Q. My friend has been really stressed, edgy, nervous, and really depressing lately. She gave me quite a scare when I noticed she had cuts and scratches on her arms and wrists. When I asked her about them she said not to worry because she hadn't tried killing herself, she was just cutting herself to relieve stress and anger. What is this and should I be worried and tell?

A. Self-cutting or self-mutilation is a symptom that often accompanies bpd. Not all people with bpd self-mutilate or cut AND not all people who self-mutilate have bpd. Research has shown that people engage in self-cutting for a variety of reasons including stress-reduction, emotional distraction, "to feel alive", "for excitement", as an attention-seeking act, to act on suicidal feelings to name just a few. Everyone and everyone's situation is unique and a good social and psychological history needs to be obtained in order to make a good assessment of what self-mutilation represents for your friend. Clearly it is a sign of emotional turmoil and upset. For this reason alone it is concerning. Consider talking to your friend about seeking professional help. Be cautious about any explanation by your friend that "it means nothing". It's neither emotionally or physically safe to engage in self-cutting and obviously the consequences can be lethal.