It has become an epidemic. And its victims are silent. They are neither seen nor heard. Their pain is so deep, so internal, that they must try to get it out in anyway possible. Those who engage in self-mutilating behavior often have a long history of abuse.
Physical pain is used as a substitute for emotional pain.
A cutter who has been abused often employs the psychological defense of self-mutilation. It is important to treat the self-mutilator just like any other human being. While the self-injurer is getting help it is not necessary to ask them to stop their behavior. Steven Levenkron does not ask his patients to quit cutting until they no longer need it as a coping mechanism. Self-mutilation is something that one can recover from.