Physical acts committed against one's self, mostly the skin, have often been referred to by commentators on radio, television, and print as the "anorexia of today". These comments suggest that this is a new disorder. Not true. Anorexia was considered a new disorder in 1978 when Hilda Bruch published The Golden Cage, and I published The Best Little Girl in the World. The comments in 1978 were as misleading as the comments about self-mutilation are today. Once again we have an "epidemic of disclosure" rather than a new disorder. Self-mutilation has, like anorexia before 1978, been one of the best kept secret psychological disorders outside of psychiatry and emergency room medicine, where it has always been plentifully documented. Perhaps very few doctors and patients found it "attractive" to discuss. It was associated with severe mental disorders and confined to the netherworld of "crazy", impossible-to-understand behaviors.

Now with new web sites, chat rooms for the initiated, and self-help groups springing up almost daily, we can welcome its victims (estimates of one-in-two hundred adolescents and older) into the category of "disorders worthy of study and treatment". Downsizing this disorder from that or arcane, non-understandable, and untreatable is important. Defining these behaviors characteristic of individuals who suffer from alienations, mistrust, loneliness, self-hatred, hopelessness, and an impoverishment of reflective language for their emotional pain, permits us to see them as persons seeking relief from these feelings by the use of physical pain. This technique goes back to the reformation at least, when Catholics lost faith in their pope and the men publicly beat themselves with chains, though the Vatican archives stated that women did self-harming behavior "in private".

Family backgrounds will vary from tragic-ridden, to over-worked, to anxious, to malevolent. Hereditary personality traits and chemical disorders causing depression and anxiety will play a role as to who is predisposed to this disorder. In my novelized case study, The Luckiest Girl in the World, (1997, Scribner/Penguin Paperback), I have characterized a girl and her family in the middle of that spectrum. In Cutting, Understanding and Overcoming Self-Mutilation (1998, W.W. Norton), I presented a variety of personalities, family structures, and treatment strategies included in this heartbreaking picture.

I see 90 percent of self-mutilators give up the self-harming behaviors within one year of treatment. This is followed by much longer period of time in therapy to heal the underlying causes of these behaviors.