Bangor Daily News (Maine)
June 4, 2005

Cutting too deep; Self-injury on the rise among young Mainers
By Jackie Farwell

The first time she did it, Heather slipped off to her grandmother’s empty beauty shop. She was 13, overwhelmed and struggling with the death of her grandfather, one of the few people in her life she could trust.

She had been closer to “Pepe” than to her own parents and watched for 16 days as he degenerated after heart surgery, eventually to the point where he could no longer talk.

The morning that the family agreed to turn off Pepe’s life support machines, Heather returned to her grandmother’s house and stole away to the attached beauty shop while family members congregated in another room.

She selected a razor blade from a box that her grandmother used for cutting hair, sat in the shop’s swivel chair, and ran the edge along the underside of her arm until blood surfaced on her skin.

“It seemed like it made everything better,” Heather, now 17, said in a recent interview, her blue eyes heavy with black eyeliner.

She asked that her last name not be used.

“It really didn’t hurt. It stung a little bit,” she said about her first time cutting.

Heather had made a discovery that teens across Maine and the country are making with alarming prevalence: Cutting herself was a way to relieve emotional pain, at least temporarily.

The troubled teenager was practicing self-injury, a behavior that is not new but seems to be on the rise, particularly among teenage girls.

“This is an exploding phenomenon,” Barent Walsh, co-author of the book Self-Mutilation: Theory, Research and Treatment and executive director of The Bridge of Central Massachusetts Inc., a nonprofit human service agency, said recently.

Walsh has written and lectured on the topic of self-injury throughout the nation. He spoke to local professionals last November in Bangor.

“Self-injury is an epidemic right now,” Walsh said. “It’s definitely on the rise.” Experts estimate that habitual self-injurers represent nearly 1 percent of the population, according to the National Mental Health Association.

Many experts agree with Walsh that self-injury is on the rise, though some argue that because the disorder is now better identified and understood, it’s suddenly getting more attention.

Add to that the admissions by celebrities, including Princess Diana, actor Johnny Depp and rock star Marilyn Manson, that they bear the scars of self-injury.

Local mental health professionals cite media influence among the reasons for a rise in cutting among teenagers, including graphic Internet sites that glorify the behavior. Increasing pressure from parents and peers to be thin, popular and successful drives many to self-injury, professionals say.

Characteristic of many who self-injure, Heather is a white female who began cutting during puberty. She also is a survivor of abuse; she was sexually assaulted at 15 by a former boyfriend, she said.

Nearly half of those who self-injure report having been physically or sexually abused during childhood, according to the National Mental Health Association.

Though men do self-injure, females are much more likely to engage in the behavior. Men tend to express emotions outwardly, sometimes with violence, while women have been socialized to direct their feelings inward, experts note.

Even outwardly successful girls sometimes resort to hurting themselves, Pam Braley, a clinical therapist and licensed social worker at New Horizons for Young Women, a camp near Lincoln for troubled adolescent girls, said in a recent interview, adding that cutting has surpassed eating disorders as the epidemic of female adolescents.

“The ones at the top get missed,” she said. “Nobody thinks they have a problem. They look fine, they’re getting good grades.”

Yet they cut themselves.

Self-injury: the disorder

Though cutting one’s wrists and arms often is associated with a suicide attempt, self-injurers rarely want to die. In fact, they use the behavior to regulate mood.

Some call self-injury the “opposite of suicide.” Instead of giving up, those who do it are at least making an effort to cope with their pain, they claim.

Self-injury is defined as the act of deliberately harming or altering the body to the point of causing tissue damage, without the conscious intent to commit suicide. Along with cutting, self-injury includes picking, scratching or rubbing off the skin, bone breaking and trichotillomania, or compulsive hair pulling.

Other commonly used terms for the disorder are self-harm, self-mutilation, self-abuse and self-inflicted violence.

In the psychiatric community, the behavior generally is considered a symptom of other disorders – particularly borderline personality disorder – rather than a diagnosis in itself. For that reason, updated statistics on the prevalence of self-injury are hard to come by. Experts agree that the disorder is pervasive, and in recent years its victims have become younger and spread throughout the general population.

In years past, self-injury primarily was the province of patients with serious psychiatric disorders, according to the experts.

Statistics on self-injury in Maine are all but nonexistent – lumped together with data on suicide – and local information is anecdotal at best. In Massachusetts, however, some figures are available.

There, 18 percent of high school students reported in 2003 that they had intentionally injured themselves at least once in the previous year, according to that state’s Youth Risk Behavior Survey, part of an annual national study performed by the Centers for Disease Control and Prevention.

The national survey includes questions on smoking, sex and suicide, but Massachusetts is the only state to include a question on self-injury in its survey, according to the most recent information available.

In Maine, interviews with anyone who deals with teenagers, including school and mental health professionals, suggest self-injury is happening everywhere.

Guidance counselors, school social workers and nurses from high schools in Bangor, Belfast, Houlton, Calais, Newport and Millinocket all have reported dealing with students who harm themselves.

The principal of Great Salt Bay School in Damariscotta in May sent a letter to parents of seventh- and eighth-grade pupils notifying them of an increase in reports of cutting at the school. Later that month, the school convened a public discussion about cutting.

A conference held Friday in Augusta by KIDSLAW, a gathering of Maine professionals who work with youths, with support from the Maine Attorney General’s Office, included a presentation on self-injury.

“We see lots of it, lots of it. More girls than boys by a pretty wide margin,” Donald Mendell, a school social worker and guidance counselor at Nokomis Regional High School in Newport, said recently.

Students at Nokomis have been caught using hairpins and paperclips to hurt themselves, he said.

“Anyone working with adolescents has been up to their waist in it for a long time,” Mendell said.

In Old Town, school resource Officer Debbie Holmes said that over the course of this spring, four or five girls have told her their friends are cutting themselves.

“I’m hearing so much more about it,” said Holmes, an Old Town police officer. “It just seems like it’s much more prevalent, more accepted, like it’s the thing to do.”

Why some hurt themselves

Peer pressure can play a role in self-injury, particularly among prepubescent youths and teenagers eager to fit in and please their friends. The behavior has even begun to creep into the lives of children as young as 11 or 12.

“It’s so prevalent in middle schools,” Walsh said, adding that half of the attendees at his self-injury seminars in Bangor, Freeport and Portland are from public schools. “There’s definitely a major issue in middle schools right now.”

Those who hurt themselves to please others, however, cause the least concern for mental health professionals.

“That’s in a sense almost the mildest form, because it’s something that they simply don’t want to engage in, and they’re engaging in it because of a peer group,” Eric Kuntz, a child and adolescent psychologist at Acadia Hospital in Bangor, said in a recent interview.

People who self-injure as a way to cope with difficult emotions are most at risk, Kuntz said. Underlying trauma motivates their behavior, and they are prone to other dangerous behavior, such as eating disorders, substance abuse and risky sexual behavior, he said. Also of concern is the ever-present risk of infection from unsanitary cutting tools and accidentally cutting too deeply, Kuntz said.

Of patients who use self-injury as a coping mechanism, two distinct groups exist: those who self-injure to relieve emotional pain, and those who do it to escape a sense of numbness or loss of touch with reality, Kuntz said.

Their motivations for attacking their bodies are opposite.

The former group tends to use pain as a way to release feelings of anger and frustration, Kuntz said.

“They say that if it did not hurt, they wouldn’t do it. So they recognize the pain, it does hurt, and they will say, ‘That’s why I cut,’” he said.

The latter group, those who regain touch with reality through cutting, say they don’t even feel the pain. For them, seeing their own blood proves that they still exist, when otherwise they feel numb and disconnected from the world.

“In the act of cutting, they’re actually establishing where they stop and the rest of the world starts,” Kuntz said. “A lot of them will say, ‘If it hurt, I wouldn’t do it.’” Heather suffered both facets of the self-injury experience, cutting herself both to relieve tension and, later, to escape a feeling of numbness.

“It hurts, but it doesn’t hurt,” she said. “I really didn’t know how I was feeling. It was kind of an adrenaline rush.”

Heather’s state of tension was intense, she said, worsened by a bad day at school or a fight with her parents. She described feeling like a potato cooking inside a hot oven without holes to release the stream.

Cutting for her was pricking that potato with a fork, she said.

Feeling the release gave Heather a high, she said. Many cutters describe becoming dependent on the rush of endorphins released into their brains when they hurt themselves, said Braley of New Horizons for Young Women.

“It becomes almost addictive. They like to look at the blood, they like to look at the cuts. They like to compare stories with their friends. They get on the Internet and find a lot of support,” Braley said.

Though some cutters swap “war stories” about their wounds with friends, many are embarrassed by their behavior, Braley said.

“Some of them have great shame and they don’t let anybody know. Then their parents find out and then they freak.”

Finding out

It wasn’t until her freshman year at Old Town High School that Heather’s parents found out what their withdrawn and sometimes violent daughter was doing to herself. By that time, Heather’s grades had slipped and she had become a heavy drug user, using cocaine, Ecstasy and taking prescription drugs, such as OxyContin and Percocet.

By that point, Heather was cutting herself deeper and more frequently, sometimes every other day, she said. She began using anything she could get her hands on; knives, broken glass, mirrors. Usually, she did it alone in her bedroom at night, she said.

“If I had a bad day, I’d go home and do it again,” Heather said.

In eighth grade, the year after her grandfather’s death, Heather started burning her hands and arms with the hot metal on her pocket lighter, she said.

“I was scared that I wasn’t going to stop,” she said.

In one incident that year, Heather cut herself while in the bathtub, she said. Startled and frightened by the sight of her blood spreading through the water, she got out of the tub, dressed herself and finally told her parents about her secret ritual.

“I said, ‘I think I have to go to a hospital,’” Heather said. “At first my dad didn’t believe me. I had to show him my arms.”

Heather was rushed to Eastern Maine Medical Center in Bangor, treated and sent to a rehabilitation program in Waterville. After participating in three weeks of therapy, and being diagnosed with bipolar disorder, she returned home.

“It took a good six to eight months before she could spend time alone,” Heather’s mother, Laurie, said in a recent interview.

Though they’d witnessed her violent temper, Heather’s parents had no idea about her cutting or the extent of her drug use. Two days after she left, they searched her room and found marijuana, empty pill bottles, razor blades and cigarette butts stuffed into porcelain figurines.

“I was devastated,” Heather’s mother said, looking weary as she sat next to her daughter at the kitchen table in their home. “I bawled. I cried for days.”

Though she was aware of Heather’s temper and grief over losing her grandfather, Laurie never suspected her daughter was cutting herself. Her husband thought Heather must have accidentally scratched her arms with her long fingernails.

Looking back, the signs were there, Laurie said. Her words of advice to other parents: Look for any changes in behavior, from attitude to appetite to dress. Heather wore long sleeves even in warm weather, Laurie recalled.

“She stayed in her room all the time,” the mother said.

Just after she returned home, Heather’s father removed her bedroom door from its hinges as his daughter slept. It was gone for the next year, allowing Heather’s parents to look in on her whenever they pleased.

Now, the bottom half of the door stands as a tangible reminder of the days when trust between parent and child was strained almost to the point of nonexistence.

“She’s earned back half a door,” Laurie said, her daughter laughing alongside her.

The road to recovery

Last year, Heather decided to stop counseling and taking her medications. In stressful situations when she once would have hurt herself, Heather now goes to her room to listen to music, usually rap by artists such as 50 Cent and Trick Daddy.

“If I’m just left alone, I’m fine,” she said.

Finding a coping mechanism to replace the cutting, such as listening to music or talking with loved ones, is key to the successful treatment of patients who self-injure, said Kuntz of Acadia Hospital.

“You never take away a patient’s defense unless you give them something back,” he said. “If you remove the cutting, you give them a more effective way of dealing with what’s going on inside of them.”

Treatment for cutting and other forms of self-injury varies, depending on the severity and the root of the emotional trauma, Kuntz said. Psychotherapy may be necessary for some, medication for many, and family therapy for patients whose environment contributes to their behavior, he said.

Much depends on the willingness of parents to work with mental health professionals to deal with the inner pain driving their child’s outward actions, Kuntz said.

“Some parents are absolutely enraged at their children [when they find out about the self-injury] and just want us to make it go away, make it stop,” he said. “Other parents are aware that there is some kind of pain that the child is feeling. They might not be able to figure out what it is, and they are absolutely desperate.”

The prognosis for those who self-injure depends on the nature of the emotional trauma driving the behavior, Kuntz said. Outpatient therapy helps many to adjust to the stresses of life outside the supportive atmosphere of the hospital, he said.

“Once they leave the hospital, these problems are still going to be waiting for them,” Kuntz said.

Heather never again cut herself after she returned from rehab, she said. As she talks longingly about her plans to move to California after graduation, the old scars on her arms are barely noticeable.

She doesn’t think she’ll ever cut herself again, though she’ll always struggle to deal constructively with life’s inevitable stress and pain.

“I still think about it,” Heather said. “But I mean I think anybody that’s cut themselves will always think about it. Because of the feeling you get, kind of like just doing drugs. You’re always going to have the urges.”

Now, when she sees the evidence of cutting on other girls’ arms, she feels repulsed, Heather said. She no longer hides her scars under long sleeves, though the once violently angry teenager does her best to keep her grandmother from seeing the old wounds. “I was just sick of living that way,” she said.

Self-injury is defined as the act of deliberately harming or altering the body to the point of causing tissue damage, without the conscious intent to commit suicide.

Cutting is the most common form of self-injury, which also is known as self-harm, self-mutilation, self-abuse and self-inflicted violence.


National Public Radio (NPR)
June 10, 2005

Practice of self-mutilation

STEVE INSKEEP, host: Kim Schumer is one of the voices we’re hearing through StoryCorps, and her experience is not uncommon. It’s estimated that two million Americans practice some form of self-injury, and self-mutilation has been around for centuries. NPR’s Alix Spiegel reports the disorder is best understood as an attempt to relieve pain rather than to inflict it.

ALIX SPIEGEL reporting: In the late 19th century, two American doctors—George Gould and Walter Pyle—documented something they saw as a strange medical phenomenon. They reported that women all over Europe were puncturing themselves with sewing needles. In fact, this practice was common enough that European doctors had developed a name for the supposedly hysterical women who practiced this form of self-torture. They were called needle girls. However, according to psychiatry professor Armando Favazza, this was not the first time or place that the behavior had surfaced.

Professor ARMANDO FAVAZZA (University of Missouri): Self-mutilation spares no social class. It spares no gender. It spares no ethnicity.

SPIEGEL: Favazza, who works at the University of Missouri, has spent years studying self-injury and has found ample evidence of the practice in all kinds of settings. It’s a problem in monasteries and nunneries, as well as modern-day prisons, and could even be found, he says, in ancient Greece. Favazza reads an excerpt from the work of the famous Greek historian Herodotus, who wrote of a Spartan leader who was thrown into the stocks after exhibiting strange behavior.

Prof. FAVAZZA: `And as he was lying there, fast bound, he noticed that all the guards had left him, except one, and he asked the man, who was his serf, to lend him his knife. As soon as the knife was in his hands, he began to mutilate himself, beginning on his shins.’

SPIEGEL: It’s difficult to understand why anyone would deliberately harm themselves. Most of us, after all, spend our lives trying to avoid pain. But after years of research, Favazza says this behavior is best understood as a form of self-help, albeit a morbid form of self-help. For people whose emotions are hyper-reactive or for those raised in an emotionally chaotic environment, it often seems like the best way to silence a swirl of pain and anxiety.

Prof. FAVAZZA: They describe it as popping a balloon. All the anxiety just seems to just go away.

Ms. REBECCA RAYE(ph) (Practices Self-Mutilation): Part of me almost feels like I am—that all the things that are really hurting me at the moment are just kind of leaving me, along with the blood.

SPIEGEL: This is 19-year-old Rebecca Raye. A series of fresh inch-long cuts climb Rebecca’s arm like a ladder, 60 neat parallel lines. She made these cuts five days ago after realizing that her financial situation was not what she hoped it would be. Overwhelmed by the stress, she went to her room and pulled out what she refers to as `the kit.’

Ms. RAYE: It’s a little purple basket, and it has a new pack of razors in it. It has a pair of scissors and a pink towel.

SPIEGEL: Whenever Rebecca is distressed, by work, by family, she returns to this kit. Before she cuts, she says her mind is exploding. But once she feels pain, there’s a kind of peace.

Ms. RAYE: I’ll just be really calm and my thoughts will finally kind of be making sense, instead of them like racing through my head and nothing quite clicking. Just kind of centralizes my thought on one thing.

SPIEGEL: Now she cuts only a couple times a week and is trying to stop, but at her worst, Raye was cutting three times a day and wouldn’t go to work without a razor blade in her pocket.

Ms. RAYE: There are still times, like, where I can’t leave the house without actually having something with me, because I’m afraid that if I need it, then I won’t have anything to use.

SPIEGEL: This is common, says Armando Favazza. He points out that people who harm themselves don’t experience pain in the usual way.

Prof. FAVAZZA: And the fact is that most self-mutilators do not feel pain when they mutilate.

SPIEGEL: You say cutters, particularly people who have been abused in some way as children, frequently respond to stress by dissociating, a mental state which, in a sense, protects them.

Prof. FAVAZZA: What’s being done is being done to their body but it’s not being done to them because they’re kind of floating out there away from their body.

SPIEGEL: Unfortunately, says Favazza, dissociation is a very uncomfortable feeling, particularly for adults.

Prof. FAVAZZA: And one of the sure ways to end these episodes of depersonalization is to cut yourself. They see the blood and they say, `OK, that’s where my body is because the blood is coming out from my skin, and I know where the boundaries of my body are,’ and then the depersonalization or the dissociative process ends.

SPIEGEL: Ends by reconnecting the mind and body through pain. Again, Rebecca Raye. Ms. RAYE: When I first start, like I can see the razor going through my skin, but it’s like it’s not there at all, so it’s not until I’ve been cutting for a while until I start to actually feel the pain, and as soon as I feel a little bit of pain, I usually—it’s usually like maybe one more cut and I stop.

SPIEGEL: Like a lot of coping mechanisms that people develop to deal with stress—alcoholism, anorexia, drugs, smoking—cutting is a difficult habit to shake. There’s a new treatment which has had some success called dialectic behavior therapy, and Rebecca is thinking of trying it. She’s never been treated for cutting before and has practiced some form of self-injury for over 10 years, so it won’t be easy. And though Rebecca is intent on stopping, she understands why she turned to the behavior in the first place.

Ms. RAYE: It was just something that seemed—I don’t want to say like a good idea, but seemed like something that would help me at the time, and it did.


The Toronto Sun
June 27, 2005

Grievous Bodily Harm; Self-Mutilation is On the Rise, Particularly Among Our Youth
By Shelly Decker

USING SHARP scissor blades to make cut marks on her wrists, Maureen prayed her parents would see the wounds as an anguished cry for help.

The Edmonton woman, who also slashed herself with razor blades, didn’t want to die.

“I did it because I couldn’t get my parents to realize how much I was hurting. I thought if they could see something on the outside that they would know how much I was hurting on the inside,” said the 38-year-old, whose parents didn’t respond to her repeated cutting over a two-year period.

Self-injury isn’t new, but little is known about the condition. It’s on the rise, perhaps due to a more stressful society, notably in adolescence, said Karen Conterio, administrative director for the Self-Abuse Finally Ends (SAFE) program at Linden Oaks Hospital at Edward in Naperville, Illinois.

“I think it’s been explosive in the last seven years,” said Conterio, who co-founded the first program to deal with self-injury and co-authored a book on the topic, Bodily Harm.

“Kids turn to this because they don’t have the family involvement to help them otherwise cope with whatever stresses there are of growing up.”

BURNING, POISONING

Conterio estimates 1% of the population self-injures, which includes burning, breaking bones and poisoning. Most are female who start hurting themselves in adolescence.

“The key thing is the adolescent hasn’t learned to talk about their feelings,” said Dr. Elizabeth Hall, a Vancouver adolescence psychiatrist.

“Clinically what I see is they don’t feel well supported,” said Hall, who treats self-mutilators at the Mood and Anxiety Disorders Clinic of B.C. Children’s Hospital. Inflicting injuries gives a physical voice to internal pain, said Keith Turton of the Canadian Mental Health Association.

“They cut as a way of proving they’re alive,” said Turton.

The behaviour has recently seen a change, said Conterio. Once a solitary and often a secretive act, cutting clubs have emerged in some cities.

“Now it’s like these groups are doing it and now these kids are showing it. It’s amazing,” said Conterio.

It’s clear people who ravage their bodies are hurting. One suggestion holds as many as 60% of self-mutilators may be sexual abuse victims. Many come from dysfunctional homes.

The answer is not simple and often involves more than one factor, said Hall. Often people can’t explain why they do it, but some problems include depression, crisis and self-hatred.

Maureen, who was bullied growing up, began to cut after peers discussed it at a mental health group she attended following a breakdown at age 25. She suffers from depression. She didn’t hide her scars. Those who hide injuries often wear long clothes, even on hot days, and make excuses.

“The No. 1 excuse we seem to hear, ‘The cat scratched me,’ “ said Conterio. “I would say parents are the last to find out.”

Maureen sought help after a close friend caught her cutting. The friendship never recovered.

‘IT’S ROULETTE’

This action can be wrongly interpreted as a suicide attempt, but Hall stressed it must immediately be ruled out. Those who do self-injure may accidentally kill themselves.

“It’s a very anxiety-provoking condition to work with,” said Hall. “Everyone is on the edge. Either accidentally or on purpose, (a person could) slice just a little too hard or take the wrong poison. It’s roulette.”

The longer a person continues to hurt themselves, the harder it is to treat them. Unchecked, it can span decades. SAFE’s oldest patient was 70 years old.

Parents need to seek help.

“This is way too hard for a parent to deal with. This is one of those things where it takes a village and we really want to increase the connection around an adolescent so they understand that people around them are concerned,” said Hall. “It’s hard for the adolescents to get better, but kids do get better.”

It can be difficult to find qualified therapists.

“In Canada, it’s terrible,” said Conterio, who treats Canadians at her clinic, which sees a 75% decrease in such behaviour among its patients.

When it comes to dealing with our kids, Conterio suggests parents remember how brutal adolescence can be. Don’t dismiss kids’ concerns no matter how small, and stay involved in your children’s lives, she added.

“The saddest thing I hear is parents not wanting to take it seriously. They think it’s a phase,” said Conterio.


Idaho Falls Post Register
June 28, 2005

Self-mutilation; They do it to transfer pain, relieve stress or for attention, but it’s dangerous and addictive
By Milan Gagnon

Janet Allen sees them all the time. Teens stroll into her Creekside Counseling with gashes, cigarette burns, puncture marks and worse on their young skin. They ask her for help, or their parents force them to seek it.

Approximately 1 percent of the U.S. population cuts or seeks out pain for reasons varying from seeking attention to a genuine emotional detachment that causes them to find pain rather than feel it, according to the American Self-Harm Clearinghouse. A recent National Public Radio story found that self-mutilation may go back as far as ancient Greece and beyond.

“It’s sort of trendy right now,” Allen says. “The community is largely asleep with regard to the issue. It’s something people don’t know about, or if they have heard about it, they find it so bizarre.”

Experts liken self-mutilation to other bad habits people develop to cope with stress, pressure and pain. Like smoking, drinking and drug use, it can become addictive—and it’s also subject to peer pressure.

“There’s the copycats, the thrill-seekers who do it as a dramatic ‘look at me’ behavior,” Allen says. “The group that we’re most concerned about, they have an incredible amount of internalized emotional pain. People who engage in self-harm behavior feel so much pain on the inside. Cutting the body transfers the pain from the inside to the outside.”

According the American Self-Harm Information Clearinghouse, people have several myths about who engages in the behavior and why. Self-harm is not usually a failed suicide attempt, for example, nor is it only done by “crazy” people, and the bulk of those do it are not merely seeking attention. Many self-mutilators can harm themselves for years before anybody notices, as they go to great lengths to cover their scars both fresh and lifelong.

“There’s an awful lot of shame involved,” Allen says. “It’s very effective in the short term, but it’s a very dangerous technique in the long run—and kids can become addicted.”


The Western Mail
July 4, 2005

I Cut for a Lot of Reasons, But Mainly to Get Rid of the Really Intense Anger and Frustration
By Madeleine Brindley

WEARING a sleeveless T-shirt, it is painful to look at Nikki’s arms. Instead of the unblemished skin after which all girls of a certain age hanker, Nikki’s fore and upper arms are covered with healing cuts.

Some are thick angry welts, which reveal how the 20-year-old was feeling just a few days ago. Others have faded to the pale silvery-white of a scar, which will forever remind the young girl of the misery of her youth.

Both arms are covered in these scars—marks of desperation, of frustration, of release. The physical scars of a young girl who needed an outlet for a tornado of emotions and feelings she couldn’t cope with.

These aren’t the only visible signs of her inner torment—Nikki has also turned the razor blade, scissors, or whatever she uses to cut herself, on her legs in a bid to keep her self-harming secret from interfering eyes.

Nikki has been cutting herself for eight years but is now trying—almost like an alcoholic—to stop. Some days are good days and she manages to cope with the hurdles and missiles life throws her way without turning to her old friend. Others are bad days.

She said, “I don’t want it to be part of my life any more—I’ve had 121 stitches this year already and a couple of weeks ago I was at A&E three times in a week.

“I started cutting myself when I was 12. Before that I used to bang my head against walls and scratch myself, I think mostly through frustration because I couldn’t express myself in any other way.

“I got bullied in the last year of primary school and by the time I got to secondary school I didn’t feel that I had anyone to talk to. I felt very alone and cutting became a way of soothing myself.”

By the time she was sweet 16, Nikki had been diagnosed with depression and was taking anti-depressants. She was sent home from college in Reading because her teachers thought she was a suicide risk and didn’t want to take responsibility for her.

At 18, she started cutting badly—badly means deep cuts, which sometimes require stitches, compared to superficial scratches.

As with so many teenagers with problems, Nikki fell through the glaring cracks in our mental health system—because she was under 18 she couldn’t see a counsellor because she was too young, and because she had left school she was not allowed access to the child and adolescent mental health services.

Nikki, who now lives in Cardiff but is hoping for a place in a specialist centre in Kent, said, “I felt like a freak. I told a couple of friends at school that I self-harmed—my best friend said it was sickening and stopped talking to me, another was too freaked out.

“I lost a lot of friends and I thought that if they treated me like that, then everyone would. There was no one to help.”

If she cuts deep, deep enough to result in a visit to A&E, Nikki will feel good for up to three days, but, like a drug, it is fast losing its effectiveness.

“I cut for a lot of reasons, but mainly to get rid of the really intense anger and frustration. I wouldn’t take these feelings out on anyone else, I wouldn’t scream or throw things, it was easier for me to take it out on myself. I guess I’m addicted to the buzz—to the adrenalin and the power you get from cutting yourself.”

Like Nikki, John—who has asked for his name to be changed—started self-harming as a teenager because he was being bullied.

Holding a razor against his skin, and slowly drawing blood felt like the most “natural” thing for the 13-year-old.

“It progressively got worse—I started cutting deeper and deeper, until I ended up saying to myself that I didn’t want to cut any more. I stopped the cutting part because some of my teachers were looking at me funny and I knew they could see something. I decided that I didn’t want to do it any more and I wanted to keep it from everyone else. Instead I started punching walls. I didn’t want anyone to know what I was doing—when people saw my bruised knuckles, they thought I’d been in fights. I didn’t want people knowing because I didn’t want them thinking that I was crazy. I’m not crazy.”

Both Nikki and John have been supported by the Amber Project, one of the few programmes to offer help for people who self-harm and self-injure.

In John’s case the involvement has helped him to stop self-harming—he stopped five months ago and an offer to become a volunteer with the project, helping out, has given him a massive confidence boost. He is now on a youth worker course and hopes to use his experiences as the basis for a career.

“I want to give back the help that was given to me,” he said. “I want to help other people develop themselves, to know that if they make mistakes there is always a place they can go. Punching walls was my only coping mechanism, but now I know that I can help other people and it makes me feel good about myself—helping other people feel good helps me.”


Anchorage Daily News
July 15, 2005

Releasing the pain; Cutting is a dangerous behavior, sometimes with regrettable results
By Maria Davydenko

Marie doesn’t remember the first time she cut herself. “Sometime last fall,” she tells me as we walk alongside Bayshore Pond. A rainfall has just ended and the air smells fresh. I ask her to tell me about her ordeal.

The Anchorage teen says depression has been a part of her childhood experience. She recalls some serious bouts, even as a young child. In fourth grade, she went for months feeling physically sick but with no remedy in sight. Her mother says doctors failed to quickly diagnose a diseased adenoid, the tissue at the back of the throat that traps harmful viruses. Marie was too sick to go to school. She didn’t improve until after two sinus surgeries and a tonsillectomy but by then she’d missed months of school and socializing with friends. Since then, she continues to struggle with lingering sinus infections.

Her mom remembers the illness as a serious low point too, and says another occurred when Marie’s father was deployed after Sept. 11, 2001. To tackle that episode, Marie ended up on anti-depressants in January 2002.

“On medication, you don’t get those valleys but you also don’t get those peaks,” says her mother, who described her medicated daughter as emotionally flat. “Face it, you’re drugged. It’s very hard to see your child without any joy.”

After Marie saw the 1999 movie Girl, Interrupted, in which one of the main characters cuts herself, she became curious. She says she visited Web sites where teens talked about self-injury and how it helped them cope with pain. Self-injury means self-mutilation, and it can run the gamut from scratching, biting, burning, pulling hair and superficial skin cuts.

Eventually, Marie gave it a try. She says now it was the beginning of one of the darkest chapters in her life.

WHAT IS IT?

Another term for cutting and behaviors like it is self-inflicted violence or SIV. This covers any behavior in which someone is intentionally harming his or her body.

Wendy Lader is a psychologist with a nationally recognized treatment program based in an Illinois hospital, but with a strong Web resource presence, called SAFE (Self-Abuse Finally Ends) Alternatives. Lader estimates that about 1 percent of America’s population, almost 3 million people, engage in some form of SIV. A higher proportion of females are involved in it than males, according to the Web site, www.selfinjury.com/index.html. The typical onset of this problem is at puberty.

According the Lader’s research, cutters commonly report that they feel empty inside and unable to express feelings. They say they are lonely, not understood by others and afraid of intimate relationships and adult responsibilities. Cutting themselves helps them cope with or relieve painful or hard-to-express feelings. Because relief is only temporary, a cycle of cutting can develop without intervening treatment.

IN ANCHORAGE

In the opinion of Arlene Briscoe, a nurse at Providence Alaska Medical Center’s Discovery Ward, a crisis center created specifically for teens who are considered a danger to themselves or others, the behavior is growing.

“It’s happening more nowadays,” she says. “Ten years ago, we just didn’t have this problem.”

Cutting patients come in waves, and the waves have been getting bigger, Briscoe says. Recently, at least five of the ward’s 15 patients were known to have a history of cutting. One of the dangers of this form of SIV is its ability to spread through communities.

“It’s catchy,” says Anchorage therapist Laura Brooks. “A girl hears about it from a friend and tries it out.” Brooks deals exclusively with self-injury and eating disorder victims. But she thinks the increase may be due to more reporting.

“We see it more now, but it isn’t necessarily new,” she says. “People are more willing to talk about the subject than they have been in the past.”

An open dialogue on such a touchy subject can seem like a gift and a curse. While talking about SIV makes parents and friends of victims more aware and understanding of the phenomenon, it can also help it spread.

“Cutting is not a passing phase,” Brooks says, but a way of coping with stress—and a very dangerous one. It’s a habit that, if allowed to continue, can have devastating results.

“It’s an addiction, just like drugs, alcohol or an eating disorder,” says local therapist Christy Williams. The more you do it, she says, the greater the need to continue. Eventually, a small cut isn’t enough.

MISCONCEPTIONS

There are a number of misconceptions about cutting, with the most common being that self-mutilation is an attempt at suicide.

“The cuts are superficial, usually only deep enough to bleed,” Briscoe says. Bleeding is the important part, she says. The presence of blood calms many cutters, giving them a feeling that powerful emotions like anger or shame are leaving their bodies.

“Cutting is a way to discharge extreme emotional stress,” says therapist Debra Ragen-Coffman, who has worked with troubled teens for more than 20 years. She notes that an increasing number of her patients have problems with mutilation.

“People are lonely,” Williams says. “They feel stuck and are experiencing these hard-to-express feelings. Cutting is their way of making emotional pain real.”

Ultimately, cutting is a coping mechanism. When times get tough and stress sets in, they turn to these activities to help them keep things in perspective.

“People who cut aren’t crazy,” Brooks says. “They just haven’t developed ways to effectively deal with pressure and trauma.”

Brooks recognizes the addictive nature of the condition and works closely with her patients to ease their pain. She doesn’t require them to immediately stop cutting.

“You can’t do that. It’s dangerous—cutting is all they have. They’ll just cut somewhere more secretive,” she says.

Brooks teaches basic first aid to her patients so they can deal with their cutting. She also tries to increase the amount of time between when a patient thinks of cutting and actually goes through with it. By doing this, cutting is eventually replaced with healthier, more effective coping behaviors.

THE WORST EXPERIENCE

Marie remembers when she hit that point. Because of her compromised sinuses, she still gets frequent sinus infections. Her mom estimates that she experiences at least four infections a winter, and usually exists on antibiotics from November through March.

Marie recalls one late night in October almost two years ago when she started thinking about cutting. In the past, her cuts had been small, usually on her hands, legs or arms. But this time, she went downstairs with a steak knife and carved the words “Kill Me” into her leg.

When she woke up the next morning, she knew that things had become much worse. She told her therapist about the incident two weeks later. The therapist called her mother in to show her the cuts. When Marie’s mother saw the cuts, then crusted over and black, she described them as “grotesque.” She said the cuts formed 2-inch-high black letters.

“The M was 3/8-inch wide,” her mother recalls.

When her parents found out, they immediately checked her into the Discovery Ward at Providence. While there, she attended workshops on coping skills and anger management.

It’s been almost two years since Marie cut herself.

“It was my way of turning emotional pain into something physical,” she says. Nowadays, she copes with stress through painting and other healthier, safer activities.

Microdermabrasion has lessened the scarring on her leg. All that remains from that painful night are the letter “I” and the word “me.”

One of Marie’s worst memories about the experience is the look on her parents’ faces when they found out.

“My parents started crying when the therapist told them,” she says sadly. “Cutting may help ease your pain, but it hurts the people who care about you.”

Her mother says facing this experience was important for the family.

“We’re closer because we’ve been through a lot,” she says. “We’ve gone through the whole gamut of analyzing ourselves.”

Her advice to friends of cutters is to talk to an adult if the teen won’t seek help independently. To parents, she suggests that they be aware of where their child is going on the Internet.

“Unless they are doing a science report, they shouldn’t be on any of those types of sites,” she says.

She describes her daughter as an unlikely candidate for something so dramatic.

“She’s pretty, she’s an only child. She travels beautifully. She’s just a wonderful child,” her mother says. She cautions parents not to assume their child would never do this. She says Marie is doing much better now. Along with addressing the cutting issue, she’s also changed antidepressant medications.

“There is a lot more joy in her life now,” her mother says.


Los Angeles Times
July 26, 2005

A happy ending to life’s dark chapter; Jolene Siana’s ‘Go Ask Ogre’ documents a time when she mutilated herself. She hopes the book can help others.
By Susan Carpenter

She lost her boyfriend, her best friend and both her grandparents in the same year, any one of which would have been traumatic. But Jolene Siana was only 16. She was already struggling with difficult life issues.

She didn’t know her father, because he was never told she’d been born. And she says her mother was emotionally and physically abusive. So Siana dealt with her problems the best she could: She cut herself with razor blades, made art and wrote letters to the lead singer of her favorite industrial rock band, Skinny Puppy.

The hundreds of letters and pieces of art she mailed to Nivek Ogre in the late ‘80s are compiled in “Go Ask Ogre: Letters From a Deathrock Cutter,” and they tell an oddly inspiring tale. Siana was a young woman who found salvation in the unlikeliest places, finding redemption in so-called devil music and a contorted attempt at self-preservation through self-injury.

It is, to be sure, dark stuff, but that’s what makes it powerful. The thoughts and emotions are real and in the moment, not hindsight recollections or clinical self-help manuals. It also strives be more authentic for a new generation of young women than, say, the 1971 cautionary tale about drugs “Go Ask Alice.”

Today, Siana is 36 and living in Los Angeles. She works as a waitress at a Burbank restaurant. And she still writes, in the notebook she carries with her at all times and on the blog she’s been keeping the past few years.

She stopped cutting herself years ago, but she still has scars on her wrists and legs. She doesn’t like to show them.

“It’s a very personal thing, and those moments were very private,” said Siana, a soft-spoken redhead who’s come to terms with her past by years of therapy. “I just hope that I can bring awareness to it. Anything to do with mental illness or mental health, it freaks people out. People are really uncomfortable talking about it. I’m not, and maybe that can open [things up].”

When Siana first began writing to Ogre, she was 17. She didn’t understand what cutting meant; bringing awareness to the issue was about the furthest thing from her mind. At the time, writing Ogre was her way of reaching out to someone she thought might understand.

When she was introduced to Skinny Puppy through a music video on MTV’s “120 Minutes,” something connected. “It didn’t sound like anything else I’d ever heard, and I found him attractive.... His lyrics, a lot of them were about pain, and I could identify.”

Siana already had a lot of pen pals, and one day, while listening to the band in her bedroom by herself, she read a quote on the back of one of its albums: “For those who make up their own minds.”

“There was an address and his name, and I thought, ‘I’m going to write him a letter,’ “ Siana said. “And then I just continued.”

Written on Valentine’s Day, 1987, that first letter wasn’t the usual sort of fawning fan mail. There was one reference to liking the way Ogre looked; the rest was about herself. Penned, in part, during a ceramics class, the letter introduced Siana as a “senior at an extremely boring high school.” She told him she was so bored she wanted to scream. She said she hated school and that her mother hated her. She told him that her grandparents died and that her stomach hurt. She said she wanted to be a journalist and travel to England, that she liked art and looking “really gothic and artsy.” It was, in a word, rambling, but the letter was also pure, lucid and engaging.

Without receiving any response, Siana wrote Ogre again 12 days later, and again the day after that, and two days after that, and so on. He wrote her back only once — two months to the day after she wrote her first letter.

What he wrote isn’t included in the book, per Ogre’s request, but a journal entry indicates he wanted to meet her. A month later, they met backstage at a Skinny Puppy show, where Ogre told Siana her letters were “fascinating and very creative” and encouraged her to “keep ’em coming.”

And so she continued writing letters that were increasingly personal, suicidal and oftentimes decorated with drawings made from her blood, using a calligraphy pen she dipped in her wounds.

Some of the art in the book “is pretty shocking,” Siana said, but it wasn’t included for the shock value. It was included — along with photos, newspaper clippings, sticky notes and ticket stubs — to form a more complete picture of how Siana was experiencing life at that time.

“I guess I’m obsessed with documentation,” Siana said. “I save everything.”

Between 1987 and 1989, Siana wrote Ogre hundreds of pages of letters, but she never expected them back. When she saw Ogre at subsequent Skinny Puppy shows over the years, “He always told me that he still had my letters, but I didn’t think that he would hold on to them,” Siana said.

He had. Three years ago, he sent them back to her in a single box. Looking through them, she said, “was sort of a sense of closing a chapter on my life and dealing with it and being OK with the dark things that happened.”

Even so, she had no intention of sharing the letters with the public until a friend suggested they might help people.

“Go Ask Ogre” is the first original title published by Process Media, co-created by Adam Parfrey, founder of the countercultural publishing venture Feral House, and Jodi Wille, founder of the art and photography publisher Dilettante Press.

“What I loved about these letters when I saw them as a whole was [they showed] a girl who is faced with a lot of challenges which a lot of young people are facing today: self-injury, dysfunctional family life,” Wille said. “This book shows how you can take difficult situations and learn to make healthy choices, which was expressing herself creatively and reaching out to other people and connecting to others. They turned out to be the choices that saved her life.”


Chicago Tribune
August 1, 2005

Self-injury cuts deeper into America’s youth; Experts say depression is on the rise, and those who turn to mutilation increasingly are younger
By Vincent J. Schodolski

When she was 16, Laura Snow moved back to the United States from Hong Kong, where her parents had been working as missionaries for more than six years.

It was a hard adjustment for her, and the problems she encountered compounded difficulties she had already experienced.

“Being a minister’s kid, you have to behave better than everybody else,” said Snow, 22.

So one day shortly after she returned, Snow picked up a pair of scissors and cut her skin. For years afterward, razor blades were the weapon of choice to cut herself in a bloody ritual that thousands of Americans—perhaps far more—do, many as a form of release.

People have engaged in self-harming behavior for decades, some experts say for millenniums. But professionals agree that younger and younger people are cutting their skin, burning themselves, bloodletting and in extreme cases even cutting off portions of fingers and ears.

While experts point out that there is an element of copycat behavior among individuals who cut, nearly all cutters have a trait in common: They are clinically depressed.

“Depression itself has increased,” said Dr. Graham Emslie, a psychiatrist and professor at the University of Texas Southwestern Medical Center in Dallas. “It [self-injury] decreases with the treatment of depression.”

Experts say depression is at the core of the behavior, but a combination of modern societal realities is contributing. Those include busy lifestyles where parents take less of a role in raising their children, a culture where beauty, sex and perfection are exalted, and new technologies that allow cutters to communicate with each other.

“The self-injury phenomenon has been around for centuries,” said Kammie Juzwin, a psychologist at Alexian Brothers Behavioral Health Hospital in Hoffman Estates, Ill. “Early Christian writing discusses the use of self-injury as ritual.”

Nearly 20 years ago, Juzwin started working with young people who intentionally injure themselves. At that time the average age of her patients was 18 to 20. Now the average age is 14 to 16, with some as young as 8.

“Globally, any behavior that happened at 16 is now happening at 12 or 13,” said Jennifer Hartstein, a psychologist at Montefiore Medical Center in Bronx, N.Y. “Kids are growing up faster and faster.”

Juzwin added, “We oversexualize our children. We are asking them to mature in a society . . . that grows increasingly less mature.”

“We have Paris Hilton, who has lived a life of privilege and got everything for her looks alone. Their [teens’] peer group is no longer the norm. Britney Spears is the norm.”

Hartstein echoed the view that societal changes are driving younger children to become involved in self-harming behavior.

“In the United States we are such a quick-fix society,” she said, adding that cutting’s instant gratification attracts some people. “I have had teenagers say to me that it `makes me feel alive.’”

According to the National Institutes of Health, 15 percent to 20 percent of American teenagers have experienced a serious episode of depression, about the same percentage as in the adult population.

However, Hartstein said “depression presents itself differently in all people. Not all depressed teens cut.”

Some drawn to Internet

Internet chat rooms now allow cutters to share what used to be an isolated practice, and group cutting has become more common, experts say.

“There are lots of sites and Web logs you can access just by typing in ‘self-injury’ or ‘cutting.’ Many parents would be shocked if they read the contents of the sites their kids are visiting,” Juzwin said.

Hartstein said that “we have kids that tell us they have cutting circles.”

However, not all aspects of group cutting sites are negative, she said, adding that patients have told her that people in such groups look out for one another and sometimes try to discourage cutting.

According to Juzwin and others, the story of Snow, the missionaries’ daughter, is typical.

“I cut because it was the one time that I had control of where I hurt, how bad it felt and whether or not it left a scar,” said Snow, who went into treatment and stopped self-injury seven months ago.

“The forces of life that affected every other aspect of my life I had no control over. My heart ached, and for those few seconds I could focus on another pain.

“I can tell you from experience that not all kids who cut are after attention. It wasn’t until I was 20 years old that my parents even discovered that I had a problem.”

Snow now works as an assistant store manager for Starbucks in Longview, Texas.

Doctors use various methods to modify the behavior of cutters and to break their impulse to cut. They suggest, for example, that cutters hold a cube of ice until it becomes painful or wear rubber bands on their wrists and snap them when the urge to cut strikes.

Treatment also involves the use of anti-depressant drugs and dialectical behavior therapy, or DBT, which encourages change while eschewing judgment about the behavior.

Jennifer, who is 29 and asked that only her first name be used, started cutting herself when she was a teenager. She stopped nine years ago using DBT, counseling and anti-depressants. The counseling lasted three years.

“I would take red markers and mark my body,” she said of one technique she employed.

Cutting does not fit neatly into any social or economic category, doctors treating such patients say.

Actress Angelina Jolie, for example, has spoken of her experiences with self-injury as a teenager.

“I was 14,” she said during a recent interview on Bravo’s “Inside the Actors Studio.” “I had started having sex, and that sex didn’t feel like enough, and no emotions were really enough.”

She explained that she first cut herself after having sex with her first boyfriend.

“In kind of a moment of kind of wanting to find something else, I grabbed a knife and cut him, and he cut me back, and we had this exchange of something, and then somehow covered in blood and feeling that my heart was racing and there was something dangerous and ... [I] suddenly felt more honest than whatever this sex was supposed to be, this connection between two people supposed to be,” Jolie said.

“So I went through a period of when I would feel trapped. I would cut myself because it felt like I was releasing something, and it was honest.”

Jolie acknowledged that she was left with “a lot of scars.”

Studies by Dr. Armando Favazza, a psychiatry professor at the University of Missouri-Columbia, and others showed a limited link between cutting and sexual behavior.

In a study of 250 chronic self-mutilators published in 1996, Favazza reported that only 2 percent reported being “often or always” sexually aroused when harming themselves. But 20 percent said they used self-injurious behavior to rid themselves of troublesome sexual feelings.

’These kids are lost’

Lauren Solotar, chief psychologist at the May Institute, a behavioral hospital in Norwood, Mass., said she sees increasing desperation and isolation among the young people she treats.

“These kids are lost,” she said. “They have nobody to turn to.”

For Snow, “it eventually got to the point that I couldn’t live without those few moments away from the pain of my life,” she said. “I already felt dead inside. By cutting I was attempting to feel alive. It was almost as if when I saw the blood running down my arm, it was then that I knew that I was alive and that I was OK.”


Newsday
August 9, 2005

Using Pain to Express Pain; Self-Injury Gains Wider Recognition as a Sign of Emotional Distress
By Kai Ma

Lauren, a Long Island native, said she always felt different. From an early age, she said, she despised her body. She wrote poems about angels and death. She remembered that in sixth grade, her friends at private school kicked her out of their circle. For a year, she cried herself to sleep.

That summer, Lauren, then 12, picked up a plastic knife and began cutting her arm. For reasons she didn’t understand, she felt relief. She even liked the pain. With needles or thumbtacks, she soon learned to brand her flesh until it bled.

“I felt that by cutting myself, others couldn’t hurt me,” said Lauren, now 18.

Lauren, who asked that her last name not be used, said that although she sometimes still brands herself, she has not cut herself in the past six months. She thanked dialectical behavioral therapy, or DBT, a program that treats adolescents who engage in impulsive self-injury or suicidal behavior.

There are no official statistics for self-injury, but based on reports by high-school guidance counselors and social workers, an estimated one out of 70 high school students in the United States cuts themselves, said Steven Levenkron, a Manhattan-based psychotherapist and author of Cutting: Understanding and Overcoming Self-Mutilation (W. W. Norton & Company, $14.95).

Barent Walsh, co-author of the book Self-Mutilation: Theory, Research and Treatment (Guilford Publications, $45), said the largest sample statistic on self-injury in the United States is the 2003 Youth Risk Behavior Survey, which was administered by the Massachusetts Department of Education and funded by the federal Centers for Disease Control and Prevention, indicating that 18 percent of high-school students reported hurting themselves on purpose at least once in the 12 months before the survey. This included cutting, burning or bruising themselves.

The survey was conducted in 50 randomly selected public schools and 3,624 students in grades 9 through 12 participated. Among the students who reported self-injurious behavior, 51 percent did so one or two times; 10 percent hurt themselves 20 or more times.

A symptom of deeper issue

Cutting tends to occur in people with depression, post-traumatic stress syndrome, or some behavioral and personality disorders, such as borderline personality and bipolar disorders. The act of self-injury often is a symptom of a deeper disorder and is not diagnosed as a disease itself.

Also known as self-mutilation, cutting is the use of knives, razor blades, safety pins, scissors, glass or other sharp objects to deliberately harm one’s body. Other forms of intentional self-inflicted violence include breaking bones, head-banging, burning, scratching or hitting oneself, or pulling out hair (called trichotillomania). Most people cut themselves on their arms and wrists, or in less conspicuous areas, such as the inner thighs or stomach.

For four years, Lauren used razor blades, and sometimes a knife, to cut her wrists, stomach and hands. She did this in secret, in her room or the school bathroom. While in 10th and 11th grades, she burned her left lower arm four times with cigarettes. During her high-school years, she repeatedly branded a heart shape on her lower stomach. Once, in 10th grade, she branded the words, “Be Strong.”

Lauren hid her marks with long sleeves and bracelets, but her mother sometimes noticed the injuries. Not knowing how to handle the situation, her mother would casually say something, or notify Lauren’s therapist. (Lauren had begun therapy in the third grade because she wanted her dreams interpreted. She continued therapy when she was diagnosed with bipolar disorder at age 12.)

In ninth grade, Lauren attempted suicide. During her hospitalization, her doctors recommended DBT.

In the 1980s, psychologist Marsha Linehan of the University of Washington in Seattle designed DBT to treat borderline personality disorder. Due to similar behavioral patterns between self-mutilators and people with borderline, Linehan discovered that the treatment also worked for cutters. The program combines individual therapy, telephone coaching and group training to teach healthy coping skills.

Lauren received treatment for a year, although she still sees a therapist.

Self-injury is commonly perceived as a problem among white female middle-class teenagers with low self-esteem. Though mental health professionals agree that this is the predominant profile, cutters range in racial group, gender and age. Upper- to middle-class white females are just more likely to seek treatment, say some professionals.

In 2000, more than 264,000 people were treated for nonfatal self-inflicted injuries in hospital emergency departments, according to a Centers for Disease Control and Prevention report, which noted self-inflicted injury rates were highest among adolescents and young female adults.

When does it usually start?

Roughly 85 percent of cutters start in high school and 15 percent start in adulthood. Although rare, cutting has occurred in children as young as 5 years old, said Levenkron, the psychotherapist and author.

“What cutters all have in common is serious impoverishment in language to conceptualize their own pain,” he said.

Levenkron said 38 percent of cutters have been sexually abused as children, adding that this figure is likely to be low. Most cutters also experienced emotional neglect and abuse in their developmental years, he said.

Others struggled with their parents’ divorce, a family member’s sickness or death, feelings of abandonment, or problems communicating such emotions as grief, disappointment and rage, said Nilde Leo, social worker and the coordinator of the DBT program serving 60 adults at Hillside Hospital in Glen Oaks.

For many adolescents, a romantic breakup often triggers cutting, said Karen Conterio, an alcohol and addictions counselor who co-founded SAFE Alternatives, an outpatient support group for self-mutilators in Naperville, Ill.

Burton Silverman, a social worker at Schneider Children’s Hospital in New Hyde Park, said people cut themselves to temporarily cope with emotional pain, tension and stress, to gain control of their lives, or to punish themselves.

“Some of them need pain to feel alive,” said Silverman, who runs the hospital’s adolescent DBT program, which currently treats 57 patients, ranging from 13 to 19, who are diagnosed with depression or borderline personality disorder. “Others say the blood provides a visual way of seeing their pain pour out.”

A long history

Cutting has been clinically noted as a major mental health problem in the past decade, said Dr. Bob Dicker, associate director of child and adolescent psychiatry at Schneider.

“Yet cutting is not a phenomenon of the 21st century,” he said. “Historically and anthropologically, self-mutilation goes back centuries.”

Dicker said cutting has not increased so much as public awareness surrounding self-harm.

The popularity of body piercing and tattooing has blurred the line between self-expression and self-injury. Sonia Wagner, executive director of Response for Suffolk County, a Stony Brook-based crisis intervention group specializing in mental illness, self-destructive and suicidal behavior, said many forms of body art would have been considered self-mutilation even a few years ago.

Dicker said motivation helps define whether an act is self-mutilation or a cultural phenomenon. Yet many adolescents who do not self-injure will pursue a piercing or tattoo to deal with stress or anxiety, he said.

“There is a gray area between the two,” he said.

Added Silverman: “Most of these kids feel overwhelmed and need a way to let the pain out. Cutting works for them, momentarily. They happen to be right in the short range, but life is not the short range. You have to live with all those scars.”

People who self-injure may be suicidal, but the act of cutting does not equate an attempted suicide, Silverman said. “Suicide is a long, thought-out process motivated by the desire to end one’s life,” he explained. “Cutting is an immediate reaction motivated by the desire to feel alive.”

Yet Dicker warned that self-mutilators are at risk of suicide because cutters are often depressed or impulsive or have a psychiatric disorder. Deep cuts can also lead to accidental death.

“Self-mutilation cannot be dismissed as not dangerous; a cutter is not necessarily suicidal, but it is possible to be both,” Dicker said.

Brianna, 26, a Queens resident who asked that her real name not be used, said that she often had thoughts of suicide. But cutting, she said, was never an attempt to end her life.

“If I was going to kill myself, then cutting wasn’t the way,” she said. “Cutting was just a relief. The two were not related at all.” But for two years, she cut herself with paper clips, pushpins and staples.

Though she was shocked the first time, “after that, it wasn’t so bad,” she said. “It became the only way I could relieve anything.”

Her parents feared for her well-being, but she said the family had problems communicating.

For Brianna, cutting occurred during her breaking points - moments when she felt so numb that she didn’t feel pain. Other times, she said, she felt so much anger and frustration that cutting allowed her to disengage from her emotions.

She covered the cuts with long sleeves but sometimes exposed her arms hoping her family would notice and help her. But it wasn’t until she was hospitalized for attempted suicide in 2003 that her parents discovered her wounds.

“I was afraid, and cutting was no longer doing it,” she said. “I wanted to keep going. I wanted my life back.”

When Brianna sought treatment in 2004, she rolled up her sleeve and told the nurse, “I need to be somewhere or I will hurt myself again.” That day, she began therapy in the DBT outpatient program at Hillside Hospital.

Brianna will soon graduate from the DBT program. Today, she said, she copes with her impulse to cut by taking a walk, squeezing an ice cube, taking a bath or flying a kite.

She said she has not cut herself since January. “The only one I was hurting was myself.”


Milwaukee Journal Sentinel (Wisconsin)
August 22, 2005

Deeper wounds Self-mutilation becoming ‘in vogue’ among young people, experts worry
By Raquel Rutledge and Sheila B. Lalwani

Siobhan Stover first sliced scissors across her body when she was 12.

A shy and self-conscious seventh-grader, she agonized over being left out of a friend’s birthday party.

“It just came as an instinct to me. I got really upset. My scissors were there, and I just did it,” she said. “I just started slashing blindly.”

Eight years later, Stover still struggles with urges to cut. Fresh and years-old scars cover her right arm, her thighs and stomach. She is officially a “cutter,” according to psychologists.

And while self-mutilation is not new, mental health experts, doctors and school counselors across Wisconsin say teens are cutting themselves at rates today like never before. And there are no signs that they’re slowing.

“Unfortunately, it’s kind of in vogue,” said Stephany Wisiol-Albert, a child and adolescent therapist with Rogers Memorial Hospital in Oconomowoc, which is known for its mental health programs. “It’s the same principle as drug use. Right now, it’s cool to self-injure.”

On a recent day, seven of the eight girls in the psychiatric unit at Rogers were cutters, Wisiol-Albert said, far more than the typical number treated in recent years.

Perhaps even more telling is the number of calls Wisiol-Albert gets from school districts across Wisconsin, desperate for the hospital’s help on how to handle the growing number of students they see using everything from pencil tips and paper clips to broken glass and box cutters to inflict pain and draw blood.

Lake Mills, Janesville, West Bend and Whitefish Bay are just a few that have sought professional advice on what to do when they spot burns or cuts on students’ arms, or more commonly, when a student tells them that a friend has been cutting.

“We need help,” said Mary Ross, head of the counseling department at Parker High School in Janesville. “It’s alarming. We see it quite a bit.”

Karen Conterio, co-founder of Self-Abuse Finally Ends Alternatives, or SAFE, a treatment program for self-injurers in Naperville, Ill., said schools across the country are looking for guidance. Her organization is designing a manual for schools to help them cope.

“There is so much demand, it’s unbelievable,” Conterio said.

Among other things, the SAFE program teaches school counselors and board members that cutting and other forms of self-mutilation are a disorder.

“They need help,” Conterio said of the students. “They shouldn’t be punished.”

Numbers are growing

Experts estimate that 2 million to 3 million people - or close to 1% of the population - deliberately injure themselves on a regular basis.

Lauren C. Solotar, chief psychologist with the May Institute in Massachusetts, said self-injury is about to catch up to eating disorders as a widespread problem among female adolescents.

Solotar calls the behavior “para-suicidal” because teens who cut aren’t trying to kill themselves. They often are trying to retaliate against people who have hurt them. And for teens, sometimes physical pain is easier to cope with than emotional pain.

“If you cut yourself, you can say, ‘I’m crying because I’m in pain,’ “ said Emma Zeldin, 17, of Madison. “I don’t have to think about the F that I just got on the test. You’re concentrated on the pain in your arm.”

Cutting herself with safety pins or scissors made Zeldin feel as if she were in control. For months, she cut herself three times a week. When life was really hard, she cut herself every night.

“It was like a drug,” she said. “I would go into the bathroom and take a pin to my arm.”

Some experts say cutting is physiologically like a drug, releasing endorphins and creating a temporary high. The more someone does it, the more difficult it is to break the habit.

Self-mutilation often strikes teens with traumatic and abusive histories. More than half report they were victims of some type of emotional, physical, or, primarily, sexual abuse, said Wisiol-Albert of Rogers Memorial.

The trend is grim on other fronts as well. The average age of first self-injury dropped to 13 this year from 14 last year, and while many counselors and therapists report seeing and treating more females than males, experts say the number of males appears to be growing.

At Youth Services of Southern Wisconsin’s Briarpatch Division in Madison, which reaches out to troubled teens, program director Aaron J. Backer said he’s seen an uptick in the number of middle school boys who drag sharp objects across their stomachs and along their arms.

In one case, a boy used a razor blade to cut names of heavy metal bands along his stomach, chest and arms. As with many other cutters, he wasn’t looking for attention but was angry that his parents wouldn’t let him listen to his favorite music.

“He liked the feeling of the physical pain,” Backer said. “Music was something that was important to him. He wasn’t trying to kill himself. He was bored and wanted to get back at his parents for taking his stuff away.”

Straight-A students not immune

But cutting isn’t limited to troubled or abused teens, said Curt Cattanach, a counselor at Whitefish Bay High School. They are talented, high achievers who are involved in drama, sports or the high school band.

“The kids come from very different backgrounds,” said Cattanach, who has been a counselor for 12 years. “They could be straight-A students. Sometimes it’s a student more at-risk. There really doesn’t seem to be any set pattern for these kids.”

Armando Favazza, a psychiatrist at the University of Missouri medical school in Columbia, says school kids are wearing their cuts as badges of honor.

“They’re getting together and forming a cut-of-the-month club where they show off once a month a different cut they’ve done on themselves,” said Favazza, author of Bodies Under Siege: Self Mutilation and Body Modification in Culture and Psychiatry. “It brings them together. It’s defiant, a stamp of rebellion.”

Depending on the severity, treatment can take years. Most heavy cutters won’t recover without therapy, Wisiol-Albert said. About a third will recover with psychotherapy, and if the treatment plan includes drug therapy, two-thirds will recover.

Siobhan Stover has been in treatment since January, when she accidentally hit an artery on her wrist. She worried she might bleed to death if she went to sleep as usual, so instead she went to the emergency room - a step that has set her on a path to recovery. The combination of medication and outpatient counseling ever since has helped her resist the regular urges to slice her arms and legs. She hopes to stay well enough to attend nursing school near her hometown in Ontario.

It’s been four weeks since she’s cut herself.

“It’s getting longer,” she said. “You’ve got to try.”

Tips for parents

* Be a supporter, not the cutting police. Don’t lock up all the sharp objects but put them out of sight so they won’t be a visual trigger.

* Talk to kids about their feelings, but don’t take responsibility for monitoring them. You can’t watch them every minute.

* Be upfront about what you see. Express concern if you notice behavior that seems related to cutting. Don’t be accusatory.

* Don’t get angry. That reinforces the child’s sense of self-disgust.

* Acknowledge the healthy things the child does. Keep in mind that if the child could stop, he or she would.

* Regulate your reactions. Keep negative and judgmental reactions to yourself. Don’t shame them for failed attempts to control it.

* Seek a support network for yourself.


The Guardian (London)
September 7, 2005

Who cares?: Self-inflicted harm is one of the heaviest blows for a caring parent, says Judith Cameron

 

Protecting one’s child from harm must be the fundamental duty of every parent. I have singularly failed to achieve this but can assert that there is no experience worse than watching impotently while your child suffers. I remember vividly the early weeks of Sophie’s illness when she was in the intensive care unit and numerous bodily incisions were made to keep her alive.

I hated the tracheotomy that was needed when she lost her ability to swallow. Before this, her speech was often rambling and incoherent, but she did have moments of clarity when she told me how much her head hurt and how frightened she was. But once fitted with the tracheotomy, she could no longer voice her suffering and it tortured me to see the despair, distress and incomprehension in her eyes.

We had no idea that by the time the tube was removed, she would have lost the power of speech. But the hardest thing to witness was the paddles used to resuscitate her after a cardiac arrest; they left two appalling burn marks. My eldest daughter’s previously perfectly formed and developing 17-year-old body had become irreparably damaged inside and out.

Ten months later, Sophie came home with profound brain damage and paralysis, and needed 24-hour care. We were grateful that she was still alive, having learned through heartbreaking experience that it is only on television that youngsters with serious illnesses always get better. We assumed that the physical damage had ended, and we wanted to care for her, hoping to witness some improvement.

Self-harm would not generally spring to mind when contemplating the difficulties involved in caring for a severely disabled individual. However, for Sophie it has been an on-going problem that, six years after her initial illness, continues to be painful and stressful for us all.

It started soon after she left hospital when, grinding her teeth violently, she loosened and finally dislodged a bottom incisor. I was very upset - she had had perfect teeth until that moment. It was one part of her body that had remained unscathed.

But this sad episode in no way prepared me for what subsequently happened when the same forceful grinding and clenching of her teeth resulted in a fracture of her jaw. It was desperately painful for me to consider what Sophie was feeling and the frustrated anger that must have caused such a powerful reaction. I was horrified and stunned that anyone could break their own jaw.

To date, that is the worst incident of self-harm, but Sophie’s clenching and grinding continues to cause problems with severe gum recession and more lost teeth. Only photographs remain to remind us of the gorgeous smile she once had.

But Sophie does not smile these days - she hasn’t got much to smile about. Her most common emotion is displeasure, and she complains a lot during the strict physiotherapy regime. It has had the positive result of far greater voluntary movement in her limbs, which in turn has had the negative result of more self-injury.

One day this summer, leaving Sophie for just a few moments strapped securely in her commode, I returned to find her foot in a pool of blood. She had somehow swung her ankle and gouged it down a bolt on the chair. She didn’t seem particularly bothered, but I wept. It was yet more evidence not just of her disability but my inadequacy at looking after her.

I am grateful that when Sophie first went into hospital, I had no idea of what the future would hold. I don’t think I could have coped with that knowledge. It is only very slowly that I have had to accept the enormity of what has happened and deal with each problem her disability poses as it arises - self-inflicted or otherwise.

I do not know what other people think when Sophie has a nasty scratch or swelling. I hate to consider the possibility that anyone could imagine I could hurt her intentionally. But, of course, although I know that her various abrasions and bruises are self-inflicted - despite my every endeavour to avoid them - no one else does.

They have no idea that given Sophie’s inability to look after herself, I not only have to be aware of possible injury each time I move her but also have to be careful that she does not hurt herself. I have an even harder job to be a good enough parent than I did before. And despite my best efforts, I am still failing to protect her from harm.



Evening News (Edinburgh)
September 8, 2005

Self Harm Counselling Offers Hope to Victims
By Linda Summerhayes

A NEW service to provide support to desperate young people who are choosing to harm themselves as a means of coping with their lives is to be launched in the Capital next week.

The project, the only one of its kind in Edinburgh, will offer one-to-one counselling to young people aged 16 to 25.

More than 16,000 people a year are admitted to Scottish hospitals due to self -injury, including those who overdose on drugs, cut and burn themselves and drink chemicals such as bleach.

The number of people who inflict harm on themselves, however, is thought to be much higher, with many never seeking medical attention for their injuries.

Project manager Maria Naranjo said support agencies in Edinburgh had identified a growing need for a service dedicated to helping those who self harm.

She said: “Self harm is a social issue which we need to start talking about because there are many people who need help and support.”

Mrs Naranjo said young people were reluctant to come forward. She added: “There is a huge stigma associated with self harm and a stigma about going to the A&E with an injury because, in the past, staff in hospital thought that people who self injured didn’t deserve the same quality of care.

“That’s what our young people come to us and say. They say they wouldn’t get in contact with medical services because of the stigma that comes with it.”

The project is a joint initiative between mental health charity Penumbra and the Scottish Executive’s Choose Life campaign which aims to cut the suicide rate by a fifth by 2013.

Penumbra runs a number of initiatives to support people who self harm throughout Scotland.

Sandra De Munoz of Choose Life in Edinburgh said: “Self harm involves young people who are really very vulnerable and feel isolated and find it difficult to talk to family members and their peers.

“Self harm is done privately so some people don’t seek intervention at all. So we don’t know how many people are doing it or what issues they have. This project will help us to find out more.”

Mrs Naranjo, 35, said there was a strong link between self harm and suicide.

Currently 17 youngsters are using the new service, which will be officially launched on Tuesday as part of International Suicide Awareness week.

Two project workers are able to support a further 18 people at their St Stephen Street office.

Mrs Naranjo added: “Self harm not something people do to attract attention but something they do as a coping mechanism in the way that some people use alcohol.

“When the young people come to us, some of them see us as a last chance. “

It was just a coping mechanism.

OVERWHELMED by living in London and feeling like she could always do better at college, Corinna Proud began cutting herself to make herself feel better.

Unable to turn to her friends, the Edinburgh resident would slice her arms or scratch herself with whatever came to hand.

“It started during my late-teens,” she said. “I think it was just a coping mechanism. I didn’t feel supported enough by the people around me so I turned to myself.

“The frustration I felt used to just build up and it was a kind of release. It was something I thought was helping but at the end of the day it was making things worse.

“I was putting myself under pressure because I felt I needed to be better than myself. I don’t think I was influenced by anyone or anything.”

Now 21, unemployed Miss Proud still bears the scars but has been attending the Penumbra Self Harm Project where she is slowly learning how to cope with her feelings.

“I didn’t just stop, it’s been a kind of gradual thing,” she said.

“It’s good to have people around me who don’t judge me for it and it’s good to have someone to talk to that is just being objective and not seeing the problem but seeing me for who I am.

“Sometimes if you tell somebody you have got a problem, they stare back at you as if you are going to start going psycho on them. It’s not what happens.”



Bristol Evening Post
September 20, 2005

First ever event aimed at women who self-harm

Young women in Bristol who self- harm are being encouraged to attend the first-ever event to be targeted at them. Young Women’s Day will take place on Saturday, October 1, and is aimed at exploring the issues around self- injury and challenging the stigma it often attracts.

The charity Bristol Crisis Service for Women (BCSW) wants women aged 16 to 25 to go along for the day.

The event will include a series of fun, relaxing and thought-provoking activities.

BCSW specialises in providing a non-judgemental service which helps women to understand and tackle the reasons behind self-injury.

Spokeswoman Lorna Henry said: “Self-injury, or causing deliberate physical harm to oneself by cutting, burning, picking the skin, or banging one’s head, arms, or legs, was once a major taboo. It is staggering to think that more than 24,000 teenagers are admitted to hospitals in the UK annually after deliberately harming themselves, and the average for children starting to self-harm is at 13 years of age.

“Our approach is to shift the focus away from simply stopping the self- injury and towards supporting the young person, to seek out appropriate support and less-harmful ways of managing difficult feelings. Young Women’s Day will involve a range of activities including discussions, creative activities, alternative therapies, and talks about self-injury.” The British Red Cross Society will join BCSW for a session during the day on how to minimise the scars from self-harm. To find out more about BCSW, including where Young Women’s Day will be held, call 0117 927 9600 or email bcsw@btconnect.com.



Hindustan Times
September 21, 2005

Why Do People Self-Mutilate?

NEW DELHI, India, Sept 21 — Rakesh(name changed) is a man in his twenties. He’s been having a one way love affair with a girl who has never responded to his overt gestures to befriend her. In utter desperation, Rakesh gets metallic alphabets and, after arranging them to match the girl’s name, burns his hand with the heated metal.

Interestingly, he doesn’t even show it to the girl or to his friends but feels better after such an act. Was all this pain worth it? What purpose is served by such acts?

Several definitions of this phenomenon exist and there are several terms to identify the behavior.

Self-harm, self-injury, and self-mutilation are often used interchangeably. Some psychologists have categorized self-mutilation as a form of self-injury.

Self-injury is characterized as any sort of self-harm that involves inflicting injury or pain on one’s own body. In addition to self-mutilation, examples of self-injury include: hair pulling, picking the skin, excessive or dangerous use of mind-altering substances such as alcohol, and eating disorders.

A common example of self-mutilating behavior is cutting the skin with a knife or razor until pain is felt or blood has been drawn. Burning the skin with an iron, or more commonly with the ignited end of a cigarette, is also a form of self-mutilation.

Self-mutilating behavior does exist within a variety of populations. People with personality disorders, mentally delayed individuals and some mental illnesses can also predispose an individual to indulge in such behavior.

CAUSES FOR SELF- MUTILATING BEHAVIOR

Self-mutilators usually experience a childhood in which they are required to provide nurturing and support for parents or caretakers. If a child experiences this reversal of dependence during formative years, that child perceives that she can only feel anger toward self, but never toward others.

This child experiences rage, but cannot express that rage toward anyone but him or herself. Consequently, self-mutilation is used as a means to express anger.

Individuals who self-injure often have suffered sexual, emotional, or physical abuse from someone with whom a significant connection has been established such as a parent or sibling. This often results in the literal or symbolic loss or disruption of the relationship.

The behavior of superficial self-mutilation has been described as an attempt to escape from intolerable or painful feelings relating to the trauma of abuse.

The person who self-harms often has difficulty experiencing feelings of anxiety, anger, or sadness. Consequently, cutting or disfiguring the skin serves as a coping mechanism.

The injury is intended to assist the individual in dissociating from immediate tension and anxiety.

People who participate in self-injurious behavior are usually likeable, intelligent, and functional. At times of high stress, these individuals often report an inability to think, the presence of unexpressable rage, and a sense of powerlessness.

An additional characteristic identified by researchers and therapists is the inability to verbally express feelings.

Some behaviors found in some other people are at times mistaken for self-mutilation. Individuals who have tattoos or piercings are often falsely accused of being self-mutilators.

Although these practices have varying degrees of social acceptability, the behavior is not typical of self-mutilation.

The majority of these persons tolerate pain for the purpose of attaining a finished product like a piercing or tattoo.

This differs from the individual who self-mutilates for whom pain experienced from cutting or damaging the skin is sought as an escape from intolerable emotional states.



NBC News Transcripts
Today 7:00 AM EST
October 5, 2005

Group of teens share their experiences with self-injury; psychiatrist Gail Saltz discusses self-injury among adolescents and warning signs parents should be looking out for

KATIE COURIC, co-host: We’re back at 7:43. And this morning on TODAY’s FAMILY, something called self-injury. Statistics are difficult to come by but it appears that more and more adolescents these days are hurting themselves on purpose. Why? Well, recently we sat down with some young people who were brave enough to share their stories.

Ms. MICHELLE SELINGER (Self-Abuse Finally Ends Alternatives): The self-injury is cutting, burning, any type of body modification that injures or wounds your body.

KRISTINA: It started in on my second grade class. Cutting became my way of reminding myself that I was still alive. I also would burn myself and pull my hair and punch walls in order just to inflict pain.

Ms. SELINGER: Self-injury is certainly something that is on the rise, between 1 and 5 percent of the general population.

BRIANNA: It’s been 13 days since the last time that I self-injured. I was so worried about people finding out about this giant secret that I had. It became just this addiction, like it helped me with everything. It numbed every emotion that I had.

Ms. SELINGER: Self-injury is a coping mechanism. And you can’t take away the coping mechanism without treating the underlying issues.

NIKI: I was 12 years old, and I started self-injury. I was just like happy, sad, every feeling in the book. Like I had to cut because I couldn’t handle it. I couldn’t handle feeling anything. You don’t cut your wrists for suicide, you do it to feel something, to feel like you’re real.

Ms. SELINGER: Many people who self-injure feel out of control by their feelings or emotions. So it is one way to gain control.

KATHI: Every day is hard. Every day is a struggle. I’ve needed help for it my whole life. I went to great lengths to hide it because it’s very—I feel very embarrassed and ashamed that this is something I do.

Ms. SELINGER: It is more common with women and girls. I would say about 10 percent of the patients we treat are males.

STEVEN: Mine started when I was 12 years old and it started after I had drug use. It was hard for me to just like even be alive without either. How my wounds healed is exactly how I can heal.

COURIC: Kristina’s now a youth counselor at the Mental Health Association here in New York City. The other four—Brianna, Niki, Kathi, and Steven—all are on their way toward recovery and spoke to us from the Self-Abuse Finally Ends or SAFE alternatives program in Naperville, Illinois. Gail Saltz, meanwhile, is a psychiatrist and TODAY contributor. Hi, Gail. Good morning.

Dr. GAIL SALTZ (TODAY Contributor): Good morning, Katie.

COURIC: Gosh, that’s so heartbreaking. It just makes—it makes you feel so terrible for those kids.

Dr. SALTZ: Well, you know, if their pain is so bad.

COURIC: And adults, by the way.

Dr. SALTZ: And adults. Many—many adults do this as well. But if their pain is so overwhelming, and that’s really what’s going on here, it is, as the person in the tape said, it is a coping mechanism. And the reason is basically that there are overwhelming feelings that are going on that are—that actually it feels like a relief to them to cut or mutilate...

COURIC: Because the pain’s better...

Dr. SALTZ: ...compared to the feelings.

COURIC: ...because they want to feel pain. I—they had a piece in Time magazine...

Dr. SALTZ: Yes.

COURIC: ...I remembered last spring...

Dr. SALTZ: Yes.

COURIC: ...and they said that “Cutting is a way to kick-start feelings when the numbness becomes worse than the pain.”

Dr. SALTZ: Well, some kids describe numbness that is worse. Some kids will describe the opposite, overwhelming feelings. They might be feelings of stress, of anxiety, of depression. But these feelings are so overwhelming that actually they would rather focus on something...

COURIC: On the physical pain.

Dr. SALTZ: ...concrete physical pain then—and it is a relief for them. It is a release for them.

COURIC: Why do you think the numbers have increased? I mean, it’s very hard to determine how many kids or adults are doing this...

Dr. SALTZ: Exactly.

COURIC: ...because it is so secretive?

Dr. SALTZ: It’s secretive, and that makes pulling statistics on this very difficult. They range...

COURIC: But I just want to mention, Gail, one study in the Journal of Abnormal Psychology says from 14 percent to 39 percent...

Dr. SALTZ: Right.

COURIC: ...of adolescents engage in self-mu—mutilative behavior.

Dr. SALTZ: Right. I mean—and that ranges from scratching, to cutting, to punching, to burning. We’re talking about basically a definition of self-injury is anything that causes tissue damage. And the problem is that it is, as many of the kids talked about, very shameful to them. So they don’t tell their parents what’s going on. They don’t tell anyone what’s going on. And it’s very difficult for them to get treatment.

COURIC: Someone once told me that this kind of behavior, this kind of self-infliction, actually releases endorphins.

Dr. SALTZ: Yes. That’s...

COURIC: Is that true?

Dr. SALTZ: ...it is an im—well, it is—it is a theory because it—you know. But, basically, the theory goes that it is both a psychological and a biological relief and release. And, yes, the body, when it gets injured or for instance when you run a marathon and you run that far releases endorphins and they give you a natural high, natural feeling of relief and calm. And that makes self-cutting potentially addictive. That’s the issue. Some kids will cut, and it just doesn’t do anything for them, it’s done. But other kids start cutting, and it—you really get into an addictive pattern, and they cannot stop.

COURIC: So real quickly, how—how can you be cured for this? I mean, do you need—do anti-depressants help? Do ther—does therapy help?

Dr. SALTZ: Here’s the issue. You must be evaluated by somebody who is familiar with adolescents and with self-cutting. Because, in fact, not all treatments are helpful. And what’s most important is, what is the underlying problem? What is the underlying diagnosis? It may be borderline personality disorder. It may be a mood disorder like major depression or bipolar disorder. It may be an anxiety disorder. So the treatment depends on what the underlying issue is.

COURIC: And you really need to get a qualified professional.

Dr. SALTZ: Exactly.

COURIC: Quick, warning signs...

Dr. SALTZ: Yes.

COURIC: ...for parents.

Dr. SALTZ: Yes.

COURIC: Your teen or child keeps disassembled razors, pieces of glass or bent paper clips in his or her bedroom, has unexplained scratches, cuts or burns. Because oftentimes it’s done with burning, too, I understand.

Dr. SALTZ: Exactly. With cigarettes, yes.

COURIC: Wears long sleeves and pants in warm weather or just all the time, right?

Dr. SALTZ: Yes.

COURIC: Experiences mood swings, is depressed and withdraws from friends and family. These are some of the warning signs. And, hopefully, since the number appears to be climbing, this will be helpful to parents.

Dr. SALTZ: And, unfortunately, it’s climbing. To some degree, it’s taken on this cult-like status. Kids may try it because they know other kids are doing it. But if you have any signs that your kid is doing this, you must bring them to a qualified professional. If you don’t know how to find that, there are centers. For instance, the Borderline Personality Disorder Resource Center, where you get free evalu—you know, told where in the nation to find someone.

COURIC: And also, given the fact that kids are so stressed these days, it’s not all that surprising that this number is increasing.

Dr. SALTZ: Exactly. Exactly.

COURIC: Gail, thanks so much.

Dr. SALTZ: My pleasure.

COURIC: Interesting and upsetting.

Dr. SALTZ: It is.

COURIC: For more information about self-injury and how you can get help, you can logon to our Web site at today.msnbc.com. And we’ll be back with more of TODAY right after this.



Tampa Tribune (Florida)
October 18, 2005

A Cry For Help
By Daylina Miller

She sits in her room and pushes her long hair out of her face, her mouth twisting in concentration. With trembling fingers, she draws her razor blade out from its sheath and presses it against the skin of her arms and her legs. Blood trickles out from the sides and down her body in a salty, crimson stream and stains her fingertips.

She goes to school the next morning in long sleeves and floor-sweeping skirts and smiles at her friends, most of whom never notice the hint of sadness in her eyes.

This is not an uncommon scenario among today’s young people. Battling depression and intense feelings leads some to cut their bodies. In their minds, this physical pain helps to block out negative emotions and gives them an outlet for their feelings of helplessness.

According to online resources on cutting, self-injury is defined as “an expression of acute psychological distress. It is an act done to oneself, by oneself, with the intention of helping oneself rather than killing oneself. Paradoxically, damage is done to the body in an attempt to preserve the integrity of the mind.”

Three years ago I was flying back to Tampa from Pennsylvania, seated next to a gentleman with a Bible on his lap. He eyed my clothes and piercings and commented that self-mutilation was against God. Not knowing how to defend myself, I commented that at least I didn’t “cut.”

He was baffled by my reply. He asked me what I meant by cutting, and I explained to him about the friends I’d known who had problems or were just plain depressed and turned to cutting themselves as a means of relief.

He was bewildered by this revelation and spent the remainder of the plane trip mulling over it, muttering about raising awareness to help these poor souls. Then he thanked me for explaining this to him and gave me his business card so that if I ever felt the need to cut myself, I’d have someone to talk to.

After that conversation, I didn’t think much about cutting until I became good friends with a girl who often appeared with scars on her ankles and the insides of her arms and had no explanation for the injuries.

Then I read an article in Portico Students Magazine, titled “Chronicles of Depression,” which interviewed two girls who were familiar with cutting on a nearly catastrophic level. Sometimes cutters cut too deep, though suicide is rarely their intention.

Karen Turnbow, a psychologist with Alabama Psychotherapy and Wellness Center, told the magazine: “Momentarily, it diverts their inner pain to a physical pain. And physical pain is easier for us to understand.” A lot of people tolerate physical pain better than inward pain, and the cuts they make are more bearable than their overwhelming emotions.

Next time you see people like my friend with scars or cuts lining their bodies, don’t hesitate to get them help. Don’t listen to their excuses of “It’s just a cat scratch” or “I had an accident in the kitchen.” These signs are a silent plea for help.

Talk to them, even if they are like my friend and don’t like to discuss the behavior. She did eventually stop after her parents took her to a counselor.

Talk to their friends. Talk to the school guidance counselor. Make sure they have every available resource at their fingertips to get the help they need, whether it’s through the school and family members or through one of several crisis hot lines.

Awareness saves lives. Don’t dismiss this as just another teenage phase.



PR Newswire US
October 20, 2005

Self-Harm Rising in Teens and Young Women with Eating Disorders; Remuda Ranch, Programs for Eating Disorders, Reports Self-Harm is Rising at Alarming Rates Among Patients

PHOENIX, Oct. 20 /PRNewswire/ — Self-harm has become a burgeoning phenomenon in our culture, primarily affecting teens and college-age women. In patients with eating disorders, prevalence for self-injurious behavior is 25-45 percent. Remuda Ranch, Programs for Eating Disorders, the leading treatment facility for women, teens and girls suffering from anorexia, bulimia and related issues, has developed a specific treatment intervention for self-injury patients.

“In 2000, we noticed more and more patients with self-injurious behavior,” said Marian Eberly, vice-president of patient care services at Remuda Ranch. “At first we were shocked, but we decided we needed to study this phenomenon from a treatment perspective. We put a task force into place that led to a treatment intervention program.”

Self-injurious behavior has garnered more attention in the last decade. In recent years, eating disorder professionals are talking about self- injurious behavior as a common co-occurring condition with both anorexia and bulimia. Common self-injurious behavior includes: scratching, cutting, carving and burning of the skin, to name a few.

“Self-harm is often hidden and there’s a lot of shame associated with this behavior,” adds Eberly. “Self-injurious behavior is a form of coping with emotional distress and it doesn’t mean the person is suicidal.”

Careful evaluation is the key to preventing and teaching patients to live successfully without self-harm. Remuda begins the evaluation process prior to admission with a comprehensive pre-screen. Then, a thorough psychosocial self-assessment tool is utilized following admission to gain information about self-injury from the patients’ perspective. A self-harm reassessment is performed halfway through treatment and again at discharge. With this information, it is possible to determine what is driving each patient’s self- harming behavior, and to teach the person healthier ways of coping with their particular emotions and issues.

Remuda’s treatment intervention has proven to be highly successful among its patient base. There has been a significant decrease in self-injury in patients Remuda has treated.

“Treatment works and the sooner the one is able to get treatment, the better,” said Eberly.

About Remuda Ranch Programs for Anorexia and Bulimia

Remuda Ranch is a caring place for women and girls who are suffering from ever-increasing levels of anorexia, bulimia and other eating disorder related issues. Remuda Treatment Centers offer professional, Biblically based programs exclusively dedicated to the professional treatment of females suffering from eating disorders. Each resident is treated by a team of six professionals including a psychiatric and primary care provider, registered dietitian, Masters-trained therapist, psychologist and registered nurse. The professional staff equips each resident with the right tools to live a healthy, productive life. For more information, call 1-800-445-1900.



South China Morning Post
October 31, 2005

Self-harm is on the rise as the pressures of modern society lead people to inflict physical pain in the hope of easing other suffering. Psychologist Sandra Comer explains

WHY WOULD ANYONE pick up a razor blade and cut into their own flesh? A big concern facing health-care professionals today is the rise in this perplexing mental health condition.

To someone on the outside, self-harm - the act of injuring oneself as a way of coping with life’s ups and downs - is incomprehensible. But as the pressures of modern society take their toll, more people are attracted to it as a way to ease emotional upsets.

As one of my Hong Kong patients says: “Cutting creates physical pain from emotional pain - which is easier to deal with.”

Some even describe a sense of euphoria. “It feels good,” says another patient. “There’s something exciting about it.”

Jadis Blurton, clinical director of Therapy Associates in Central, says: “The good news is that it’s not typically a suicidal gesture, although it certainly looks like one”.

Studies consistently show that women are more prone to self-harm than men.

“Men act out - women act out by acting in,” says Dusty Miller, author of Women Who Hurt Themselves: A Book of Hope and Understanding. Because many women don’t express anger externally, when they do experience rage, they tend to turn it on themselves, she says.

Based on a 1986 survey, Armando Favazza and Karen Conterio developed a profile of the typical self-injurer.

She is female (97 per cent of respondents), in her mid-20s to early 30s, and has engaged in this kind of behaviour since adolescence. She tends to be middle or upper-middle class, intelligent and well educated. She has a higher likelihood of coming from a background of physical and/or sexual abuse, or from a home with at least one alcoholic parent.

Eating disorders are also often reported in this group. Methods of inflicting pain include cutting, hitting, burning, head banging, breaking bones and preventing wounds healing. According to recent estimates, 1-3 per cent of America’s population of about 280 million people have injured themselves.

Although many people use more than one method, studies show that cutting wrists, upper arms and inner thighs are the most popular means.

Some researchers say cutting provides relief from overwhelming anxiety, fear or sadness in a person’s life. Self-harm is often the only coping mechanism they know. Of course, in the long term, it creates more problems - such as feelings of inadequacy and failure, a loss of control, embarrassment and physical injury.

In a study by Ulrich Sachsse and colleagues, published in the American Journal of Psychiatry (2002), the nightly cortisol levels (the stress hormone) in a woman who harmed herself were tracked. They were significantly lower on the days she harmed herself than on the days she didn’t, the stress having been relieved by the abuse.

At times, these acts may divert attention from issues too painful to address, so the focus narrows to the act itself. Similarly, some describe their actions as a way of escaping depression and feelings of emptiness or numbness. And, like my patient, many get a sense of euphoria from harming themselves.

This makes sense, given that the body releases a hormone called endorphin, which is a natural opiate, in response to pain. Endorphins are responsible for what’s called the runner’s high.

It’s well established that this same hormone is released as a result of vomiting, which may partly explain the addictive nature of those suffering from the eating disorder bulimia.

For many, self-harm is a way to relieve anger they can’t express otherwise. Or, it may be a way of punishing themselves. For others, it’s about control - that is, exerting control over their bodies or the behaviour of others.

A commonly held belief is that self-harm is a way to get attention, but this is an oversimplification, because many people choose to harm themselves in places where people can’t see their injuries.

Nevertheless, for some it represents a desperate need to communicate with others the extent of their inner turmoil or their need for support. Self-harm can become a means of expressing feelings of alienation. In addition, it may be a continuation of abuse.

Childhood abuse leaves a sense of guilt in the survivor, especially if it happened at an early age. The victim can’t understand why they were punished and, as a result, concludes that there is something inherently wrong with them.

Self-harm can become a way of continuing the punishment.

In an article in The Journal of Clinical Psychology (2000), the authors said that people who deliberately injured themselves usually had failed to develop three important self-capacities: the ability to tolerate strong emotion; the ability to maintain a sense of self-worth; and the ability to maintain a sense of connection to others.

“The development of a healthy sense of self worth is impaired when strong feelings are met with punishment or the suggestion that such feelings are unacceptable,” they wrote.

“The ability to maintain a sense of oneself as a person of worth can’t be developed when a child never feels she is good enough or when her accomplishments are either not acknowledged or met with abusive words or actions.”

In a study in the Journal of Abnormal Psychology in 1995, groups of self -injuring and non-self-injuring people were led through guided imagery sessions in which each experienced the same four scenarios: a scene in which aggression was imagined; a neutral scene; a scene of accidental injury; and one in which self-injury was imagined. During the guided imagery sessions, physiological arousal and subjective arousal were measured. The results provide strong evidence that self-injury provides a quick, effective release of physiological tension, which would include that brought on by overwhelming psychological stress.

Reactions across groups were similar on the aggression, accident and neutral scripts. However, during the self-injury script, the control groups went to a high level of arousal where they remained, despite relaxation instructions. In contrast, self-injurers initially experienced increased arousal until the decision to self-injure was made, at which point their tension dropped.

As a result, the researchers suggested that self-injury could be a preferred coping mechanism because it quickly calmed the body, even though people who injured themselves often have negative feelings after an episode. But, although they may feel bad, the overwhelming psycho-physiological pressure and tension has been relieved.

So what do you do if you know, or suspect, your teenager or a friend is engaging in self-harm?

“Parents and professionals usually react with shock, dismay, fear and anger,” Blurton says. “But it’s important to remain as calm as possible and to be non -judgmental.

“Many kids try it only once. But for those who do it more often, it can become an extremely hard habit to break. One book I find helpful with teenagers and their parents is A Bright Red Scream: Self-Mutilation and the Language of Pain.

“This book helps them to realise they’re not alone, and helps their parents to recognise and understand the emotions behind it.”



Copley News Service
November 6, 2005

Teen speaks out after years of deeply cutting her body
By Molly Parker

Can’t take the anger. Can’t take the pain. Must relieve the only way I can. Cut.

Cut.

Cut.

Seventeen-year-old Alicia Moore started cutting in the sixth grade.

The first time she did it, Alicia was talking to her boyfriend on the phone.

She can’t remember what they were arguing about - it couldn’t have been much more than a sixth-grade lover’s quarrel - but she was so mad she ripped a soda can in half and used the sharp aluminum to cut herself on the wrist, near the bone. “I didn’t know why I did it,” says Alicia, a petite blonde with a charming smile and scars marring nearly every part of her body, including remnants of cuts that left capital letter scars of the word “HATE” stretching down her left leg. But it made her feel better. Before long, she was cutting every time she got mad, and then even when nothing was specifically wrong.

“I remember cutting, thinking, ‘I wonder who’s going to see this, and I wonder who will care,’” she says. Self-mutilation is a disease that - unless it grips you - is difficult to comprehend.

Why would people want to hurt themselves? What makes a person want to cut herself so deep it draws blood? What kind of relief can possibly come from pain?

“It’s concentrating on something else than what you feel on the inside,” explains Alicia, who spoke out about her illness for the first time during a Mental Illness Awareness Week symposium.

“I cut so I wouldn’t remember,” she says. “I did it to forget my emotional pain.”

Alicia isn’t alone. It’s estimated that some 2 million people nationwide use self injury as a coping method. A high school senior now at Richwoods (Ill.) High School, Alicia says she knows other students are cutting, sometimes in social groups.

Local high school counselors also say they see marks of students they suspect are cutting.

“It’s in every high school, and we certainly have students who are cutters here,” says Mary Kay Berjohn, a school psychologist at Richwoods who has been there 23 years. “It’s probably more pervasive than it’s ever been before. More and more students seem to be doing it.”

REASONS WHY

The reasons people cut are varied, doctors say, but one thing is certain: The root problem is much deeper than the cuts themselves.

Self-mutilation is a mental disorder that usually is coupled with another, such as depression or borderline personality disorder or other mood disorders.

Cutting is not typically an attempt at suicide, but that doesn’t mean it should be dismissed as a childish cry for attention.

“I was suicidal, but I didn’t cut to commit suicide,” says Alicia, who has been diagnosed with clinical depression. Beyond the fact that anyone intentionally cutting is in need of help, it’s also possible for a cutter to make a mistake and cut too deep, thereby unintentionally killing himself, doctors say. Parents or friends who suspect someone is cutting should not ignore or dismiss the problem. It’s scary and difficult to confront - as Moore’s parents attest - but there is help, and there is hope.

“It was highly emotional, and it’s devastating,” says Alicia’s mother, Mindy. “But it’s an important story to tell because I think it’s happening a whole lot more than people realize.”

Alicia has not cut herself for at least two years. But it took a lot of time, and patience - and the support of her family and counselor - to get to where she is today.

“In our society saying ‘help’ is such a weak thing to do. That was my secret way of saying, ‘Help me,”‘ Alicia says. Now, she’s preparing to speak out to high schools, hoping her story of recovery will encourage other students to get the help they need. And perhaps also, she said, it will shed light on the subject for those who don’t understand and deem people who cut “crazy,” rather than real individuals crying out for help.

Blood dripping from a new wound. Emotional pain transformed into physical. Relief. Twisted emotions sorted out. Smile across my face. Crimson Blood.

CHILD PSYCHIATRIST

Dr. Shobha Nookala, a child psychiatrist at Methodist Medical Center in Peoria, Ill., says she sees a lot of self-injury in the in-patient unit among adolescents she treats.

It’s usually cutting of the wrist and arms, but it comes in the form of cigarette burns, scratching, biting and hitting. It’s most prevalent in young girls and women, though Nookala says she sees young boys with the problem as well.

“There is typically a history of some kind of abuse, but not everybody who cuts is abused,” Nookala explains. People who cut often have feelings of inadequacy from growing up, difficulty with problem-solving and communicating pain, and also suffer from depression, impulsivity and aggression. It’s also common among people who grew up with abuse, neglect or invalid feelings for one reason or another. A cutter typically has poor interpersonal relationships and a shaky sense of self.

“People who cut usually say, ‘I had so much emotional pain I couldn’t take it anymore. When I see blood, my emotional pain decreases.”‘ Nookala says. “For some people it’s a coping mechanism when they feel that no one is listening. It’s also a cry for help, showing other people ‘I am in distress.”‘

Nookala says she’s not sure if there’s more self-injury going on than in the past, or if people and the media are putting it in the spotlight. She does, however, believe it is somewhat contagious among young people who see others doing it and may think it’s a way for them, too, to release pain.

Drip.

Drip.

Drip.

Dripping from my wrist. My leg. My stomach. My heart.

PARENT’S NIGHTMARE

Mindy Moore and her husband, Tom, first learned of their child’s problems when they found a diary she kept under her bed. It was stained with something red and filled with horrifying words for any parent to read.

“I wanted to believe it was lipstick,” her mom says of that moment about five years ago. “I didn’t know anything about cutting. I had never heard about it.” They sought counseling and attempted to understand what to them seemed incomprehensible: Their beautiful little girl - a gifted student with an amazing knack for piano and dance who has an ability to learn that surpasses most of her peers - was hurting, and she was doing it to herself.

The scenes that played themselves out over the years were horrifying. Mindy Moore recalls one day her daughter emerged from their upstairs bathroom, dripping with fresh blood from her midsection. Alicia had slashed herself 10 times on the stomach.

“I couldn’t get hysterical. The counselor had told us don’t overreact because you don’t want them to feel that’s an appropriate way to get attention,” Mindy Moore says. “But it was awful to see your daughter standing at the top of the stairs bleeding.”

Alicia says her pain started at a young age. For reasons she doesn’t understand, she could never make friends. She tried fitting in with the preppy girls, the sporty crowd, the misfits and any other clique typical of school children to form. But she never had a group to call home and was constantly the source of ridicule and mean-spirited taunts.

“I don’t think I’ll ever be able to figure out why I couldn’t make friends,” she says. “I just could not fit in. But I was like everyone else as far as I could tell.”

Her father, Tom, surmised she must have been seen as a threat to other students. Alicia saw that, too, and dropped all her interests with the sole goal of making friends.

Finally, as a freshman in high school, she found a group that took her in. She went “Goth,” dyed her hair black, wore dark red lipstick and began piercing all over her body - including on her knees and on the skin between her thumb and finger. Her new friends were into drugs and several were also cutting themselves. She also started running away from home and was suspended from school twice.

At one point, she overdosed on cough syrup and speed and landed in the emergency room. It was during this episode that she cut “hate” into herself. She and one of her friends were in the bathroom at school, carrying on and having a conversation, when suddenly they “pulled out safety pins and started going nuts.” “We were laughing and making ourselves bleed,” she recalls of that day.

“It doesn’t feel like that was me at all,” she says about her life that transpired only a few short years ago. She has only one picture of herself from that era. “My hair’s greasy and my teeth are yellow. I look at it all the time and think, ‘No way that was me.”‘

Today, she and her parents have found the ability to laugh about those harrowing years: how she used to tie sheets together to jump out her second-floor bedroom window, and how her dad used to lie under the kitchen table trying to catch her sneaking out.

“Mindy and I felt hopeless,” Tom Moore says. “Recovery proceeded at a snail’s pace. But the best medicine Mindy and I used during the whole process was to maintain our sense of humor.”

Today, they’re proud of the way their daughter has recovered, and her ability to speak out about her pain. “It’s a story of recovery and hope,” Mindy Moore says. “Things still aren’t always rosy, rosy, but it’s like looking at a different child today.

“You wish your child didn’t have to go through it, but now she has a certain strength about her. People are put through things for different reasons, and maybe this is the reason.”

ANOTHER WAY TO COPE

Alicia was able to recover with medication and therapy that taught her new ways to cope with her internal demons. She stopped hanging out with her old friends, realizing that after she was hospitalized and they didn’t call or visit once, that perhaps they weren’t ever friends at all. To stop the addictive act of cutting, she acted out her impulses on soap, cutting it into shreds rather than her skin. She also cut her desk.

Alicia says she no longer has the impulse to hurt herself, even though she still struggles with depression. And she admits that school is still hard. People still look at her differently, remembering who she was back then. She doesn’t have many high school friends, but she hangs out with a different crowd now. Her boyfriend attends Bradley University, and Alicia also plans to go there after she graduates.

“It’s hard not to have high school friends,” she says. “People aren’t as mean. They just leave me alone now.”

There’s still a long road ahead, but Alicia knows she has the ability to walk it straight. During the height of her depression, she kept an online diary filled with poems about how she felt in the process. Her mom would like to have it published. Alicia keeps it tucked closed to her as a reminder of what she’s been through.

She wrote the poem dispersed throughout this story in December 2001.

She’s speaking out because she wants others to know that cutting isn’t the only way to cope. And that at the end of the day, there are places to turn for help. “I want two things,” Alicia says about her decision to speak out. “I want people not going through it to realize it’s a serious problem. I got so much crap from people, kids saying ‘she’s psychotic’ and ‘she’s insane.’ I want people to know mental health is important for everyone and getting help does not mean you’re weak or insane.

“And I want people going through it to know that it’s OK to ask for help.”



Western Mail
December 19, 2005

Devastated Maria admits to 17 years of secretly cutting herself
By Madeleine Brindley

Maria Church’s revelations that she has been self-harming for 17 years could help younger people struggling with the same problems. Self-harm support organisations last night said Maria, mother of singing sensation Charlotte Church, was brave to speak out about the ‘hidden’ issue. Maria revealed her self-harming secret in an interview with a Sunday tabloid newspaper. She spoke of how nurses had discovered the scars while she was receiving treatment after taking an overdose, which had been prompted by a kiss-and-tell story about husband James’s affair with chef and friend Anna Goddard.

Caryl Stock, of the Cardiff-based Amber Project, which helps young people who self-harm, said, ‘It is very helpful when people like Maria are brave enough to speak out as it does increase awareness. ‘So often people think that those who self-harm don’t cope but, for many, this is a way of coping with difficulties in life. ‘It also emphasises that while for some people self-harm is problematic and something they need to work through, others see it as a coping mechanism.’

Maria, 39, told of how she hurts herself at times of emotional stress or after drinking alcohol. ‘Everyone has their own steam valve,’ she said. ‘Some people drink, others take drugs. ‘Self-harm is my release valve. But people don’t understand it as it is so extreme and it’s a secret I’ve carried for a long time. ‘It’s something I never wanted to reveal. But now is the time to speak out and tell the world the truth. I need proper help. ‘When you are that emotional and tense it’s a release. ‘For some people it’s the pain, for others the blood. For me it’s both, the more I cut the better I feel. I’ve never gone to hospital with it as I didn’t want people to know. ‘A good friend who is a nurse would come down and sort me out. ‘My arms are a bloody nightmare. That’s why I’ve always got to wear long sleeves. There are lots of scars.

‘Most of the time it’s when I’ve had a drink. And usually when I’ve had an argument with James or Charlotte or I feel I’ve upset someone. ‘If I feel I have hurt someone I take it out on myself. I’m about to start counselling. I know I need help.’ Maria revealed she has been self-harming for the last 17 years, although she said she had hidden the secret from daughter Charlotte for 14 years.

She claims husband James - Charlotte’s step-father - told the singer about her self-harming three years ago. Maria said, ‘When James dropped the bombshell about my self-harming on her three years ago, she didn’t take it very well. ‘She’s still very angry and hurt. She doesn’t understand, but she tries.’ Charlotte last night vowed to help her mother through her problems, telling close friends that she would pay for expert help. She told the friend, ‘I’m closer to my mum than anyone else in the world but I had no idea this has been going on since I was five. ‘I’m glad this has come out now - although I wish the whole world didn’t know. ‘At least she can get treatment for her illness - that’s what it is.’ Maria also revealed how 19-year-old Charlotte saved her life when she took an overdose. She revealed how she took pills after she learned about her husband James’s affair with Anna, 30, who worked at their pub, The Robin Hood, in Cardiff.

Maria said she swallowed about 25 pills from her bathroom cabinet until she lost consciousness.

She said, ‘The next thing I remember is Charlotte shaking me to try and wake me up. ‘Charlotte rang the hospital and they said to get me in immediately. ‘My initial reaction was ‘No’, in case the press found out. But Charlotte insisted. ‘Thank God for Charlotte. I couldn’t have got through any of this without her.’ Maria’s revelations about her self-harming come after double-Olympic gold winning athlete Dame Kelly Holmes spoke about how she would cut herself with scissors before her Athens triumph. Dame Kelly said, ‘I thought I was cursed. It’s the lowest I’ve ever, ever been.’:

Harming yourself

Self-harm can include alcohol or drug abuse, eating disorders, failing to look after yourself either physically or emotionally, or it may involve physical injury. In its widest sense it includes any action that may be potentially damaging. A more narrow term of self-injury refers to types of self-harm which involve a greater degree of immediate impact. The term is usually used to refer to deliberate actions, such as purposefully cutting, burning scalding or branding yourself. Self-harm is more common than people realise, but the fact that people rarely talk about it, or present to health services needing care, means that the true extent of the problem is not known.

There are no easy answers to why people self-harm.

It may be because physical pain stops them thinking about the pain they feel inside, it may be because it gives the person a degree of control over themselves or acts as a kind of pressure valve.

For help or advice about self-harm contact the Amber Project on 029 2034 4776 or the Self-Harm Alliance helpline on 01242 578 820. The National Self-Harm Network can be contacted by post at PO Box 7264, Nottingham NG1 6WJ.



The Gloucester Citizen
December 20, 2005

Self-harm: the facts

Self-harm often represents the prevention of a suicidal episode and may be a survival strategy.

The most common forms are cutting the arms, hands and legs.

Some self harmers burn or scald themselves, others inflict blows on their bodies, or bang themselves against something.

Other ways people injure themselves include scratching, picking, biting and scraping.

Common forms of self-injury that rarely reach medical attention include sufferers pulling out their own hair and eyelashes, picking at spots or skin and scrubbing themselves so hard as to cause abrasion, sometimes using cleaners such as bleach.

It is unclear how common self-mutilation is because it’s such a secretive activity, although some studies have found that 11% of students questioned had slashed or cut themselves at some point.



Newsday (New York)
December 23, 2005

Staff for teen program cut; Parents, kids upset sessions for self-injury at Schneider’s will suffer as therapists are reduced by third
By Ridgely Ochs

Parents and teenagers are protesting staff reductions in a highly successful program at Schneider Children’s Hospital that treats adolescents who cut or otherwise hurt themselves intentionally.

“This is a gem of a program,” said Ronni Mordechai-Strongin of Levittown, whose daughter, Ilana, 15, has been attending group and private therapy sessions there for six months. “It’s not too often that you have a psychiatric program that’s such a huge success.”

The program - the only one of its kind in the area - operates under both Schneider and Zucker Hillside Hospital in Glen Oaks. It uses dialectical behavior therapy, which focuses on teaching teenagers who cut, burn or otherwise intentionally hurt themselves how to moderate their emotions.

While there are no official statistics on self-injury, studies show a range of 6 percent to 39 percent of teenagers nationally who engage in some form of self-mutilation.

As part of 152 layoffs that North Shore-Long Island Jewish Health System announced earlier this month, the program is losing two of its six therapists. A part-time psychologist is being laid off, and a social worker has been reassigned. That means larger group sessions for the more than 50 patients and longer waits for those trying to get into the program.

Mordechai-Strongin and other parents are demanding to meet with North Shore-LIJ’s chief executive, Michael Dowling. “This is a program that he should be parading in front of the world, not cutting,” she said.

North Shore-LIJ spokesman Terry Lynam said the program - which he said makes money for the hospital - was not the target of reductions. The staff positions were, he said.

“Understandably, many parents are very anxious because their children will be switching therapists,” Lynam said. He said a more senior social worker will replace the one being reassigned.

But parents and teenagers are baffled and angry.

“I’ve never heard a negative word about this program; it’s like a godsend,” said Trisha Boronow of Dix Hills, whose daughter, Jennifer, has attended therapy there for the past three months. “She’s a different person. She smiles again.”

Jennifer, 15, who began cutting and burning herself in seventh grade, said she had been in and out of other programs before she began attending Schneider’s.

“This is the first therapy that actually works,” she said.

Upset by the loss of her psychologist, Jennifer said she is trying to use the skills she has learned in counseling and plans to make a documentary about the hospital.

“I just need to do something about it,” she said.



San Antonio Express-News
December 30, 2005

Less pain for teen who used to cut herself
By Marina Pisano

The girl sitting across the table isn’t the same sad, stressed-out teenager who sat down six months ago to talk about cutting — about the anxiety and pain that drove her to burn, bruise and slice herself with sharp objects; about her embarrassment over the scars that covered her young body; about her month-long effort to stop.

Allison has pulled it off. After three years of cutting, the 16-year-old has stopped, and that victory shines through in her smiling face and self-assured manner.

“I went cold turkey. I had to. It was the only way I could do it, and I haven’t had any slips at all. And I’m happy,” says the high-school junior, her long, light brown hair falling on a black sweatshirt, her face free of makeup and still a little flushed from her tae kwon do class.

Allison’s story was part of “Out of pain, they cut,” an article about self-injury in youth and adults that ran in S.A. Life on May 2 this year. Allison asks that her real name not be used.

She is doing so well that her psychiatrist lowered the dosage on her medication for depression and anxiety. After the article appeared, she consulted a plastic surgeon, and he was able to reduce some of the thick scars on her arms and legs with injections. “I could actually go swimming,” she says.

Among other achievements, she recently was elected to the National Honor Society, and she looks ahead to studying marine biology in college. In martial arts, she has earned a black belt, a big confidence booster. At home, she finds peace in writing poetry.

“There’s always those days when you feel down and want to do it, but then the poetry really helps. I put my feelings in it, and I calm down after a while. I don’t need to cut,” she says.

She has made more friends. “I’m trying to reach out more to people, and I’ve helped some people who were going through a bad time,” she says. “I’m older and have more perspective. I feel like I was so self-absorbed and selfish. Now I know there are people who have it worse than I do — like the people in Katrina.”

“She is like a different person now,” Allison’s mother says. “And I think the article helped because it made it real for her, seeing it in black-and-white in print and seeing that other people were going through this, too.”

Allison understands that stress is unavoidable. Some nights she can’t sleep ruminating about bad things — like a boy who disappoints her.

“Before, that would have hurt me. Now, I just think, he’s a jerk. I can do better,” she says, adding with a smile, “Then I think about Brad Pitt.”


Daily Post (Liverpool)
December 31, 2005

Why we abuse our own bodies; DVD explains self-harm
By HOMA KHALEELI

YOUNG women in Merseyside are speaking out about their experiences of self-harm to help thousands of children suffering in silence.

A group from Liverpool have created a DVD for schools and social workers to explode the myths surrounding the problem, which causes people to injure themselves, often with knives or cigarettes.

Last year alone, Childline, the national children’s helpline, dealt with more than 5,000 calls from young people who cut or harmed themselves, with the numbers steadily rising.

Now the group from the Liverpool Young Person’s Advisory Service hope their video will explain this behaviour to parents and health and social work professionals.

Matthew Byrne, from the centre, said self-harming could affect young people from every walk of life.

He said: “It’s a coping mechanism - to cope with feelings of isolation or being different, or being bullied and can be seen in all social classes.”

Claire Davis has run the self-injury group for 16-25 year olds for five years, and said the young women and girls involved wanted to reach out to other sufferers.

The video explains self-injury is not an attempt at suicide, but is done to control feelings of anger or frustration.

Melissa, 23, from Norris Green, has been cutting herself for 10 years, but said meeting other people with the same problem had helped her feel less isolated.

She added: “We wanted to show people who self-harm that they aren’t alone. And to say to people not to judge us.

“I started cutting myself with a knife or razor blade when I was 13.

“I have never been abused or anything like that and I felt selfish. But everyone has a nasty streak in them and this is my way of keeping it in.”

Seventeen-year-old Michaela said she hoped the DVD would change attitudes to people with self-inflicted injuries.

Her behaviour stemmed from abuse she suffered as a child, she said.

She added: “Talking about it has really helped and made me feel less ashamed.”

Childline North West supervisor Charles Frost said it was important for people to realise that self harming was a symptom of a problem.

“So raising awareness like this is very important.”