The Tennessean
June 22, 2004

Cutting away the pain
By Sameh Fahmy

Christopher Nichols was just 14 when he first cut himself on purpose.

His girlfriend had just broken up with him, and he wanted to hurt—but not kill—himself. So he took a paring knife and created an inch-long gash in his left arm.

“I had to let the pain out some way,” says Nichols, now 17. “So I sliced the top of my arm.”

In the paradoxical world of youth who purposely and compulsively injure themselves, it makes perfect sense: By cutting, burning or otherwise hurting themselves, they relieve a much deeper, psychological pain—at least for a little while.

Such behavior predates biblical times, but researchers say that the number of youth who injure themselves has surged in the past few years. The behavior can frustrate and confuse parents, but mental health professionals say there is hope in treatment.

Painful isolation

Body piercing and tattooing are done for social or aesthetic reasons, but self-injurers hurt themselves to relieve an underlying anxiety.

Wendy Lader, clinical director and co-founder of SAFE (Self Abuse Finally Ends) Alternatives, an inpatient unit exclusively for self-injurers in Naperville, Ill., says self-injurers are often creative and bright, but have trouble dealing with anger, frustration and other painful emotions.

They’re more likely to be girls than boys (by a 60:40 ratio) and tend to feel alienated from others. Often, they have a sense of self-loathing.

When Nichols would feel bad about himself, he’d use cutting as a form of self-punishment. It was also a way to relieve stress and escape from a troubled childhood that included the suicide of his father, frequent moves and a sense of isolation.

“You know in middle school and elementary school, there was always that kid who you didn’t want to hang out with,” he says. “Well, I was that kid. And I hated it every day.”

He resorted to cutting, but his sense of relief never lasted long. After he cut himself for the first time, he did it again three and a half hours later, using the same knife.

Because cutting is done in secret and because large studies are costly and time-consuming, researchers don’t have a precise sense of how many youth self injure.

Dr. Armando Favazza, professor of psychiatry at the University of Missouri-Columbia and author of Bodies Under Siege: Self Mutilation and Body Modification in Culture and Psychiatry, estimates the number is at least 2.5 million.

That number is on the rise, he says, and he isn’t alone.

“I almost hate to use such histrionic (dramatic) kinds of words,” says Lader, who is also the co-author of Bodily Harm: The Breakthrough Treatment Program for Self-Injurers, “but it really is like an explosion in the last few years in school-age kids.”

Judy Freudenthal is clinical director for the nonprofit Oasis Center in Nashville, which provides counseling, residential programs and leadership programs for youth. She estimates that five to 10 years ago, 1% to 2% of the youth seen through their outpatient counseling and residential shelters had self-injured.

Now that number is about 10% for the youth in their shelter and between 5% and 10% for their outpatient-counseling program.

Nichols says he personally knows of about 30 kids who have self-injured. Freudenthal says that while she has no way of verifying that number, it wouldn’t be unheard of.

Although mental-health experts are certain that the number of youth who self-injure is on the rise, they’re not sure what’s causing the increase.

One popular theory is that youth today feel a greater sense of isolation than generations past. Considering that many parents spend long hours at work and move frequently with jobs or after divorces, it’s easy to see how kids can feel disconnected.

“They have a lot of things,” Lader says, referring to the fact that many youth have TVs in their rooms, cell phones and computers, “but they’re not getting mentoring. They’re having to deal with a lot more in society with a lot less mentoring.”

Some say that today’s youth—like today’s adults—are increasingly looking for a quick fix to their problems. And although researchers stress that tattooing and body piercing aren’t the same as self-mutilation, they feel that the rise in body art may have a role in the increase in cutting.

“As people get more and more pierced, it just seems easier to put holes into your body and to do something to your body,” Favazza says. “Just knowing that so many people are doing that makes it a little easier to cut yourself.”

Seeking help

Self-injurers usually continue their behavior for anywhere from five to 20 years, and most of them do it sporadically. Favazza says that about 5% of self-injurers have cut themselves more than 25 times.

Still, the behavior can escalate and Lader has seen patients who have severely burned themselves, cut digits off or have had to be institutionalized because they couldn’t stop. Favazza says self-injurers can become so demoralized at the idea that they can’t stop that they contemplate, and sometimes commit, suicide.

At his worst, Nichols cut himself three times a day. His parents were going through bankruptcy, but it wasn’t the money issue that bothered him.

“The thing I wanted most from my parents was to care about me,” he says. “And when they were struggling so hard to get this money, they weren’t paying attention to me. I was just basically ignored, and it killed me.”

As things got better at home, he started cutting less—down to twice a week and then once a month. He didn’t stop entirely, however, until friends, teachers and even a janitor at school learned about his problem and encouraged him to resist the urge.

“People have told me they care about me and when I do it, it hurts them,” Nichols says. “So that’s the main thing that keeps me from doing it—I don’t want to hurt my friends anymore.”

Although Nichols never sought formal treatment for his problem, mental-health professionals recommend that self-injurers seek professional help.

Lader says that often when parents try to deal with the behavior on their own, they either minimize it—believing that it’s just a phase—or make youth feel shameful or guilty about their behavior, which only makes them want to cut more.

The goal of therapy, Lader says, is to first get self-injurers to agree not to harm themselves. The next step is to help them figure out which emotions make them want to do it. Next, they teach them a better way to deal with those emotions.

Preliminary data from SAFE Alternatives’s two-year follow-up surveys indicates that about 75% of its patients don’t hurt themselves within two years of discharge, Lader says.

Mental-health professionals aren’t sure how to stem the rising number of self-injurers, but urge parents to be more involved with their children and for youth to become more involved in community activities and service projects.

“When they’re doing that they feel so good about what they’re able to contribute, and they view themselves differently,” Freudenthal says. “And they’re just not as affected by this culture around them that lends itself to feeling bad about yourself.”

Warning signs

Self injury crosses gender, racial and socioeconomic lines, but there are some common warning signs:

The Houston Chronicle
June 24, 2004

Alief woman works to save those in pain from themselves; Author, speaker calls attention to self-injury
By Mary Lee Grant

Michelle Devlin didn’t know how to express feelings of anger and sadness that resulted from childhood sexual abuse. When the emotions became too much to stand, she cut herself, first with small implements like a pocket knife, then with large knives, until finally she began carving words like “Sad” and obscenities into her arms and legs with a razor.

Devlin has a disorder that mental health professionals say is a growing problem, especially among women and teenagers. She practices self-injury as a way of dealing with emotional pain. Others may bang their heads against the wall, burn themselves, hit themselves, break their bones, pick at their skin and scabs, or pull their hair.

Devlin, 50, has recently published a novel based on her own experiences of abuse and self-injury, and she has been making speeches throughout the Houston area on the topic.

“Cutting myself is a way to deal with overwhelming emotional pain,” she said. “When you have cut yourself, you can’t feel your emotional pain anymore, because the physical pain is overwhelming.”

As a victim of childhood sexual abuse, she said she grew up overwhelmed by feelings of rage, self-loathing and shame. In an effort to express those feelings and diffuse their intensity, she began writing her book, Afraid of the Dark, a composite of fact and fiction.

While struggling to overcome the effects of her abuse, she turned to alcohol and drugs, then finally, to self-injury. Now, she is on a mission to raise awareness about self-injury and to promote a better understanding of the behavior.

New age anorexia

Having bipolar disorder contributes to Devlin’s daily struggle not to cut herself, she said, and speaking and writing have become her most helpful tools in staying away from the knife. Now she is working on a sequel to Afraid of the Dark.

Devlin said self-mutilation has been named the “new age anorexia,” with 2 million cases in the United States. One out of every 200 girls between ages 13 and 19 self-injure, she said, and more than one in 10 adolescents have deliberately harmed themselves. About 50 percent of self-injurers have a history of sexual or physical abuse and many have at least one alcoholic parent. Devlin wasn’t typical of self-injurers, because she didn’t start cutting herself until she was in her 40s.

“Before that, I used alcohol and drugs to deal with my emotions,” she said.

She said the illness has become an alarming new theme in popular songs.

“It has become the controversial problem, like anorexia or sexual abuse were 20 years ago,” she said.

Celebrities speak out

The Goo Goo dolls sing “You bleed just to know you’re alive” while Eminem says “Sometimes I even cut myself to see how much it bleeds. It’s like adrenaline, the pain is such a sudden rush for me.” Nine Inch Nails sings “I hurt myself today, to see if I still feel I focus on the pain, the only thing that’s real,” and Tori Amos writes “got a little red line that tells you, boy, where the razor’s been.” Celebrities who have admitted they were cutters include Elton John, Johnny Depp, Angelina Jolie and the late Princess Diana, Devlin said.

Though therapy helps, it is a problem that is hard to overcome.

“I battle it every day. You begin to see it as a panacea and want to do it to deal with all sorts of problems. It began one night when I was drinking,” she said. “I was overwhelmed by my emotional pain and took a pocketknife out of my purse and started jabbing my arm with it. It helped me. I felt better, and the next night I did the exact same thing. I went straight to the knife The relief is instant. The first time I just acted out of desperation, then it became addictive.”

She tried to hide her cuts by wearing long sleeves and cutting only high up on her arms, but her body now is covered with scars.

“A lot of people think it is a failed suicide attempt, but it is something completely different,” she said.

Still, about 57 percent of people who self-injure do overdose at one time or another, she said, adding that she almost lost her own life to alcohol and pills a few years back.

“One myth is that self-injury is a way to gain attention, but that is not true, because we try to hide it,” she said.

Overcoming the stigma

Now her courage in addressing the issue is helping others, said Lana Hand, president of the Tomball Chapter of the National Alliance for the Mentally Ill. She said that Devlin has spoken to classes she gives to help families deal with mental illness.

“What she said was very enlightening,” Hand said.

Hand said self-injury is an illness many in Houston are dealing with, though it would be hard to estimate their numbers.

“It is a very common illness, but one that is highly stigmatized and often misdiagnosed,” Hand said. “It is very common among children. I wouldn’t say there is one in every classroom, but I would say there is at least one in every school.”

The Kansas City Star
June 25, 2004

Looking for comfort in pain; Admitting you have a problem is first step in getting help for cutting and other forms of self-mutilation
By Rebecca Delaney

“Once, I felt extremely bad and was so frustrated that I grabbed a safety pin and started scratching my skin. I liked the feeling I was getting, so I increased the pressure to get actual cuts,” Amy said. “I was overcome with a calming sensation.”

Today is a bad day.

Amy* sits in her bedroom next to a small, carefully hidden collection of razor blades and broken glass fragments. Her scarred right fist tightly clutches a shard of glass. She lifts up her shirt.

Underneath lies a stomach covered in a blanket of jagged slashes. She surveys the skin, searching for a patch free from the red wisps of scar tissue. Some of the cuts are from months ago—only faint white lines still visible. Others are only days old, still raw.

Holding her breath, she drags the glass across skin near her bellybutton. The shard leaves an inch-long wound behind. She numbly stares at the gash as a small stream of blood trickles and pools on her stomach.

Yes, today is another bad day. Beneath Amy’s clothes rest the marks of many bad days, etched in tiny lines of red and white.

“I began cutting when I was in seventh grade,” said Amy, who is now a high school student in Greater Kansas City. “I would constantly tell myself how bad of a person I was and that I needed to be punished ... so I would cut (myself). It was a comfort for me. I didn’t think I could function without it.”

She is not alone.

Wendy Lader, a psychologist who co-wrote the book Bodily Harm, estimated 1 percent of Americans deliberately injure themselves as a way to deal with deep emotional trouble. Of those, a large majority are between the ages of 11 and 26, according to Steven Levenkron, author of Cutting.

And, researchers estimate, 70 percent of those who hurt themselves are women. They burn themselves, they bruise themselves, sometimes hitting their own heads against walls. They hurt themselves by picking at healing wounds. They pull their hair, some even break their own bones.

But the most widespread form of self-mutilation is what Amy does. Commonly called “cutting,” it involves intentionally slitting skin with a sharp object.

“Cutting happens for a lot of reasons. One is as a source of comfort or relief, and that’s a very common one. Another is to feel something, anything, because you feel numb, or robotic, or insensitive to emotions at all,” said psychiatrist Stephen Huk of Leawood. “The other reason is when your emotions are too intense, and you’re looking for physical pain that matches the emotional pain.

“It occurs throughout the life span. It does tend to extinguish a bit when you get into your 40s, 50s and 60s, but it’s still very common in the 20s and 30s. It’s become almost trendy, and it’s paralleled the increase in piercings and body alterations. As piercings, tattoos, etc., have increased, there’s been more cutting.”

Often self-mutilators make intense efforts to conceal their wounds, masking them by wearing long-sleeved shirts, pants, makeup and sweatbands.

“I was very cautious of where I cut so nobody would notice. Eventually, it got to a point where I was willing to cover it up so I had more places to cut,” Amy said. “(To hide it) I would wear long sleeves and jeans. When I was feeling courageous I would put on dark hose and wear a skirt so nobody would suspect.” Self-mutilators divide into two categories: those who display the injuries for attention and those who hide the wounds.

“Hiding it is not a good sign,” Huk said. “Someone who cuts on the wrist is often not as serious of a cutter as someone who cuts on a part of the body that you’re not able to see. The cutting of the wrists is almost a communication to others, a cry for help. The cutting of a hidden body part winds up being much more a sign of serious illness. They’re more likely ill. It’s more likely a long-term behavior, harder to treat.”

Reasons for mutilation are as diverse as the techniques to hide it. For Amy, her self-injury was a response to depression and anger.

“I remember the first time I cut very well. I was going through a severe case of depression and was a very angry person. I’d blow up at my family and scream at them for no reason,” she said.

“Once, I felt extremely bad and was so frustrated that I grabbed a safety pin and started scratching my skin. I liked the feeling I was getting, so I increased the pressure to get actual cuts. I was overcome with a calming sensation.”

The “calming sensation” described by Amy is said to be common for many self-injurers. The biological explanation, according to an article from the American Psychological Association, is that the human body releases endorphins in response to new injuries. For some, these endorphins have effects similar to morphine, reducing physical pain and possibly curbing hurtful emotions.

“When you cut your body, you cut nerve endings,” Huk said. “The sight of blood and all of that triggers reactions that are instinctual or reflex-like. With that adrenaline release, there can be a surge of excitability, which makes you feel alive, or to someone who is already overworked, overexcited, over stimulated ... that adrenaline release can help redirect and manage emotions a bit.”

To stop, he said, the cutter must see self-injury as a legitimate emotional and psychological issue.

“The first thing is to recognize the problem and label it as a problem,” Huk said. “It needs to be labeled as an abnormal behavior.”

For Amy, acknowledging the “problem” with her mutilation was a jarring experience.

“I felt numb to the pain, so I kept cutting and cutting. Eventually I looked down and practically my entire body was covered in cuts and blood. I was absolutely disgusted with myself. That was the day I decided that I wanted and needed to stop ... I’ve been trying to stop for several years, but it has been extremely difficult. It has been a month since I have done anything to myself, which I’m very proud of.”

Therapy and counseling are the most practical solutions, Huk said. “(A self-injurer) is going to have to then substitute more adaptive solutions to the quick fix that may require counseling to guide and find what’s upsetting. It may require medications. Cutting is often a sign of a more serious mood disorder where medications ought to be considered.”

However, self-mutilators can be so consumed by their disorder that they will not seek help.

This is where friends can play a role, Huk said. If one suspects a loved one of practicing self-mutilation, intervention is vital. Contacting their parents, counselor, physician or responsible adults is the first step, followed by support and understanding.

“Express your concern and make yourself available for help,” he said. “Invite them to communicate with you. ... a lot of people are afraid that if they report this, their friend will no longer care for them. But if you didn’t report it, what kind of friend would you be? In the long run, that friend will appreciate that you cared enough to do something.”

Through counseling, therapy and the aid of friends and loved ones, Amy found the support and strength to cope with her destructive behavior. Amy, who now channels the urge to cut by keeping a journal, reading, creating artwork and listening to music, said in the end she is responsible for her own actions.

“I hate letting people down, so others help motivate me not to cut. (Someone else) can’t make a person stop self-mutilating, but it means a lot just to know that somebody is there to listen and support you and encourage you to stop. I have my occasional relapse, but the past year I have come to terms with myself ...these days I simply tell myself it isn’t worth it. I make myself think of things, such as how I’d like to wear summer clothes, or I think of the reactions I used to get. The self-mutilation just isn’t worth it.”

With a tissue, Amy blots the blood from the fresh wound on her stomach, making sure the bleeding has stopped. She rises from her seat on the floor to pull a bandage from the bureau drawer. She places it on the cut.

Delicately, she picks the shards of broken glass and razor blades from their hiding place near the bedroom floor. As she places the cutting tools in the trash can, she whispers, “That’s right. The self-mutilation just isn’t worth it.”

Today is a bad day. But tomorrow will be better.

(*Amy is a high school student in the Kansas City area. Her real name has been withheld to protect her privacy.)

USA Today
June 28, 2004

Students’ scars point to emotional pain
By Patrick Welsh

With school out and the summer officially underway, some kids are going to be forced to come out of the closet if they want to get into bathing suits, shorts, tank tops or other comfortable apparel. I am referring to the “cutters” closet, where kids who indulged in what psychiatrists call self-injurious behavior (SIB) have been hiding during the school year.

After about 30 years of teaching at T.C. Williams High School in Alexandria, Va., I thought that nothing teenagers could do would surprise me. But last month, a bright, sweet 16-year-old girl shocked me when she rolled up the sleeves of her black shirt and showed me the scars from burns and cuts that she had made on both arms. She and her fellow cutters—a group of about 20 girls and boys, most of whom, she said, have horrible relationships with their parents—often compare and discuss how their wounds came to be.

Nancy Runton, the school nurse, said such behavior is becoming more common. Just weeks ago, a student rushed to Runton’s office to report a girl who was sitting in class cutting her arm with a piece of glass. After Runton hunted the student down, she learned the girl had been cutting herself for more than a year.

The next teen disorder

In one way, there is nothing new about self-injurious behavior. Some orders of Catholic priests practice self-flagellation; groups of devout Shiites in Iraq beat themselves in religious processions. But these culturally sanctioned rituals are not the same as the pathological self-injury among today’s adolescents.

Psychiatrist Joshua Weiner, who has treated adolescent cutters in metropolitan Washington, says self-injury is “the anorexia and bulimia of the new millennium.” And just as Americans were slow to catch on to the problems of anorexia and bulimia 20 years ago, Weiner says, we are just now beginning to understand the nature and depth of this phenomenon.

Parents and educators can’t afford to let self-injury creep into the American lexicon. If we don’t act aggressively to understand and treat these kids, the suffering will continue, with incalculable costs to these adolescents and our society.

Fortunately, awareness is growing. More books are being written. Scores of Web sites discuss the culture of self-injury. Help is available. Yet no definitive studies have determined whether the attention being paid to SIB stems from a real increase in the behavior or a greater awareness. Weiner and other health professionals say it is a combination of both factors.

Kaye Randall, a social worker in Greensboro, S.C., and co-author of the book See My Pain!, says she has seen an enormous rise in teen self-injury in her practice during the past five years. She also has seen audiences grow at self-injury seminars nationwide.

A school system in Mesa, Ariz., has had such a big increase in self-injury that it initiated programs to help its staff understand and recognize the problem.

Standing question: Why?

Some of this behavior is temporary, often an attempt to get attention from peers or parents. Sarah Ball, a senior in my English class, recalls that in the eighth grade, several kids who would cut themselves “were rebellious types trying to project Kurt Cobain teen angst. ...Some of them gave it up by high school, but some ended up being hospitalized.”

Though self-injury has a social component, Randall cautions against believing that kids are just trying to belong to a group: “Cutting and other forms of mutilation become a coping mechanism...a way of dealing with powerful emotions that they don’t know how to deal with. It’s as if they have a volcano inside, and that has to erupt. Cutting makes them feel calmer.”

In the worst cases, the calming effect can make self-injury addictive. Some studies suggest that cutting releases endorphins (neurotransmitters in the brain that reduce pain) into the blood stream. The young woman who showed me her cuts and burns said that after three years of mutilating herself, she is trying to stop but sometimes “falls off the wagon and goes on a cutting binge.”

Weiner, who defines SIB as the intention of harming one’s body without conscious suicide intent, says the act can be a form of punishment. “I had a girl who was such a perfectionist that she would injure herself when she didn’t do well on tests,” he says. “Some boys cut because they are worried that they are gay and feel guilty and want to punish themselves.”

I feel a little guilty myself, having been oblivious to the self-injury problem, but it is not easily confronted. Kids feel such shame that they hide their wounds. A common theme on the numerous Web sites is getting beyond the shame. Also, the behavior seems so unnatural that parents have a difficult time accepting it.

Educators and parents must look for clues to self-injury—some visible in the summer sunshine, others well below the skin—and address them openly, with no shame. The bloodletting will stop when kids learn healthier ways to deal with painful emotions.

The Independent
July 6, 2004

A Cutting Response to a Cry for Help
By Deborah Orr

For many people, the culture of confession, the medicalisation of “normal” human experience, the deification of celebrity, and the general fuss people are encouraged to make about their own tiny feelings, represent all that is wrong with society. For the stiff-upper-lip brigade, the confessions of the 24-year-old actress Christina Ricci are typical of our culture’s growing narcissism and self-indulgence.

She said last week: “I used to burn myself. I was in a lot of emotional pain. When you’re a teen unable to accept how much pain you are in, physical pain gives you justification.” She went on to explain that she had beaten anorexia and self-injury because of her relationship with her actor boyfriend, Adam Goldberg. “I’ve accepted my body now,” she says. “When someone loves you and loves your body, you feel sexy.”

Indeed, it all does sound slightly preposterous. The feted teen actress was so very plainly in the public eye at that time. Could she really have been inflicting such seemingly obvious damage without it being noticed? And is that stuff about physical pain legitimising emotional pain really credible? Anyway, could her problems really have been as great as she is now suggesting, if the holy grail of teenage cliché, finding a nice boyfriend, was all that she needed to cure her?

The answer to all three questions is a resounding yes. Ms Ricci’s confessions are absolutely certainly genuine, for they chime so perfectly with the experience of very many self-harmers.

First, self-injury and eating disorders are indeed closely linked. Often people suffer from both, as Ricci describes. Sometimes, when an anorexic is forced to eat, she turns to self-harm instead. Second, self-harm is always intensely private. Those carrying out injury do their utmost to conceal or dismiss it. So also do others involved: parents, teachers, and even, sometimes, healthcare professionals. There have been reports that at one girls’ boarding school an explosion in self-injury was hushed up, with several of the pupils thought to be the leaders in the practice expelled.

No one really knows how many people in Britain self-harm, but estimates suggest 400,000 women sufferers and 55,750 men. The Mental Health Foundation is fundraising at the moment in an effort to meet the huge rise in demand for services treating young people at risk from self-injury.

As for Ms Ricci’s rather banal explanation about physical and emotional pain, anyone cynical about such a crude analysis of cause and effect should beware. Again and again when people who self-injure talk about their motivations, they give an extremely similar explanation.

Finally, that some-day-my-prince-will-come cure. Once more, Ms Ricci’s experience is widely shared—although ominously there are some reports suggesting an end to the stablilising relationship can herald a resurgence of the destructive symptoms.

The experience of self-injury can seem uncommonly universal. Ms Ricci is not the first celebrity to share her experience, and she is not likely either to be the last. But the same troubles are seen across the social spectrum, among the pampered and the tough, the rich and the poor, the young and the old. There were, for example, 59 incidents of self-harm logged at the notorious Deepcut army barracks between 1996 and 2001.

Self-harm in prison is widely acknowledged to be rife. And it is among prison populations that that the strong tendency for self-harm to be a mainly female problem is most clearly seen. Men do self-harm, but statistics suggest that women are seven times more likely to resort to this extreme—which is variously described as an addiction, a disorder and a coping mechanism.

In prisons, although women make up just 6 per cent of the total inmate population they are responsible for almost half of all self-injury incidents. Partly this is because of a kind of hysteria, with the impulse to do such an act proving almost contagious.

Today it would be almost accurate to describe self-injury as “fashionable.” Just as once the media fell over itself to break the “taboos” around anorexia, now it is doing the same thing with self-harm. The practice has been spotlighted in films from Girl, Interrupted to Secretary. Most recently it surfaced in Thirteen. The current issue of Cosmo Girl, aimed at girls in their young teens, sports the cover-line “You and Self-Harm: All your urgent questions answered.” The internet meanwhile offers a plethora of websites, some of them so eager to support self-harmers that you can feel rather freaky for never having thought of trying it.

That may sound flip and irresponsible. But there is a real issue here. Part of the huge increase in self-injury may well be linked to a straightforward increase in the knowledge that such a mechanism exists.

This sort of publicity runs the risk of making self-harm seem attractive to teenagers and also like a distasteful and silly piece of teenage subversion to non-sufferers. And it is true that many people might be tempted to try a little self-harm because they see it in the glossies and the films. But the ones who return to it again and again are the ones who have underlying psychological issues that self-mutilation somehow addresses.

Beliefs about exactly what these are at present something of a moveable feast. Self-injury is linked to all kinds of other obsessive-compulsive disorders.

Its particular attraction for teenage girls is, however, both predictable and paradoxical. It is predictable because the triggers seem to chime closely with the condition of being a teenage girl—that narcissistic lack of physical confidence, the dread of never “finding love,” the fear of growing up and having to assume responsibility. It is paradoxical for the same reasonthat it reinforces all the irritations adults have with teenagers about their selfishness and their self-obsession and their inability to get their not-central place in the universal into perspective.

This is why most adults, when confronted with a self-harming teenager, will do exactly what they shouldn’t. They show disgust and distress, tell sufferers to get a grip, and sometimes collude in the secrecy that surrounds the act—like the parents and teachers who hushed up the self-harming activities at the school.

Worse, healthcare professionals themselves are sometimes poorly geared up for dealing with self-harm. Some people tell of turning up in the accident and emergency department and being treated with contempt, being left until last to have their injuries stitched or dressed, and generally undergoing ritual humiliation.

However irritating and attention-seeking the self-harmer may seem, the only thing to do is to provide attention rather than denying it, understanding that the need for attention is not shallow but deep.

What the alarming increase in self-harm among young people tells us, quite simply, is that it is getting harder and less attractive to grow up and take a place in adult society. Sadly, our present attitude to this heartfelt and dangerous cry for help—which is to attempt to belittle or reject it—merely confirms the sufferers’ worst suspicions.

Canberra Times (Australia)
July 9, 2004

Self-harm a secret mental illness
By Karin MacDonald

Every day, Canberra Lifeline counsellors take at least two calls from people who have harmed themselves, are thinking about it or are in the process. These people could be your friends, family members, neighbours or colleagues, and chances are you would have no idea they are harming themselves, because self-harm is easily hidden.

Self-harm and suicide have been increasing steadily since the 1950s and it has been estimated that tens of thousands harm or put themselves at risk each year.

Five per cent of the population occasionally harm themselves and 1per cent often severely injure themselves. Self-injury is defined as deliberate, non-threatening, self-effected bodily harm or socially unacceptable disfigurement.

The most common forms include cutting, burning, self-hitting and biting, nail and cuticle mutilation, injurious masturbation, insertion of dangerous objects into body openings, head-banging, application of caustics and abrasives, scalding showers, swallowing foreign objects, hair-pulling and abrasive scratching.

These injuries are not always noticeable, however, as some self-harmers cut themselves under their arms or behind their knees or in other less noticeable places and often don’t need or seek medical assistance for their injuries.

Many fall through the gaps for treatment because they hide their illness from their friends, family and colleagues, and many, at face value, can be considered happy and healthy, but at the same time are trying to cope with their mental illness.

Self-harm is an illness that many people have not even heard of or even understand. I became aware of it only when a friend confided in me that she had harmed herself. She couldn’t explain why she had done it, only that she was stressed about life.

This is the case for many self-harmers; others injure themselves to feel in control of the pain they are feeling, to reduce anger and tension, to block upsetting memories and flashbacks, to demonstrate a need for help or to ensure their safety and self-protection.

The ACT Legislative Assembly passed a motion I put forward this week, recognising that a significant number of people in our community resort to self-harm as a means of coping with the stresses they face.

My motion identified that better knowledge and management of mental health was an important foundation for sound mental health in the future.

The worrying thing is that, because self-harm is a hidden illness, generally funding for and research into it is neglected.

The ACT Government has had self-harm and suicide in mind in the 2004-05 Budget, allocating $1.373million over four years to mental health. This includes the employment of a full-time prevention project officer to develop strategy and promote a more coordinated approach to the management of self harm and suicide.

But self-harm will not go away by simply throwing money at it. Counselling and support services such as Lifeline, Beyond Blue and Sane Australia are integral in helping those who self-harm and reducing the stigma associated with it.

Sane Australia, for example, has played an important role as a watchdog, monitoring the portrayal of mental illness in the media. It has committed itself to fighting the stigma attached to mental illness and is improving the community understanding of it, mainly through its StigmaWatch program.

In 2003, through StigmaWatch, Sane Australia identified an increasing public intolerance of inaccurate and insulting reporting of mental illness and an improved understanding of the harm such reporting does.

As a consequence, it has noted an improved sensitivity among health, medical and social-affairs journalists to how they report on mental illness.

Sane Australia is one organisation among many that have been helpful in addressing the stigma attached to mental illness and so has contributed largely to changing the community’s attitude to mental illnesses such as self-harm.

Mental illnesses often don’t have noticeable symptoms, and self-harm is often no exception.

If you suspect that someone you know may be harming him or herself, it is important to discuss the issue with them and offer your support.Any one needing advice or simply someone to talk to can contact Canberra Lifeline on 131144 and speak to a qualified counsellor.

It is important that we give as much support as we can to those suffering from this and other mental illnesses.

They are our friends, our family, our co-workers, and one day, it could even be ourself.

The Christchurch Press
July 13, 2004

Mutilation Trend Among Teens ‘Needs Exploring’
By Tim Hume

Troubled New Zealand teens are succumbing to the disturbing phenomenon of self-harm, with one expert estimating one in 10 high school students deliberately mutilate their bodies.

Legions of young people intentionally injure themselves without suicidal intent each year, engaging in skin-cutting, head-banging, self-burning and biting, and inserting and swallowing sharp objects. It is a behavioural trend mental health experts say needs further investigation.

Professor Peter Joyce, head of the Christchurch School of Medicine’s psychological medicine department, has recently submitted a paper detailing self-mutilation data collected from outpatients receiving treatment for depression since 1994.

More than 20 per cent of the 195 patients surveyed reported having self-mutilated. “We know very little about it, about why it happens or doesn’t happen,” said Joyce. “But almost inevitably patients describe an intensely distressed, spaced-out feeling, which is improved with pain. They often describe the harming as relieving that tension.”

Most reported feeling no pain when they injured themselves.

He said no studies had been done to determine how widespread self-harm was, but he expected the lower end of the 10% to 15% quoted in overseas studies applied to New Zealand teens.

Britain has launched a national inquiry into the phenomenon after a steep rise in self-harm hospital admissions, while internet websites for “cutters” abound.

Joyce said most of those who self-harmed were in their teens or early 20s, with slightly more women than men. But it had “been around for a long time,” and was reported across all ages and social groups.

“We’ve got a 60-year-old woman still cutting herself regularly.”

Self-harm was possibly increasing, although the lack of baseline data made it impossible to say. Harith Swadi, the Canterbury District Health Board’s child and adolescent mental health services clinical director, said that between March 2002 and March 2003, 45% of admissions to the youth inpatient unit, for acute psychiatric patients aged 15-18, had deliberately self-harmed without the intent of killing themselves.

“Some young people report they do it for relief of tension, others for feeling angry with themselves and for punishment, while others do it for purposes of suppressing bad feelings and emotions.”

Those with mental health problems or personality and relationship difficulties, as well as people who had been sexually abused or were suffering from post-traumatic stress were more likely to harm themselves.

A “contagion effect” existed, where young people in inpatient, school and other community settings copied each other by mutilating themselves.

Joyce said most mental health practitioners viewed self-harm as a completely separate behaviour from suicide attempts.

Aside from scarring, self-injury generally caused no lasting harm.

Doctors had no specific treatment for self-harm, instead treating sufferers for depression.

He suspected self-harm happened for biological reasons connected to brain maturation.

Self-harm ‘just came naturally to me’

Joanne first cut herself when she was dumped by her third-form boyfriend.

The 13-year-old had never heard of self-mutilation before, and says the impulse to take to her thighs with a razor was instinctual.

“It was something natural that just came to me.”

Now aged 18 and in her last year of high school, she has all but stopped the habit she describes as “an addiction.”

She quit for six months last year, but began again earlier this year after being sexually assaulted and undergoing the ordeal of a court case. She describes her mutilation as “like a drug.”

“When you cut yourself, you get really light in the head; it sort of feels like you’re not really there.”

She wears long sleeves to cover the scars of her self-injury, which has variously taken the form of burning, inserting safety pins and cutting herself with a razor on her arms, legs, chest and stomach. Her wounds have required stitches.

Joanne, a confident, intelligent girl who intends to become a professional dancer, takes anti-depressants, and has been admitted to Princess Margaret Hospital’s psychiatric ward.

“Everyone in there did it,” she said.

Many of her schoolmates cut themselves during their fifth-form year, but she believed many of them were doing it as a “fad.”

She would like to stop harming herself, but knows she is always at risk of resuming the behaviour, which is triggered by bad experiences.

“Someone might say something to you which you take personally; you could have an argument with someone.”

The Independent
July 27, 2004

We Must Confront Our Fears and Face Up to this Tragic Epidemic of Self-Harm

Sometimes it takes one particularly tragic story to highlight a much wider problem and provide the impetus for a radical change in attitudes. The story of Sarah Lawson, a suicidal young woman who was repeatedly failed by the mental health services, should be one such case.

Ms Lawson had suffered from manic depression for a decade, and during that time had deliberately harmed herself regularly. After these incidents turned into full-blown suicide attempts, her parents tried to place her in a secure psychiatric unit. Ms Lawson was eventually admitted to Homefields psychiatric hospital in Worthing, only to be ejected after one day for allegedly smoking cannabis. Her father, James Lawson, felt there was nowhere left to turn and suffocated his daughter in what has been described as a “mercy killing”. He admitted manslaughter on the grounds of diminished responsibility and received a two-year suspended sentence.

A report into the affair by West Sussex social services and the Sussex Strategic Health Authority, published yesterday, points to several instances in which the social services and the NHS badly failed the Lawson family. Ms Lawson’s treatment for depression was “fragmented” in the three years before her death. Information about her circumstances and case history was not passed on. No attempt was made to find out whether her parents were able to cope with caring for her. If it had been, the social services would have discovered that Mr Lawson himself had been diagnosed with depression and was in an increasingly desperate state of mind over his daughter. The report concludes that the quality of care Ms Lawson received was “generally of a high standard”, but too often “poor”. There can be no doubt that, at crucial times, it fell far below what was required.

That these failings resulted in such dire consequences should serve as a warning to all those involved in the provision of services for the mentally ill, in particular those who harm themselves. There are 170,000 people admitted to hospital each year as a result of self-harm, and the numbers are steadily growing. This is an astonishing figure, and the prospect that there are vulnerable people, like Ms Lawson, being denied the treatment and supervision they so badly need, is frightening.

An important aspect of the problem seems to be that, as with anorexia before the phenomenon became imprinted on the public consciousness, society does not understand why people self-harm. Often it is considered to be merely a fad, an attempt by young girls to attract attention. This attitude can even be found in the NHS. Some self-harmers have complained of being treated with contempt when they have turned up at accident and emergency departments. The speed with which Ms Lawson was ejected from hospital for smoking cannabis suggests a similarly dismissive attitude was a factor in her case, too.

The reality is that a propensity to self-harm is just as serious a condition as anorexia. Indeed, the two are often linked; when forced to eat, anorexics often resort to cutting themselves. Most self-harmers are young women. Institutions with harsh rules, such as the army and prisons, have seen an alarming spike in the number of cases. The notorious Deepcut barracks logged 59 instances of female self-harm between 1996 and 2001. Prisons, too, register a very high proportion of self-injury cases.

What leads people to deliberately harm themselves is still unclear. Many young people admit they do it because of insecurities over their bodies. It can also be an extreme symptom of clinical depression. Some psychiatrists identify it as a coping mechanism. But it is now manifestly clear that telling sufferers to “get a grip” is no way to tackle the problem. The mental health division of the NHS must start treating self-harm as a serious issue. Psychiatry and counselling must be made more readily available to sufferers. There can be no repeat of the failings that had such a tragic outcome for the Lawson family.

Press Association
July 28, 2004

Self-Harmers ‘Must Get Equal Treatment’
By Louise Barnett

People who inflict self-harm should receive the same levels of care and respect as other patients, according to new NHS guidelines.

Around 170,000 patients are admitted to casualty departments each year after injuring or attempting to poison themselves, according to the National Institute for Clinical Excellence (NICE).

All self-harmers treated by the NHS should be given a psycho-social assessment in effort to improve their treatment, new guidelines compiled by NICE said.

They set out how ambulance personnel, GPs and A&E staff should respond to distressed patients who have inflicted self-harm within the previous 48 hours. Non-clinical staff should also be trained in how to respond to self-harmers, almost half of whom currently receive no follow-up care or psychological assessment.

Self-harmers should also be assessed for possible mental illness, their levels of distress, and the likelihood of them self harming again, according to NICE.

Professor Paul Lelliott, director of the Royal College of Psychiatrists’ Research Unit and chair of the guideline development group, said self-harmers sometimes received a poorer standard of NHS care than other patients.

He said: “There are still examples of people having wounds stitched without anaesthetic, the idea being ‘well you cut yourself without anaesthetic so why should we use it?’ This makes people reluctant to seek medical help and sometimes when they do, they have a bad experience.”

The guidelines for the NHS in England and Wales were produced in partnership by NICE and the National Collaborating Centre for Mental Health.

They say self-harmers should be offered treatment for their physical injuries, with anaesthetic if necessary, regardless of whether they accept psychiatric treatment.

Activated charcoal which absorbs drugs and poisons should be offered, where appropriate, to patients who have overdosed, the guidelines say.

All patients who self-harm should be assessed for the risk of doing it again or attempting suicide in future.

Further psychiatric, psychological and social assessments should be carried out before a course of future treatment is decided.

Richard Pacitti, guideline development group member, said self-harming was often used as a means of coping with emotional distress or even preventing suicide.

“Healthcare professionals sometimes find this hard to understand and people who self-harm are often thought of as ‘attention seekers’,” he said.

Cutting is the most common means of self-injury, although people who overdose on medicine or drugs are most likely to seek medical help.

Research shows that people who self harm at least once are 100 times more likely to commit suicide than those who do not.

Research carried out by the Samaritans last year showed one in 10 adolescents had self-harmed as a way of coping with emotional distress.

Pam Blackwood, caller care manager with Samaritans, said receiving the right physical treatment encouraged people to seek emotional help.

“Self-harm is a way of dealing with emotional pain in a physical way—like screaming without opening your mouth,” she said.

Earlier this year the first nationwide inquiry was launched into the “worrying” increase in the number of young people deliberately harming themselves.

The investigation, run jointly by the Mental Health Foundation and the Camelot Foundation, is looking at the incidence, causes and treatment of self-harm in those aged 11 to 25.

The UK has growing rates of self-harm which are the highest in Europe, according to the charities.

The average age for children to start self-harming is 13, but there have been reports of incidents in youngsters as young as seven.

The Guardian
July 30, 2004

This Band-Aid won’t stop the bleeding: The new guidelines on how to treat self-harmers will do little to increase public understanding
By Nick Johnstone

One evening when I was 19, I deliberately cut my arms with a razor blade. I didn’t know it then, but this was to be the first of many acts of self-harm. A report published this week to much fanfare by the National Institute for Clinical Excellence (Nice) aims to set new clinical guidelines for NHS treatment of “intentional self-harm” by healthcare professionals such as GPs, social workers and psychiatrists. But, from the perspective of a recovered self-harmer, the guideline are hopelessly off the mark.

Take this, the first one: “People who have self-harmed should be treated with the same care, respect and privacy as any patient.” The language used contradicts the goals of the report, implying that self-harmers are somehow not like other patients and therefore not entitled to the same standards of treatment.

The report, which was researched by Nice in association with the National Collaborating Centre For Mental Health (which included input from the British Psychological Society, the Royal College of Psychiatrists, Mind and Manic Depression Fellowship), does draw attention to the often insensitive treatment self-harmers receive at accident and emergency units, but fails to take into account the opinions of those seeking treatment.

Most self-harmers would do anything to avoid seeking medical attention. In the four years that I regularly cut myself, I always had a tube of Savlon and a pack of Band-Aids to hand. A surf around self-harm websites will tell you that this kind of meticulous self-doctoring is common practice. Safeguarding against infection is also a way of avoiding healthcare professionals. During my battle with self-harm, I never sought out medical treatment nor did I broach the subject with the GPs and counsellors treating me for depression. Like most self-harmers, I kept my practice secretive and private.

Although Nice estimate that 170,000 people seek medical attention at A&E in Britain each year, they do not attempt to put a figure to the vast majority who never seek out medical attention. As a result, the impression given to healthcare professionals and the public is that all acts of self-harm require hospital treatment. This kind of sensationalistic sloppiness reinforces stereotypes of self-harmers as dangerous, out of control, crazy.

Granted, a small minority do inflict severe self-injury but most, the majority who are ignored by these new guidelines, cut, burn, scratch or pull their hair: minor acts of self-injurious behaviour that do not require medical attention.

In most cases, self-harm is an act of self-preservation, a way to cope with overwhelming mental pain. It is not an act of self-destruction, attention-seeking or time-wasting. The report, while acknowledging that self-harmers require “immediate psychiatric assessment”, does not state the obvious, which is that self-harm is a morbid behaviour typical of depressive illness and other psychiatric disorders. As one disclaimer conveniently concedes, the report “does not seek to explain self-harm”. With that approach, quite how NHS workers are going to overcome the widespread misinformation and ignorance surrounding the subject is anyone’s guess.

Rash connections are made between self-harm and suicide. The report states: “Those who have self-harmed are 100 times more die by suicide in the subsequent year. One half of the 4,000 people who die by suicide each year will have self-harmed at some time in the past.” This is rather like saying that smoking pot will eventually lead to crack addiction. If there is one stereotype that all self-harmers despise, it is that self-harm is a half-hearted suicide attempt.

The report misses the fundamental truth of self-harm: people do it to feel better, the injury triggering a release of endorphins, bringing a much-needed “high” in the midst of depression or other mental illness.

Another guideline that shows this report was composed by those treating, not those being treated, states: “Include family or friends if the service user wants their support during assessment and treatment.” Considering most self-harmers live in terror of their family discovering their habit, this is bizarre. I only found the strength to tell my family eight years after I stopped. I doubt very much that self-harmers who find themselves in A&E will want their family present. But Nice seem to think that they would. So now it’ll be standard practice to suggest it.

But the most absurd part of the report is the accompanying “Information for the Public” which tells a self-harmer what to expect when she or he seeks medical treatment. Apparently, if you feel the guidelines haven’t been followed, you should: “Discuss your concerns with your GP or other healthcare professionals involved in your care.” Considering most acts of self-harm are accompanied by a dissociative stateanother glaring omission from this reportand resulting from acute mental distress, it’s unlikely that any self-harmer will be remotely interested in citing the Nice report and crying “foul treatment.”

Press Enterprise (Riverside, CA)
August 1, 2004

A way to deal; Inland programs try to provide other outlets for the growing number of teens who cut themselves
By Janet Zimmerman

One teenage girl says she slices her skin because she feels too much; another says it’s because she doesn’t feel enough. For a third, cutting gives her control while her family life is chaotic.

“It’s the way I deal with things. Some people go home and have a beer; I go home and cut,” says a 15-year-old girl, a sophomore at Riverside’s John W. North High School, who spoke on condition that she not be identified.

Though her parents are aware of her three-year habit, the girl hides hundreds of thin white scars from most people with wide, studded bracelets and under her black T-shirt and knee-length shorts. The old wounds are minor compared with the “speed bumps” a friend gave herself with a pencil, the girl says.

Slouching around a table at the high school’s Wellness Center, she and other girls give voice to this startling, and increasingly common and dangerous practice among adolescents.

They are punks and jocks, Goths and honor students, linked by the urge to ease their pain from an assortment of intense feelings—anger, depression, abandonment, a sense that no one understands them.

“It’s a coping strategy,” says psychologist Wendy Lader, clinical director of SAFE Alternatives, an in-patient treatment program for cutters near Chicago. “I liken it to drug or alcohol abuse, where it’s a form of self-medication. It gives them instant relief.”

Cutting is the most well-known form of self-injury, but there’s also burning, hitting, biting, hair-pulling and picking at scabs. Beyond the obvious knives and razor blades, cutters use nails, paper clips, soda cans and their own fingernails.

The problem is often misinterpreted as a suicide attempt when, in fact, it’s typically an effort by cutters to show that they are still alive and capable of feeling, psychologists say.

The endorphin release that comes from cutting varies. Some teens get relief in the sight of blood, others in the pain. The depth of their cutting also varies. Some cut superficially, others deep enough to need stitches, Lader says.

Long-term and deeper cutting can leave permanent scarring and nerve damage, she says. Lader cautions that the danger of cutting should not be underestimated.

“Often times, like with drugs, they may need more and more for relief, so they can accidentally sever an artery and bleed out. If it’s not working, they may choose suicide. They’re not mutually exclusive, and I think people have gotten way too complacent about this,” she says.

Self-injury is often linked to earlier sexual abuse, and many of its victims also have eating disorders, experts say. Most are teen and pre-teen girls, though increasingly, boys are doing it too, says Dr. Mary Ann Schaepper, director of the adolescent unit at Loma Linda University Behavioral Medicine Center.

“It’s been more popularized in the last five years,” she says. Researchers estimate that 2 million Americans cut themselves on purpose. The problem has a growing pop-culture element that makes it almost trendy, and may be driving some of the cases, psychologists say.

A girl at a Fontana middle school told the principal she discovered the practice on an episode of MTV’s “Real World.” Cutting also was depicted in the movie Thirteen, mentioned in Princess Diana’s biography and admitted to by Angelina Jolie, Courtney Love, Johnny Depp and other celebrities.

“It’s very out there and it’s become epidemic. Now it’s gotten to the point where schools are calling, needing protocols because it’s so rampant,” Lader says.

Samantha Pellitteri, a psychologist with the Etiwanda School District in Rancho Cucamonga, is seeing more cases and at a younger age. “There probably are more than we’re aware of, but I wouldn’t say most kids are out there doing it.”

Lader blames the increase on the growing difficulty of being an adolescent. At increasingly younger ages, children are forced to deal with exposure to sex, drugs and divorce, coupled with low self-esteem. “Adolescence is a hard time anyway, but I think it’s gotten harder,” she says.

At North High School, Scream, a support group for cutters, started in February with eight members. By the time school let out for summer, 20 kids had joined, many of them referred by teachers and friends.

The group meets during lunch twice a week. The members support each other, learn to express their feelings and come up with other ways to deal with their feelings.

They put together intervention boxes filled with items to distract them from the urge to cut, including Play-Doh, bubbles and pictures of friends. One girl cuts on a Barbie doll instead of herself.

“They’re not crazy kids. They’ve latched on to an unhealthy way of dealing, the same way people latch on to drugs. It’s about helping them find healthier ways to deal,” says Deborah Norys, the teacher who runs the group.

The 15-year-old girl from North, who wears thick black eyeliner and blue nail polish, says her cutting started one day when she was angry and playing with a kitchen knife.

In her “heyday,” she cut every day for four months, covering the evidence with a sweatshirt, even in summer.

Recently, she slipped up when her mother went on vacation and left her home alone for five days. The girl says she dealt with feelings of loneliness by cutting herself a few times with her mother’s razor before turning to a friend for help.

When she gets the urge to cut, she calls fellow support group members whose numbers she keeps in her wallet, and writes her friends’ names in places on her body where she might cut.

Mostly, she says she has stopped hurting herself since joining nthe group. “Now I have a support system that is nonjudgmental.”

Philadelphia Inquirer
August 2, 2004

Fighting pain with pain; Self-injury, especially cutting, seems to be on the rise with young people. It’s a way to deal with emotions, experts say, and parents shouldn’t overreact.
By Virginia A. Smith

At 35, Vicki Duffy is amazed at her good fortune: a strong faith, a loving husband, and a babytheir firston the way.

She also has about 250 scars on her wrists, forearms, thighs, calves and biceps, reminders of a turbulent history of burning herself with lighters and cigarettes and cutting herself with razor blades and knives.

Most of the scars are faded now, more white than red, but some are screamers—like the 5-inch by 3-inch, third-degree burn on her left forearm. That’s from 1993, when she ground lighted cigarettes into her skin 13 times and then scorched it all with a long lighter.

It would be comforting to think that Duffy is an anomaly, someone once so mentally ill her experience stands alone. But self-injury—especially cutting—is more common, more talked about, than ever before.

“It’s in the mainstream now. It’s considered a normal coping mechanism,” said Margarita Pebley, program director of child and adolescent services at Friends Hospital in Northeast Philadelphia.

Many doctors and therapists say they have seen a surge of cutting cases in the last five years. And they report that younger children are coming in for treatment, augmenting the traditional ranks of high school students and young adults.

Others caution against hyperbole, suggesting that just as anorexia and bulimia were once kept hidden, so it may have—until relatively recently—with self-injury.

“It’s probably more common than most adults think it is, and not as common as the hype is playing it to be,” said Kenneth R. Ginsburg, adolescent medical specialist at Children’s Hospital of Philadelphia.

Current data are hard to come by, but a study published in the British Medical Journal in 2002 found that 7 percent of 6,000 English high school students surveyed had tried to harm themselves within the previous year. About two-thirds of those incidents involved cutting, with girls four times more likely to try to hurt themselves than boys.

There are cutters like Duffy, who suffered repeated sexual abuse, including rape, growing up in Seaside Heights, N.J., and later. Over time, she exhibited many pathological behaviors in addition to compulsive cutting: She punched herself, flung herself into door frames, hit herself with bricks, binged and purged and starved herself, pulled her hair out, and, in one episode, ripped the metal braces off her teeth, one by one, with pliers.

For two years, Duffy obsessively cut, drawn to it again and again by the euphoric feeling it gave her. One theory is that cutting prompts the release of endorphins into the bloodstream, causing a numbing or pleasurable sensation.

“I couldn’t break from the feeling that I felt from cutting,” she said. “I couldn’t wait to cut again. I was fantasizing about how deep I’d go, how long I’d go, what kind of cuts they would be... That’s all I thought about.”

Although feeling overwhelmed and alienated, cutters don’t always have serious psychiatric problems or a history of abuse. Sometimes, kids try cutting because they have heard about it or seen someone’s scars.

“For some, it may not even be a sign of distress,” said Jane W. Hyman, author of Women Living With Self-Injury. “For some kids, it becomes the ‘in’ thing to do, some kind of fashion... but it’s still very real.”

References to cutting abound on TV, in popular music and movies, in books, and all over Web sites and chat rooms.

For example, the movies Thirteen, Secretary, and even Harry Potter and the Chamber of Secrets show characters deliberately harming themselves. The Goo Goo Dolls’s hit song “Iris” contains the lyric, “And you bleed just to know you’re alive,” while “All My Life” by the Foo Fighters has this reference: “another reason to bleed, one by one hidden up my sleeve.”

Increasingly, too, celebrities acknowledge cutting themselves, among them the late Princess Diana, Johnny Depp, and Angelina Jolie. In a sense, it has become glorified, even glamorous.

Whatever the genesis, cutting behavior is frightening to parents, said Janice K. Hillman, an adolescent medicine specialist in King of Prussia, “but parents should be reassured that cutting does not necessarily mean severe psychopathology. It’s a new way for kids to express emotion.”

Therapists say cutting behavior commonly appears in adolescence because that is a tumultuous time. Kids are struggling to become individuals, their bodies are changing beyond their control, their stresses and frustrations building. Some do grow out of it, but adults cut, too. No one is sure how many.

Cutters typically use disassembled razor blades, knives, scissors, paper clips, broken glass or lightbulbs, even their own fingernails, to slash themselves. They usually do it in private, clean up the blood, and hide the results with long sleeves and baggy pants, sweatbands and bracelets.

Cutting is not usually a suicide attempt, although adults commonly assume that. Ginsburg of Children’s Hospital calls it “controlled pain.”

“These are kids with pain, sadness or trauma in their lives,” he said, “and dealing with that is really hard work and really confusing and emotionally painful. Kids feel a loss of control over things that have happened in the past or over a particularly difficult relationship.”

Cutting, he said, “is a pain that they control.”

Ginsburg urges parents who discover their children are cutting themselves “not to get all up in arms and terrified. They need to recognize it for what it is—it’s a very strong reaction to stress and pain, and the solution is to guide someone away from this successful but worrisome coping strategy and toward a positive coping strategy.”

Most children do have or can learn positive coping strategies to draw on, whether dance, sports, music, or, as Ginsburg teaches, meditation, deep breathing, or writing a journal.

“Looking at the source of pain and helping kids heal from that... that is ultimately the answer,” Ginsburg said.

For Duffy of Denville, N.J., the answer was hard to come by. She endured years of hospitalizations, medication and therapy and had concluded, “There is nothing in the world that will help me.”

That began to change in 1995, when she discovered Living Praise Church in Florham Park, N.J. Today, she has forgiven everyone who hurt her and has a Web site (

“People ask all the time, ‘What happened to you?’ and I say, ‘Years ago I had a lot of problems and as a way of coping, I used to cut my body.’”

Some recoil. Others stay to talk.

“There are a lot of hurting people out there,” Duffy said. “I let them know there is hope.”

The Bradenton Herald
August 7, 2004

How to help friend who is a cutter

Anna’s wearing long sleeves again under her soccer jersey. She tells you she’s worried about getting too much sun, but when she raises her arm, you see fresh cuts on her forearm. When she sees you looking at them, she says something about losing a fight with her mother’s rose bushes. You’re aware that some kids cut themselves on purpose. Could Anna be one of them? If she is, what should you do?

Be an informed friend

About 1 percent of people in the United States—nearly all of them girls or women and many of them teenagers—cope with sadness, depression, stress, guilt or anger by cutting their own skin with knives, razors, broken glass or other sharp objects. Cutting is the most common form of self-injury (sometimes referred to as SI), but others include head banging, hitting, burning the skin, picking at scabs or wounds to prevent healing, or even breaking bones on purpose.

Most teens who self-injure come from middle- or upper-class families and are well-educated and bright. Many have at least one parent who is alcoholic or depressed. Some are victims of neglect or abuse or have been through other painful life circumstances. Cutters often feel that they have little control over their lives. They may also believe that it’s useless, inappropriate or not allowable to express anger or distress directly toward a person or situation. It can be hard for someone else to understand how self-injury can feel “good” to some people. That can make the idea of cutting difficult for friends to grasp or understand.

Because some people find cutting brings temporary emotional relief, the behavior can become addictive. And the longer a person practices self-injury, the harder the habit is to break.

Ways to help

Understanding why a friend may be cutting allows you be supportive, but what can you do to actually help your friend stop? The first thing is to be realistic about what you can accomplish: As with any damaging behavior (such as alcoholism, drugs, or eating disorders), some people just may not be ready to acknowledge their problem and stop. So don’t put too much pressure on yourself—your friend’s problem could be a long-standing one that requires help from a professional therapist or counselor.

Here are some things that you can try to help a friend who cuts:

Talk about it. You’ve asked your friend about the cuts and scratches, and he or she may have changed the subject. Try again, letting your friend know that you won’t judge, and that you want to help if you can. If your friend still won’t talk about it, just let him or her know the offer stands.

Tell someone. If your friend asks you to keep the cutting a secret, say that you aren’t sure you can because you care. Tell your friend that he or she deserves to feel better. Then tell an adult in a position to help, like your parents, a school psychologist or counselor, or a teacher or coach your friend is close to.

Help your friend find resources. Try to help your friend find someone to talk to and a place to get treatment. There are also some good books and online support groups for teens who self-injure. Be careful, though: Although some Web sites for cutters offer useful suggestions about how to resist these urges, the stories or pictures some cutters contribute may actually trigger the urge to cut in those who read or view them.

Help your friend find alternatives to cutting. Some people find that the to urge self-injure passes if they squeeze an ice cube in their hand really hard, draw with a red marker on the body part they feel like cutting, take a walk with a friend (you!), or find another distraction or outlet for their feelings. These strategies don’t take the place of getting professional counseling, but they can help in the short run.

Acknowledge your friend’s pain. Let friends who cut know that you get it by saying things like, “Your feelings must just overwhelm you sometimes. You’ve been through a lot—no wonder you hurt. I want to help you find a way to cope that won’t hurt you any more.”

And here are two things you should avoid doing with cutters:

Don’t deliver an ultimatum. The best thing friends can do is to be there for each other, accepting and supporting one another without judgment.

Don’t accidentally reinforce the behavior. Among some people, cutting can have a certain mystique. If you’re concerned about a friend who cuts, don’t let the cutter buy into the notion that the behavior is a sign of strength or simply a part of the cutter’s personal identity.

How important is it to help?

Cutting can result in severe injury or death, even when suicide is not the goal. People who self-injure risk infections, scarring, shock (from blood loss) and they can die as a result of extreme injury or bad cuts that don’t get treated promptly.

Without help, cutters are also likely to continue to feel socially isolated and depressed. They may have other problems (such as eating disorders, obsessive-compulsive disorder, bipolar disorder, borderline personality disorder or severe depression) that require long-term professional care. By helping a friend address cutting problems, you may open the door for him or her to resolve other issues, too.

If you’re with a friend who has a serious injury from cutting, call 911 immediately and notify a parent, teacher or other responsible adult. Get your friend to a hospital or emergency medical clinic. Make sure the emergency room staff knows how the injury occurred. Stay with your friend. Even cutters who say they’re not suicidal are often interviewed by hospital mental health professionals when they’re admitted for treatment.

It’s often difficult to help a friend who cuts and you may not see changes overnight, if at all. Remember, some people aren’t ready to face what they’re going through and you can’t blame yourself for that.

New Straits Times (Malaysia)
August 17, 2004

Self-injury sign of deeper problem
By Manveet Kaur

You’re in the majority if you’re not aware of the alarming and growing number of children and teens who vent inner frustration through self-inflicted cuts, bruises, scars, and breaks.

They can harm themselves for a number of reasons. Some young people cut or brand themselves as a sign they are part of a particular group. Like other forms of self-inflicted harm, it is a risky thing to do.

Other young people harm themselves for reasons which are often linked to relationships—it could be a recent conflict, a break-up in the family or with a girl or boyfriend, or it may be linked to abuse. Sometimes it can be related to being lonely or confused about their sexuality or how they are affected by other people’s reaction to their sexuality.

They harm themselves in different ways. It can include cutting their flesh, eating hardly anything or binge eating and being sick, or even attempting suicide. It can include activities like heavy drinking, smoking or drug use. Some people also consider suicide to be an extreme form of self-inflicted harm.

Tracy Alderman, the author of Scarred Soul: Understanding and Ending Self-Inflicted Violence, says that girls are more likely than boys to harm themselves in such ways. She describes the stereotypical self-injurer as “bright, sensitive, helpful to other people, the caretakers of their friends and family, good listeners, above-average students, and invisible.”

“Boys can get away with showing up with bruises and cuts on themselves,” says Alderman.

The behaviour generally starts around age 12 or 13. Some experts believe that it can linger on for years; others suggest that as the adolescent gets older, he or she finds other ways of coping with the stress that triggers the condition.

This is where parents enter the picture. They will likely notice cuts or marks on their child’s body that teachers with 35 or 40 children in a class will miss. Parents will notice quiet or sullen behaviour not manifested at school.

Alderman says it is important not to get upset with your child should you suspect that he or she is involved in self-injury. Remember, your otherwise normal child may be experiencing feelings of alienation, isolation or depression. They need someone to talk to, not someone to yell at them.

If you do not feel able to handle the job, talk to a school counsellor about your concerns. This person will be able to refer you to someone who can help. Do not, however, disregard your concerns. This problem for your child, if one exists, will not go away by ignoring it. Get professional help and get it right away. The sooner you get your child started on professional treatment, the better.

As a reminder, this column is being written to draw attention to the issues concerning parenting, and should not be relied upon for medical advice. It is not intended to replace the advice of your child’s physician.

South Wales Evening Post
September 7, 2004

Tragic tales of self harm

A Neath family were today grieving the loss of their 13-year-old daughter who is believed to have overdosed on painkillers after entering into a suicide pact with another teenager. The tragic death of Laura Rhodes, of Cimla, happened as shock new figures were revealed showing a disturbing rise in the number of children self-harming themselves in the UK.

Almost 4,300 children and young people talked to ChildLine counsellors about self-harm in the 12 months ending last March, an increase of nearly 30 per cent on the previous year.

The charity said that the number of children speaking to ChildLine counsellors about self-harming had grown steadily over the last 10 years with an average rise of 23 per cent annually over the last decade.

Children, usually over the age of 11 but occasionally much younger, have been treated for deliberately cutting or burning themselves, hitting themselves, hitting walls or other hard objects and taking overdoses.

Girls are more likely to try to harm themselves than boys. Horrific injuries can be caused.

Children calling ChildLine have described cutting themselves with razor blades and pieces of glass.

They have banged their heads against walls, pulled out their hair or burned themselves.

According to figures revealed in September 2003, up to 600 adolescents try to kill themselves in Swansea alone every year while another 500 to 1,800 children up to the age of 16 in the city are estimated to suffer from major depression.

Thankfully, unlike tragic Laura, very few manage to kill themselves but for each attempt at self-injury there is a story of a desperate child who urgently needs help.

So why do children try to cause themselves such terrible injury? According to the children’s charity, NCH, it is usually because of some difficulty which they have had. This might include anxiety, depression, bullying, being abused or family breakdown but can involve many other problems which people face in their every day lives.

“Self-harm is often a way of coping, not a failed attempt at suicide,” said the charity. “But, sometimes, self-harm can mean young people kill or seriously injure themselves, even if they do not necessarily mean to.”

ChildLine said girls were especially vulnerable with 12 times as many girls calling its helplines as boys. Seventy per cent of them are aged between 12 and 15.

A national inquiry is under way into self-harm and is due to report in the autumn of next year.

But at the weekend its compilers, the Mental Health Foundation and the Camelot Foundation, released interim results based on ChildLine’s new self-harm figures. According to the charity, young people who self-harm have rung its helpline describing feelings of powerlessness and despair.

They said they had turned to self-harm as a way of releasing powerful and frightening emotions, relieving unbearable tension or gaining a fleeting sense of control.

The mental health charity, Sane, said it was shocked at some of the calls it received from children who found their only release from inner distress was in inflicting physical pain on themselves.

“It seems as though by making the wounds visible to themselves, young people who self-harm, can ease invisible hurt, although they tend to conceal it so well that it is only when others see the scars on their bodies that they release how desperately they need help,” said Sane chief executive Marjorie Wallace.

“You have to look deeper than exam stress to find the underlying reasons why young people have to seek such extreme release from their problems. Every year, 19,000 young people under 25 are seen in A&E departments because of deliberate self-harm. Sadly, because our child and adolescent mental health services are so undeveloped, they are all too often sent home and not given the therapy they need.”

ChildLine said its counsellors worked with these vulnerable and often damaged young people to help them see that self-harming could come to an end and help was available.

The charity’s chief executive Dr Carole Easton said: “We believe the inquiry into self-harm could and should provide the foundation for the provision of services, therapy or treatment that will mean young people who self-harm get the support and help they need to end their damaging and often dangerous cycle of behaviour.

“The experiences of ChildLine’s callers highlight the need for directly accessible, widely available and well-resourced child and adolescent mental health services,” said Dr Easton.

Sunday Express
September 12, 2004

When Only Pain Can Take Away The Pain
By Louisa Metcalfe

Popular and pretty Sian Davies is a 26-year-old with a close group of friends and a job she loves. She appears to be like any other young woman with a full and vibrant life. Look closer at Sian, however, and you will see that there is evidence of another, far darker, side to her life: her arms are an appalling network of scars, the result of the five years she has spent cutting and scratching herself with a set of compasses.

Sian, a student disabilities officer at the National Union of Students, admits she is attempting to alleviate her mental anguish.

“I have a very public persona and a very private one,” she says. “People meet me and see me as a confident, bubbly person—not one they imagine self-harms. I find it very difficult to explain how I am feeling.”

Sian says that underneath it all, she has low self-esteem and self-harm is the way she deals with it.

“When I’ve done it, I feel relief in a strange way. Also, because I’m hurting myself, I can physically see some of the pain that is going on internally. It’s a coping mechanism.”

Tragically, Sian is not alone. A report released this week by The Mental Health Foundation and The Camelot Foundation, which has launched the UK’s first inquiry into this still relatively unknown problem, revealed that one in 10 children is so driven by anxiety and feelings of low self-worth that he or she deliberately self-harms.

Britain has the highest rate of self-harming in Europe, so much so that the charity ChildLine reports a 30 per cent increase over the past year in young callers admitting to it.

Self-harm encompasses a range of behaviour—from cutting, scratching, burning and scalding oneself to swallowing toxic substances.

Some celebrities have openly admitted their problem. Actress Christina Ricci recently said that she had deliberately burned herself, singer Shirley Manson had a teenage habit of slashing her legs with a razor and Princess Diana acknowledged that, in desperation, she cut herself with a penknife.

The official figure is just the tip of the iceberg since most youngsters do not seek help. Gerrilyn Smith, a clinical psychologist at Liverpool’s Alder Hey Hospital, says: “Self-harm is very easy to pass off as something else. Such people often don’t contact the authorities and, if they do, the treatment is so negative that most don’t go back.”

Dr Marcia Brophy, an inquiry project manager, adds: “Self-harm seems to be starting at a much younger age. The youngest we have heard about is seven, but the average is still just 13.”

While most self-harmers are young women, there are groups that are more vulnerable than others.

Dr Brophy says: “There is a particular growth in the numbers of young Asian women but it is not a problem restricted to teenagers. We’ve seen women who started when they were about 12 to 15 and have gone through to their 40s and 50s.”

To many adults, self-harm appears to be just a new type of pubescent attention-seeing behaviour and a spectacularly melodramatic response to the usual teenage angst. Experts are quick to contradict this.

Gerrilyn Smith said: “I suspect it has always been there but people haven’t shown it. It seems more prevalent now because we talk about it more.”

Counsellor Jan Sutton, author of Healing The Hurt Within, says people think self-harm is a suicidal act but, in fact, it counteracts suicidal tendencies or feelings. “It calms by relieving emotional turmoil. It also serves the function of castigation and self-punishment and it can be a way of people blaming themselves, for abuse or for rape.

“Self-injury serves as a form of control, anger and rage and helps episodes of dissociation. Many people who self-harm feel dead inside and numb as though they don’t exist. Cutting or burning themselves confirms their existence.”

For despairing parents, there is hope. After seeing a psychologist, Sian Davis can now go for months without cutting herself.

Today, if she ever feels the desire to self-harm, Sian heads to the gym for a painful experience of another kind. “I do a damn good 30 minutes on the cross-trainer.”

Gemma’s story

Gemma Tovey, 21, who lives with her parents in Birmingham, battled with self-harm for seven years.

It all began when I was 14. I felt indescribably useless. Self-harming was a way of punishing myself because I felt I deserved the pain.

I was being bullied at the time. One girl actually suggested that I try to commit suicide.

I usually cut myself at night, when I felt most despairing and wound-up. I would feel really good for about 30 seconds. Then I would hate myself for doing it. I would curse and tell myself I’d never do it again.

However, when the cuts started to heal I wanted them to stay, which made me do it again, blanking out the guilt and recollecting how good I felt.

The circle really is vicious because you feel worse for allowing yourself to do it again.

I was really at my worst when I developed full-blown depression at 19. During that time, I was self-harming up to three times a week.

I used a sharp craft knife to cut my hands, arms and legs. Once, I gave myself 16 cuts. One probably needed stitches because the scar is both wide and long but I was so drugged up on high doses of Seroxat, other anti-depressants and sleeping pills that the whole period is a blur.

I knew intuitively that the pills, not the condition, were making everything worse but all my doctor wanted to do was increase my already high dosages. He referred me to a mental health clinic, where people didn’t seem concerned and asked questions in an officious, cold way.

If you weren’t suicidal, they seemed to feel they could leave you to get on with it. I was never given advice and it took two years to organise a referral to a psychologist.

Gemma’s mum Kathyrn Tovey, 56, is a laboratory consultant.

She told Lucy Mayhew: I only once saw the full effects of Gemma’s self-harming. She had cut all her fingertips and the back of her hand. She was scared and surrounded by blood. For a long time, I didn’t realise she was self-harming and I was horrified and frightened because I didn’t understand it. I still don’t, though I now know it’s triggered by feeling bad about yourself.

I lived in perpetual terror of Gemma committing suicide although, from researching the Internet, I know this is rarely the case. I was determined to find something to help her and eventually I discovered the London-based Brain Bio Clinic, which specialises in treating mental illness using nutritional therapy.

We were so impressed by the comprehensive tests and tailored treatment programme. Gemma started at the clinic about eight months ago. She has changed indescribably for the better. She is no longer “drugged to the eyeballs”—as she puts it—and has only self-harmed once in the past three months.

I know her greatest frustration is that the nutritional intervention has been costly and she feels very strongly that the NHS should be more open to helping people using the methods that finally helped her deal with this misunderstood but common condition.

Intelligencer Journal (Lancaster, Pa.)
September 16, 2004

Self-injury: Why pain offers relief
By Linda Espenshade

“Self-injury is the act of deliberately destroying body tissue, at times to change a way of feeling,” according to the American Academy of Child and Adolescent Psychiatry. It can take many forms: cutting, scratching, burning, biting, bruising, head banging, excessive body piercing or tattooing or picking and pulling at skin and hair.

Psychotherapist Susan Baker of Greystone Psychological Center in Lancaster said her clients who cut themselves tell her they do it for two major reasons: “I was feeling so much, (and) I had nowhere to put it. It just felt better. I was numb. I needed to feel something.”

One client told Baker, “I feel so dead inside, that when I see the blood flowing, I feel alive. I don’t really feel the pain, I just feel more alive.”

The common denominator in people who cut is that they have difficulty expressing emotions and they have difficulty solving the problem that’s causing them to cut.

Physically, cutting can be rewarding because pain causes the brain to release endorphins, neurotransmitters that elevate a person’s mood, according to Tricia Groff, a therapist at Crossroads Counseling Center in East Hempfield.

Cutting, also called self-harm, self-injury or self-mutilation, is most common among teenage girls in middle to upper class, said Groff.

There is a higher incidence of self-mutilation in people who have experienced trauma, said Baker, though not everyone who cuts has been traumatized.

Baker said her female clients who cut often have an unstable relationship with their mothers, but the psychotherapist does not blame mothers for the destructive habit.

“They (teen girls) need to feel I’m special,” Baker said. They want to know that their mothers want to spend time with them and want to be genuine with them. Girls want their mothers to be a guide, a mentor and a teacher, but for whatever reason she is not being that.

Cutting can also be an early sign of an undiagnosed mental illness, Baker said, though not everyone who cuts has a mental illness.

At Cornerstone, a recently established practice, Groff said, therapists are seeing a surprising number of clients who are cutting.

At Baker’s practice, however, she’s seeing a decline in clients who cut within the past two years. Nevertheless, Baker said, “without a doubt, in the past decade, self mutilation has increased.”

National statistics on the specific problem were not available from the American Academy of Child and Adolescent Psychiatry or the National Institutes of Mental Health.

“Be as calm as you can be. If you are hysterical your child will be hysterical,” said Baker. Parents who panic can exacerbate their teen’s feeling of loneliness and alienation, said Groff. That’s especially true if parents pile on the guilt: “How could you do this? You’re making me feel guilty for your life.”

A much more helpful reaction, Groff said, is for parents to listen to their child and ask, “How can we help?”

It’s not uncommon, though, Baker said, for teens to minimize their behavior and act surprised that their parents think it’s a problem.

Nevertheless, cutting is one of those situations where parents must seek professional help.

The Desert Sun (Palm Springs, CA)
September 19, 2004

Teen reveals painful details of self-mutilation
By Kelly O’Connor

Chris sits down on her bed, pink walls surround her. In one hand is a paper napkin. She will use this to soak up the blood. In the teen’s other hand is a razor. Chris makes a slash on her forearm. No blood yet.

She spreads the wound with two fingers and reinserts the razor, digging it back and forth until drops of blood appear.

She feels no pain, just relief. “I’d rather feel the blood than the tears,” she said.

It’s been six months since Chris, a 16-year-old from La Quinta, cut herself intentionally to deal with the pressures of school, taunting classmates and a rocky home life.

Experts define the act as self-injury. But the people who do it, most of them young teen girls like Chris, have earned a medical moniker: “cutters.”

Even though she’s in therapy to combat her depression, signs of Chris’ cutting are still visible. The words HATE and LIES are faintly recognizable on her left forearm. The word GUILT, etched on her upper thigh, is a fading shade of red. The memories and scars help her heal, she said.

Chris is not being fully identified by The Desert Sun so she can tell her story honestly and with as much candor as possible.

Her hope: Perhaps the painful details will help other cutters in the valley know they are not alone. And maybe her story, she said, will help local parents better understand the growing and complex problem.

Chris is among an estimated 2 million cutters in the country, and medical experts say there could be as many as 2,500 in the Coachella Valley.

Chris and the thousands of young girls like her are part of a growing epidemic in America, said Karen Contario. She is co-founder of S.A.F.E. Alternatives, an international treatment and educational facility in Naperville, Ill., which is dedicated to self-injurious behavior.

The largest study on self-injury was conducted by Contario and Armando Favazza, professor of psychiatry at University of Missouri in 1986. They found that 750 people per 100,000 take part in some form of self-mutilation.

These numbers are steadily increasing, Contario said in a phone interview. The high volume of teens seeking treatment and the number of cutting inquiries are startling, she said.

Mainly girls ages 12 to 19 turn to cutting, Contario said. Boys and adults are also deliberately harming themselves, but at a rate much lower than teen girls. “It’s not unlike the eating disorder profile,” Contario said. “It’s typically middle- to upper-class girls who are shy, artistic and tend to be caretakers of others.”

Cutters have found an outlet, albeit disturbing and dangerous, to release their emotional pain. And although it’s rarely a suicide attempt, cutting can lead to fatal actions if untreated.

Loneliness at home

As the middle child, Chris said her parents’ attention was always on her older brother and younger sister. She didn’t want to bother her parents with her problems. Her father was working six days a week as a mechanic. Her stay-at-home mother was home-schooling Chris’s sister.

Besides, Chris thought her parents wouldn’t understand.

She had one middle-school friend she turned to. Chris called her best friend her twin.

“We looked alike and we felt each other’s pain,” she said.

It was this friend that Chris would share her dream of being an actress, without fear of being judged.

The two were nearly inseparable since they were 10. Then, just as Chris needed her the most, her friend and her friend’s family moved to Colorado. That was the last day of eighth grade.

How, Chris wondered, was she going to get through high school without her faithful sidekick? The loss of her friend was compounded by Chris’s first heartbreak when she was rejected by her yearlong crush.

She was only 13, but she felt hopeless and unworthy of love. Emptiness consumed her.

Chris sought solace in her room. Crying and confused, she focused her attention on rearranging her bedroom.

In one crying fit, as Chris was maneuvering her bed across the room, the steel frame fell and slashed her forearm. As blood came to the surface of her skin, Chris’s tears stopped. Inexplicably, all her sadness was gone.

“If I were to drop something on my toe, I would be the biggest baby and cry,” she said. “But not with cutting.”

That accidental cut at age 13 would lead to three years of self-injuring.

Identity crisis

With cutting, Chris’s new coping mechanism, came a renewed sense of hope. She had faith that her life may even improve when she started high school.

“This was my opportunity to be part of a crowd,” she said.

Struggling to find her identity, Chris soon realized she didn’t fit into any one clique. There were the jocks, the brains, the rich kids, the populars, the wannabe thugs and the hardcore nerds.

Chris said students of the same ethnicity also gravitated toward each other. Not Chris, she was rejected by most Mexican-Americans at the school.

They called her “whitewash” because she had white friends. Some told her to “stick to her own culture.”

Other teens called her stupid and fat. When Chris dated a Jewish boy, the students teased her. Because she is against the war in Iraq, they called her “anti-American.”

These hate-filled words were uttered by the same students who took a field trip, along with Chris, to the Museum of Tolerance, founded to challenge bigotry, in Los Angeles.

Still seeking her own persona, she painted her nails jet black, the same shade as her hair. Rarely did she wear anything but black Dickie pants and T-shirts that depicted her favorite punk bands—New Found Glory, Mest and Good Charlotte.

Tired of being known to her family and friends as “innocent Chrissy,” she rebelled by turning to drugs and alcohol. At age 14, she started smoking marijuana with friends in the student parking lot.

Even that failed to win her close friends. She knew other students labeled her as a Goth, a punk and a druggie. Chris didn’t understand why.

“I saw myself as just being me, being different and not fitting in,” she said.

While she found some respect and friendship as a water girl for the football team, she still felt like an outcast.

The words of her peers played over in her head. When she looked in the mirror, she saw a lifeless girl who was “ugly and dumb.”

“Some days I wanted to punch the mirror,” Chris said. Maybe her peers were right, she thought.

Her downward spiral worsened. She found comfort through cocaine, marijuana and Jack Daniels whiskey, all provided by older friends.

But when she was home and had no drugs or alcohol, she reached for the razor.

Feelings of guilt and shame rooted to her deceit and the drugs and booze overwhelmed her. Then she would cut herself.

Too much pain

Most of her self-injuring was done after school. Chris came home feeling drained. “I felt like dirt, like I was nothing,” she said.

She locked herself in her room and cranked the music.

“Typical teenager,” her mother said she remembered thinking at the time.

The booming music helped Chris drown her thoughts. The noise drove her mother crazy.

She played the hit song “Hold On,” by pop-punk band Good Charlotte over and over. The lyrics brought hope. “Hold on if you feel like letting go / Don’t stop searching, it’s not over.” These words kept Chris from inching the razor closer to her wrist. Instead, she carved her feelings into her upper thighs. These physical wounds she could endure—it was the emotional pain she could not bear.

The overwhelming surge of emotions that flooded Chris’s mind would vanish with one quick slice of the razor.

“I felt the pain and understood it,” Chris said.

This is a common response among cutters, said Kim Phillips, counselor at the Barbara Sinatra Children’s Center and a licensed marriage and family therapist in Rancho Mirage.

“They feel disassociated from their bodies,” she said. “As it’s described to me, it’s as if (cutting) brings them back to their body.”

Please listen

When Chris moved her cutting from her thighs to her forearms early this year, she was looking for more than relief. She wanted her family’s attention.

Teens who cut or self-injure often feel this is the only way to express themselves, said Phillips, a local marriage and family therapist.

“They are emotionally lost and they don’t know how to express or name their feelings,” she said. “‘Please, listen to me,’ they are crying out.” For Chris, the long-sleeved sweater she wore to hide her cuts came off when she was at home.

Her mom was the first to notice the marks. She thought Chris was making temporary tattoos and scolded her. “I told her I’d take her to get a real tattoo if she wanted to feel pain,” said Chris’s mom.

On a car-trip to the store, Chris exposed her scars when she pointed out a hot-air balloon to her sister.

Her mom again noticed the cuts and asked what they were. Chris hid them with a wrist band and changed the subject.

During dinner one night, her father noticed the slashes. “You missed a spot,” Chris remembers him saying.

In an August interview, Chris’s mother admitted that she and her husband ignored their daughter’s pain and cutting.

“It was too unbelievable,” she said.

Chris’s mom suffered from severe anxiety and panic attacks at the time. Remaining numb and distant to her daughter’s feelings was a way to survive. Being consumed by those feelings would only deplete her remaining energy.

Chris’s younger sister was dependent. “Home-schooling my daughter was first priority and my responsibility,” said their mother.

Desperate for attention, Chris made other attempts to get noticed.

She wrote a poem that was published in her high school newspaper. Its title: “To Earn Your Respect”:

I try so many things to make you see me,
I try to keep my grades up so mom would like me,
I wanted to do things that boys would do, so Dad would love me like he used to.

Her mom said nothing about the poem. Her dad gave her a “good job.”

“I wanted them to listen with their heart, not just their head,” Chris said.

To further earn her family’s respect, Chris pledged to do what her father and brother hadn’t—graduate high school. She maintained Bs and Cs, but was consumed with pressure to succeed.

Reaching out

When Chris didn’t get the support she was looking for at home, she called the advice radio show Loveline, with addiction specialist Dr. Drew Pinsky. His advice was simple: If your parents aren’t hearing you, get help on your own.

That was nearly six months ago and proved to be the prompting Chris needed to change her life.

Although graduating school was a top priority to Chris, the teasing and taunting was too much to endure. She pulled out of her high school in February.

With her father’s help, she enrolled in independent studies through Amistad Continuation High School in Indio.

“I felt like if I did this I would concentrate more on my schoolwork,” Chris said.

Her next step was to see a doctor. Without her trusty sweater, Chris went to a health clinic. She exposed her scars and fresh cuts. The counselor asked Chris if she planned to cut again.

She wanted to stop, she said. She just wasn’t sure she could.

Taking no chances, the counselor phoned the police to escort Chris to Indio Mental Health Clinic.

Chris’s mother was called. This time there was no avoiding the truth. Her daughter is a cutter, they told her.

Chris went to a behavioral health center in San Diego. Her mother hoped her daughter’s feelings would pass.

“Teenagers always grow out of these things,” she said.

That’s not always true, said Michael Avriette, director of behavioral health at Desert Regional Medical Center.

If there is underlying clinical depression or borderline personality disorder, which is often the case with cutters, more than time is needed for healing, he said.

Hitting bottom

Despite her efforts, Chris was becoming increasingly aware that her distress was not going to pass.

Although cutting was never an attempt at suicide, the cuts were no longer enough to ease her depression. Now, she wanted to die. In May, she swallowed handfuls of aspirin and again landed in a behavioral health center.

Once released from the hospital, Chris was adamant about recoveringthis time for good. She would do whatever was necessary. The former atheist prayed to God. She opened up to her family. She accepted the fact that she could not recover alone.

Finding faith

Through regular therapy sessions, Chris is currently combating her depression. She has been sober seven months and dropped the friends with whom she did drugs.

The last time Chris cut herself was May 24. Still, she wrestles with the temptation daily—just like an alcoholic craves a drink.

She keeps the razor in her shoe. Chris keeps it there “for protection” during her walks home from the library.

When the urge to cut gets overwhelming Chris takes out her razor, sets it on her desk and stares at it.

“Is it really worth going to the hospital again and putting your family through this?” she asks herself.

Chris also prays a lot. “I ask God to not let me fall back to my old ways,” she said.

She attends a youth group every Wednesday and Sunday at Grace Chapel Indio. Here, she has found friends who “see beyond the scars.” She trusts them.

Holding on

Just days before her 17th birthday, Chris has new hope for the future. She wants to be a kindergarten teacher.

With her parents’ newfound support, she feels loved. Through family therapy, her mother has developed patience.

And Chris has also made a discovery: She can cope without cutting.

She now plays the guitar and is learning to play, “Hold On,” the song by Good Charlotte that Chris credits for saving her life.

“I can’t go back to my past and change it,” she said. “But I don’t ever want to make my past my future.”

Glance: Seven things you need to know about self-injury and “cutting”

What is it?

Also known as self-injury, cutting is the impulsive harming of one’s body to release emotional pain. It is not an attempt at suicide. It’s usually done with shards of glass, razors and other sharp objects like paper clips or staples. Other forms of self-injury include pulling out hair, banging one’s head, breaking bones, picking obsessively at wounds and other forms of bodily harm.

Who is doing it?

Potentially 2 million Americans and an estimated 2,500 Coachella Valley residents are self-injurers. Most often young girls, ages 12 to 19. Typically middle- to upper-class background. Usually average to high intelligence but suffering from low self-esteem. An estimated 1 percent of the country’s 290 million people are self-injurers.

Why are they doing it?

Cutters often feel alone or empty. The act provides psychological relief, allowing them to deal with overwhelming feelings and emotional pain. Nearly half of cutters report sexual or physical abuse. An estimated 90 percent say they were discouraged from expressing their feelings by their family. Cutting may be a symptom of an underlying and treatable mental health problem.

What are the signs?

Clothing: Cutters will often cover up scars with clothing. Many will wear long sleeves or pants even when the weather is warm. Excuses: If the marks are discovered, the individual may say they fell or the cat scratched them. Many cutters also struggle with alcohol or drugs or an eating disorder.

What should parents do?

Ask your child directly, “Are you hurting yourself intentionally?” Seek treatment or therapy with a psychotherapist, marriage and family therapist or other counselor. Be open-minded and learn all that you can. “You don’t have to understand it, just appreciate it and recognize it,” said Karen Contario, of S.A.F.E. Alternatives. Be a patient listener. “Listen to your kids no matter what they have to say, because you can’t help guide these teens unless they know that you’re at least trying to understand who they are,” said Kim Phillips, Rancho Mirage marriage and family therapist.

How to help a friend

Talk to a school counselor if you or a friend is cutting or struggling with depression. If a child is afraid to talk to a parent, a school counselor is a good option. School counseling is free and confidential for kids 12 and older. Ask about your school’s Student Assistance Program to create a recovery plan. If you notice a friend withdrawing from activities he or she used to enjoy and spending more time alone, the friend may be depressed. Talk to him or her and ask questions that show you care. Find a professional for information. Some Web sites on cutting are more of a hindrance than a help.

Glance: Talk with your kidslisten and be patient

Stifling a teenager’s overwhelming emotions and feelings can result in drastic measures, such as self-injuring. Experts say communication between parents or guardians and their childrenespecially teens—is critical to raising emotionally healthy kids.

“It’s the No. 1 priority, it’s really that important,” said Karen Contario of S.A.F.E. Alternative, a treatment and educational facility in Naperville, Ill., dedicated to self-injurious behavior.

Make the time for your children, be non-judgmental and really listen, Contario said. If you can’t, enlist the help of a family friend or a therapist, she said.

“Parents are always telling me that their kids would rather hang out with their friends,” said Cynthia Kisamore, a neuropsychologist and former school counselor in La Costa, near San Diego.

While that may be true, she said, parents are using it as an excuse for not spending much-needed time with their children.

It’s tougher for kids to be merely kids these days, experts say. For example, gone are the days of going to college and deciding on a major along the way.

“Schools want proof of what they want to do and have community service requirements,” Kisamore said. “Parents are not working with kids to teach them how to balance their lives.”

More than hormones

In many cases, parents are writing off their child’s anger as hormones or typical teenage antics.

“Often underneath that anger is sadness,” Kisamore said.

Children need strategies for dealing with life and all its curve balls, she said.

She suggests that parents sit with their kids and ask questions about their lives. Be willing to offer guidance. Steer clear of the, “Did you have a good day?” and, “Do you have homework?” type questions, Kisamore warns. Ask them yes or no questions and that’s what you’ll get—yes or no answers.

“What was good about your day?” or, “What homework are you working on?” are better questions to spark conversation.

The communication skills of today’s youth are diminishing with the rise of e-mails, chat rooms and instant messaging, Kisamore said.

All of these trends are putting more pressure on parents, too, said 40-year-old Kisamore. She’s the mother of twoa 14-year-old son and a 10-year-old daughter—and understands it’s not always easy to talk with a child.

And sometimes, there are good reasons for that. Mood regulation, impulse control, and critical thinking and organization skills are among the last developments in the adolescent brain, Kisamore said.

Often when kids and teens can’t explain their feelings, they become just as frustrated as parents.

“We’re not honoring or validating them,” Kisamore said.

She is establishing a teen coalition so that young adults can turn to one another for support. Teens Connection will extend throughout Southern California and hopefully spread across the nation, she said.

Community Care
September 23, 2004

Worse than self-harm; Even if someone is no longer self-harming they may still be going through torment, says Alex Williams

When I am in a cycle of self-harm I cannot imagine that there can be anything worse. But I have found that there is—sitting with the urges to hurt myself and not acting on them. This can be more excruciating than the self-injury itself.

In a recent 10-month period I needed 23 blood transfusions with more than 50 hospital admissions. Self-harm became my focus. I thought of myself as a self-harmer and about how much damage I had done. While I sometimes wanted to change I felt reluctant to give up the harming. It was as though it formed my identity and purpose. But the cutting had become painful. Before there had been some strong emotion overriding the pain—anger, upset or anxiety. These lessened but I continued to feel low.

What also challenged my habitual self-harming was when an emergency consultant told me I would not be alive in six months if I continued. She warned me that my hand might have to be amputated if an infection spread. But I still felt the desire to harm myself. Being unable to do this because of unbearable physical pain made me feel defeated.

The evenings were hard to get through since I associated them with the rituals of my self-injury. I found myself thinking about harming myself all the time and was frustrated that I could not do it as I had before. I became more depressed and even neglected myself when it came to washing and dressing.

Several things have helped me through, including internet support groups. You get to know the people who frequently post messages and are there to support other members. I have often sent messages about feeling that what I am living now is just an existence and how I miss the mental drama of self-harming. You write “trigger” in the subject line of messages if they concern self-injury, abuse or suicide. I feel the support group members understand.

I joined an occupational therapy sports group and this has given me a reason to regain energy by taking iron tablets to replace lost blood. It meets weekly and is facilitated by an occupational therapist and a support worker. There are six members from both sexes. The group plays badminton and softball tennis at the local sports centre.

One practical way of getting through each day has been comfort eating. I make sure that this is done on lots of fruit and vegetables so minimising weight gain.

Social care workers should recognise that someone is battling self-harm even when they are no longer physically hurting themselves. The mental torment does not end when that person resists using the blade.

London Free Press (Ontario, Canada)
October 6, 2004

‘It Felt Good’
By Marissa Nelson

A bloody nose would be easier to deal with.

Fat. Ugly. Lard-ass. The words sear her insides. Sarah hears them every day she’s at her Elgin County elementary school.

She feels like she doesn’t belong. She doesn’t measure up to her siblings and the Barbie-like physique of her sister. She doesn’t fit the picture-perfect family image everyone sees at church.

Then Sarah, a Grade 6 pupil, sees a boy in her class carving his girlfriend’s name in his arm.

So sweet. So cool.

Sarah takes a pencil sharpener apart, takes the blade out and carves a heart in her arm.

“It felt good,” Sarah says.

It’s not deep. But the feelings are.

For a moment Sarah—not her real name—feels relief from all the terrible feelings she has about herself. The cutting didn’t hurt then but it has since led to years of hurt.

“I wish I could take back time,” the now 17-year-old says.

While CNN recently called it the “secret plague,” it’s hard to estimate how many people in this region are cutting.

“We have cases every year. Really we deal with the whole spectrum of self-abuse,” says Suzanne Book of the Thames Valley District school board.

They see self-injury in elementary and high schools, she says. It may be one student who has a real mental health problem, or a group of kids using cutting as a way to identify their group of friends, like blood brothers.

“It may start with one kid cutting themselves with a pencil, then it becomes the thing to do,” Book says.

The board has had more referrals for self-abuse but Book’s not sure if that’s from more awareness or more self-abuse.

Either way, it’s something the schools can’t ignore because it can be traumatic for other students.

“We’ve had situations where kids have cut at school and other kids have seen it,” Book says.

B.J. Thom, executive-director of Self Abuse Finally Ends in Canada—or SAFE—a London-based group, says it gets calls for help from all over the province, from Sarnia to Woodstock to Thunder Bay.

“There isn’t a high school out there that doesn’t have a self-injurer,” Thom says.

This summer, nearly a dozen teens sought help at SAFE. Last year, 58 per cent of SAFE’s clients were teens.

What worries Thom is the age cutters are starting their self-abuse. In 1999, the average age for the first time a SAFE client hurt themselves was 16. Last year it was 12.

Thom believes the Internet is part of the problem.

“Kids are knowing about it at a younger age,” she says. “We’ve created a monster with technology. I know parents who lock their computers. The Internet can be terribly toxic, because they encourage how they do it—glorifying it.”

For Sarah, that first cut instigated a life of routine cutting. Like an addiction, it’s hard to stop because it’s an easy road to relief and one that’s guaranteed to work. The scars, like ladders running up her arms, are the evidence.

By Grade 7, the depressed girl was cutting habitually. She didn’t like her teacher, didn’t fit in and was picked on. She took a kitchen knife and hid it under her mattress.

“It was my thing. It was my thing that I used,” she says.

Cutting was always secretive. She was careful to hide her knives and wounds.

Eventually a friend saw the cuts and Sarah pleaded with her friend to stay silent, but Sarah’s mom found out. Her mother barged into her bedroom, caught her in the act and sent Sarah to therapy.

It helped for a while, but cutting reappeared in Grade 9.

“Everything hit the fan,” she says. “My sister was on student council. I was always in her shadow. I felt like I never could be good enough.”

Sarah’s depression worsened. While the cutting was never an attempt at suicide, she began to think about it and, finally, she tried to kill herself. That took her to psychiatric hospitals in London and St. Thomas.

In hospital, she’d hurt herself—you can always find a way, whether it’s cutting, scratching or hitting yourself or even banging your head.

“You need to deal with the stress and that’s the only way you know how,” Sarah says in the living room of her group home.

Her cutting now varies with stress. Some weeks are better than others.

Sometimes she goes deeper than she intends and needs stitches.

“Last week I was cutting more, this week less,” she says. On bad days, she cuts herself two or three times. “I need it. It’s like nicotine. You get addicted and you can’t stop. It becomes part of your life.”

STOP’s Thom, who used to hurt herself, says she still thinks about hurting herself when she has a stressful day.

It’s a lifelong battle, she says. “I get parents who say ‘fix them.’ There are no quick fixes. The ones who work best are when the whole family is involved.”

Most don’t feel pain when they’re hurting themselves. “They get addicted to the high of self-injury,” Thom says. “There’s an adrenaline high. You feel indestructible.”

It’s a habit like a stressed smoker lighting up.

“All you want to do is relieve the stress of the moment. It’s short-term relief in exchange for long-term harm,” Thom says. “As a teen, there isn’t a tomorrow. They want to get rid of the pain.”

At Regional Mental Health Care, London, a team tries to teach self-injurers how to regulate their emotions without hurting themselves.

The contagious aspect of self-injury isn’t unlike other adolescent behaviours. If your friends are doing it, you likely will, says Pam Geiger, a nurse who’s part of the team.

The mental health professionals try to treat the emotions that lead to the injury, not the injury itself because that’s just a symptom.

“It’s a coping mechanism,” Geiger says. “It’s not an attempted suicide. It’s about staying alive.”

Society zeros in on the injury because it’s repulsive. The cure isn’t hiding the knife, because cutters always find a way to hurt themselves.

Self injury often shows up in adolescence because it’s a period of heightened emotion.

“It’s when you have the first heartbreak, the first death in the family—those might lead to self injury,” says Gord Clifford, a child-care worker on the team. “In our experience, self-injury is more a life-affirming experience for them. Like ‘seeing myself bleed lets me know that I’m alive. I would rather have my arm broken than my heart.’ The cutting lets the emotions out. I’m not sure the clients would see it as hurting themselves.”

Adds Geiger: “It’s similar to alcohol—once you cross the line you’re always at risk.”

Sarah is taking small steps. She dreams of a day when she won’t think about cutting, but she’s proud she hasn’t been back to hospital for six months—a major step.

“I’m always so nervous that I’ll go back to the hospital,” she says. “I wish there was a patch for this that’d make it go away.”

Dreams of graduating high school with her friends have faded. Sarah now goes to a London school where she expects to be bullied as she has everywhere else.

Sarah knows and regrets the impact cutting has had on her family. The illness has—at least in Sarah’s mind—made her the black sheep of the family who tarnished the perfect-family stereotype.

“I’ve ruined that image. I didn’t want to hurt my family. I get so mad when I cut that I want to cut again. It’s a vicious cycle.”

It’s not that she doesn’t want to stop. It’s just hard to.

“I want to stop, I really do. I want my scars to fade. I don’t want my kids to ask about them,” she says.

Sarah wants parents to know that getting help early is the key—don’t ignore it.

“I’m nervous about my next 17 years...I’ve always hated myself and how I looked. I’ve always been teased,” she says. “But thank goodness for second chances.”


The Bellingham Herald
November 26, 2004

Understanding self-injury helps treatment
By Michelle Nolan

Now in her eighth year as a mental health counselor at Western Washington University, Joan Kimball is receiving national recognition for her research on people who injure themselves on purpose.

Kimball, who completed her doctoral dissertation on the subject last year, was prominently featured in an article, “Self Injury on the Rise,” in the October issue of Counseling Today, a professional journal.

Kimball, a Stanford University graduate, got her master’s degree in mental-health counseling from Western in 1981 and her doctorate in clinical psychology from Seattle Pacific University. Of her three children and three stepchildren, five are taking college courses and one is in high school.

Question: How did you become interested in helping people who self-injure?

Answer: Six or seven years ago I was talking with several students who were self-injuring and I wanted to understand it better. I found there was some literature on the topic, but not a lot. There’s a lot more now. What I discovered was that a lot of people have misconceptions about self-injury.

Q: What are those misconceptions?

A: The primary misconception is that people who self-injure are always suicidal. Usually, these people are not suicidal. Instead, self-injurious behavior is often done to calm people down. There’s emotional turmoil going on and it becomes internalized.

Q: Are there other misconceptions?

A: Yes. Some people think self-injury is always a form of self-punishment, though often it’s not. And some people see self-injury as an attention-getting behavior. Actually, it’s not. Most people hide the fact they self-injure. Self-injury is a private behavior.

Q: So why do people self-injure?

A: It’s normally done for emotional regulation; it’s a strategy used to manage one’s emotions. Some estimates say childhood sexual abuse is part of the background of 75 to 80 percent of those who self-injure. I think that’s a little bit of an exaggeration, but I think sexual abuse does play a significant role.

Q: Is the trend toward piercings and tattoos in recent years a form of self-injury?

A: I do not consider piercings and tattoos to be the same phenomenon. They’re doing that for cosmetic reasons. Some students have said both self-injury and piercing have a calming effect, but their motivations are different.

Q: What else is important to know about why people self-injure?

A: It’s often associated with dissociation. We all dissociate at times—daydreaming, for example—but the kind of dissociation I’m talking about is a numbing of the senses. People sometimes self-injure to either end a dissociation or to induce one, but they’re usually trying to end a dissociation. They want to bring themselves back to their bodies. People who have been abused have often learned to dissociate; kids do it to survive.

Q: Do people feel it when they self-injure by cutting and so on?

A: A lot of people don’t feel it when they’re self-injuring. It’s not really clear, but a lot of people report no physical sensation while they’re self-injuring, but they do afterward. Personally, I think it’s because they’re dissociating when they cut.

Q: How serious is the problem?

A: It’s a serious problem on college campuses, and it’s a growing problem in middle school and high school. Self-injuring is now occurring in elementary schools. The literature is inconsistent on the subject of gender and self-injuring. The percentage among college students who self-injure in the literature seems to be anywhere from 8 to 10 percent, with 12 percent reported in some high school and middle school populations.

Q: Are these people crazy?

A: My view as a counselor is that human behavior is purposeful, and so is self-injury. There’s a reason behind it. Understanding the reason is important in treatment. I’ve treated a number of students at Western for this.

Q: What’s the first step?

A: It’s to understand the purpose self-injury is serving in the individual. Usually, it has a calming effect. Treatment is two-fold. We need to find other ways to calm a self-injurer, such as calling a friend, taking a walk, drinking tea, taking a hot bath, listening to music. And we need to find the underlying issue involved, such as abuse, depression, anxiety, trauma. Many people who self-injure have suffered personally traumatic setbacks. Most of these people have emotional issues to deal with. It’s not clear why some people self-injure and others find different ways to cope.

Current Health
December 1, 2004

Hurts so bad: why are troubled teens taking their inner pain out on themselves?
By Julie Mehta

Camelia had been in a fight with her mother. She doesn’t remember now what it was about, only the terrible feelings that threatened to overwhelm her. Camelia went into the kitchen. On impulse, she picked up a knife from the counter and pressed it against her upper chest, just hard enough to draw blood. “It was a way to get hold of the pain,” she said, “a visual realization of everything going on inside me.”

That was Camelia’s first experience with self-injury. Soon the 15-year-old was making cuts on her wrists and wearing bracelets to hide them. She pulled her socks up over the cuts on her ankles. “I knew I was scarring myself, but I was so depressed, the cutting felt good. I felt like I was in a black hole and that this was a way to get out of there, to get back to a place where I could feel.”

Understanding Self-Injury

Now 25, Camelia didn’t know back then that there was a name for what she was doing to herself—self-injury—and that other people were doing it too. But in 1995, Princess Diana of Britain admitted in an interview to repeatedly harming herself, bringing into worldwide focus a problem that had long been shrouded in secrecy. Recently, the issue of self-injury has surfaced in movies (Thirteen), TV shows (Real World and Seventh Heaven), and songs.

Still, many people have difficulty understanding why someone would want to deliberately harm himself or herself. Ironically, self-injurers are actually doing it to feel better. Whereas most people might cry when they’re unhappy or shout when they’re angry, those who self-injure have trouble expressing their negative emotions.

“Many teens who hurt themselves say that if they start to cry, they’re scared they won’t be able to stop. Or if they get angry, they’re afraid they’ll hurt someone,” said Andrew Levander, clinical director of the Healing House, a self-injury treatment program in southern California. For those teens, harming themselves becomes a coping mechanism, a way to avoid dealing with difficult emotions.

Experts estimate that about 3 million people in the United States engage in self-injury, with a high incidence among adolescents. (The teenage years are usually when the behavior starts.) Experts also say that self-injury is more common among girls, because they tend to turn their pain inward, whereas boys turn theirs outward. But many boys harm themselves too, often more seriously than girls do.

Because most people who harm themselves cut their skin, self-injury is often referred to simply as cutting. But self-injurers may also burn or bite themselves, carve words or shapes into their skin, bang their heads against walls, break their own bones, or pick at wounds so they’re unable to heal.

Eighteen-year-old Joelle from Sebastian, Fla., began cutting three years ago, when she dragged an open safety pin across her stomach. Her verbally abusive boyfriend had made her feel worthless, and her parents were not supportive when she turned to them, she says. “I’d been raised to think it was bad to have negative emotions, so I pushed them aside and put on a happy face,” she explained. “Cutting felt like a kind of release.”

Beneath the Surface

Like Joelle, many people say they self-injure to relieve tension or to slow racing thoughts. “Some feel tremendous emotional pain, and cutting provides a brief anesthetic,” said Steven Levenkron, a New York City psychotherapist and the author of Cutting. Many self-injurers are perfectionists with low self-esteem who punish themselves for doing or feeling something “wrong.” Some self-injurers have been sexually abused and hurt themselves in order to gain control over their bodies and a past in which they felt powerless.

Though often mistaken for a suicide attempt, self-injury is really a desperate effort to stay alive. Although a few people may self-injure to get others to care for them, most don’t do it for attention but try their best to hide their scars. Camelia hid hers for years. “I was actually one of the most popular kids in school,” she said. “I was on the student council, dance team, volleyball team. People would look at me like they wanted to be me, and I thought if they found out who I really was, I’d be alone.”

The increased media attention has prompted more teens to seek help but also may have led to more experimentation. Levander says that the Healing House has had a tenfold increase in inquiries from self-injurers over just the past year. He believes more kids are picking up the behavior from others. Charla of Beaver Dam, Ky., started cutting at age 15 because her older sister was doing it. That sister had been molested by their uncle. Charla’s younger sister had attention deficit disorder (ADD). Yet it was Charla, the one who didn’t have an apparent “problem,” who continued to hurt herself long after her sister had stopped.

Karen Conterio, cofounder of Self-Abuse Finally Ends (S.A.F.E.) Alternatives, a treatment program for self-injurers in Illinois, says that for every patient she’s seen from an abusive background, she has seen someone like Charla. “Often there’s a sibling with ADD or a divorce or loss of a grandmother early on, and the child becomes a supergood kid, like a parent taking care of the others but unable to express [his or her] own feelings.”

The Downward Spiral

Whatever their reasons for starting, self-injurers often find that stopping is extremely hard. “I thought it would be OK to do it the one time,” Joelle said of her first experience with self-injury. “But it became an addiction real fast.”

Soon Joelle was carrying a pocketknife to school and cutting in the restroom. One day, she says, she “lost it” and cut all over her arms. That’s when her parents noticed. She was hospitalized but continued to cut herself, using the zipper on her pants.

Charla cut nearly every day until one of her friends anonymously reported her to a school counselor. “I’ve tried to stop, but it’s very hard,” she said. Once a top student, she’s had to quit school because of repeated hospitalizations.

Experts believe that one reason self-injury is so addictive is that it causes the brain to release endorphins, pain-triggered chemicals that create a kind of temporary high. Cutters find they have to make deeper cuts more often to get the same effect. Sometimes they accidentally cut a vein or an artery, requiring a trip to the emergency room. They risk developing infections or spreading diseases through shared cutting instruments.

“[A cutter becomes] less able to handle things,” said Levenkron. “Each cut in the body is like a cut in the mind too. You get more cut off from yourself.”

Time to Heal

Fortunately, Levenkron says, cutters are treatable. The first step is diagnosing the underlying disorder. Levenkron treated Camelia’s depression with medication and therapy after her cutting was finally discovered by her college roommate.

After her hospitalization, Joelle tried the S.A.F.E. Alternatives inpatient program. “What helped me the most there was keeping an impulse log, where I wrote down situations that triggered my wanting to cut,” she said. “It helped me see how I was cutting to escape my feelings.” All treatments for self-injury focus on getting in touch with feelings, finding new ways to relieve stress, and learning to build positive relationships.

Now Joelle’s parents are her greatest source of support. Joelle has been self-injury-free for almost a year now and starts college in January. She’s confident she’s left cutting in the past, but she knows that the scars on her legs and stomach will always be with her. “They remind me of where I’ve been,” she said, “and that I can’t go there again.”

Emotional Relief

If you’re thinking about hurting yourself, try to figure out what is triggering the impulse. What are you feeling? Then do something to match the feeling.

If you’re angry:
* exercise. Sports can help relieve tension. A walk is a great way to clear your head.
* rip up an old phone book or newspaper.

If you’re sad:
* take a warm bubble bath.
* smooth body lotion on the places you want to hurt.

If you’re feeling disconnected:
* focus on your breathing. Try yoga or meditation.
* bite into a hot pepper or squeeze ice cubes in your fist.

Keeping a journal, listening to or playing music, and calling a friend or a crisis line can all help you work through whatever you’re feeling. If any of these suggestions makes you feel worse, stop immediately.

Remember that self-injury can be very hard to stop without help. If you are hurting yourself, tell your parents, a teacher, a counselor, or a coach. Ask a friend to come along for support. If discussing your problem face-to-face with someone still seems too difficult, try writing a letter about it and giving it to an adult you trust.


* Why do some people practice self-injury? (They have trouble expressing negative emotions in a healthful way.)
* What are some positive ways of expressing negative emotions? (Answers will vary but can include the following: exercising; talking to a friend; taking anger out on an inanimate object, such as a pillow.)


1. Brainstorm with your students to find safe ways of relieving stress, then make a list. Try a different stress reliever every day to get students into the habit of using these techniques rather than inappropriate ones.
2. Have your students write about a stressful time in their lives. Ask: What did you do to cope with the stress? What helped you when you were feeling stressed? Were you able to talk to someone? What advice would you give a stressed-out friend?

The News Journal
December 4, 2004

‘Cutters’ Reveal Dangerous Behavior; Nursing students create documentary about self-injury
By Michele Besso

Depressed about her grades and nervous about going to college, she sliced small lines on her lower leg with a razor. Somehow, it made her feel better.

She started cutting herself when she was a senior in high school. The bathroom was always her place of solace whenever she was really upset—whenever she wanted to cry.

One time she noticed a razor and decided to try to cut herself.

“It seemed like a way to change where the pain was,” said Jen, 21, now a senior at the University of Delaware. “I would feel initial relief, and then I’d feel really guilty for doing it afterwards. ... I’d almost get disappointed when I couldn’t get it to bleed as much as I wanted. I couldn’t even do that right,” she said.

Jen, who did not want her last name used, said she eventually talked to her parents and a social worker about cutting herself. She now regularly sees a therapist but said she has cut herself occasionally at college when she felt she couldn’t control something, such as not getting along with her roommate.

“I don’t smoke or drink, but I try to smoke a cigarette when I’m under a lot of pressure rather than go cut now,” she said.

Teenagers, particularly women, are more likely to cut, though the behavior touches all socioeconomic groups. Deliberate self-injury is becoming an increasingly popular and dangerous form of self-expression, officials said.

Young people like Jen have been portrayed in movies such as Thirteen and shown on MTV’s The Real World – San Diego. Even adult celebrities like Angelina Jolie and Princess Diana admitted they cut themselves to relieve emotional pain.

Eight University of Delaware nursing students are calling attention to cutting through a documentary and presentation at middle and high schools and health fairs across the state.

The 15-minute documentary, Cutting to the Chase, includes interviews with teenagers who cut themselves, advice from a psychiatrist, role-playing exercises and tips for how to get help.

One woman in the film, Grace E., 22, of Kennett Square, Pa, said she cut herself in high school because of the pressure to be perfect.

“It was addictive,” she said Friday. “If I cut myself once, I had to do it the next day. I tried to make myself feel better. ... It was my dirty little secret.”

Grace’s friend Kelly Snyder said she was shocked when her friend pulled up her sleeve and showed her the marks on her arm. They were red and bleeding a little bit, she said.

“I didn’t really know what to do,” she said. “Cutting was very foreign to me. I wanted to understand what she was feeling. ... She would come in to school in sleeveless shirts and show her marks. It got to a point where I did say, ‘Grace, I’d really like you to stop,’ but she thought it was a big game.”

Lisa McBeth-Snyder, a registered nurse and the UD instructor who supervised the students making the documentary, said she chose the topic of cutting for her students to research because many people are not familiar with it. Even though cutting has been around for decades, it has started to take on a “fad” quality, she said.

“Before it used to be alcohol and drugs, now they are trying this,” she said. “Guidance counselors and nurses are starting to see it. My 14-year-old kid talks about girls chatting online about trying cutting. They all know kids who have done it.”

The most recent statistics available in Delaware are from high school wellness centers, McBeth-Snyder said. A small percentage of students attend the centers. Many students don’t seek help or report the problem.

Last school year, 59 students made a total of 127 visits for cutting to one of the 27 wellness centers in the state, McBeth-Snyder said.

“We have guidance counselors and nurses telling us this is growing problem, and we’re seeing it more and more in schools,” McBeth-Snyder said.

Dr. Saleem Khan, a board-certified child and adolescent psychiatrist who practices in Wilmington and Newark, said cutting has always existed, but physicians, schools and the public have just recently become more aware of it.

“It’s definitely happening here in Delaware,” Khan said. “Talking to therapists, psychologists and schools, it seems there is a significant number of teenagers exhibiting this behavior and they definitely need help.”

Joan Troutman, a family and consumer science teacher at Skyline Middle School in Pike Creek, said she showed the film to her seventh- and eighth-grade students because she felt it was important for them to learn more about the problem.

“I understand there have been four incidents at the school this year,” she said. “I’m thankful this school allows us to include this in our curriculum. Some schools don’t address these issues.”

Emily Brown, 13, of Newark, a student in Troutman’s class, said she never met anyone who cut themselves, but after seeing the documentary she better understands the reasons why people may do it.

“I don’t think I could do it, though,” she said.

Dale Smith, a guidance counselor at Gunning Bedford Middle School in New Castle, said cutting is not a major problem at the school. The school and others in the Colonial School District have not decided whether they will show the documentary.

“I think it should first be shown to the staff, and not initially used with students,” Smith said. “I’m afraid kids are so subjective, it may give them ideas of things they never thought about doing. We should let the staff talk about where and what portions might be appropriate for kids.”

According to Khan, cutters need to recognize that they can learn to deal with their inner pain in more appropriate and socially acceptable ways.

When people cut, the brain releases a chemical called endorphin, which is the body’s natural pain reliever, and gives the person a sense of relief and a feeling of being high, Khan said. If the person keeps repeating that behavior, the feelings they get may eventually lead to an addiction to the behavior.

“Most of the time what they hear from nurses and teachers or friends is ‘Stop it. Don’t do it,’” Khan said. “That doesn’t help. I let patients know that I understand why they do it, and gradually we start helping them see that in many ways it’s inappropriate behavior.” Grace E., the young woman in the film, eventually spent time in a psychiatric treatment center before deciding to stop cutting two and a half years ago.

“The consequences outweighed the benefits,” she said of why she finally stopped. “It wasn’t helping anymore. I didn’t want to live that way anymore.”