In m line of work, Iv seen some pretty crazy things in my life when it comes to self-mutilation. Ive seen people with large scars down their wrist to people with knife cuts, recently stiched, on their neck, about as close to the juggular one can get without actually hitting it. In talking to these people about it, Ive generally gotten one of three, general responses.
The first, and most frequent, has been a cry for attention. About 80% of the people Ive dealt with who've cut have done so because they felt like they weren't being heard by significant others, whether it be family, friends, or a love interest. It's hard for me to comment on this one because while it's simply less painful in one way to just tell someone you feel neglected, what Ive heard far too often was how much easier it was to get someone to listen to them when they engaged in this behavior. To them, it was liberating, because they felt like they were finally being taken seriously, and not brushed off. I don't condone this in any fashion, but I can understand why a person who feels so ignored would do something to get attention they truly need.
The second reason is out of guilt. Ive seen people who have been living wth things they did that they hate themselves for, and they're "punishing" themselves as a result. The other type of guilt I've seen has been among the homosexual community. Ive seen several people who were raised in religious homes, and taught homosexuality is wrong and a sin. What Ive experienced in these situations is the person is hiding their sexual orientation out of fear of rejection, and feel guilty not only for hiding from who they truly are, but from "straying" from the beliefs they were raised with. Again, it's something I understand, but don't condone.
The final type of person Ive dealt with have been those who have truly been trying to kill themself. I met a guy one time who cut both sides of his throat and just missed hitting the juggular. He was so overwhelmed with life that he truly wanted to die, and simply grabbed a knife and cut. This is the hardest part for me because I know of several people who've been successful in repeated attempts, a few of which were my clients. Their lives had just become so unmanageable that they didn't want to live one time, anymore, and their wrists or neck were an easy option to them. Without going into detail, Ive seen more then one person dead from suicide via cutting less then an hour after they expired, and words can't express the heartbreak I felt.
For the latter scenario I described, Im not sure what would get someone to the point where they would feel that would be their only answer. There's always help, and a way out in my mind. I have empathy for all 3, even if I feel there are better ways of getting attention, dealing with guilt, or feelings of hopelessness. Ive seen enough people come out on the other side and live productve lives after feeling each way, and the first step is to talk. It's the most difficult step, often painful, but far less then the alternative.