“How did you cut your arm?” a parent asked her daughter. “It happened during a gym class at school,” her teenage daughter replied.

But a report from the Mayo Clinic shows that “there are cuts, and there are cuts,” and many are self-inflicted. Why would teenage girls, even a royal princess, want to injure themselves?

It’s called the “Cutting Disease” and experts say it has been on the rise for the last 10 years.

Self-mutilation is not a new disorder. Dr. Amando Favazz, a psychiatrist at the University of Missouri, the guru on self-mutilation, refers to a reference from the gospel of St. Mark, chapter five, in which a man cries out and cuts himself with sharp stones.

Piercing one’s ears and tongue is one thing. But intentionally cutting yourself regularly with razor blades, burning the skin with cigarettes, pulling out hair or breaking bones is to most people an unthinkable way to act. Normally most of us try to prevent injury.

Self-cutting involves both the rich and poor. But nearly 100% of the time it’s females that are tormented by this disorder.

The Mayo Clinic reports “there’s no single or simple cause to explain this problem as it’s often triggered by a mix of emotional disorders and an inability to cope in a healthy way with psychological pain.” In short, a whole basket of emotional problems.

Experts stress that self-mutilation is vastly different from suicide where the intention is to end one’s life. Rather, regularly cutting the skin is an attempt to use the body to express that their physical pain is nothing compared to the awful feelings they bear inside. And that self-injury is due to a mixture of anger, fear, anxiety, loneliness, guilt or emptiness that engulfs the lives of sufferers.

One psychiatrist remarked, “Initially, cutting helps to relieve their intense anxiety. But they quickly realize that the problem still exists and they feel ashamed, guilty and try to hide the scars.”

When analyzing the histories of such tormented people, several underlying problems stand out. The majority have endured an unhappy childhood for a variety of reasons. Some were maltreated by abusive parents. Others faced the emotional turmoil of seeing parents divorce and being shuttled back and forth between unhappy households. Or there’s a recurrent history of drug, alcohol or sexual abuse.

A prime example is the late Princess Diana, who witnessed the divorce of her parents. She was shuttled between households and later bound by an unhappy marriage to Prince Charles.

She then shocked the world in 1995 during a television interview with the BBC, revealing that she was a self-injurer having cut her arms and legs. She explained “You have so much pain inside yourself that you try and hurt yourself on the outside because you want help”.

In Diana Her True Story, a biography about her life, she admits she had often thrown herself against a glass cabinet at Kensington Palace, slashed her wrist with a razor blade and a serrated lemon slicer.

Once during an argument with Prince Charles she cut her wrist and thighs with a pen knife. On another occasion, during a plane flight, she locked herself in the bathroom, cut her arms and smeared the blood on the cabin walls and seats.

When patients are asked why they self mutilate they provide a number of different reasons. One remarked poetically, “I know it’s wrong, but it feels so right, so I’ll just add another scar tonight”.

Others say it gives them a sense of control over their body. Or as Tracy Thompson wrote in The Beast: A Reckoning With Depression that “It’s better to inflict injury on myself than let other people do it.”

There’s no magic bullet to ease the internal turmoil in these people as it’s never easy to treat depression, anxiety, obsessive compulsive disease and other emotional troubles. Besides, self-cutters hide their secret for years by wearing long sleeves or using other deceptions.

But I hope this column will alert parents who see suspicious cuts and bruises. They should see that their teenage daughter receives prompt treatment. The longer cutters cut, the more difficult the treatment.