Most start out with one tiny scratch, but then the need to go deeper increases as time goes on. The first time most people cut they love the "release" they feel, but afterwards feel like what they have done is insane, and they are crazy. They go on to have cutting bouts, which are generally set off by real, or even perceived experience. Their sense of themselves and the ability to control their lives has been dictated so much by external events that they believe their existence depends on how others see them. They often see "nothing" when looking in the mirror, just a body empty of a soul.
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