she'd crossed the wrong person and was laying in a ditch somewhere). She looked a lot better and seemed to be in a better place, emotionally. Her parents were still standing by her although the family dynamics had not really changed. Dad was still an advocate of tough love and mom ranged from fury to guilt and back. The younger sibling reportedly was trying to arrange to go to college out of state. We never got to the bottom of what "caused" her psychological problems although she was eventually diagnosed as bipolar. I always suspected she'd been sexually abused based upon her symptoms but she denied it and we never found evidence in support other than her behavior. For what it is worth, I don't think the father had anything to do with it if she was abused.

She was an extreme case but has colored my approach to cutters by making me realize just how bad it can get. Most kids are not nearly that far down the road, thank goodness. I wish her well and keep her (and her family) in my prayers.