I think the bottom line is one of overall functioning. A person can have piercings all over their body, and have alot of habits that you and I would consider unusual, at best, but if that person is satisfied and unconcerned, than that is the bottom line. We all do things to exert control over our bodies, be it wearing a girdle, having breast implants, exercising, coloring hair, smoking, to name a few. None of these things in and of themselves qualify as counseling concerns. The cutting described in this client goes beyond the fashionability of piercing. In this case, there is real injury, and this is not done for beauty enhancement, however in the eye of the beholder. People who do this kind of cutting are not driven by social interest or making a public statement, but by an internal dynamic whose compulsion can only be relieved by giving into a destructive urge. The compulsion can be so strong so as not to be considered voluntary.
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