Plain Dealer (Cleveland)
January 9, 2005

Dark Salvation; Slicing open her skin was the only way to make her pain go away. It worked every time.
By Diana Keough

I hate my life. I hate my life. I hate my life.

Lynnie was sitting on her bed the first time she ran a rusty scissors blade across her left wrist, creating several jagged lines, each a half-inch long. She was alone and desperate. She felt if she didn’t do something, the despair would swallow her; that she might die. She watched the blood bubble out from the cuts, pooling on her wrist. She could hear herself breathe. Slow. Steady. In. Out. She pressed a Kleenex against the cuts. It felt cool, unlike the blood saturating it. A few drops of blood dribbled onto her sheets.

It didn’t hurt, she thought, closing her eyes and falling back onto the pillows stacked on her bed, surrounded by her favorite stuffed animals. The misery she’d felt moments before was gone.

After that first time, Lynnie cut herself again and again to relieve emotional distress. Some weeks, she would cut herself three, four times a day – before going to school and as soon as she returned to her suburban home south of Cleveland. She’d use knives, a box cutter, paper clips, anything sharp enough to puncture her skin and draw blood. Her favorite tools were the twin blades she’d broken out of her disposable Daisy razor. She took to carrying them to school in her backpack, “just in case,” she says.

She went to the bathroom at school, just to cut. After each episode, she would promise herself she’d never do it again.

Seventh grade was difficult for Lynnie. Girls in her class made fun of her straight black hair and taunted her about her weight. They called her “the brain.” It wasn’t a compliment.

Lynnie describes herself as shy. She says she wishes she could be invisible. That way, maybe the girls would stop picking on her. She hasn’t had a friend over to hang out in two years, maybe longer. She says she can’t remember.

When she speaks, Lynnie focuses on her hands in her lap as she locks and unlocks her fingers. She rarely smiles.

Lynnie is a talented cello player, but she doesn’t like to tell anyone that. She says it’s uncool. She’d rather be known as a softball player. Her favorite position is a popular one – on last year’s team so many girls preferred that spot that she was rarely given the chance to play it. She likes to draw, watch TV and chat online with girls she refers to as “my friends.” Her “friends,” though, rarely respond to her e-mails, and when they do, says Lynnie, things she types “get twisted and then everyone is mad at me the next day.”

In April, she watched as rumors that she was to blame for another girl leaving the school were “instant messaged” to all the girls in her class and then to strangers. Feeling helpless to set the record straight, she did what she had promised herself she’d never do again. She went into her room and cut herself.

The next day at school, several girls called her “a bitch.” No one would talk to her or sit beside her at lunch.

My life is hell.

She says she felt as if she was being suffocated by a heavy blanket she couldn’t get out from under. She knew how to make the pain go away. Lynnie reached into her backpack, grabbed the razor blades and asked to go to the bathroom.

A classmate also asked for permission to use the restroom and followed her. Lynnie didn’t care and began slashing at her arm as soon as the lavatory door swung shut. Her classmate told the teacher, who notified her parents.

Lynnie’s mother, Colleen, was frightened and stunned. She called her daughter’s pediatrician, who refused to see her. According to Colleen, the doctor told her that her daughter’s problems were bigger than he could handle. He suggested she take her directly to the emergency room.

There, nurses, doctors and even the police questioned Lynnie. The ER psychiatrist prescribed the antidepressant Paxil, but Lynnie’s compulsion to cut herself didn’t go away.

Her mother anxiously monitored her behavior, checking her arms while she slept and asking her to pull up her sleeves when she came down for breakfast in the morning. Colleen went through the house, removing every sharp object. She didn’t know Lynnie had a hidden stash of razors and knives in her bedroom.

Lynnie wrote “I WANT TO DIE” on her bedsheets in permanent black ink. Colleen saw those words the same evening she discovered her daughter, asleep, curled up with a steak knife next to her. After that, she began sleeping in her daughter’s bed. Anything to protect her daughter from herself.

Clinically, cutting is known as self-mutilation. Other names for it include self-injury, self-harm, self-abuse and the newest term, self-inflicted violence. The behavior can include cutting, burning, bone breaking, head banging, needle poking, skin scratching, obsessively picking at scabs, fingers or the bottoms of feet, excessive tattooing and body piercings. It also can include “incredibly reckless activities with drugs and alcohol way past ... where they’re attempting to blot out or destroy feelings,” says Mark Warren, medical director and chief of psychiatry at University Hospitals’ Laurelwood in Willoughby.

According to a 1989 study of 240 American females – the only large-scale survey taken of self-injurers – the average practitioner begins at 13 and continues injuring, often with increasing severity, into her late twenties. Most cutters are intelligent high-achievers, often compulsive about being perfect, says Ruta Mazelis, editor of The Cutting Edge, an international newsletter.

Like anorexia, cutting has long been considered “a rich white girl problem.” But that’s just another stereotype, says Warren. Studies seem to indicate cutting is just as prevalent among African Americans and Asians as it is among Caucasians.

Another commonality among cutters, according to Warren, is some form of depression. He says it is usually a symptom of other disorders, such as borderline personality disorder, anxiety disorder, bipolar or schizophrenia. Experts just aren’t sure which comes first: The behavior or the disorder.

“All self-harming behavior serves a mechanism to try and help someone manage a situation better,” Warren says. A great many of his patients engage in some form of self-harm behavior.

“Even though the behavior is hurtful, its intention is to soothe something that feels really intense, stressful or overly painful,” says Mazelis.

Cutting is not new, she says, although it’s often called “the anorexia of the new century.” “There are many women my age – and I’m 46 – who have been doing it since they were 12 or 13.”

Some national statistics suggest that 1 to 4 percent, or as many as four of 100 people in the general population, engage in some form of self-injury. Gillian Woldorf, a fourth-year graduate student in psychology at Case Western Reserve University who is writing her dissertation on self-injury, says those figures are probably low.

“Most self-injurers are so secretive. We probably don’t know about half of the teens who have tried it or who are currently doing it,” she says.

Woldorf admits her extensive research into self-injury was spurred by the desire to understand her own cutting habit, which began when she was around 13.

Ingrid Monteith, an adolescent therapist in private practice in Cuyahoga Falls, says she’s noticed an increase in the number of her patients seeking help for self-mutilation.

Eileen Blattner, director of guidance at Shaker Heights High School, says that 20 years ago, when she first began working in the school system, self-injury was virtually unheard of. “Over the past five years, though, it is not unusual for me to have at least eight to 10 students each year who cut themselves.”

At Solon High School, student assistance facilitator Tonda Sills says that during the last school year she worked with 10 girls and two boys who cut themselves – the highest number she’s experienced in the nine years she’s been there.

Yet both Sills and Blattner say they don’t think the phenomenon has increased among teens but that school administrators and parents are better at identifying it.

Monteith agrees. Large-screen movies such as Thirteen and Girl, Interrupted, as well as TV shows such as 90210 and Seventh Heaven, whose main characters have discovered a friend cutting, have drawn more attention to self-harm behavior. So have Hollywood stars Johnny Depp and Angelina Jolie, who have publicly admitted cutting themselves. Even Princess Diana confessed in one biography that she cut herself.

According to Woldorf’s research, boys and men are just as likely to self-injure as women and girls, though “women are more likely to show up in mental health settings, asking for help.”

Male cutters, she says, generally struggle with a gross lack of social skills.

As part of her dissertation, Woldorf is conducting a large-scale, Internet-based study on cutting behavior to try to obtain a more accurate picture of how prevalent it really is. Lynnie’s cutting put her family through hell, says her mother.

At first, Colleen accused her daughter of cutting herself to garner attention and make everyone feel sorry for her. Experts caution parents, educators and health professionals from jumping to that conclusion.

Warren says little about cutting has to do with seeking attention. For starters, he says, cutting is not easy to do. “Even as we talk about it, one gets a little squeamish because the actual act itself is not one that comes naturally.”

Says Mazelis, “If you’re cutting for attention, you do it once, because as soon as it’s discovered, the reaction to it is usually shame and disgust. People start calling you manipulative and attention-seeking. That kind of attention is not what most girls had in mind.”

Kathryn opens the door of a Lakewood coffee shop and scans the room nervously before squaring her shoulders, lifting her head and walking to the counter to place her order.

“I’ll have a large Vanilla Cooler,” the eighteen-year-old honor student says. She’s dressed in an oversized sweat shirt, baggy jeans and tennis shoes; her brown wavy hair falls below her shoulders and is parted down the middle. After she collects her drink, she plops down at the table, folds one leg underneath her, and quickly takes off her sweat shirt, revealing a left arm that is a tapestry of scars she no longer bothers to hide. She shares that her hips, thighs, abdomen and legs also are riddled with scars. She is a senior in high school.

“People need to stop acting like [cutting] doesn’t exist and that girls don’t really do it. That’s why I don’t mind showing them,” she says, twirling her hair in and out of her fingers. “If a stranger walks up to me and says, ‘This is just sick and crazy,’ I say, ‘That’s OK because I don’t know you and I wouldn’t want somebody like you in my life anyway.’”

Kathryn says every scar tells a story – a bad breakup, a fight with friends, an argument with her mom or grandma, yet another disappointment from her emotionally distant father who never married her mom and whom she saw once a month, maybe less, before he died a year ago. For years, she had a nightly routine: Say goodnight to her mom, go to her room, light a candle, turn on some music, cut herself.

She says that rather than telling people they had hurt her feelings or upset her, she’d take it out on herself. “I didn’t want to make anyone else angry. So instead of focusing on ‘I’m so mad at this person,’ I could focus on ‘Oh my God, my arm’s bleeding and I need to go and bandage myself,’” she says.

Cutting for Kathryn is a “strength-vs.-weakness thing,” she says. “Crying is weak and cutting is the stronger way to express myself. I know it sounds crazy. I’ve never cried over anything, nothing. I could only cut. I couldn’t cry.”

Therapy didn’t help. She says she manipulated the therapist.

“I said exactly what I knew she wanted to hear so I could get the hell out of there,” she says, smiling. Medication didn’t help, either, she claims – although she’s still on Zoloft (for anxiety), Wellbutrin (for depression) and Neurotin (to help her deal with insomnia, a side effect of the first two drugs). If it weren’t for the meds, she says she’d lie awake most nights, worrying “about getting to my locker between periods because I have to leave school early; about whether I printed out my paper, what time my friend is coming over and did I leave the door unlocked, did I make coffee, do I have enough coffee to make? Stupid s –-! like that.”

She knows she worries too much about her schoolwork. She’s never received a B. She also worries about her mom, who is on disability and does not work.

Kathryn kept her cutting secret for two-and-a-half years. A friend saw the cuts one day as Kathryn raised her hand to answer a question in class. After Kathryn’s mom found out, she blamed herself, which made Kathryn feel guilty. Seeing her mom so hurt by her behavior made her want to stop. When Kathryn couldn’t, she realized she was no longer in control. Cutting was controlling her.

Kathryn’s mom believes she hasn’t cut herself in two years. Kathryn says the newest scar on her shoulder is over a month old. But it looks too red, angry and fresh. Then she admits it is only a week old, and shrugs her shoulders.

For her honors psych class last year, Kathryn wrote a research paper on self-mutilation she called “Black and White Blood. Not what you think and not what they say.” After that, she was asked by Kristine Jares, a therapist at Lakewood Hospital Teen Health Center to “tell her story” on self-mutilation at an information session on the subject at the hospital. Lakewood High’s school nurse, Kristina Purdy, walked out in anger while Kathryn was speaking.

“She was up there speaking to us as an expert, which, in my opinion, was highly inappropriate. She’s still cutting and the last thing she needs is this type of attention, says Purdy. (Jares says Kathryn had given her and her colleagues the impression that she had stopped cutting and was actively seeking professional help. “Afterwards, Kathryn admitted she wasn’t ready to seek help,” says Jares.)

Lakewood guidance counselor Emmy Young agrees. “Kathryn’s now known as ‘The Queen of Cutters,’ which is an identity she proudly owns,” says Young.

Young, Purdy and other administrators at Lakewood High are aware that Kathryn’s cutting “is being morphed and copied by other girls in our high school who view Kathryn’s behavior as ‘cool,’” says Purdy. They know of at least 25 girls at Lakewood High who cut themselves. Most of these girls hang with Kathryn.

“Troubled kids tend to hang together,” Purdy says.

Kathryn scoffs at their accusation. “Yeah, right! Like cutting’s contagious like getting pregnant is.

“That really pisses me off because I see girls who go home at night and leave three safety pin scratches on their arm or on the back of their hand and then they’ll come into school and say, ‘Oh my god you guys, I was so upset last night. Look what I did,’” she says, holding up her arm, in imitation.

“That’s an attention thing. There’s a fine line between people who hurt themselves for attention and people who hurt themselves because that’s how they deal with their lives,” she says, leaning forward, eyes squinting in anger.

Kathryn blames the media for the belief that cutters cut for attention.

“All the lame articles that have been written about it never go into it enough and it’s like all the rage now to have a cutter in your TV show or in your movie,” she says. “They never go into anything on why cutters are cutting.” When she finishes her rant, she leans back in her chair and slumps down, as though she’s suddenly very, very tired.

“I reiterate that all the time because people do not hear me,” she says, quietly, her voice barely audible above the noise of the espresso machine. I speak and people do not hear me.”

Although the concept of someone doing harm to herself is upsetting, the wounds from cutting are usually not that serious. While people who self-injure can be suicidal, “more often than not, self-injury tends to help somebody who’s suicidal avert a suicide attempt,” says Mazelis, who is also on staff with the Maryland-based Sidran Institute, a national nonprofit organization devoted to advocacy and research on treatments for trauma-related stress disorders.

“To have cutting interpreted as a suicide attempt is kind of like saying, ‘You’re really screwed up because you can’t even kill yourself right.’”

Self-injury is a way to communicate despair that cutters are unable to communicate verbally, experts agree.

“When the voice that should come out of one’s mouth can’t, you create another voice, another opportunity to somehow speak and communicate,” Mazelis says. “The cut becomes a voice on the skin.”

A poem written by one of her newsletter subscribers describes it best, says Mazelis: I hurt so much I bleed.

“Cutters have an incredible amount of inner tension and stress, usually with an intense emotion to it, like profound grief or pain or terror or rage. The self-injury represents a way of all that emotion to leave the body.”

One common denominator among many cutters is a history of trauma, says Mazelis, who serves as a consultant and board member to the National Trauma Consortium. Past trauma could include sexual, emotional or physical abuse, “or anything stressful the cutter doesn’t know how to cope with.”

The invasiveness of sexual abuse “makes people lose their edges and boundaries,” Mazelis says. “If someone is so severely dissociated that they’re afraid they’re going to just lose themselves, they’ll cut to say ‘OK, this is where I am. I can tell by this blood, from these cuts that this is where my body starts and stops.’”

Lynnie says she hasn’t been sexually abused, though her mother isn’t as sure. In retrospect, Colleen recalls an incident, when her daughter was in preschool, that’s always made her wonder. After a visit to a friend’s home, Lynnie became withdrawn, had trouble sleeping and began hitting herself when she became angry. Every time she was invited back to this little girl’s home, Lynnie became frightened and began to cry, begging not to go.

“It’s hard to know because I wasn’t there with her, but maybe that’s why she still doesn’t like to go to other people’s houses,” Colleen says. Looking back, she says she can’t explain why she didn’t investigate the incident.

Lynnie was helped along by aunts, uncles and even a couple of girls from Lynnie’s school who found out what she was doing and sent her notes and letters telling her how special she was to them. Lynnie hung them next to her bed, naming the display her “Cherish Wall.”

Now Lynnie looks at her wall and remembers that she’s not alone and that these people care. Colleen is relieved. She says she believes Lynnie has stopped cutting herself. Listening to her mother say this, Lynnie nods in agreement. But when her mom leaves the room, Lynnie admits she still thinks about cutting herself every day. “Whenever I feel stressed,” she says.

Before she can say whether she’s actually done it, her mom re-enters the room and the conversation.

Lynnie falls silent.

One moment, 21-year-old Kelly emotes self-confidence; the next, she’s barely able to contain her raw emotional fragility. Often, when speaking of her past, her eyes tear up but then, as if she realizes she is feeling something, she uncrosses her legs, straightens her back and her eyes take on a vacant, dazed look.

In her bottom lip is a tiny hoop; in one nostril, a diamond stud. Her blond bangs constantly fall into her face and she often leaves them there, covering her eyes as she speaks. She is tall and slender. She wears no makeup. Her skin is smooth, almost perfect. Her eyes are made more noticeable by long, dark lashes. She says she modeled when she was in high school.

Her hands shake as she pulls a cigarette out of the pack and lights it, taking one long drag as soon as the end glows red. She leans her head back and blows the smoke toward the ceiling. She closes her eyes, inhales deeply again, trying to calm herself.

“I cut myself again on Tuesday,” she finally says, taking another extended drag on her cigarette. It is Friday.

“I didn’t realize what I had done until Wednesday and I was like, ‘Oh my God, it’s been months and months and I can’t believe this happened again.’”

A made-for-television movie she watched triggered intense feelings. “I usually deal with triggers pretty well, but this time I couldn’t handle them,” she explains.

Kelly says she identified closely with the fictional family’s dynamics. “The mother was very invasive of her daughter’s life and there were no boundaries between where the mother stopped and the daughter started.

“That mother had no idea what was inappropriate to discuss with her daughter,” the senior in college says. She is majoring in psychology at Case Western Reserve University. “It was so similar to how I grew up.”

Kelly says her mother would rifle through her CD collection, movies, her diary, her closet, searching for things “that ... would make Jesus cry. She’d tell me that God wouldn’t love me if I would do the stuff she was reading about in my diary.

“When you’re a kid, you equate your mom with God – and if you feel like your mom or God is not going to love you, if makes you feel so bad or rotten or hate yourself,” she says, lighting another cigarette.

She thought of her father as “someone who helped me with my homework, but I don’t ever remember talking to him.”

She viewed herself as “bad, wrong and terrible and that I deserved to be punished.” At 15, feeling sad, lonely and desperate, she burned little dots into her arms with smoldering incense. It gave her immediate relief from her emotional darkness.

Then she used nail clippers to slice lines in her wrists. A month later she broke apart a disposable razor and started cutting, first her calves and then her forearms. She says most of the marks from those initial cuts have faded. Even so, her arms, shoulders, abdomen, hips, thighs and legs are riddled with lines, some of which crisscross, or go right through raised, round lumps, that look, oddly, like smiley faces.

Those, she says, are scars left by a Bic lighter. The darkest marks were left by the straight-edged razor she still keeps hidden in her room, next to the smaller, thinner disposable ones.

She knows she should throw them all out. But she can’t. Not yet.

She spent the summer undergoing intensive psychotherapy, trying to sort things out. She spent her junior year organizing a support group for those struggling with mental health issues. This fall, she solicited poems and essays from other cutters on the Internet for an anthology she is putting together on self-injury for her senior project. She felt she was turning a corner. She wants to stop cutting.

On the day of her most recent cutting episode, she came home from class, took a shower and took out all of her razors – laying them out on her bed, letting her fingers glide up and down, trying to decide which one to use. This was a ritual she knew by heart. All day she had been preoccupied, mulling over “the perfect place” on her body. “You always have to find the right place,” she says. “You fantasize about the length, the depth, the damage you want to do.”

And then she did it. Everything else became remarkably quiet. “It’s like unplugging my brain from my body or taking the phone off the hook,” she says.

She’d spent the last six months trying to convince herself that cutting was horrible, that it hurt and that it didn’t do anything for her. But in-stead of second-guessing her actions, she took out a butterfly bandage and gauze and covered the 4-inch line on her hip.

The place, she says, she made “the decision and the indecision to start cutting again.” With the bandage in place, she padded barefoot into the kitchen, poured herself a glass of red wine, lit a cigarette and tried not to think about what she just did.

Afterward, Kelly wrote in her journal:

What strikes me, is how incredibly easy it was. I claim my own recovery but yet I find myself razor in hand, like the old days, measuring out the length of my skin, slicing with the precision of a diver, when my razor and I lived out a passionate love affair. All that therapy, all that work and putting together this collection brings to mind what it was like before all that – when I used marks on my skin to speak instead of words.

She wishes she could put the behavior behind her and be done with it, but she knows that’s probably not going to happen. As she says this, her eyes fill with tears.

“It’s going to be with me the rest of my life and I’ve just kind of accepted that,” she says, her eyes going dark once again.

Treatment for self-mutilation is a combination of medication and therapy, with an emphasis on making the behavior stop, Warren says. However, says Mazelis, some in the psychiatric profession are no longer demanding that you try to make this behavior stop, “because they’ve figured out that if you take away the cutting as an option, you actually increase the chance that somebody may attempt suicide and succeed.”

Cutting, claims Mazelis, “can jolt people out of states of numbness and emptiness and sometimes, make them feel alive.” One reason that self-mutilators so often feel no pain when cutting themselves is because of “dissociation,” she says. “Physically and emotionally some self-injurers say they disappear or feel like they blacked out. Others describe the act as an ‘out of body experience’ and say as they were cutting themselves, they floated above and watched.”

According to Warren, cutting provides mood-regulating effects, along with a certain addictive quality. “There are beta-endorphins released as they wound themselves,” Warren says. Beta-endorphins are the body’s own opiates. Over time, the injurer must hurt herself more frequently and more violently to achieve the same degree of relief, he explains.

The key to successful treatment, Mazelis says, is finding the root cause of what is making the cutter self-mutilate.

“When that happens and they begin to heal from those issues, self-injurers find they no longer need cutting to cope,” she says.

To watch Lynnie walk the halls of her new school, her thick, black ponytail bouncing behind her, chatting and giggling with other girls, you’d never know the personal havoc she has been through this past year.

“Eighth grade is great,” she says. New school. New friends. Fresh start. She was asked to leave her former middle school because school officials felt Lynnie’s emotional problems were bigger than they could manage. Initially, their decision devastated her mother. But now, Colleen says with a flip of her hand, “It was for the best.”

Lynnie rattles off all the things she’s learned this past year, a teenage philosopher, with an old soul: “When I was cutting, I was pretty selfish, thinking that I was the only one with problems. Life is like a chalkboard that you can erase and that’s what I’m doing. It has to be the cutter’s decision to stop and I’ve decided to stop. I used to tell my friends about my problems, but they were going through the same stuff I was and it’s too much for them to handle. I need to talk to my mom, instead.”

“I can’t believe I even did that,” Lynnie says, glancing first at her mom before responding. She says she no longer needs to hide razors in her room. Mom and daughter sit side by side in the screened-in porch of their home, surrounded by boxes filled with junk they’re going to throw out or sell at a yard sale.

Lynnie laughs when her mom mentions the yard sale. “Our house is always like this,” she says.

There’s a box cutter on the table. The floor of the living room is covered with more stuff, as is their dining room, foyer and the hallways leading to and from the kitchen.

Colleen reaches over and puts her hand on her daughter’s thigh. Lynnie smiles. She says she’s learned her mom is her greatest ally, although she still rolls her eyes whenever her mom says something to her.

“Through this, I’ve learned to listen more and talk less,” says Colleen, whose actions contradict that claim.

Colleen confirms that her daughter’s attitude and demeanor have dramatically improved. She closely monitors her daughter’s time on the computer, going so far as to install a program that allows her to print out every “instant message” conversation.

Lynnie and her mother wear bright-yellow rubber bracelets, imprinted with the words “LiveStrong.” Lynnie ordered more than a dozen of them online, handing them out to her family and her new friends at school. (The bands raise money for the Lance Armstrong Foundation.) Lynnie says that now when she’s stressed or feeling sad, instead of cutting she pulls the band, snapping it so hard against her wrist that the pain makes her flinch. Lynnie is still taking Paxil and seeing a therapist once a week. Colleen attributes most of Lynnie’s improvements to “God now being part of her life.” When Lynnie isn’t going to school or playing the piano or cello, her free time is taken up with the activities of her church’s youth group.

Colleen admits she still checks her daughter’s arms, stealing glances when she’s draped only in a towel after a shower or whenever she’s changing her clothes.

Lynnie says her father “is trying to get better about talking to me.” Last month, he took just her out to dinner.

“It was sort of awkward,” she says. It was the first time ever that she and her father had done something together, she says, just the two them. Ever.

Colleen says those initial strides her husband made to connect with Lynnie, promising to spend more time with the family, are over. He’s back to working and going to school full time. In the process of explaining this, Colleen suddenly stops, looks at Lynnie and asks, “What do you think?”

“I dunno,” Lynnie says, shrugging her shoulders.

Colleen, taking that as her cue to fill the silent moment that follows Lynnie’s answer, picks up where she left off, explaining how Lynnie is feeling now.

Lynnie listens and continues to smile, playing with the yellow band on her wrist.

Kathryn is busy filling out college applications. She wants to study pharmacology. With her 4.2 grade point average, gaining acceptance to the University of Toledo, her first choice, won’t be tough. She doesn’t want to go too far from home – just in case her mom needs her.

She has tried to stop cutting by using a number of techniques suggested on self-injury Web sites: When the urge to cut hits, substitute the compulsion to hurt yourself with cutting paper or plastic. Kathryn actually clipped out an advertisement for angina medication that pictured other people’s wrists.

“Whenever I felt like cutting, I’d cut other people’s wrists,” Kathryn says, laughing. “For some sick reason, doing that worked for a while – like, it was symbolic or something.” She also tried holding ice cubes to her arm, which worked for a day or two because she says it hurt. One Web site recommended she pour ketchup on her arm. She says the reason behind that is that “sometimes it’s not the gashes or the act of cutting. A lot of it is seeing the blood and then taking care of it.”

“The ketchup thing was just messy,” she says and laughs.

Kathryn says she’s terrified of being alone. Her friends are her main support system, but she’s aware that they’re teenagers, too, and they’re only capable of “so much.” She also knows they can be as fickle about their relationship as she can.

“If everybody decided one day that they didn’t like me anymore because I just wasn’t good enough for them, I don’t know what I would do,” she says.

When she imagines her life in the future, her mom’s no longer sick, she’s living in a different house, she’s starting a family, and she has her own life.

“Then I won’t have to deal with people the same way because then I’ll be living by my own rules and then hopefully my maturity level will rise and I’ll be in circumstances that make it easier for me to be happy,” she says.

Happiness, to Kathryn, is finally getting her No. 1 wish fulfilled: That she no longer cuts and, even better, that she no longer wants to.

“If I’m going to reach that, I’m going to have to do it one step at a time because I’m a long way from there. A long way,” she says.

Kelly has a hard time trusting people, especially boys who want to date her. If a boy wants to be intimate, it is impossible for her to hide her scars: She wears her past all over her body.

Cutting is such a personal, private ritual that sharing it, sharing herself, takes a real leap of faith – one she’s taken too soon, too often, getting her heart broken in the process. During a recent conversation with her boyfriend, Kelly looked down at all the scars covering her body and asked him, “Aren’t I disgusting to you? Don’t I repulse you?” He told her the scars didn’t bother him. And though she wants to believe him, there’s a part of her that can’t.

This semester at college she is working at The Free Clinic, allowing medical students to learn how to give gynecological exams, using her body. She feels this experience is helping her overcome her negative body image and “grow an appreciation for how beautiful my body is.”

A few weeks after her last cutting incident, she says she made up her mind that she’s not looking back. “I’m just going to say, ‘F –- it, this happened’ and deal with it. I can’t spend time looking back and regretting things,” she announces confidently. “For every two steps forward, you take one step back!”

Then she becomes quiet again. Last night, she says she was “really pissed” at her boyfriend. “I really needed him to talk to me,” she says. Instead of talking, he fell asleep. While she stood watching him sleep, she felt the rush of familiar dark feelings. As she says this, she pulls her long sleeve up, revealing a Band-Aid on her forearm. Carefully, she peels it back and says, “I panicked when I couldn’t find my razors so I used my Bic.” The burn mark from the lighter is raised, red and oozing.

Still holding the Band-Aid, she looks up defiantly and says, “It felt really good.” She looks down, staring at her wound. “Once I start, I just want to keep going,” she whispers, her eyes still on her arm.

“I feel like I fail every time I cut again. [Cutting’s] taken so much of my life and it’s so hard to stop,” she says, reaching for a cigarette. Her hands are trembling. Her boyfriend never knew what she did while he slept.

“I didn’t want him to worry,” she says.

Kelly says she thinks her self-injury has served a valuable purpose in her life. “If I hadn’t started ... I don’t know what I would have done. I don’t know how I would’ve dealt with these emotions.

“It’s very possible that I would have killed myself by now.”


Express & Echo (Exeter)
January 10, 2005

Self-harm factfile

Contrary to the popular myths on the subject, people who harm themselves are not trying to commit suicide. Self-harm is often used as a way of coping with difficult emotions. Instead of expressing their feelings openly, they take them out on their bodies by cutting or burning themselves, picking their skin, taking an overdose, bruising themselves or pulling their hair out.

Experts say a person who harms themselves only slightly may be just as seriously ill as one who takes an overdose.

The are many myths surrounding self-harm. These include: it is performed to gain attention, and it does not hurt others.

Triggers for self-harm can include bullying, bereavement, pressure at work, abuse, financial problems, pressure to fit in and relationship problems.

Self-harm is often linked to feelings of self-hatred and depression and appears more commonly in women than men.

Many people who self-harm do not even know they are doing it. For example, some people pinch themselves until they create a scar or pick at their toenails or fingernails until they bleed.

Immediately after people hurt themselves, they usually experience some short-term relief. This is usually followed by feelings of shame, guilt, pain or embarrassment.

Identifying a self-injurer can be a difficult task. Most perform their ritual in private, bandage their own injuries and don’t discuss the issue with anyone.

Some people find it difficult to give up the behaviour despite realising that it could be life-threatening and is not rational.

Experts advise that people seek help to confront the reasons behind their behaviour. They also say it is easier to give up if sufferers can find other ways of dealing with stress.

For further information, contact the National Self-Harm Network (NSHN)—a survivor-led organisation which campaigns for the rights and understanding of people who self-harm.

NSHN supports survivors, people who self-harm and the people it indirectly affects. E-mail info@nshn.co.uk, visit wwww.nshn.co.uk or wrote to NSHN, Po Box 7264, Nottingham, NG1 6WJ.


Fort Collins Coloradoan
January 22, 2005

Cutting the pain away
By Sara Reed

On the surface, MacKenzie Kelly looks like any other college student.

She works and goes to class. She likes to hang out with her friends. She volunteers. In high school she played three varsity sports, was the class vice-president and was elected to the homecoming court.

But she is also the face of a problem that’s been growing silently for years.

Kelly, a 20-year-old pre-med psychology student at Colorado State University, is one of at least 2 million people who, according to the National Mental Health Association, regularly cut themselves or engage in other self-injurious behavior each year.

Cutters deliberately cut themselves on the arms, legs, abdomens and other parts of their bodies with razors, knives or other instruments. The incisions are usually shallow, but can be long and occasionally deep.

“I started cutting to feel anything,” she said. “With depression, you feel so dull, so unmotivated and so unstimulated. That (cutting) was a way for me to make sure that I was still alive.”

Kelly, who was diagnosed with depression at 14, said she began cutting herself when she was 12 to cope with that depression. She’s been struggling with it on and off ever since. “I didn’t feel good about myself until I did bleed or felt enough pain,” Kelly said.

She used razors and kitchen knives to cut her forearms, her stomach and her upper legs.

At 16, Kelly told her father what she was doing. She started going to therapy and taking anti-depressants.

But that doesn’t mean she’s cured.

Sometimes she will cut multiple times in a week; sometimes she will go more than a year without. Kelly said it’s been three months since she last cut, but knows it could happen anytime.

Relieving the pain

Not many statistics are available for cutting, and although it is well understood in the mental health community, it is still a very understudied phenomenon, said Dr. Kathy Sigda, a psychologist at Mountain Crest Behavioral Healthcare Center.

It is known that cutters are more likely to be women than men and that many cutters were abused as children, she said, but beyond that, information is not readily available.

“Depression and difficulty with regulating mood is more common in females,” said Sigda, who works primarily with adolescents. “These are the kinds of things that can lead to cutting.”

Aside from the gender split, cutters are spread across demographic lines.

“There is no picture of a typical cutter,” Sigda said.

Many cutters have an underlying psychological disorder, including borderline personality disorder, bi-polar disorder, schizophrenia and depression, that contributes to the behavior, said Susie Street, director of community services with the Mental Health Association of Colorado.

Street, a licensed social worker, said these disorders can leave patients numb, causing them to cut as a way to experience some sort of emotion or because the physical pain is better than the emotional pain.

“Cutting is a method of regulating intense emotional pain,” Sigda said.

Treatment options

Because there can be multiple factors as to why people cut, it can sometimes be difficult to treat.

“There really isn’t any kind of medication that can help (with the cutting),” Street said.

Medications can be used to treat the related psychological disorders, but some experts argue that the behavior also needs to be addressed.

“We have to teach them a better way to regulate their emotions,” Sigda said. “We have to target the behavior directly.”

Kelly said she recently began wearing a rubber band around her wrist and snapping it when she felt the urge to cut. She said it has worked lately, giving her a bit of pain without the cutting.

Both Street and Sigda said that dialectical behavioral therapy, an intense course of group therapy involving talk therapy and journaling, has been effective in treating cutters. “There’s a sense of being accountable to a group,” Street said.

Cutting also can be difficult to treat because it is a self-reinforcing behavior, Sigda said. People cut because they want to feel better; endorphins are released when they cut, making them they feel better, so they want to cut again.

Are more people cutting?

Andrea Tribelhorn, the district counseling coordinator for Poudre School District and a counselor at Fossil Ridge High School, said she’s seen an increase in students cutting during her 11 years as a high school counselor, especially over the past four or five.

“When I first started, there would be one or two students a year,” she said. “But now there are quite a few kiddos who experiment with this type of behavior.”

Tribelhorn thinks the increase in cases is because people are more aware of what to look for, and kids are more comfortable asking for help.

“I think students feel more comfortable coming to adults now,” she said. “It’s a lot more out there. It’s a lot more talked about.”

Tribelhorn said the district is working to address the issue. The Suicide Resource Center of Larimer County talks to 10th-grade health classes about topics such as depression, suicide and self-injury, she said. There is also communication between counselors and teachers about warning signs and concerns about who might be cutting.

“The teachers are our first line of defense,” Tribelhorn said.

The number of cutting cases also is increasing at the college level.

Dr. Patricia Vigil, a senior staff psychologist and emergency services coordinator with the University Counseling Center at CSU, said she thinks the increase is because more people are engaging in that behavior.

“I’ve seen much more cutting in the last 10 years,” she said. “People are doing it more as a way of coping.”

Demystifying the issue

There are still some misconceptions about cutting.

One is that cutting is a suicide attempt. Sigda and Street both said for most cutters, death is not the intention.

“Cutting is not trying to kill oneself,” Street said. “It’s trying to feel some kind of pain, some way to connect to some emotion.”

Kelly said that although she did attempt suicide this summer, that is not why she cuts. “It’s not an intent to harm myself,” she said. “It’s a slap in the face, a reality check.” Both women said a barrier to treatment is the feeling they are the only people who cut or being embarrassed about asking for help.

“There’s a lot of shame associated with cutting,” Sigda said. “There’s still a social stigma attached to cutting.”

The more the public becomes informed on the issue, the more research will be done on the topic, Sigda said.

“It’s almost like sexual abuse in the ‘80s,” she said. “It needs someone to call attention to it. It needs someone to champion for this as a cause.”

Kelly has become that champion.

Through the SRC, Kelly goes to local high schools to share her story and talk to kids about depression, cutting and suicide. She also speaks to classes at CSU.

She does this so that others might learn from her experiences.

“Sharing my story isn’t about getting attention,” she said. “It’s about educating people. If you are educated, you have the knowledge to get help for yourself or someone else.”

Signs of cutting

--Wearing long sleeves and pants, even during the summer
--Unexplained, frequent cuts
--Low self-esteem
--Difficulty handling feelings

If you know someone who might be cutting, don’t be afraid to talk to them. Tell them you think they are harming themselves and you are worried about them. Tell them you will stick with them and help them get through it. Go to appointments and support groups if it means they will go. If you don’t know what to do, don’t be afraid to ask for help.


Belfast Telegraph
February 16, 2005

Experts bid to tackle surge in self-harm
By Nigel Gould

Health experts were today meeting community leaders in a major bid to dramatically reduce soaring Ulster rates of suicide and self-harm.

They are aiming to curb a problem that is growing, particularly Belfast.

Latest shock figures show that every year around 1,000 people attend the casualty unit with self-harm injuries.

And in 2003 there were 132 suicides in the Eastern Health Board area alone.

The figures emerged during a one-day conference today organised by the North and West Belfast Health and Social Services Trust, in partnership with Mater Hospitals Trust.

It was attended by a range of professionals working in the field and those with personal experience of self-harm.

Others among the 150-strong delegation were carers and representatives from voluntary, community and statutory organisations as well as churches and education.

A spokeswoman said: “Research has shown that there is a strong correlation between self-harming behaviour and suicide.

“While not all people who self-harm will complete suicide there is evidence that of those who die by suicide a high number will have had a previous suicide or self-harm attempt.

“Self-injury and suicide are major concerns for community, voluntary and statutory organisation as well as individuals.”

Pat McCartan, chairman of the North and West Belfast Health Trust, said there was a need for a deeper understanding of why individuals self harm.

He said: “Self harm and suicidal behaviours are complex behaviours with multiple causes and require a co-ordinated range of support and treatment services.

“We want to use the day to begin to develop an action plan which will provide support to those engaged in self-injury and their families and carers. This conference will kick start that process.”

The conference is part of an ongoing suicide prevention strategy developed by Northern West Belfast Health and Social Services Trust.

Mr McCartan added: “The prevention of suicide is a key priority of the Trust and we have therefore put in place a co-ordinated and ongoing strategy to address this issue.

The bedrock of this strategy is working in partnership with our community and all concerned agencies to ensure awareness of the issues and access to support for individuals and families in crisis.”


The Kansas City Star
February 25, 2005

Parents, here’s the bloody truth
By Michelle Malkin

Have you heard of “cutting”? If you’re a parent, you’d better read up. “Cutting” refers to self-mutilation – using knives, razor blades or even safety pins to deliberately harm one’s own body – and it’s spreading to a school near you.

Actresses Angelina Jolie and Christina Ricci did it. So did Courtney Love and the late Princess Diana. On the Internet, there are scores of Web sites (with titles such as “Blood Red,” “Razor Blade Kisses” and “The Cutting World”) featuring “famous self-injurers,” photos of teenagers’ self-inflicted wounds and descriptions of their techniques.

The destructive practice has been depicted in films focusing on young girls and teens (such as “Thirteen”). There is even music associated with promoting the cutting culture.

In Britain, health-care researchers estimate that one in 10 teenagers engages in addictive self-injury. According to psychiatrist Gary Litovitz, medical director of Dominion Hospital in Falls Church, Va., the growing trend here in America has alarmed school guidance counselors around the country.

It’s not just delinquents and social misfits who are doing it. A concerned parent sent me the following letter recently:

“I just found out this week that my 14-year-old daughter is a ‘cutter.’ She has a 4.0 average, 8th grade, goes to a good school, and is well-liked by all who know her. She is popular, has two homes (mine and her dad’s) with supportive, loving families in each. Her own friends cut, too: four of them that I know of now between the ages of 11 and 14 ... As do her two cousins, ages 11 and 15.

“My daughter cuts herself with a safety pin. I found this out on her own personal website, which I discovered she had been hiding on a hidden account she used at another relative’s home. She had links to Web rings about cutting, suicide and broken hearts as well as images and poetry. Her friends all feature cutting/suicide links, icons and song lyrics as well.

“The counselor at her school told me this: At her middle school, ‘70 percent of the kids here cut or know someone who does. It’s cool, a trend, and acceptable. Boys do it as well but are more public about it. ... You’re not even the first parent this week: you’re the third, and just today a girl received stitches in the hospital for cutting herself so bad.’ ”

While many public schools deny the problem exists, public health advocacy groups are warning medical professionals of the cutting craze – and have even declared March 1 “Self Injury Awareness Day.”

This madness would not be as popular as it is among young people if not for the glamorizing endorsement of nitwit celebrities such as 20-something actress Christina Ricci. Several of the Web sites I researched highlighted the same quotes from Ricci describing her experiences with self-injury:

In an Us Magazine interview, for example, Ricci blabbed about various scars on her hands and arms: “I wanted to see if I can handle pain. It’s sort of an experiment to see if I can handle pain.” In another interview, she described putting cigarettes out on her arm and answered questions about whether it hurt: “No. You get this endorphin rush. You can actually faint from pain. It takes a second, a little sting, and then it’s like you really don’t feel anything. It’s calming actually.”

And in Rolling Stone, Ricci prattled about scratching her forearms with her nails and soda can tops: “It’s like having a drink. But it’s quicker. You know how your brain shuts down from pain? The pain would be so bad, it would force my body to slow down, and I wouldn’t be as anxious. It made me calm.”

It may be all fun and games for a Hollywood starlet like Ricci, but her mindless stunts have inspired countless young girls to carve themselves into a bloody stupor. Hollyweird strikes again.


Evening Times (Glasgow)
March 1, 2005

Plight of self-harming kids

Young Scots are being urged to share their experiences of self-harming as part of a nationwide investigation being launched today.

Shock statistics reveal more than 24,000 UK teenagers are admitted to hospital every year after deliberately harming themselves.

Now a joint campaign by the Mental Health Institute and the Camelot Foundation aims to tackle the emotional issues associated with the problem.

The launch coincides with National Self-Injury Awareness Day today.

Inquiry chairwoman Catherine McLoughlin said: “The inquiry wants to hear from young people, their friends and families. This research will help us to understand why more young people seem to be harming themselves, and what we can do to help.”

It’s thought self harming affects as many as one in 10 teenagers in the UK and the rates have increased dramatically over the past decade.

For an information pack visit www.selfharmUK.org


The Capital (Annapolis, MD)
March 7, 2005

Self-injury, mutilation can signal many things
By Molly Groo

Suppose your best friend had been acting moody and upset, and seemed withdrawn and secretive about her life. One day, she rolls up her sleeves, and you see scars on her arms. She confides in you that she has been cutting herself with razors for more than a year. Most likely, this would frighten and shock you. You may not understand why someone would deliberately do this, but the fact is, for many, it is a terrifying reality.

The phenomenon of self-injury (SI) has become “the new eating disorder” of our time, says school psychologist Stephanie Bachman. Self-injury is an intentional act of harming your own body, without the intention of committing suicide, or altering your body appearance. In simpler terms, self-injury (also known as self-harm, self-mutilation or self-inflicted violence) is intentionally hurting yourself with no apparent benefit. Self-injury includes cutting, burning, hitting, punching, or scratching your own skin, picking at wounds (or wound-interference), pulling out hair (trichtillomania) or, much less common forms, such as breaking bones.

Although there seems to be no benefit to hurting your own body, and the very idea can send shivers up your spine, there must be some plausible reason, as this behavior is more common than you think. An estimated two to three million Americans engage in a form of self-injury, according to www.coolnurse.com. So, why would someone want to hurt his or her own body? Ms. Bachman said self-injury is a release of depression or overwhelming feelings, such as stress. There may also be an underlying mood disorder, such as anxiety, depression or bi-polar disorder that may trigger self-harm.

There may also be a chemical factor in the way SI works. When the body is injured, endorphins are released, causing pleasant, calm feelings for the individual. Dissociation also plays a major role in the causes of self-injury. Dissociation is when the mind separates itself from the body, or separates emotions from actions, in order to protect the mind from painful or traumatic experiences. When in a dissociated state, a person feels as if they are not real, they feel little or no pain and they may not be able to recall experiences that occurred when in a dissociated state. Because numbness is an effect of dissociation, some may not feel pain when engaging in self-injury. An anonymous Anne Arundel student said, “I cut myself to feel like I’m alive. The blood reminds me that I am real, that I exist.”

A common cause of intentional self-injury is a history of being sexually, physically or emotionally abused. A study done in 1991 showed that nearly 50 percent of the people having self-injurious tendencies were victims of some type of abuse as a young child. However, self-injurious behavior does not necessarily mean that the individual was abused.

The reasons for self-injury are widespread, and every individual has their own emotions and problems. Self-injury may not be a “normal” way to cope with emotions because the idea of hurting oneself deliberately is taboo.

“It’s hard to understand,” says Bachman, “But, in a way, many people harm themselves through alcohol, drugs, overeating, eating disorders . . . you wouldn’t call an anorexic person crazy.”

You may know friends or family members who hurt themselves, or you may even engage in SI yourself, and the pain of self-injury is all too real to you. It may seem like the last thing you would want to do, but the first step to recovery from SI and learning new coping skills is by seeking help. You can call the toll-free number, 800-DONTCUT, to receive counseling to stop or ask a parent, teacher, youth leader, friend or any trusted, responsible person for help. Self-injury may cause a short-term relief, but it also causes scarring, built up emotions, and shame. Because endorphins are released during self-injury, it can be highly addictive.

This news may come as a shock, because, although there is no definite profile of a self-injurer, many people find that many teens who engage in SI appear to be healthy and happy.

“It’s the high-achieving kids . . . who are doing this . . . kids no one suspects”, says Bachman.

Common reactions to SI are anger, frustration, sadness and confusion. Many Web sites, such as www.self-injury.net/familyandfriends can help prepare someone to seek help for their self-injurious behaviors. Talking to a counselor, parent, teacher or someone responsible can help end the cycle of shame and self-abuse.


The Times Educational Supplement
March 18, 2005

Self-harm
By Sarah Jenkins

Research published in January by the national inquiry into self-harm found that a tenth of 15 to 16-year-olds had deliberately hurt themselves.

Last year, an NHS agency warned that self-harm was reaching “epidemic” proportions, with growing numbers admitted to casualty departments. The problem can be particularly difficult to tackle in schools, where teenage girls have been known to set up “cutting clubs,” and where teachers can be bewildered and disgusted by children who deliberately hurt themselves. So is it a growing problem or are we just becoming more aware of the issue? Can we dismiss it as teenage attention-seeking, or is it more deep-seated? And if a pupil comes to you with cuts on their arms, what’s the best thing to do?

What is self-harm?

Self-harm is the term used to describe deliberately injuring yourself. The most common method is by repeatedly cutting the skin (usually the arms or legs) with knives, razor blades or scissors. But some people burn or scald themselves, pull out hair or eyelashes, jump from heights, strangle themselves, swallow sharp objects or take poisons. Often they try a combination of techniques. And at the extreme end of the scale, self-harmers gouge out eyes or amputate nipples or fingers.

A particular problem for schools?

The figures for self-harm appear to be rising alarmingly, and young people are particularly at risk. Around 24,000 under-18s are treated in casualty departments every year as the result of self-inflicted injuries. But this may be only about a tenth of the number affected. Most self-harm happens in private, and many don’t seek medical help. Government research in 2002 found that 215,000 11 to 15-year-olds may have harmed themselves at some time, and recent figures from ChildLine show that calls about self-harm have increased by around 65 per cent in two years. Which all suggests that, in an average class of 20 pupils, two will deliberately harm themselves during their teen years.

Nor is it just a problem for secondaries to worry about: a report published in September last year by the national inquiry into self-harm found that children as young as five could be deliberately banging their heads or grazing their knees in the playground. “We don’t know if self-harm is growing or whether there’s just more people seeking support,” says Caroline Roe, secretary of the National Self Harm Network, “but around half of the people using our website are young people. So it’s clearly a massive area.”

Who is most at risk?

There is no one type of self-harmer. “It’s not all about kids dressed in black,” explains Dr Marcia Brophy, project manager for the national inquiry into self-harm. “We can’t just look for risk factors and then find a target group. There doesn’t seem to be a typical self-harmer, just a very wide range of ages, backgrounds and reasons for doing it.”

But the figures show that girls are more likely to self-harm than boys. A study of 15 and 16-year-olds carried out in 2002 by researchers at Oxford University’s department of psychiatry found that girls were four times more likely to deliberately hurt themselves. The rate is particularly high for girls living with one parent, and Asian girls, though no one is yet sure why. Self-harm is more common among those who have been bullied and is strongly associated with physical and sexual abuse. Recent evidence also suggests a strong link with poverty. But it’s not just an issue for teenage girls: figures collated by North Lanarkshire schools between 1999 and 2002, for example, found that at primary level boys were more likely to harm themselves than girls.

Why do it?

Just as there’s no simple formula for working out who might self-harm, so the reasons why young people do it are often complicated. The idea that it’s a thrill-seeking “cutting craze” is wrong; it’s much more likely to be connected to long-term distress. In a research project carried out in 2002 by the children’s charity NCH, all the young people interviewed said their self-injury was a result of childhood traumas including rape, unwanted pregnancy, bullying, parental divorce and bereavement. Exam stress, relationship problems, worries about sexual identity, perceived pressure from parents and lack of self-confidence can also play a part.

Contrary to popular myth, self-harm is not an attention-seeking ploy, or a cry for help. Most of it happens in private, in bedrooms or school toilets, and most young people are careful to cover the evidence. “It’s simply not a case of trying to get attention or indulging in copycat behaviour,” says Dr Brophy. “Our research shows that more than 90 per cent of cases are hidden and take place in isolation.” And despite the fact that, statistically, those who self-harm are a hundred times more likely to go on to commit suicide than those who do not, most young people who hurt themselves are not suicidal but are simply trying to cope with their feelings.

“Self-harmers are often bad at social problem-solving,” says Louise Carpenter, senior child and adolescent mental health officer for North-east Wales NHS Trust and self-harm specialist. “They tend to have a narrow view of the world and find it hard to look at the positives. So they resort to dysfunctional ways of coping.”

The feelgood factor There are, though, some common factors that help explain why young people self-harm. Many say it makes them feel more in control. Research has shown that one common trait, for example, is careful preparation and cleaning up; having tissues, antiseptic and plasters to hand and following a well-rehearsed routine. Others report feelings of overwhelming relief from their problems or suggest it makes them feel more alive.

But the reasons why someone starts self-harming may be different from why they keep on doing it. Just like alcohol or drugs, self-harm is addictive.

When we feel pain our bodies release endorphins, natural morphine-like chemicals that act as painkillers, which explains why many people say they feel euphoric after hurting themselves. Those who self-harm repeatedly could well be addicted to this rush of endorphins.

Keeping quiet

Young people who self-harm are often wary of going to hospital. And their fears may be justified. A report in 2004 by the National Institute for Clinical Excellence found that half of those seeking treatment for their injuries received no follow-up care or psychological assessment, while some NHS staff, especially in overworked casualty departments, were unsympathetic. In extreme cases, doctors stitched up self-inflicted wounds without anaesthetic.

But schools are not much higher on the list of sympathetic institutions.

Statistics from the Samaritans and the Centre for Suicide Research at Oxford University show that nearly half of young people who hurt themselves have tried to find help, but find it difficult to talk to teachers because they are too embarrassed, or feel their problem is not important enough.

Others are worried that a word in the ear of a favourite teacher may soon become a painful “official” experience: one girl found with lacerated arms was repeatedly asked to dredge up her worries for the PE teacher (who discovered the cuts), then her year tutor, pastoral head, head teacher, school nurse and, finally, a community paediatrician.

“It can be very difficult for a school,” says Louise Carpenter. “If a child is found with a knife in the toilets, for example, then obviously the school has to respond. But often these children don’t know how to describe what they’re feeling; they can’t talk about it, which is why they’re cutting themselves. And by taking away the knife, the school is also taking away one way for that child to cope.”

...or speaking out?

Despite not necessarily wanting to talk about their own case, a recent poll of young people on a self-harm web forum showed that 82 per cent of respondents would like self-harm discussed more openly in their schools.

And while some said it was a subject they had covered in PSHE, others said it was something they had learned about the hard way from their own or a friend’s experience. The national inquiry into self-harm points out that self-harm is rarely covered specifically by initiatives such as the healthy schools standard or the DfES healthy living blueprint, and has called for more open discussion and better training for teachers. But some experts warn that it can be a fine line between putting ideas into some pupils’ heads and providing necessary information. “Self-harm can be catching, so it’s important not to glamorise it,” says Amanda Allard, senior public policy officer for NCH.

“You have to try to normalise it, putting it into a spectrum with other behaviour that’s not necessarily so good for us, such as too much drinking.”

Schools that do tackle the problem often put staff training top of the list. Knowing how to spot tell-tale signs—is someone wearing long sleeves on a hot day?—and how to access local support services is a start. But it’s also necessary to prepare staff for the distressing nature of self-harm. “People often feel a lot of revulsion, but it’s important not to let these feelings show,” says Ms Allard. “Teachers must understand the complicated factors involved, and they need to be aware of just how common it is in school.”

You are not alone Because the issues underlying self-harm are so complex and varied, the “right” response will vary from case to case. “It should be unique to each person,” says Caroline Roe. “Some might need putting in touch with services such as helplines or web forums, some might want hands-on, face-to-face support.”

The National Self Harm Network finds its email support particularly popular with young people, some of whom might be blocked from using online self-help forums by parental control facilities on their computers. But its advice to schools is to start with the basics. “A bit of kindness and sensitivity is needed,” says Ms Roe. “It’s important not to see someone who self-harms as a problem, because that negativity will feed back. Schools need to take time to listen and to make someone feel valued. And whoever makes the intervention, even if they say the wrong thing in the right way, can have a massive impact on breaking the cycle of harm.”

Home truths

Most specialists believe the best way to deal with self-harm is to take a whole school approach that offers everyone (staff, students and parents) the chance to develop effective ways of coping with stress, anxiety and unhappiness. This may include anything from developing communication and social skills through “circle time” to finding ways of improving self-esteem and positive thinking. Peer support programmes, such as buddy schemes, are also important because many self-harmers prefer to confide in someone their own age.

But some schools report difficulties in getting help from parents to tackle self-harm. Sometimes they are unwilling to admit there’s a problem, and refuse to seek professional advice. And sometimes they don’t want difficulties at home—which may be one of the underlying causes of the self-harm—to come into the open. Just as importantly, many young people don’t want their parents involved. “Talking to parents can be really damaging,” says Caroline Roe. “Try taking time, taking a deep breath, and remembering that self-harm is about staying alive. Then you might not feel you need to break a confidence by calling in parents. And be aware of your limitations. If you don’t feel able to deal with a case, then seek support.”

In the fold Sometimes getting that support isn’t easy. Many schools lack funding for specialist posts such as a school nurse, while voluntary organisations can be overwhelmed with calls for help. Some LEAs are beginning to tackle self-harm in partnership with specialists such as educational psychologists and social workers, but training provision for schools and individual teachers is patchy.

There are, however, some basics any school can tackle while setting up a more structured programme of support. Making sure everyone’s aware of potential triggers, such as transition to senior school, options and exams, is a good start. Teenagers interviewed by the national inquiry into self-harm also recommended simple measures, such as covering self-harm in school magazines, providing a free telephone link to a support organisation or offering first aid equipment for students to treat their own wounds.

If a case is discovered, the important thing is not to focus on the injuries, but on the underlying problems; too much attention to the cuts and bruises might encourage someone to repeat the harming. Many specialists also advise trying to find alternatives to excluding a self-harmer, even if they are consistently found in school with a knife. “Schools sometimes assess the risk and decide to keep the child at home,” says Louise Carpenter, “but you are possibly removing them from their most important source of safety and security. For many young self-harmers, being part of the school network is what keeps them going.”

Not all bad news

There’s no easy “cure” for self-harm: the national inquiry collected evidence from 50 and 60-year-olds who still hurt themselves in times of particular stress. But experts suggest that our increasing willingness to talk about the problem should help young people feel less isolated and give them more information about support networks.

“There are so many stereotypes and wrong ideas,” says Dr Brophy. “If we can encourage even a basic understanding then young people will feel less isolated when they go for guidance. In the long term it means friends and family are more aware and open to talking about the problems underlying self-harm, even if they struggle to deal with the self-harm itself.” And many teenagers show impressive commitment, and ingenuity, in trying to stop themselves self-harming. Recent postings to a self-harm web forum included “115 things to do instead of self-harming,” advocating distractions such as playing online Scrabble.

Perhaps surprisingly, the 2002 report by NCH suggested we should be encouraged by the stories young people had to tell, concluding that “overwhelmingly, the message is that self-injury is a means of self-protection, not self-destruction”. Researchers quoted a conversation with a young person who helped them look at things in a new light. “People always look at the negatives of self-harm,” she said. “Whereas they should actually look at the positives, and the positive is that the person is still alive.”



Florida Times-Union (Jacksonville)
April 5, 2005

Explaining self-injury by youths
By Phillip Milano

QUESTION
Has anyone ever cut themself before? I have, because my mum accused me of stealing money from her. –Lou, 13, white female, United Kingdom

REPLIES
I’ve done it on and off about 10 years. When someone hurts you, hurting yourself is acknowledging you’re as bad as they say you are. You’re confirming it to yourself, and that’s not a good thing. I used to visualize my pain in that blood, and letting it out let out the pain. –Scarlet, 23, white female, France

I’m a cutter—shoulders, arms, stomach, anywhere. I couldn’t possibly talk to anyone about it, because that would mean my parents finding out, and I get so much pressure from them to be a certain way that they’d totally freak out if they found out. –J., 14, white female, Saratoga, N.Y.

About a year ago I began cutting myself on the palm of my hand, to prove to myself I could withstand physical pain so the emotional pain I was in wouldn’t matter. After several months of psychiatric treatment I’m all right, but I know a lot people who aren’t. I cannot urge you enough to see a doctor, or if I can’t persuade you of that, at least talk to someone you trust. –Alex, 18, male, Wisconsin

I cut because I want to. It is a rush to some people. It doesn’t mean you are deranged. Some people just like different things. –Ryan, 18, white male, New Orleans

I have been cutting myself for five years, and I did it because I felt like I was in control of something for once. –Tyeshia, 17, black female, New York

EXPERT SAYS
There’s more self-injury going on among the young than people realize, says Wendy Lader, clinical director of the 20-year-old S.A.F.E. Alternatives (www.selfinjury.com) at Linden Oaks Hospital in Naperville, Ill., designed to help those engaging in “repetitive self-harm behavior.”

Youths are more disenfranchised, see less of their parents, receive less mentoring, isolate themselves at their computers and video games and witness more uncensored sex and violence through the media than ever before, Lader argues.

“They are overloaded and have intense feeling states that they don’t know how to manage. They see self-injury as an immediate way to cope,” said Lader, co-author of Bodily Harm: The Breakthrough Healing Program for Self Injurers (Hyperion). “I call it spicing up the cover so someone might read the book.”

Lader has seen cases of people cutting themselves with razors; rubbing their skin with erasers; burning with cigarettes; cutting off digits; breaking bones; and even injecting feces, urine or the AIDS virus.

Parents shouldn’t accept implausible excuses for very precise and repetitive wounds, she said. And those who say cutting is self-expression fail to see that such actions won’t communicate much.

“Most folks will just think they’re crazy, which invalidates their emotional pain.”



The San Francisco Chronicle
April 19, 2005

Epidemic that cuts to the bone
By C.W. Nevius

Her parents wondered why she was always so cold. Their daughter insisted on wearing a sweatshirt, even on the sunniest of afternoons. It was strange.

Probably another one of those teen fashion things, they figured. That would explain why she pulled the sleeves down over her hand and stuck her thumb through a loop she’d cut in the cuff. Just another offbeat style trend.

But the girl, whose identity was withheld by her counselor for obvious reasons, was a textbook example of a bloody epidemic among American teenage girls.

When these girls are identified, often by concerned friends, their parents are horrified to find their arms slashed with parallel gashes, each 2 to 3 inches long, cut into their flesh with razors or knives.

It’s called “cutting,” the practice of self-injury and self-mutilation, and it is a scary trend among troubled teenage girls. If you have a daughter and this surprises you, it only confirms that you are out of the loop.

“I get a lot of calls from parents who are shocked,” says Kirsten Beuthin, a marriage and family therapist who practices in Oakland and San Francisco. “But it hasn’t shocked me in a long time.”

The number of girls who engage in cutting – and they are, overwhelmingly, girls – ranges from as many as 2 million nationwide, to, as one 1986 study by the University of Missouri suggested, 750 of every 100,000 Americans engaging in self-mutilation.

Based upon her 19 years as a therapist and school counselor at King Middle School in Berkeley, Jan Sells has a reply to those statistics.

“I would say the issues we are hearing about are the tip of the iceberg,” she says. “It has definitely become an epidemic.”

The first reaction, of course, is disbelief.

“Parents have never come across this,” says Beuthin, who says 70 percent of her patients are teenage girls and 80 percent of them have engaged in cutting. “It was never an issue 30 years ago.”

But the real stunner is who is at risk. It isn’t the girls you might think.

“They have everything,” says Sandra Lessenden, a Walnut Creek family therapist who works with teens in the upscale communities of San Ramon, Danville and Alamo. “They have a brand-new car as soon as they can drive and plenty of pocket money.”

The typical “cutter” is often a straight-A student and almost always a girl. Beuthin says kids between the ages of 13 and 15 are prime candidates, caught in the “mean girl” maelstrom of middle school and shaky self-esteem. And in her experience, they are generally from affluent, high-achieving homes.

The breakdown comes when the girl feels she is not measuring up. In an affluent culture where families subtly size each other up based upon which schools their children attend, what cars they drive and where they go to college, it can be devastating for a teenage girl to feel she isn’t making the grade.

“There is this sense of ‘why can’t I just be happy?’ “ Beuthin says.

The answer is complicated. Because their expectations and stress are too high. Because two-income families leave so-called latch-key girls alone at home after school. And because the family support system has vanished, along with the family dinner together every night. When frustrated, boys punch a wall or ride off a skateboard ramp; girls sit at home and brood. They are ashamed of their “failure” and of the razor marks on their bodies.

“Even now girls are socialized to be good and quiet and not speak up for themselves,” Beuthin says. “If you are cutting, oh my God, you don’t want to upset your parents or the community.”

That’s why they wear the sweatshirts. Sells says hooking the thumbs through cutouts in the cuffs keeps the sleeves from sliding down, even when they raise their arms.

Now, what you’d like to hear now is that cutting is a no-win game that hurts everyone. But there’s a scary secret to the practice, says Beuthin.

“I think it does make them feel better,” she says. “It is very short-term fix, just like using drugs, but it is the pressure-cooker theory. It has built up to the point, and they are so cut off, detached from their feelings, that this brings them back to themselves.”

If that’s the case, I have two questions: My God, what are we doing to our daughters?

And how can we stop?



Birmingham News (Alabama)
April 24, 2005

Self-injury usually done to cope with intense feelings
By Vivian Friedman

My 16-year-old daughter is deliberately cutting herself. She tells me that she does it because it feels good. I find this hard to understand. I have bribed her with offers to buy clothes for her or take her on a trip if she stops, but she says she can’t. Why is she doing this?

The frequency of self-injurious behavior – cutting, burning, and scab-picking – has increased dramatically over the last several years. I saw virtually none 20 years ago. It is, unfortunately, not uncommon now.

While to many parents it may appear to be an irrational or senseless behavior, most behaviors occur for a reason. Cutting is typically done to cope with intense and overwhelming feelings that the adolescent, usually a girl, cannot bear. It continues because the self-injurer feels a dramatic drop in tension after the cut and thus the behavior is reinforced. Behavior that is reinforced is repeated.

The reasons for self-harm can be grouped into three categories: regulation of feelings, communication of distress and self-punishment.

The first of these is the most common, and probably is present among all self-injuring adolescents.

Cutting or burning can be an attempt to bring the mind and body back to equilibrium in the presence of overwhelmingly intense feelings. Pain can serve to relieve emptiness and feelings of unreality. It can relieve rage that the victim cannot express outwardly. It can even serve as an alternative to suicide. Cutting is not, of itself, a suicide attempt. Some cutters, who feel emotionally empty, say they use cutting to escape numbness. They do it in order to feel something. The sight of their own blood serves as a tangible reminder that they are alive.

Some cutters use self-harm as a way to communicate feelings that they cannot convey in other ways. They want you to literally see their pain. When the self-injury is used to communicate, it is often seen as manipulative.

Cutters, if they are also anorexics and bulimics, may cut to maintain a sense of uniqueness. They feel that they disappear if they are not special. They have no internal sense of who they are. They require constant affirmation from others.

Some cutters harm themselves for punishment. This is often true of children who were abused. They make the passive experience of abuse active, by harming themselves. This is a “trauma re-enactment.” They feel they are bad and need to be punished.

Many cutters use pain to divert attention from issues and feelings that are too painful to bear. The physical pain is easier to tolerate than the emotional pain and takes its place. People who cut usually have failed to develop the ability to tolerate strong feelings. They have difficulty maintaining a sense of self-worth without constant approval from others. They have trouble maintaining meaningful connections to others.

Behavior therapy uses pain substitution to avoid injury. Squeezing ice cubes, snapping a rubber band or eating a hot pepper leaves no physical mark.

Antidepressant medication can alter the biochemistry that is thought to be a part of this illness.

Insight-oriented psychotherapy is essential in helping the sufferer to understand the source of despair and to fill the empty hole inside.



San Antonio Express-News
May 2, 2005

Out of pain they cut
By Marina Pisano

Meryl was 8 when she went out to the wooded field behind her apartment complex and tightly wrapped a piece of barbed wire around her body until it cut into her skin. Kids do get scrapes when they play, her mother remarked.

Allison first did it when she was 12, sitting alone in her room and using a safety pin to scratch away the skin on her arm. Mom didn’t notice, not until there were more cuts, and soon the girl had moved from her arms to fresh hidden skin.

Most cutters, or self-injurers, can recall that first slice and spurt of blood – the cut that brought them, not great pain, but enormous relief. And they can talk about the long sleeves, secretiveness, cutting rituals, embarrassment, guilt and blame that go with years of self-abuse, sometimes continuing far into adulthood. With enough trust and nonjudgmental acceptance, they might even bare their scars. But they make it plain, this is something private that they own, they control.

It seems unthinkable that anyone would deliberately and repeatedly attack her own body and inflict such pain and scarring on herself. But Chicago-based psychologist Wendy Lader, a nationally recognized expert in self-injury, says it is underreported and “more rampant than people think,” spreading across income and racial and ethnic lines.

In fact, Karen Cabral, a San Antonio therapist who specializes in treating self-harm, says, “I’m concerned because I’ve seen so much of this lately that I feel like it’s almost epidemic. In the last two months, I’ve had more cases than I’ve had in my entire career (15 years) – almost all of them teenage girls.”

Treatment is difficult. Allison is 15 now and her stomach, legs and back, which she has used as a kind of cutting board for three years, are covered with disfiguring scars, varying in size, thickness and redness, created by burns, razors, scissors, knives, tacks, you name it. The bruises from when she threw herself down the stairs have healed. But there is the nasty scar on her leg where she shaved off skin to raw flesh. She is in therapy and on medication for depression and anxiety and hasn’t cut herself for four months.

Meryl, 37, is also on medications and in therapy, but she still cuts herself three, four times a day, at home, driving or at work. She keeps a cutting “kit” of sharp objects in a black cosmetic bag and, having run out of places on her stomach and legs, she is now slashing her feet. Lately, she has had scary urges to cut her face and last week admitted herself to the hospital for treatment. “It’s so hard. I’m pushing 40, and I’m still doing this. It’s crazy,” says Meryl, who like Allison, asked that her real name not be used in this story.

It is estimated that, like Allison and Meryl, about 1 percent of the U.S. population uses cutting or self-harm – carving, burning, biting, bruising, breaking bones, pulling out hair and more – to cope with extreme emotional distress.

The numbers are higher in teens. Based on national figures, Debbie Healy, director of counseling and guidance for the Northside School District, estimates 7 percent to 12 percent of adolescents engage in cutting. She says school counselors see more of it in girls, but boys are self-injuring as well, punching walls or playing bruising sports.

“More girls may do it because they have a love-hate relationship with their bodies. And they have a harder time with direct anger. They’d rather hurt themselves than someone else,” says Lader, clinical director of the pioneering S.A.F.E. Alternatives (Self-Abuse Finally Ends) treatment program.

Lader has worked with children as young as 5, and others who made their first cut as adults. But more often, self-injury begins in middle school, a time of tremendous change in children’s bodies and emotions, the way they look, act and relate to others. Just when they need to feel accepted and OK, they encounter peer pressure, cliques and bullying and end up feeling frustrated and overwhelmed by school stresses. If they have an impulse-control problem, they turn violence inward rather than acting out.

“I think kids today are in a lot more psychological trouble,” Lader says. “More and more are experiencing feeling invisible, not being understood, not communicating. Stresses can set it off. Parents divorce, they break up with a boyfriend, they don’t make the team, and they do self-injury.”

Granted, some adolescents reach for a razor as an expression of rebellious, risk-taking behavior or to get attention or because celebrities, such as Christina Ricci and Johnny Depp, did it. It’s cool, and there are even Web sites that glorify it.

But the problem goes far beyond celebrity-driven fad. As Allison recalls, “When I got to middle school, a lot of my friends were doing it, and I’d seen things about it on TV. But I don’t do this because Angelina Jolie did it. And I don’t do it to get attention. The last thing I want is attention.”

Specialists distinguish between typical cutting and suicide attempts, although in some, the behavior may develop into a suicidal act. It is actually a bizarre coping strategy in which the relief is temporary and the scars, in many cases, permanent. “I don’t do this to die,” says Meryl, a slim, attractive blonde. “I do this to survive.”

Low self-esteem and the inability to talk about emotions are factors. In some instances, there is a history of sexual abuse or abandonment. Psychiatrist Karola White, who treats troubled children at Methodist Specialty and Transplant Hospital, says self-injury can signal a psychiatric illness. It is listed as a symptom of borderline personality disorder. Or there could be major depression, bipolar disorder, psychosis or post-traumatic stress disorder.

As Karola explains, in self-injury, the brain responds by releasing endorphins, the body’s natural morphine supply and a valuable survival aid. Endorphins block pain and produce a pleasant, peaceful sensation. In fact, she says, “Some who get an endorphin release from physical pain can become addicted to it, like an opiate addiction.” And like a drug addict, the cutter eventually needs do more and deeper cutting to get endorphin release from painful emotions, with cuts getting so deep they might be life-threatening.

“In some cases, kids dissociate when they cut. They zone out, numb out, go away, so they don’t have to feel the pain,” Cabral says. “But this is very complicated. Every kid doesn’t cut for the same reason. Some are cutting to let out feelings, some are cutting to let out anger or to punish themselves.”

Allison, a pretty girl with brown hair and a flawless complexion – she never cut her face – says cutting became addictive for her. Last May after a hurtful incident with a boy, she cut her wrist so deeply she had to be rushed to the emergency room for stitches. Doctors quickly recognized it wasn’t a true suicide attempt, but she was treated for depression at the hospital for four days.

As Allison recounts it, the self-injury – done at home, in school, at the movies and at friends’ homes – got progressively worse as she struggled with anxiety and bad feelings. Before cutting, she says, “I used to have panic attacks. I used to cry a lot at the least little thing. I finally wanted to not have any emotions or feelings for pain. I wanted to feel numb. With cutting, I didn’t cry. I didn’t feel anything. With bruising, it was like an ocean wave going over me. Peaceful. Sometimes I’d wish I hadn’t done it. Sometimes, I was glad I did it.”

Meryl’s story is more harrowing. She grew up in a dysfunctional family surviving some frightening years in which she was sexually abused and raped and blacked out certain experiences. Her father was violently abusive and died in prison. Her mother remarried, but she suffered from schizophrenia, and for years, Meryl and her brother played the role of parents and cared for her.

Meryl stopped cutting for seven years as she and her first husband had three children, but she soon started up again. They divorced after 10 years, and the children live with him. A second marriage to an abusive man ended as well.

Her kit of razors and needles always lies ready. “I cut myself pretty deep,” Meryl describes her ritual. “You want to feel something. Hey, I’m alive. I’m here in control. But for me, it’s not the amount of cutting, how deep, so much as the blood. Once I see blood, it releases whatever is bothering me – like I’m cleansing myself. After, you clean yourself up, and you feel guilty. It’s like a cycle.”

Whether in a child, teen or adult, cutting shouldn’t be dismissed. Lader has seen patients die from the consequences of self-injury. Extremes run from dangerous infections to mutilation and amputation of body parts and ingestion of harmful chemicals. One patient, a nurse, injected herself with the AIDS virus.

Blaming and shaming the cutter are not advised. Often therapy must address a cluster of issues, including eating disorders, substance abuse and trauma. Doctors and therapists usually treat the underlying depression, anxiety or other disorder and employ journaling, contracts and self-esteem-building tools to help patients gain self-control. A combination of cognitive behavioral therapy and analytical treatment can be effective.

Some schools have seen a rash of cutting and even groups of friends doing it. Healy says counselors work with cutters individually, not in groups, to avoid the “contagion effect.”

“Cure is not exactly the word for what happens,” Cabral says. “The goal is to not automatically use cutting as a coping mechanism when you’re under extreme stress.”

Meryl has been diagnosed with bipolar disorder and obsessive-compulsive disorder, and recently her therapist has found evidence of multiple personality disorder too. Through it all, she works and keeps her journal. But scars, even covered with tanning cream, make intimate relationships tense. “I have backed off from men getting close to me at all,” she says. “The last person I was seeing, I kept my clothes on, and that ended that relationship. Maybe you use it to protect yourself.”

Allison, who maintains good grades in school, says medication is helping, and she’s forging self-esteem. Still, there are the scores of scars and keloids – excessive scar tissue – on her young body. “The only way I can go swimming is fully clothed in the dark. And I love swimming,” she says with wistful humor.

At one point in the conversation, she hopes that something can be done about the scars, some treatment. Later, she reconsiders.

“Maybe it’s kind of good to have the reminders.”



Aberdeen Press and Journal
May 11, 2005

Self-harm can be recurring behaviour
By Cameron Brooks

A new study on self-harm has found some sufferers may never be free from an urge to hurt themselves. Research published yesterday showed patients took comfort from knowing they had their favourite cutting instrument stored safely away for future use if necessary.

The findings were based on interviews with 10 people aged between 29 and 40 who were currently self-cutting or had self-injured in the past.

The research was conducted by Dianne Cameron, who has just completed a PhD on the subject at the department of nursing and midwifery at Stirling University. It is aimed at exploring the experiences of people who self-injure in order to identify and understand the processes involved.

Ms Cameron said: “People may be free from cutting in the sense that they have not injured themselves for weeks, months or even years however this does not mean that they are free from the urge to cut. Knowing that they had access to a cutting tool if needed appeared to give the participants a feeling of comfort.” According to the See Me campaign, a 2002 study showed 13% of 15 to 16-year-olds had self-harmed – amounting to more than 17,000 people in Scotland.

Rates of self-harm in the UK have increased over the past decade and are thought to be among the highest in Europe.

More than 24,000 teenagers are admitted to hospital in the UK each year after harming themselves deliberately.

Ms Cameron said she found that people who self-injure appeared to face a paradox of finding it very difficult to live with self-cutting, while simultaneously facing the challenge of living without the behaviour.” Interviewees shared their experiences of self-injury emphasising both the meaning and function of cutting for them, and the struggle they face living with the behaviour.

The findings emphasised that it was not only the act of cutting which needed to be understood, but also the urge to cut within the context of people’s everyday lives. Ms Cameron added: “It is necessary to look beyond the cuts and scars which people inflict upon themselves in order to discover how and why they engage in self-cutting.

“Although the participants at times found cutting and its consequences difficult to tolerate, some also expressed a need to cut, to help them cope with negative feelings and distressing past experiences.”



The Express
May 21, 2005

Self-Harm Capital for Troubled Girls; Depression and Suicide Attempts Rife In Edinburgh
By Brian Swanson

DEPRESSION and bullying are driving Edinburgh schoolgirls to harm themselves with knives or overdose on pills at a greater rate than anywhere else in Europe.

Yet the majority of them do not seek help and are not seen by social workers, a conference heard yesterday.

The United Kingdom has the highest rate of self-harm among teenagers in Europe with nearly one in 10 owning up to hurting themselves. But the survey, carried out by a team from Edinburgh University’s Law Department, found levels of self-injury among teenage girls in the city were significantly higher than anywhere else in the UK.

Dr Lesley McAra, a lecturer in criminology, revealed the alarming figures to educationalists attending the Problem Girls conference in Edinburgh.

Researchers who interviewed children from 23 local secondaries, eight independent schools and nine special needs schools discovered that rates of self-harm are significantly higher among girls than boys.

About 28 per cent of the fourth-year girls questioned admitted to some form of self-harm compared to 12 per cent of boys from the same age group.

Dr McAra said: “Around the age of 14 and 15, one in three girls and one in eight boys reported that they had self-harmed. This compares with one in 10 in the UK.”

She added that during the survey, 169 fifth-year girls said they had attempted suicide compared with 57 fifth-year boys.

She said: “That makes up five per cent of the total and that to me seems an extraordinarily high figure.”

But, according to the Dr McAra, the girls most needing help and support were unknown to social workers or care agencies. She added: “The human nature of much self-destructive behaviour means that girls often slip through the net of the case system.”

However, Dr McAra said her research did not suggest that the Capital was in the grip of a teenage self-harm epidemic.

Dr McAra said: “The reason for the figures being so high was that the rate of disclosure was much higher than anywhere else in the UK.”

The study, which began in 1998, follows a single year group of 4,300 young people who began secondary school that year.

Each year the children are asked questions about what happened to them in the previous 12 months for the Edinburgh Study of Youth Transitions and Crime.

Researchers hope to follow the group’s progress until they reach 30.

Dr McAra added: “The study covers many different aspects of their lives as well as crime and delinquency.

“Edinburgh is such a varied city that we hope the results of the study can be used to help young people elsewhere in Scotland and the UK, as well as within many other countries.”



National Post (f/k/a The Financial Post) (Canada)
May 25, 2005

‘It’s cool’ to cut: ‘If you do it, you’re dark and mysterious,’ says a Toronto private school girl. But for some, self-mutilation is not so simple
By Celia Milne

Cutting classes isn’t the only kind of cutting that’s going on among teens these days.

It’s not uncommon now for troubled teenagers to cut themselves repeatedly with razor blades or shards of glass, leaving rows and rows of angry scars on their young skin.

Like anorexia or bulimia, cutting terrifies parents, baffles guidance counsellors and challenges doctors. While cutting may start as a quick fix for stress or as a way to fit into a peer group, it can become one of the toughest addictions known to medicine.

Self-mutilation has been around forever, according to Dr. Armando Favazza, a psychiatrist at the University of Missouri medical school in Columbia, who wrote Bodies Under Siege. What’s new is that it has taken hold in the teen community. “It’s cool,” says Caitlin (not her real name), a 14-year-old girl who attends a private school in Toronto.

She says she has known six cutters in the last two years. “If you do it, you’re dark and mysterious.” How does she know these girls are cutting? “They reach up and you see the cuts, usually on their wrists. Or their skirt moves and you see their thigh. Or they change for swimming and you see these big, long, nasty things on their stomach.”

What is especially alarming, Dr. Favazza says in a phone interview, is the camaraderie of cutting. Cutting clubs are developing at junior-high and high-school age, and there are plenty of chat rooms on the Internet where kids can discuss their cuts. “Kids who get together almost treat it like a joke. They have the cut-of-the-month club, where they meet for 10 or 15 minutes to show off their latest cut,” says Dr. Favazza. “They do it for the glamour; it makes them different; they get attention, and it ticks off their parents.

In 2003, nearly 70% of U.S. counselling centre directors reported increases in cases of self-injury such as deliberate cutting or cigarette burning of body tissue, according to an article in Psychology Today. And a recent Oprah television show (April 26) profiled the torturous journey of a teenaged girl who worked her way out of her cutting addiction, with the help of family and therapy.

While it is not known what percentage of teenagers cut themselves, estimates indicate that between two and eight million Americans have deliberately harmed themselves. Canadian estimates are based on surveys in the U.S., such as one that revealed 12% of college students had at least once in their lives deliberately cut, burned or similarly harmed themselves.

Fashion accessories for cutters include wrist bands, arm warmers, panty hose worn like sleeves around their forearms and elastic braces, designed to say the wearer is hip and a little dangerous. “Our school is known for cutting,” says Caitlin with bravado, referring to her private girls’ school, “whereas [another school close by] is known for eating disorders.” Her tone implies that anyone uncool enough to be alarmed by this should get a life.

“It’s a symptom of our times,” says Matthew Selekman, a social worker in Evanston, Illinois, who works with teens who cut. He visited Toronto this month to teach a group of doctors how to care for adolescent cutters. Our society is a ripe environment for this kind of behaviour, he says. Teenagers are often under immense pressure not only to fit in with their peer group, but to be overachievers as well. And now, more than ever, their parents are absent. Often they are both working long hours. “Teens want to be loved and validated,” he says, “but they feel ‘dissed’ by their parents. Cutting becomes like a friend.”

Kids who cut are those who are subconsciously looking for an outlet for their anger, pain, anxiety, emptiness or fear. Research shows 62% of cutters have been abused as children. Many are from broken homes or families where physical appearance and material possessions are stressed more than thoughts and feelings. For girls – who self-harm in greater numbers than boys – cutting can be a reaction against expectations to have perfect bodies. “It’s too much pressure,” said a girl interviewed by Teen Vogue magazine in its recent expose on cutting.

Another plausible theory on why cutting is popular, says Dr. Favazza, is that kids live in a world of virtual reality and need to feel their own lives more sharply. They cut so they can feel.

Most kids who cut themselves are not trying to end their own lives. Rather, says Dr. Elizabeth Baerg Hall, an adolescent psychiatrist at the Mood and Anxiety Disorders Clinic of B.C. Children’s Hospital in Vancouver, cutting is “faulty problem-solving.” Many cutters are suffering from emotional pain and have difficulties with the expression of this pain. Kids cut to feel pain on the outside rather than the inside. Many describe the sight of their own blood as soothing.

For one cutter who writes about it on a website, it is the perfect escape. “As soon as the blood appears, our world stops for the moment.”

Teens who cut sporadically can become hooked. Whether or not the behaviour becomes addictive depends on a complex mix of brain chemistry and environment. “Some in the [cutting] group will lose control and once they lose control their lives will be ruined,” says Dr. Favazza. “Pretty soon they have scars all over their bodies and they look like hell. It can go on for decades.”

In fact, says Toronto psychiatrist Dr. David Kreindler, “Patients who repeatedly engage in self-harm are among the most difficult and challenging patients to manage in all of medicine.” Dr. Kreindler works in the division of youth psychiatry at Sunnybrook and Women’s College Health Sciences Centre in Toronto.

Those who show off their scars because they see them as hip are not yet out of control, says Dr. Favazza. Hiding scars is a sign the behaviour is out of control. “People who can’t control it don’t show it off,” he explains.

Serious cutters can drift back and forth between cutting, an eating disorder, kleptomania and/or alcoholism. Diana, Princess of Wales, suffered from both bulimia and cutting, according to the biography Diana: Her True Story by Andrew Morton. Like Diana, cutters can be quite high functioning. “Self-injurers are often bright, talented, creative achievers – perfectionists who push themselves beyond all human bounds, people-pleasers who cover their pain with a happy face,” writes journalist Marilee Strong in her book A Bright Red Scream.

If you suspect your teenager is cutting, you should try to support her by talking about it, without judging. Dr. Kreindler says that it is okay to do this. “Can asking about self-harm cause it? No. The same way asking about suicide won’t cause it. Feel free to ask.”

If the answer is yes, you will need the help of several people. If the teen is actually trying to commit suicide (rarely the case in cutting), the situation should be considered an emergency, and you should call the hospital or your community’s youth psychiatric emergency services. If the teen is cutting to relieve emotional distress, you will need to find a good therapist who has dealt with this before. Dr. Baerg Hall has had success treating these teens by “building a web around the kid.” Kids under caring scrutiny, she says, are less likely to cut.

Besides parents, other trusted supporters can include the teacher, the guidance counsellor, the family physician and friends. “I hear time and time again that the kid stops cutting because people found out. I love it when a kid turns their best friend in.”

Dr. Baerg Hall suggests twice-weekly visits to a family doctor or a psychiatrist to give the child the message that they are being supported. “Instilling hope, having kids feel there is a workable plan, knowing that it is treatable,” are all beneficial messages, she says. The antidepressant drugs selective serotonin reuptake inhibitors (SSRIs) have shown promise as a treatment. Therapists are also using a treatment called dialectic behavioural therapy (DBT) – designed to increase interpersonal skills and increase the child’s toolbox of self-management approaches – with success. Essentially, teens need to learn alternative tools for coping with the stressors in their lives.

Meanwhile, their “community of healers” as Matthew Selekman calls it, provides caring watchfulness. Mr. Selekman tries to include in therapy not only friends and parents, but also an “inspirational other,” usually a trusted adult from outside the home. “Working with kids who cut requires time and compassion.”

“A lot who try to help them don’t understand it,” admits Dr. Favazza. Cutters’ remarks on a chat site certainly bear this out. Busy doctors “pull attitude” on them, they say, and make them feel like they’re a waste of time because they have inflicted these cuts on themselves. Cutting may be purifying for the cutter, but for the observer – including caregivers – it is grotesque and intimidating.

And sadly, it is creeping into the mainstream. As Caitlin says, “When you first see it you don’t expect it. I wouldn’t be surprised now; I’ve seen it so often.”



The Toronto Sun
May 29, 2005

Unkindest Cut: Frightening Practice of Self-Mutilation Has Health Workers Worried
By Linda White

IT’S A disturbing behaviour that goes by any of a number of names: cutting, self-injury, self-abuse, self-mutilation. Though it’s impossible to determine if the number of teens cutting themselves is on the rise here, educators and health care workers say it is definitely more visible than ever before.

“I’m very sure you’re seeing it throughout Durham, across Ontario and beyond,” says Dr. Mary Morrison, chief psychologist for the Durham District School Board. “It’s not a brand new issue for teens, but it’s good adults are finding out more about it, because they can help.”

It’s defined as a deliberate, repetitive, impulsive and non-lethal harming of oneself. And it does pose risks, warns Christina Morino of the Durham chapter of the Canadian Mental Health Association. “Most of the kids doing this don’t have the intent of taking their lives, but if they cut too deep, they could die.”

The behaviour is more common among females than males and though it’s most common among teenagers, it’s not limited to adolescents. Tools of choice include razor blades, scissors and broken glass. Cutting is only one form of self-injury. Others include carving, hair plucking, biting, burning and abrasions.

“It’s a myth these kids do this to seek attention,” says Morino. “Most often, it’s a mechanism for coping with some sort of mental distress. Sometimes, tending to their wound is the only self-love these kids will give themselves ... The biggest myth is that it indicates a suicide attempt.”

In Uxbridge, doctors, educators and social workers have come together to raise awareness of the issue and to support cutters. “It very much becomes a group behaviour,” says Dr. Kathy Chapman, an Uxbridge physician who became alarmed last fall by an increase in the number of patients injuring themselves.

“I talked to other doctors in town and they were observing the same thing,” says Chapman. She spoke to teachers at Uxbridge Secondary School so they knew what to watch for and how to help. These kids have told her cutting gives them a sense of control and that physical pain is better than emotional pain.

“These kids are honest. You ask them if they’re a cutter, they will tell you. You won’t make them cut if you ask them,” says Chapman.

Cutters don’t want to be judged, says Uxbridge guidance counsellor Carolyn Allen. “They complain about parents and friends who tell them what they’re doing is stupid,” she says. “The students I’ve gotten to know well aren’t really reaching out for help. They are hurting so badly emotionally that they feel a sense of relief when they cut themselves. It allows them to forget that pain.”

Cutters often injure themselves on their arms and thighs, but some girls cut on their bra or bikini line so their injury is better hidden. “Students needs to talk about their triggers,” says Allen. “Talking about those deep issues can make it a little bit worse for awhile, but then we celebrate the number of days they go without cutting.”

The school hosts a self-injury support group called The Razor’s Edge. Co-facilitator Amanda Warner is a former Uxbridge student who shares with students her story of cutting and recovery. “Cutting can be addictive,” says the 20-year-old. “It’s almost like a high. Once you stop, you are in recovery forever. I call our group a ‘first step group’. I encourage them to seek counselling.”


The Herald (Glasgow)
May 30, 2005

Olympic champion reveals she slashed her body while in despair

KELLY Holmes, Britain’s Olympic heroine, yesterday revealed she slashed her body with scissors during a two-month self-harming ordeal just a year before her double gold victory in Athens.

The 800 and 1500-metre champion said she began cutting first her wrists then her chest in despair over a series of injuries which she feared would ruin her medal chances. She said in a Sunday newspaper: “I even thought brief ly, just for a moment, about pressing the scissors harder in my wrists.

“It wouldn’t have taken much and all the worry would have been over. I thought I was cursed. It’s the lowest I’ve ever, ever been.”

The 35-year-old runner, who was made a dame in the Queen’s New Year honours, began self-harming 14 months before her gold medal victories last August.

At the time, she was training with Maria Mutola, her coach, in the French Pyrenees. Dame Kelly was in constant pain from a damaged calf and tissue strain and was unable to run properly until, eventually, she sought professional medical help.

Marjorie Wallace, chief executive of Sane, the mental health charity, said self-harming was a problem approaching epidemic proportions.

Sane’s helpline receives thousands of calls from people who find that cutting themselves can release “intolerable mental pressures.”

Ms Wallace said: “We believe that self-harm has become almost an epidemic, particularly among young people who are damaging themselves in increasingly disturbing ways.”

Self-injury can take many forms and is prevalent among young people, but appears to affect anyone who is under significant stress, is depressed or going through great emotional pain.

Its most common form is cutting – the wounds are not usually deep, but in some cases they can be. Some people burn, punch or hit their bodies against something, or pick their skin or pull out hair.

Describing the problem, the Bristol Crisis Service for Women said: “Self-injury seems to be more common among women. This is partly because men are more likely to express strong feelings – such as anger – outwardly.

“Many women who self-injure believe they are the only person who does this. Fear and shame may force women to keep self-injury secret for many years.

“This means that no-one knows how big the problem really is. Our experience shows that where it is acceptable to talk about it, many women will say that they have self-injured at some time.”