The Press Enterprise (Riverside, CA)
January 8, 2006

Help for Cutters
By Mitchell Rosen

In a few weeks, I will be giving a presentation to educators on students who self-mutilate. Some people call them “cutters,” the students who use knives or razor blades to cut parts of their bodies. One of the questions I will surely be asked, “Is this behavior normal?”

Even though the sheer number of students who are cutting is skyrocketing, the answer is, “No, this is not a normal or typical adolescent behavior.”

Young people who self-injure are not going through a phase. The reasons they do it vary.

For some, it is a means to communicate. They are telling others by these behaviors that their emotional pain is so intense, so unmanageable, they want others to know the amount of discomfort they are experiencing. These students lack confidence in their ability to communicate and do not feel they will be understood.

Another reason often cited by self-injurers is, “It relieves my pain.” Students who cut themselves will say, “When I cut I feel more in control. It’s the only way I can relieve the tension that builds inside of me.” It is their way of controlling the uncontrollable.

Some come from broken homes, some do not. Some have experienced sexual, emotional or physical abuse, and others have fairly benign childhoods.

Many parents react to the news their child is cutting themselves with horror or disgust. They’ll say things like, “Get away from me!” or “Stop this right now!” Neither of these reactions is helpful, although they are understandable.

Parents who have a child who chooses to self-injure should put their own anger aside and try to understand what could motivate a child to act so angrily toward him- or herself.

These adolescents need professional help to assist them in sorting through what may seem like insurmountable problems. Typically these young people believe they are victims of external problems and have no choice but to act out physically.

No therapist, no doctor is going to “fix” these young people, but rather the professional will join forces with them to build up their confidence in communicating in less destructive ways and help them understand they do not need to be punished or pay penance.

The process is individual, but this condition is certainly treatable. Most cutters do not need to be hospitalized, and only a few of them are truly suicidal (many cutters will say they self-injure so they won’t kill themselves).

But it is not a transient or insignificant behavior. I will encourage all educators to resist the temptation to build an alliance by keeping a student’s self-injury a secret and understand it must be told to parents so the parents can get their child the help they need.

Albuquerque Tribune (New Mexico)
February 6, 2006

An Ugly Slice of Life: Difficulty in Coping
By Sue Vorenberg

Adrian’s body was a canvas. He painted it by cutting his legs and thighs with a razor, knife or screwdriver bit.

In the mornings, he’d wake up with his pajamas stuck to the clotted wounds. It felt good pulling them off and letting the blood flow again, he said.

“It was a tangible expression of what’s going on inside—like poetry,” the Albuquerque man said. “It made it concrete.”

Adrian’s parents, with whom he still lives, don’t want his last name used because they fear he’ll be stigmatized for being a “cutter.” He started at 21, and he’s now almost 23; he stopped cutting himself six months ago.

Adrian’s problem is not uncommon.

Psychologists and counselors around Albuquerque say they’ve noticed an increasing number of patients reporting self-injury.

Although the Department of Health, University of New Mexico and other groups don’t track statistics about the phenomenon in New Mexico, anecdotal evidence supports the idea that cutting is on the rise, said Laura Owen, a resource counselor with Albuquerque Public Schools.

It’s easier in today’s culture to admit to cutting than it was in the past, Owen said. “I think more students are feeling comfortable (talking about it).”

And talking about it can spread the problem among impressionable teens, said Nancy Heath, an associate psychology professor at McGill University in Canada and expert on self-injury.

“It’s extremely contagious,” Heath said.

In her recent study of 728 college students in Canada, which has been submitted to the journal Clinical Psychology: Science and Practice, Heath found about 12 percent had tried self-injury at least once, usually in high school.

“It’s out there in huge numbers,” she said. “The schools out there don’t know what to do.”

In Heath’s study of undergraduate students, 85 said they intentionally cut themselves at some point in their lives. Of those, 15 were men (9.4 percent of the men in the group of 728) and 70 were women (12.3 percent of the women in the group).

When Heath started studying the issue about five years ago, she found no literature. Now, she’s seeing more interest from the academic and scientific communities.

“There’s no question it’s happening more than it was when (my generation was) younger,” said Heath, who is 44.

The idea that more people are reporting cutting now than in the past does not surprise Jane McGrath, a school health officer for the New Mexico Department of Health in Santa Fe, who worked in a hospital about five years ago.

“When I taught (medical) residents, I used to say you can tell (right- or left-) handedness by the arm they cut on,” McGrath said. “It’s kind of a grim joke, but I was seeing it a lot.”

A Coping Strategy

The problem goes by a number of names: self-injury, self-harm, self-inflicted violence, self-mutilation. Most people who do it refer to themselves as cutters.

People injure themselves various reasons. At its heart is some sort of emotional torment, said Rachelle Dobey, director of Age to Age Counseling, which sponsors a support group for teenage cutters in Albuquerque.

“It’s a coping strategy, but they can’t regulate their emotions,” Dobey said. “It seems to go, ’I get stressed; I cut myself to feel better. I get angry; I cut myself to feel better. I get depressed; I cut myself to feel better.’ ” The most common methods of self-mutilation are cutting and burning, but sometimes the self injury goes further.

“They could break bones. They could amputate digits, chew on body parts, pulling out fingernails, hitting themselves, injection of toxin,” she said.

Dobey has run the support group over the past year. Each nine-week session averages six to nine participants, she said.

Cutting might also release endorphins, which some doctors think turns into a chemical addiction.

“I think typically they start cutting for the reason that they’re under emotional pain, but the chemicals that are released become a high, and then they cut because they get addicted to that euphoric feeling,” Owen said.

Long-term cutting is more closely associated with some sort of traumatic childhood abuse or neglect, Heath said. Short-term cutters don’t tend to have that, although they still have problems controlling emotions.

“What’s dramatically increasing is using self-injury in the same way as experimental drug use, other risky behavior,” she said. ”They do it for a brief period of time.”

’It made me feel better’

For Adrian, cutting was an outgrowth of his depressive and anxiety disorders, which were diagnosed after getting help through a psychiatrist and counselor.

“I can’t get over how much I enjoyed it,” Adrian said. “In one sense, it did make me feel better. I loved waking up in the morning and seeing that I had done something to myself.”

Cutting is typically more frequent among girls and women, but it’s not limited to one gender, Dobey said.

A 15-year-old Santa Fe girl, whose parents requested she not be named, said she started cutting herself in eighth grade with safety pins and scissors after a friend in school told her it helped with emotional pain.

The teen ended up cutting with a group of three other friends; they’d cut in private and then show each other the wounds later, she said. “I tried it, and it helped, but it became kind of a habit,” the girl said in a phone interview.

Adrian’s first memory of trying to injure himself was at UNM, where he is a student, about two years ago with a girl he liked but knew he should stay away from.

“I just remember I was rubbing my wrist on something” that scraped off his skin, Adrian said. “It was almost like I was telling myself to stop.”

It was a small start, but it accelerated quickly.

“I actually carved the word ’whore’ into my leg,” Adrian said. “I think it described my hatred for me.” Sometimes, he’d trace over that word. Sometimes, he’d make cuts around it and on both legs. On July 6, 2005, cutting landed him in the hospital. “That whole day was horrible,” Adrian said. “I went home—it was the most I ever cut myself.” He doesn’t recall what set him off other than that it was a bad day. When he realized the severity of the injury, he held the deep horizontal cuts across his legs together with his hands and limped to his parents’ room down the hall to ask for help. “I cut myself so deep I required staples,” Adrian said.

He remembers talking to a social worker in the emergency room shortly after coming in.

“I told her basically that night I did not care what I did to myself,” Adrian said.

Cutters usually try to hide the injuries; that’s why Adrian cut on his upper legs, where people couldn’t see them.

It can be a very personal practice for some people. At the same time, it can be a cry for help, said McGrath of the Health Department.

“I think these kids feel very isolated, alone, shut in and like there’s not a lot of help for the emotional conflicts they’re dealing with,” McGrath said.

The Santa Fe girl, who used to cut on her arms and hide them under a sweat shirt, saw her frequent arguments with her parents and her lack of close friends as proof of her isolation, she said. “I didn’t feel I could talk to anybody,” she said.

The “Anti-Suicide”

The biggest myth about cutters is they are trying to kill themselves, Dobey says. While the act can sometimes lead to suicide, most of the time cutting is what she calls a “survival strategy.”

“Probably the top one (excuse) I hear is that this person is attempting suicide,” Dobey said. “Very often, it’s the complete opposite.”

They cut because they feel they would do something more drastic if they couldn’t express their pain, she said.

Kristen Cunningham, a UNM graduate now in her early 30s and no longer living in Albuquerque, said she used to tear out her hair and slice her arms when she was young. She said she was not suicidal when she hurt herself.

“For me, it was like letting something out—my demon,” said Cunningham, who didn’t want to provide any information besides her name. “It was negative emotions. Not numb—I was overwhelmed with my own emotions.”

Considering cutters to be suicidal can actually do more harm than good because the treatment can make them more stressed, Heath said.

“Do you want to stop them? It’s a maladaptive coping strategy,” Heath said. “It’s not a good choice, but some people call it ’the antisuicide’ because they’re using it to cope until they learn a better coping strategy.”

Counselors can teach better strategies—such as learning how to express emotion verbally and calming down—without the need for therapy, Heath said.

Schools or counselors should educate the short-term cutters and spend the bulk of their resources on long-term cutters who need more prolonged help, Heath said.

Some studies indicate cutters stop in their late teens or early 20s, after the brain is less prone to impulsive behavior. If untreated, the practice could continue for a lifetime, Dobey said.

“Usually when adults do it, they’ve been doing it for a lot of years, and they on average started when they were teenagers, and they’re still doing it,” Dobey said. “It doesn’t really stop, most of the time,” she said.

Stopping the Pain

Cutting goes with a host of mental illnesses, including drug and alcohol addiction and post-traumatic stress disorder.

It’s a key marker for borderline personality disorder, a disease where the patient has a hard time regulating emotions, said Evelyn Sandeen, a psychologist and head of the in-patient psychiatry unit at the VA Hospital in Albuquerque.

“With borderline personality, there are feelings of emptiness or unreality,” Sandeen said. “The cutting makes them feel present and real, and the physical pain is preferable to the psychological pain they’re feeling.”

Treatment for cutters typically involves some form of talk-therapy, teaching them better ways to express emotions and sometimes antidepressants or other drugs.

For the Santa Fe girl, who stopped several months ago, relief came when she found a therapist she could trust.

She urges others not to try it. “It becomes like a drug. ... After living through it (the problem), it’s really not as bad as it seemed at the time,” she said.

Adrian’s path toward health started when he was at the hospital being treated for his severe cuts. A friend made him realize his cutting also hurt other people.

“He wept. I’d never seen that from him,” Adrian said. “Seeing that from my friends and family—that was the first time I wanted to stop.”

Adrian had to learn how to talk to himself without self-hatred, without calling himself a ”whore” or a ”jerk.” It has been a struggle for the past six months, when he stopped cutting, but he’s making progress, he says.

“To me, what it (my internal voice) was saying was right,” Adrian said. “Making myself let go and not do that was so hard.”

The marks of his struggle with self-hatred might never go away, he said, looking at his legs and wincing slightly.

“I have to give all these excuses why I don’t own any shorts,” Adrian said.“I say things like ’I have chicken legs’ or ’I don’t like warm weather, and I’m going to move somewhere cold.’ ”

Now that he has been through it, Adrian wants to help others who suffer from the same problem.

“I feel like I’ve really made changes in how I view myself,” Adrian said. “I feel like the most serious part of it has calmed down.”

Warning Signs

The following might indicate someone you know is injuring himself or herself: Cut or burn marks on arms, legs, abdomen, feet or other areas. Cutting instruments like razors, knives, needles in the person’s belongings. Friends or peers who cut, especially in teenage groups. Wearing long pants or long-sleeve shirts consistently, even in warm weather. Bloodstains on clothing. Regularly seeking isolation and privacy when emotionally distraught or depressed.

Treatment Options

Some strategies used to treat self-cutters: Individual, group and family therapy. Medication, usually antidepressants. In-patient hospitalization. 12-step programs. Stress reduction and management skills.

Source: New Mexico State University, “Adolescents and Self-Cutting (Self-Harm): Information for Parents.”

Suggested Alternatives

If you are a cutter, try the following instead of cutting:

If cutting is a way to deal with anger you can’t express openly, try taking those feelings out on something else—running, dancing fast, screaming, punching a pillow, throwing something, ripping something apart.

If cutting is a way to feel something when you feel numb inside, try holding ice or a package of frozen food, taking a very hot or very cold shower, chewing something with a strong taste (like chile peppers, raw ginger root or a grapefruit peel) or snapping a rubber band on your wrist.

If cutting is a way to calm yourself, try taking a bubble bath, doing deep breathing, writing a journal, drawing or doing yoga.

If cutting involves having to see blood, try drawing a red ink line where you would usually cut yourself, in combination with the other suggestions.

Mainichi Daily News
February 6, 2006

Self-injury Phenomenon Emerging at Japanese Schools

Wrist-cutting and other forms of self-injury are surfacing as problems at schools, a survey by the National Center of Neurology and Psychiatry’s National Institute of Mental Health has found.

Wrist-cutting had been cited as a problem at Japanese junior high schools and high schools in the past, but the survey is the first to back up such fears.

The survey was conducted on 126 second-year students at a girls’ high school in Kanagawa Prefecture, and 477 second- and third-year students at a public junior high school in the same prefecture.

The students were asked various questions, such as, ”Have you ever injured your body with a knife or pointed object?” Answers were recorded anonymously.

A total of 14.3 percent of the female high school students said they had purposely injured themselves at least once, while 6.3 percent said they had done so at least 10 times.

At the junior high school 9.3 percent of the 238 female students and 8 percent of the 239 male students said they had cut themselves with blades.

In addition 27.7 percent of male junior high and high school students and 12.2 percent of female junior high and high school students said they had smashed their heads or fists against walls or similar objects.

When asked why they had injured themselves, various answers were given, such as to escape feelings of anger or as an expression that they were seeking help.

Some schools are struggling to deal with the problem. Last year, wrist-cutting suddenly began to spread at a public junior high school in the Tokyo metropolitan area. At first the problem was limited to just a few students, but the school later confirmed that at least 20 of the fewer than 200 third-year students at the school had slashed their wrists. School officials said students appeared one after the other at the school nurse’s office saying, “I went and cut myself.”

A teacher who treated some of the students said there had sometimes been more than one injury at a time.

“There were times when I treated the wrist of one student with one hand while tightly holding the hand of another student. It wasn’t limited to just wrists either. A group that cut crosses on the backs of their hands also appeared. All of them seemed to want others to notice their suffering,” the teacher said.

Because of the problem, teachers at various junior high schools and high schools have held meetings to help people learn about wrist-cutting. However, those involved have continued to come forward with various worries, saying the number of young people who injure themselves is continuing to increase, but there are no places or time to quietly speak with each of the victims, and that the mental burden on teachers who see students with cut wrists every day is severe. Others wonder how far into households schools should delve when dealing with the problem.

Osamu Mizutani, a 49-year-old teacher who is known to have helped many troubled youths, often receives inquiries from people who have injured themselves. He said in one case all of the members of a junior high school girls’ basketball team injured themselves, thinking it was their fault that a teacher had told off one person.

Toshihiko Matsumoto, a doctor at the National Institute of Mental Health, said he has also heard of an increase in the number of people injuring themselves from his colleagues.

“I want people to give (the victims) words of sympathy, such as, It’s hard for you, isn’t it? or, Let me know if you feel like cutting yourself again, and to give them the chance to express themselves in words and understand their feelings,” he said.

The Guardian (London)
February 16, 2006

“I keep cutting till I feel better”: One in Five Girls Aged between 15 and 17 has Deliberately Hurt Themselves, According to New Research
Paul Lewis

Apart from the dark verses of introspection written on her walls, there appears to be nothing in Nia Could’s bedroom to indicate an addiction she has had since she was 12. Then she peels back her duvet to uncover a black leather journal and a packet of plasters. “It’s the perfect hiding place,” she says, delicately tapping the side of her diary until six razor blades fall into her hand.

Next, from beneath a messy pile of laundry next to her bed, she pulls a large blood-soaked towel. “I don’t wash it as often as I should,” she admits, before hurriedly packing away her cutting paraphernalia. “I’m not really one for caring for my wounds.”

Along with two other girls, 14-year-old Nia, who lives with her father and brother at their home in Charford, near Birmingham, is the subject of a Channel 4 documentary, The Cutting Club, which exposes the world of self-harm from the perspective of the young, usually female, victims.

Nia is an exceptionally intelligent girl, and she knows her self-harming is a problem. “I do want to stop. It’s not a healthy thing, it’s not normal. Whatever normal is, it’s not that.”

But she isn’t as abnormal as she might think. Self harm is now recognised by mental health professionals as an addiction and last year, a survey published by The Priory Group found that 20% of girls aged between 15 and 17 have deliberately hurt themselves. The survey also found that more than a million British adolescents, including boys, have at some point considered harming themselves. Experts say that a small minority of these teenagers will continue self-harming into adulthood.

The first time Nia cut herself was two weeks before her 13th birthday. “I’d been given a pen-knife by my uncle for Christmas. I was messing around with it in my room, cutting up bits of paper. It must have just made sense; I was stressed and I wanted to take it out on myself.”

There are a number of problems that could explain Nia’s cutting. Top of the list, she admits, is her lack of self-esteem. “As long as I can remember I’ve disliked myself,” she explains. “I’ve never exactly detested myself, but I can’t remember ever being comfortable in my own skin.” Then there is school: a place where she was constantly bullied. Nia’s depressions have led her to overdosing four times and spending eight weeks at an adolescent unit.

But her father, Pete, a mental health nurse, believes there is another reason his daughter turned to self-harm. Several months before she first cut, Nia’s mother, Denise, died of cancer.

“With her mum passing away she lost her best friend and someone to talk to,” says Pete. “We tried to find counselling, but there was a waiting list. So there was no one there for her to relate to.”

But whatever the initial cause, Nia’s addiction persists. She now injures herself about twice a week. This is an improvement: a year ago it was daily, sometimes in the school toilets. Her arms are criss-crossed with a patchwork of healing scars.

When her father discovered she was injuring herself, he was devastated. “You know what’s happening but you’re just a spectator. I looked at my beautiful daughter and thought how can she mutilate herself like that? But there’s nothing I can do to stop her. At its worst, it was like when my wife was dying: my input was simply to be there and witness it.” Now Pete has learned to live with—although not accept—what his daughter calls her “coping mechanism”. Some parents go further. In the documentary one girl, Abigail, tearfully cries “I need my scars” after her father removes cutting equipment from her room. The next day her mother gives in and supplies her with a razor.

Nia doesn’t blame her father for struggling to understand why she cuts. “Emotions don’t just disappear,” she says. “There’s always got to be something that makes them go away. Some people go out for a walk. I just think: why walk when I can cut? Occasionally I do it out of anger. I think: I deserve to hurt. Other times I just feel overwhelmed and need to restore some sense of normality within myself. Hurting, you see, it’s normal; it’s normal to feel pain. It hurts,” she admits. “I won’t lie and say it doesn’t. But at the same time you’re expecting the pain, so there’s no shock.”

It’s no coincidence that Nia’s rationalisations are well-formed; she is used to discussing self-injury. Along with 20,000 others, she belongs to an online community who use the controversial website (known among users as RYL) to seek information and solidarity from fellow self-harmers. She logs on to RYL for up to five hours a day.

The site was developed by Harley Morlsworth, a 24-year-old web designer from Suffolk, originally under the name “Ruin Your Life”. ”It was initially a forum for the intellectual discussion of the art of self-destruction,” he says, somewhat blithely.

The truth is more sinister: under its previous title, the website contained graphic photographs of self-injury, postings known as “triggers” that would prompt users to injure themselves. For Nia, then aged 12, the website provided a lens through which to comprehend what she had tentatively started with her uncle’s pen-knife.

Morlsworth recently renovated the site to offer advice and support to users, and improved mechanisms for moderating the content. From 1,000 hits a week at its inception, RYL now receives more than 1 million a week—although he denies that the huge audience visiting RYL are ever encouraged to self harm. “Nowhere on the site do we say self-harm is a good thing,” he says.

Indeed, Morlsworth now says he’s an expert on self-harm, claiming to have read every medical journal on the subject, and hopes to register RYL as a charity. ”I have become dedicated to a community that continues to amaze me,” he says. “They need a central person to direct things.”

But Dr Andrew McCulloch, chief executive of the Mental Health Foundation, which will publish a national inquiry into self-harm next month, is worried about sites such as RYL, which he says can serve to normalise the problem. “These sites can do more harm than good,” he warns. “Warnings that postings might induce self-harm are clearly inadequate.”

Nia accepts the risks, but continues to see RYL as a source of support and friendship; an open space where people will understand her. ”On the internet there’s always someone there,” she explains. “It’s better than the outside world”

Edmonton Journal (Alberta)
February 18, 2006

The First Cut: They Fight Off a World of Pain by Hurting Their Own Bodies
By Elizabeth Withey

It began with one little lie.

I fell into some rose bushes, Rebecca said, when people asked about the scratches criss-crossing the top of her hand.

But the lies got bigger. Multiplied.

There was a nail sticking out under the bed. I burned myself. The cat clawed me. I don’t remember.

Rebecca did things that looked like they could have been an accident. Sometimes she had to hide the cuts and burn marks until they faded.

But while the wounds healed, Rebecca’s lies piled up and rotted, like corpses in a mass grave. They haunted her. She couldn’t stand the rotten smell of those lies, but she didn’t know how to clean up the mess. How to stop hurting herself.

Especially when the pain was so satisfying.

“It’s like a relief of tension,” she explains. “And yet you know it’s bad. It’s really bad.”

Self-injury, simply put, is a way of altering a mood state. By inflicting tissue damage on the body, self-injurers like Rebecca distract themselves from emotional pain by replacing it with physical pain. It’s also known as self-harm, self-abuse, self-mutilation and self-inflicted violence.

“Self-harmers are unable to express their feelings and so they take it out on themselves,” Edmonton psychologist Patricia Kehoe says. “They’ve learned the self-harm is a good way to disassociate from the feelings.”

Rebecca was 22, home alone and stressed out at university when the first incident happened. She can’t recall why she dragged the shard of broken glass repeatedly across her hand. But it made her feel better.

“Once I had some scratches I was fine,” she says. “For me, it was like that. It wasn’t just to show, hey, people, I’m hurt, pity me, because I couldn’t stand when someone made a fuss about it. It was just this feeling that, now I am objectively hurt, because it made it agree more with how I felt.”

Sometimes Rebecca hurt herself every day, sometimes she did nothing for months. It depended on triggers: academic pressures, loneliness, self-loathing. The pain masked other pain.

Once, when she was fed up with a clingy boyfriend, Rebecca poured a pot of boiling water on her hand.

“It does take some forcing yourself to keep your hand under,” she says. “The instinct is to pull back.”

Rebecca didn’t want scars, so she rarely used razor blades. She preferred dull objects, like glass, or scissors, in part because they hurt more.

Still, people noticed the wounds on her skin. Some asked questions.

“I would say, it wasn’t anybody else, but I wouldn’t say what it was,” Rebecca says. “At some point, they just gave up.”

Research on self-injury is still in its infancy, but according to psychiatrist Dr. Armando Favazza, renowned author of Bodies Under Siege, about 12 in every 1,000 people—around one per cent of the population—commit self-injurious acts each year. Women’s cases come to attention more often, but 40 per cent of sufferers are men.

A common misconception is that self-injury is a failed suicide attempt. But self-injurers do it to survive.

“Self-harm, for many people, is a way to feel better, when things are too intense and they can’t handle it,” Kehoe says.

Still, the condition can be fatal. A cut that was meant to be superficial can accidentally become a deep wound, especially when a person is using alcohol or drugs.

Medical research and public awareness about self-injury are increasing, but so, too, are the number of sufferers.

“In the last three years, it has become almost epidemic, compared with what we’ve seen before,” Kehoe says. “Self-harm is the same thing we used to think of as anorexia 10 years ago.”

Impulsive self-injury like cutting and burning usually begins around age 14, Favazza says, and the condition can last as long as 20 years.

Jamie was in Grade 8 when kids at her Edmonton school started bullying her. They broke into her locker and threw her stuff all over the hall, and called her names like “the slut,” even though she wore loose pants and sweaters.

She took it out on herself.

“I couldn’t control how they hurt me, so I could at least control how I hurt me,” Jamie says.

The first time Jamie cut herself was an accident. A sharp pottery tool slipped, and she sliced her finger. But the physical pain hurt less than the name-calling, so Jamie began making “designs” on her hands and hooked one of the tools through the skin on her wrist.

“I don’t remember the pain,” she says. “It made everything feel numb.”

Jamie focused most of her bullying frustrations on her shins. Using dull knives, box cutters, even a pencil sharpener blade, she regularly slashed a confetti of cuts into the pale flesh of her legs.

“The blood was a distraction because I could watch it, and clean it up. It was something that I used to keep my mind off other things.”

Jamie once carved the word “curse” vertically into her left shin. She felt cursed for always choosing bad friends, she says. The teen has burned herself, too, heating up pins under a candle and pressing them into her hand. The rush, and the release, makes it hard to stop.

“It’s like a drug addiction,” she says. “It’s something you need to do. And afterwards I was, like, ’Oh, f***, what was I doing.’ ”

Bullying can often lead to self-injury.

“Parents said, ’Sticks and stones will break your bones but names will never hurt you,’” Kehoe says, “and actually it hurts a lot more, because at least if someone broke my arm, somebody would have done something about it.”

Sexual abuse is often cited as another root cause of self-injury, though the condition can be linked and intertwined in a complex web of substance abuse, depression, anxiety and eating disorders.

And like other destructive coping mechanisms, self-injury can become addictive. Repetitive self-injurers come to depend this anxiety escape, craving what Kehoe calls “fake pain.”

Though Rebecca was using physical pain to escape, she continued to function, trying not to tumble into what she calls “an abyss,” be it a nervous breakdown or a life-threatening injury.

“You go close to the edge and you teeter a bit, and you go back again,” she says. “And you’re right there on the edge again a little bit later, and somehow I just never fell.”

But her facade didn’t fool everyone. When Rebecca was 27, her master’s thesis supervisor confronted her. Was it abuse, the supervisor wanted to know. No, Rebecca said, making excuses. The supervisor was the first person who told her to get professional help.

“That was the first time I realized this, in a way, affects people around me,” she says.

Rebecca realized she was sick. Sick of the lies, too.

“You would tell stories,” she says. “You would make things up. You would lead people into the belief that something else had happened. At some point I just decided, I don’t want to lie anymore.”

Like so many mental health conditions, counselling and medication are the best ways to correct self-injurious behaviour.

Still, Kehoe tries not to focus on the self-injury when she sees clients.

“There are a whole bunch of things that come before self-harm,” she says. “You don’t just wake up and go, ’You know what? It’s a good day, I’m in a bad mood, I’m going to burn myself.’ ”

For Rebecca, self-injury has been a struggle for more than a decade. Now 34, she is has PhD and recently left Edmonton after accepting a new job at a Canadian university. She is hard-working, intelligent and multilingual, the picture of success.

But that reflection is only skin-deep.

Rebecca has nightmares about the unconfirmed belief she may have been abused. She struggles with intimacy, and ends up feeling isolated when her romantic relationships hit the rocks. She grapples with self-hatred and depression.

“I guess I just don’t care a lot about myself,” she says.

As an educated woman in her 30s, Rebecca fits the mould of a self-injurer, according to a self-injury website called Secret Shame ( But as a logical scientist, Rebecca cannot comprehend why she would cut or burn her own flesh. Why she would do something that isn’t instinctual or healthy. Why she would willingly inflict physical pain on her body.

“It’s like being victim and perpetrator in one person,” she says. “You really face the dark side in yourself.”

Jamie, now 17, knows it’s not healthy, too, though she has been hurting herself for five years. She sees a counsellor, takes anti-anxiety medications and, with her parents’ support, plans to leave her high school to do her Grade 12 at home.

To keep her hands and mind busy, Jamie chews sunflower seeds. And she covers the gash marks on her shins with pants or long socks.

Many of those cuts have faded into pale pink scars, but 22 wounds are fresh. A falling out with friends in January ended in Jamie’s most brutal episode.

“I bled and I bled and I bled and I bled,” she says. “I cried with my mom for hours.”

Jamie’s mother tries her best to be supportive, though she was devastated and confused when she found out what Jamie was doing.

“You have to be very strong,” Jamie’s mom says. “You have to let them know that you love them all the time, because they need to know that somebody does.”

Support from friends and family is key to recovery, Kehoe says, but ultimatums and bribes won’t help.

“’Promise not to do this and la-da-da-da-da,’ or, ’If you do this, I’m not going to do this’ only adds to their self-loathing,” Kehoe says. “Be supportive, don’t freak out because it will shut them down.”

In Edmonton, Rebecca had support. She went to group counselling, and some people knew about her condition. Now, in a new place and a new job, she copes alone. Rebecca works long hours writing grant proposals, teaching and doing lab research. Her professional success adds to the pressure not to fail.

“You get into this cycle where you’ve been successful, you are successful and you have to prove it, and that’s the only security you have,” she says.

No one in Rebecca’s new city knows about the past that haunts her. She hasn’t self-injured in nine months and she doesn’t have any major scars, but she is afraid someone will discover her secret.

“You always feel like you’ll be found out at some point,” she says. ”You’ll be found out and people will realize that this is just fake, that that is just the mask you’re putting on for the role, and really, let’s face it, really you’re just this horrible human being.”

Despite that fear, and despite years of pain, Rebecca is working up the courage to reach out. To seek wellness, and truth.

“It’s about taking responsibility for myself and not running away,” she says. “Hurting is in part running away.”

Sherbrooke Record (Quebec)
February 28, 2006

Teen Fighting Self-Injury Disorder, Ignorance: National Self-injury Day is March 1
By Jen Young

What would possess a person to purposely burn their flesh with a match, or pick up a razor blade and slice so deeply into their skin that they bleed?

The answer to this question is not easy to find, which is why “cutter” Megan Latulippe has vowed to raise awareness on national Self-Injury Awareness Day March 1.

“I want people to know about the disorder because it is very hard to find help and support,” said the 15-year-old straight A student. “A cutter is someone who purposely cuts or scratches themselves until they bleed, or some people burn themselves, as some sort of a coping mechanism. Physical pain is easier to see and deal with then emotional. People are becoming more and more aware of the disorder, but it is finding help that is very difficult.”

Celebrities such as Courtney Love and Christina Ricci have reportedly practiced the ritual cuttings, but Latulippe says the disorder is nothing to be proud of.

Psychologist Annie Poulin, who has spent more than five years in local high schools studying self-injury, says the disorder is becoming more and more of a threat.

“In my studies we learned there is an obvious suffering in teens who perform self-mutilation,” she said. “Each one of the individuals is suffering from emotional pain or trauma and this was their way of showing everyone else how badly they are hurting.”

How does Latulippe know so much about the disorder? Because she has been a cutter since the age of 12.

“I really can’t say exactly why it started happening,” said the teen who also suffers from severe panic attacks. “I was in the bathroom and having an attack. When I get them I feel as though I am honestly going to die. I am extremely anxious and panicky. I feel as though my head is full of thoughts, but at the same time I can’t think of anything. I saw the razor on top of the mirror and the next thing I knew, I was just cutting.”

After the first cut Latulippe felt a rush of adrenaline that took the emphasis off her inside turmoil.

“After the first time I felt as though I had finally found a means of feeling better during my attacks and I kept doing it. I was addicted,” she said. “I can’t really explain it, other than to say that while I’m bleeding it’s like I can see my pain, and the more I bleed demonstrates how badly I was feeling.”

Cutting is not an indication of attempted suicide. In fact, Latulippe says she has never wanted to end her life, only to relieve inner pain.

“I never thought of ending my life. I find that I need to cut deeper now than in the beginning because the more scars that are on the skin the harder it is to draw blood, which is why cutters cut deeper or move to different parts of the body,” Latulippe explained.

Latulippe knows she must find a different method to deal with her panic attacks. Thanks to her high school guidance counselor she now feels she has found one.

“Doctors have prescribed different medications to help me with my panic disorder, but nothing worked,” she stated. ”The panic attacks got worse this year. I was rushed to the hospital in a couple incidents. That’s when I visited my guidance counselor. She has showed me breathing techniques that help me during an attack, so now I have found a new way of dealing and I find myself needing to cut less often.

“I don’t want to do this (cutting) for the rest of my life. I would like to stop, and I have slowed down. Now I have to kick the habit.”

To cutters who have not yet been able to kick the habit, scars are like constant reminders.

“It’s weird to say but I really like my scars,” said Latulippe. ”When I walk through school some people look at me like I’m sick or I’m a freak, but my cuts mean something to me. It’s like they got me through, and I can look at them and feel satisfied that I made it through another attack.”

It has been a long, difficult endeavor for Latulippe and her family.

“It was really hard to tell my parents. Actually they found out because they saw my cuts. At first my dad would get mad because he was scared and didn’t know what to do. My mom would just cry. I couldn’t figure out why what I was doing was hurting them so much since it was actually making me feel better,” she explained.

“My parents went through a very hard time trying to find someone that could help. I swear my mom literally called every therapist in the phone book. Finally we found one that told us not to hide my scars, keep them in sight. That’s why I want people to take part in Self-Injury Awareness Day.”

Latulippe says the first step is to tell someone who won’t judge you, like she did with her guidance counselor and her parents, and then work to find different means to cope with the condition.

Poulin agreed and said having support can make all the difference.

“Adults need to pay attention,” Poulin stated. “Teens that feel they need to do this demonstrates they need help dealing with what lead them to perform self-mutilation in the first place.

“While working on one case at a high school, I noticed a large difference once the (student’s) mother became involved. Parents need to become a support group.”

Latulippe has not stopped completely, and fears she may succumb to cutting for years to come, but she says things have improved thanks to her strong support system.

Despite the difficult times, the disorder has introduced her to a passion.

“I learned that I really love biology,” she concluded. “After all my research I was able to diagnose why my medications were not working, and I found a love for science. I’m not a very social person so I don’t think I would be happy in a career as a doctor, but I also love animals. I think that I will go into a veterinarian career, but science will always be my passion.”

On March 1, Latulippe will give her family orange ribbons to wear in hopes that self-injury will be discussed openly.

Birmingham News (Alabama)
March 26, 2006

Teens’ Secret Cutting Getting More Scrutiny by Professionals; Once Rare, Self-Mutilation Slipped into Pop Culture
By Hannah Wolfson

One night after a fight with her boyfriend during her sophomore year in college, Amanda Oliver pulled a pair of scissors from a drawer and slashed her fingertips.

It was the first time she cut herself.

Over the next four years, even as she tried to fight off the urge, she sliced her arms, stomach and hips with everything from box cutters to shards of glass to broken compact discs.

Now cut-free for more than a year, the 24-year-old is worried about stories she hears of teens as young as middle school experimenting with cutting. She fears peer pressure will push them into the same vicious cycle.

Alabama therapists say they’ve seen more cutting cases in recent years. Although self-mutilation has long been associated with certain kinds of mental illness, some suspect it has become more common among teens.

“In the early ’80s, we really only saw cutting in the most severely psychiatrically ill young people,” said Dale Wisely, a Birmingham child and adolescent psychologist. “During the ’90s, it seems to me, we saw it spread more into young people who, by all outward appearances, were more mainstream.”

It has also slipped into the popular culture. References show up in teen novels and music by bands such as Slipknot and Linkin Park, whose video for the song “Numb” features a girl with scars on her arms. Some Web sites highlight celebrities who have admitted to cutting themselves, including Princess Diana and Angelina Jolie, while others rack up postings from teens sharing their own cutting stories.

“It is something that they are more familiar with than people of a generation ago,” said Glenda Isenhour, a licensed professional counselor and vice president for student affairs at the University of Montevallo. “It happens at the high school; I’m sure it’s happening at middle school.”

Vivian Friedman, a child and family psychologist at UAB who sees a number of cutters, says they tend to be girls 15 and older, although a few are as young as 13. They’re urban or suburban and mostly middle class. Among her patients are teens from Hoover, Vestavia Hills, Trussville and Bessemer.

Gloria Anderson, director of student services for Mountain Brook schools, says she saw her first case there about a dozen years ago and has heard of several more since.

“There are trends in behaviors and there are cultural things that become established or appear in a culture and catch on and hang on for a while,” she said. “I think all mental health responses are culturally situated.”

Cutting to Cope

Therapists and counselors say studies of cutting are relatively new and professionals are still trying to figure it out. Self-mutilation—which includes cutting and other behaviors such as burning—isn’t categorized as its own disorder in the DSM-IV, the manual of psychology. Instead, it’s listed as a symptom of a few ailments, including borderline personality disorder. The behavior also turns up in patients diagnosed with depression, eating disorders such as anorexia and bulimia, obsessivecompulsive disorder and others.

Although they may slash their wrists and arms, cutters aren’t trying to kill themselves or even mimicking suicide for attention. Rather, many patients say the pain of cutting is a release from anxiety.

Once they start bleeding, they feel a profound sense of relief. Others say they feel numb except when they cut, and the pain makes them feel “real” or “alive.”

Those who treat cutters say it can be a coping mechanism, much like alcohol and drugs. Like those behaviors, it can also be addictive.

Oliver, a Pinson resident, agreed. A self-described perfectionist who was chaplain for Montevallo’s student government association and editor of the school literary magazine, she said her cutting increased whenever pressures at school got too intense.

“I would have counselors that asked me why do you do it or what do you get out of it,” she said. “It depended. Sometimes it was dealing with emotional difficulties that triggered it. Part of it is an addictive sort of thing . . . When you’re in the middle of it, it’s like any other addiction—you don’t see it.”

Soon after her first tentative attempt, Oliver was cutting regularly. She kept the scabs and scars hidden, cutting mostly on her hips and stomach so parents and professors wouldn’t see. But she did tell a small group of friends, who tried to protect her by regularly emptying her room of knives and scissors.

It didn’t help. Oliver taped razor blades inside her notebooks, smashed picture frames and cut herself with the pieces, and even broke apart compact discs to cut in the car. She also started overdosing on laxatives and throwing up her food.

“If I wasn’t cutting, I would do other things to hurt myself like smashing my fists against the walls,” she said. “It would be like I would have to do something.”

It was months before she saw a counselor. What she thought would be an easy fix took years—during which time she left school, tried outpatient care and was admitted repeatedly to Hillcrest Behavioral Health.

For much of the time, she wasn’t ready to change and resisted opening up. She says she was finally able to kick the habit through a Sunday school and Bible study group because that gave her a connection to God that therapy didn’t.

Parents Last to Know

University of Montevallo’s Isenhour said one of the most disturbing trends when it comes to cutters is that they’ll tell friends, who often try to protect them without notifying an adult. She said such efforts rarely stop the behavior, which can result in serious infection, blood loss and even the chance of death if a cutter aims too deep. “I know that there are more cases on campus than have been reported to the counseling center,” Isenhour said.

Parents are often the last to know, because cutters go to great lengths to hide their wounds, wearing long sleeves in the summertime or saying they were scratched by a friend’s cat. Parents unfamiliar with the problem are unlikely to spot the signs. They’re often informed by teachers or a school counselor.

That’s how it happened for Linda Payne, director of the Gender Studies Program at the University of South Alabama in Mobile. She learned about her daughter’s cutting about two years ago through her softball coach.

The impulsive 15-year-old had tried cutting during a bout of depression and had been hurting herself for several months before Payne found out. Her daughter had been showing off her scars to friends and teammates.

“I think she was relieved to have people find out,” Payne said. “She was becoming increasingly dismayed about being out of control.”

The mother, on the other hand, said she was shocked and terrified when she found out. Although she had read about self-mutilation in her studies of women, she had no idea it was widespread or happened at high school.

“Of course you’re wracked with guilt,” she said. “In a way, having found out about it was a blessing in disguise because I realized that she needed more love and attention than she was getting, and I became very hands-on in her life, just trying to be involved in everything and keeping tabs on her a lot.”

Friedman, the UAB psychologist, said many of the cutters she treats say they feel isolated or misunderstood by their families. Although cutting has been linked to sexual abuse, she said it’s more common that teens just feel lost in the hustle of family life.

“They cut themselves to maintain a sense of uniqueness,” she said. “They feel they disappear when they’re not special.”

They may also be doing it out of peer pressure, said Oliver, who writes poetry about her illness and plans to write and discuss it more publicly.

“I think it’s very important for kids to understand that it’s not something to be taken lightly. People cut themselves for 10 to 15 years, they’re trapped in bondage, or they get locked up in mental institutions,” she said.

“If I could tell anybody anything it would be, put the scissors down. I just wish I could put them back in the drawer because once you start, it’s so hard to stop.”

Monterey County Herald (California)
April 2, 2006

Self-Mutilation Now Commonplace
By Jackie Burrell, Contra Costa Times

They use pink Daisy razors, kitchen knives, even sharpened paper clips to slice deep cuts in their arms or legs. And when their parents catch them, some resort to cutting between their breasts or inner thighs, where no one will see.

Twenty years ago, self-mutilation was rarely seen outside psychiatric wards and no one talked about it. Even today, many adults have never heard of “cutting”—though their older kids probably have.

Self-mutilation, once seen as the behavior of such seriously disturbed individuals that it was treated with anti-psychotic drugs, is now commonplace, Cornell University researchers and other experts say. Nearly 15 percent of adolescents—three to five students in every middle or high school classroom—claim to use it as a way to deal with stress and emotional pain. And, self-injury appears to be on the rise.

In a letter to parents at Berkeley’s King Middle School last year, crisis counselor Jan Sells called cutting an “epidemic” that has swelled dramatically in the past five years.

Counselors and students at other schools have noticed a similar surge, though no one knows if it’s the numbers that are up, or simply heightened awareness. The Mt. Diablo school district was concerned enough last year to send its crisis counselors to workshops on the topic. Counselor Lance Friis held a self-injury workshop for Foothill Middle School parents in Walnut Creek last month.

Las Lomas crisis counselor Merritt Rollins says the problem is not limited to razor blades. Some kids use erasers—the hard, pink kind—to slough off layers of skin. Others turn to flame, using a lighter or match to burn the soft flesh under their arms.

Many experts now look at cutting and other kinds of self-mutilation in the same light as bulimia—disorders that typically begin in adolescence, affect far more girls than boys, and ultimately stem from other issues.

“It spans the spectrum from a teenage thing to do, to some very severe psychopathology,” said Herbert Schreier, psychiatrist at Children’s Hospital in Oakland.

For “Lindsey,” it was pressure at school, troubles at home, a darkened room and a pair of scissors.

“When I saw the blood start to trickle, a feeling came over me,” the Livermore High senior said. “I felt calm. I felt like I had some control over something for once.”

That first night, Lindsey sliced up her hand. She cut across her palm and up and down her fingers. She had to wear gloves for a week.

She then switched to her wrist, cutting along an inch-wide strip of skin hidden by her watch wristband, before moving on to her arms. About two months into it, scabs covered a 4-by-6-inch swath of forearm.

Cutting has become “incredibly popular,” said “Anna,” a California High School senior who used to carve words into her skin using the sharp nail file from her Swiss Army knife.

“My best friend cut herself over a boyfriend,” the San Ramon teen said, “and a girl I tutor now has carved her favorite band into her wrist.”

Anna believes the media has glamorized cutting, that movies such as Thirteen and the “emo” punk rock music stereotype “have made it mainstream.”

Anna says she isn’t sure why she began doing it, but she had been depressed for some time “and somehow this just made sense to me.”

Parents must talk to their kids, said Schreier, to determine whether they are cutting because “everybody at school is doing it” or because of something considerably more serious that requires professional help from a doctor or therapist.

Doctors and counselors know more about the disorder now. They look at the causes before tackling symptoms and devising alternative coping strategies.

Half the teens who self-mutilate, said Friis, are victims of sexual or physical abuse.

“Obviously, that’s the first place everyone goes when they hear about it,” the crisis counselor said. “But that also means that half of them are (doing it) for other reasons. There’s rarely one thing going on in the child’s life and they may use a variety of poor coping mechanisms.”

Some doctors believe that the release of endorphins—the body’s euphoric pain inhibitors—are part of the appeal.

Teens who cut use words like “addiction” and “compulsion” when they talk about it. Left untreated, the compulsion escalates.

“Katie,” a Richmond teen who attends a small private school, started with pin scratches, then a razor and, ultimately, branding.

“I would light a candle and heat up something metal and burn myself with it on my left forearm,” she said. “I was always so paranoid that someone would notice the red marks. Yet at the same time, I almost hoped they would, because then maybe I would get some help or find someone who understood it.”

She found that in a church-run, 12-step program in Richmond.

“It’s so much harder to hide when others are asking you how you’re doing,” she said. “I’ve also made it harder to access any tools. But even then, it’s amazing the lengths I would go to get that fix.’ I think cutting truly is an addiction.”

But therapy wasn’t enough for Lindsey. The Livermore teen continued cutting and finally attempted suicide, before she realized that although therapy wasn’t working for her, neither was cutting.

“I would cut and cut and cut and not feel any better, which just made me angry,” she said. “So I stopped.”

It has been a year since Lindsey last hurt herself.

“There’s a line though,” she said, “(When) my stress level crosses over, cutting is the first thing I think of. Sometimes I just jump straight to suicide. I hope one day I won’t think of either of these things for any reason, but until then, I’ve found a counselor that I do like.

The Daily Telegraph
May 1, 2006

‘I don’t want to cut myself any more.’ Should nurses and hospitals be more understanding towards ‘self-harmers’? Lisa Reich, who started hurting herself at 14 with a pin, before moving on to shards of glass, thinks they should

Charlene Thomas stopped me in the corridor outside the art class and told me I smelt of vomit, which, in her defence I probably did. At 14, I was already a veteran bulimic. She said she was going to call me “Pukey” and that she wasn’t going to sit next to me ever again. She said I was a fat bitch who smelt of horses, too (horses were my passion, a salve to the horrors of school).

Instead of feeling anger, and telling her that at least I wasn’t a bully who reeked of cigarettes, I recoiled from her. Deep inside I felt a self-loathing so strong it was like a jolt of electricity—a visceral punch, the force of which knocked me off my feet, literally.

“Ew! I can see your knickers,” laughed Charlene as I landed, legs splayed. And off she skipped, to tell the class about Pukey, the girl who fell over when you were mean to her, and smelt of horses to boot.

As I clambered to my feet, I saw a drawing pin embedded in the soft flesh of my palm. It had dropped from the notice board outside the art room and I’d landed on it when I fell.

I studied the pin. Then, instead of taking it out, I pushed it in a bit deeper. Then I dragged it up to my wrist, and pushed harder, making a deep scratch. It hurt, and yet... it didn’t. And then I saw the little bubbles of crimson pop up, and as I dragged the pin deeper still, the bubbles turned into a little stream, and the blood began to trickle.

It was a “Eureka” moment. Finally, I was able to let out the big scream that had been held inside me, the scream that mere sulks or throwing up my food couldn’t ever convey.

Suffice to say, I was not a happy child. I didn’t fit in, I couldn’t fit in. In my head, horses and dogs liked me, other children didn’t. I was plump and unwieldy, I ate too much, and when other children told me how horrible I was, it never crossed my mind to disbelieve them. My first, self-inflicted, bloody scratch somehow made all the bad stuff disappear.

I carried that drawing pin everywhere and yelled at my mother when she stealth-washed my jeans with the pin inside the pocket. Luckily, it had lodged in the seam, so I managed to pass off my near-violent tantrum (I had wanted to hit her) as annoyance that a “vitally important” phone number was lost.

I stood over the machine for the entire cycle, and when I found that the pin was safe, my relief was so enormous that I hugged my mother, which astonished her, apologised, which astonished her even more, then ran up to my room, locked the door, and had a celebratory scratch.

My panic over losing the pin, together with the fear of someone discovering why, had created a storm inside me and it had to be assuaged. By that stage just scratching didn’t really do it for me, so I’d push the pin in a little deeper every time. But never too deep, and never anywhere obvious. I was careful. I knew which arteries and veins to avoid.

Self-harming was great (though I never thought of it as “harming”). It was good for me. It made me stop throwing up so much. I didn’t need bulimia any more. Bulimia was so yesterday. And this was better for my teeth.

My parents said I looked much happier. One morning, with a girls-together smile, my mother asked: “Is there something you want to tell me?”, probably hoping that I’d finally found a boyfriend. I mirrored her smile, wiggled my eyebrows in a “could be, could be” fashion and let her think the best.

The problem with self-harming is that your canvas quickly becomes cluttered. The constant scratching creates scars and marks, and these are what eventually gave me away.

I had kept my secret with a long-sleeves-no-matter-what policy for an entire summer, cursing the heat wave. I told everyone I was terrified of getting skin cancer. And then I came down for breakfast one day, and knew my secret was out.

My parents had suspected something. There had been a nocturnal parental visitation, the covers carefully pulled down to reveal the lace-like scratch scars over my body. Everything sharp disappeared from the house; I was told off by my GP; scolded by the nurse as, rather brutally, she administered a tetanus booster.

I said: “It was only a pin, for God’s sake—how much damage could I do!”—a statement that was greeted with horror by everyone. And so I became a more secretive and creative self-harmer—but less careful.

The pin had been confiscated, but I needed something harder anyway. Bits of glass found on the street, sharp rocks, anything with a hard edge. I’d smirk when my mother spotted a new scar, feeling only fleeting guilt at the second-party pain I was causing.

At 16, I got blood poisoning after using a sliver of glass. My arm swelled like a balloon and I nearly died. I hadn’t wanted to die, of course, though the A&E nurses refused to believe me. To them, my self-harm was clearly building up to a suicide attempt. A theory that had me rolling my eyes, wondering how they could get it so wrong. I tried to explain it was fine, that it was my way of coping with feelings, but they didn’t understand.

It went on for years. Then, a week before my 18th birthday, I made a cut with a bit of glass I’d found in the park. It was too deep. It revealed the flesh beneath, the fat, the tissue, the ugliness, all of it. I showed my mother the wound, and told her I wanted to stop. I can’t say exactly why I chose that moment to stop. Much in the same way as I couldn’t say exactly why I started. But a door had closed. I had only ever found comfort in blood—the damaged flesh made me feel fearfully mortal.

I saw a therapist for two years, and she helped me to find a voice that wasn’t blood. And, while I still look at knives in a different way to “normal” people, I’ve pretty much managed to abstain for a decade.

OK, so I’ve fallen off the wagon a few times—but never deliberately. I still have my moments—best depicted by Munch’s “The Scream”—and I’m even mildly nostalgic for the release I know that self-harm will give. But I manage to control it because I’ve learnt another language. I’ve learnt to articulate my feelings—and I’ve learnt a lot about self-harm.

I am a self harmer in the same way that an alcoholic will always be an alcoholic. From my experience, self-harm is misunderstood. It is greeted by raised eyebrows and mild disgust. It’s seen, quite simply, as a bad thing.

Well, it isn’t. It is a language that some people need in order to cope with their lives. Stopping people, telling them it is wrong, forces their hand, and that hand becomes more frantic, less careful.

At the Royal College of Nursing Congress last week, it was suggested that health-care workers should help people who repeatedly do harm to themselves to do so safely.

Chris Holley, a consultant nurse, who is involved in a pilot study at a hospital in Staffordshire that offers advice on how to self-harm safely, says that self-harmers have “a therapeutic need for self-injury. They should be supported, not chastised and made to feel as if they are hiding some sort of dirty affliction.

“It’s not about handing out cutting implements to patients,” Holley said. “It’s about helping people who use self-harm to manage their feelings.” According to Holley, for some self-harmers the cutting is a “safe coping strategy,” which reduces suicidal thoughts. And, while the long-term goal is always to help people find “a better way of coping,” it often does more harm to confiscate their “tools,” and try to prevent them from harming themselves.

“When self-injury is inevitable, we need to support patients, not judge and criticise them,” Holley said. “Hoping someone won’t do it won’t work. We need to discover the reason behind self-injury, what cutting means to those who do it, and explore alternatives to the self-harm.”

However, the dilemma for nurses is clear, and it is understandable why many feel that such an approach is a breach of their duty of care.

Tania Dickinson, chairman of the National Self-Harm Network charity, supports Holley’s views, and “any kind of shift in the NHS’s perspective that looks more understandingly upon self-harm.”

She is right. Looking back, I believe that what pushed me towards dangerous edges, mentally and physically, was not self-harming per se, but the treatment from some of the nurses who tended my wounds.

They made me feel like a nuisance, a nutter, an attention-seeking brat. Now, though, I can appreciate that this was probably motivated by fear, disbelief and a concern that, if they did lend me a sympathetic ear, I may have taken it to mean: “Go ahead! Cut! We’re not stopping you!”

I hope that Holley’s enlightened approach to a much misunderstood agony is embraced. Half a million people will be very grateful for it.

The Kansas City Star
May 1, 2006

Internet Sites Encourage Self-Injuring
By Karen Uhlenhuth

Adolescents who are prone to cutting or otherwise hurting themselves may find reinforcement among the proliferating Web sites devoted to self-injury, warns a study out today in Developmental Psychology.

The study’s three authors, all from Cornell University, point out that although Internet contacts “clearly provide essential social support for otherwise isolated adolescents, they may also normalize and encourage self-injurious behavior.”

The study’s lead author, Janis Whitlock, explained in an interview that the marginalized adolescents who hurt themselves often are the types who are drawn to anonymous social contacts provided by Internet bulletin boards and chat rooms.

And in the world of self-injury, the number of those virtual communities has grown prodigiously over the past decade, according to Whitlock’s research. The first was established in 1998. Currently, 406 exist.

Whitlock’s study is one of six published in a special section of the current issue of Developmental Psychology, a bimonthly journal published by the American Psychological Association. The issue is dedicated to adolescents’ use of the Internet. While Whitlock’s study raises concerns about Web sites that emphasize self-injury, other studies in the special section looked at more positive Web features that adolescents use.

Whitlock said many teens and others who use Internet chat rooms and bulletin boards are looking for some type of connection, especially people with whom they can be candid about their habit. In her article, she wrote that the Internet “may be especially advantageous for shy, socially anxious or marginalized youth, enabling them to practice social skills without the risks associated with on the ground’ interactions.”

In addition, the article says, young people who find their way to self-injury Web sites may find the kind of support they need. Some of the self-injury Web sites are monitored by professionals or other people who want to and can provide support to teens wishing to stop hurting themselves. Of the 3,200 postings that Whitlock and her associates studied on self-injury Web sites, about 28 percent of the messages were supportive.

Other postings, however, are much less benign. In her article, Whitlock quoted an exchange among three persons, who described in great detail how to cut oneself and increase the bleeding.

Of great concern to Whitlock is evidence that when some susceptible people hear or read about self-injury, they tend to try it. That dimension of self-injury “suggests that the Internet may spread or deepen the practice among the adolescent population,” she said.

Whitlock told about a woman she met at a workshop. The woman told her that after she found a self-injury Web group, she began cutting herself more frequently.

That resonated with Michael Lubbers, a psychologist and psychotherapist in Kansas City. He has led therapeutic support groups and has observed the group dynamic—especially among groups of people with the same tendencies and histories.

“They tend to trigger off one another,” Lubbers said. “They’re all into the same kind of behavior and have had the same kinds of experiences. They tell each other their stories. You get drawn into another person’s story, and in a way it becomes your story and activates your own emotional experience.”

With regard to Internet bulletin and chat rooms, he said, “My concern is that that’s the world for so many people.”

Adolescents who find relief in injuring themselves often feel they cannot share that with people, and virtual communities of people who do the same can provide a measure of comfort and community not available “on the ground,” Whitlock said. “It’s like a homecoming.”

Whitlock said she sees her study as one more reminder that parents need to be alert to their children’s online lives.

“There are a lot of young people out there looking for a way and a place to belong,” she said. “As long as virtual communities provide a way to belong—to have some sort of visibility and role that’s acknowledged by others—they’re going to be popular places to go.”

The Scotsman
May 22, 2006

Is ‘Safe’ Cutting the Best Way to Deal with Self-Harm?
By Anna Smyth

SELF-HARM is a controversial and complex condition to treat, but if a pilot study is adopted UK-wide, patients may be allowed to injure themselves in “safeChospital conditions, from next year. A Department of Health scheme in St George’s mental health hospital in Staffordshire is following the progress of patients who are allowed to keep their blades, while being advised on how to cut or harm themselves safely and tend to the wounds afterwards.

Nurses have supported the proposal, arguing that to let people continue self-injury under supervision may be the most realistic method of treatment. At the annual conference of the Royal College of Nursing last month, delegates called for a change in their professional code of conduct to permit them to manage this behaviour.

“For a variety of reasons, we have traditionally prevented these patients from self-injuring while in hospital,V says Dr Alastair McElroy, Senior Research Fellow at the Royal College of Nursing. “However, prevention often increases the patient’s distress. We need to rethink this strategy and explore procedures that are aimed at harm minimisation rather than prevention.” During admission, patients are encouraged to explore alternative coping strategies—which can include using ice cubes on the skin, flicking the skin with elastic bands—and cognitive behavioural therapy sessions.

“If all this fails, the patient is going to cut themselves whether we agree or not,” says McElroy. “Many have been self-injuring for 30 or 40 years so it is not going to stop overnight.

Angus Forsyth, a nurse consultant at Newcastle, North Tyneside and Northumberland Mental Health Trust, agrees: “Knowing patients will find some way to harm themselves, we need to ensure they do it safely. The pilot offers an open and honest way of dealing with self-injuring by providing acceptance and support. It initially allows the patient to injure themselves safely and advice on how to care for wounds, where to cut safely, using clean implements, and cleaning wounds is offered. It also helps them not to feel so isolated or ashamed. Then we move on to ways of helping them stop harming altogether.”

But there is a debate over the best method of treatment for self-harmers. It is estimated one in ten teenagers self-harm on a regular basis—5 percent on school premises—and Scotland’s See Me campaign on mental health says that among 15-16 year-olds the figure rises to 13 percent—or 17,000 in Scotland.

A spokesperson for the Mental Health Foundation (MHF) says we understand as much about self-harm as we did about anorexia 20 years ago, and wants an open debate about treatment options, including “safe harm.”

“There has simply never been enough systematic, quantitative and evaluative research on this,” says Catherine McLoughlin of the MHF. “It is a very private issue, but estimates of 10 per cent are probably the tip of the iceberg.”

The See Me campaign recently found 40 per cent of adults think self-harming teenagers are seeking attention. Young people report reactions of hostility and ridicule if they seek help from adults. Linda Dunion, the director of See Me, agrees more research is necessary.

“There are many misconceptions about self-harm which lead to misunderstandings,” explains Dunion. “Self-harm is a sign of emotional distress and many of those who self-harm describe it as a means of staying alive, yet too often it is confused with attempted suicide. As a coping strategy, it is not something anyone would condone, but removing someone’s means of self-harm can drive them to find alternative, more dangerous, means of hurting themselves.”

The pilot study is expected show a reduction in these more drastic consequences of self-harm denial, and for this reason, nurses such as George Earll—a community psychiatric nurse in north-west Edinburgh and a Royal College of Nursing board member—believe it is worth investigating.

“This has been going on in the community for years—psychiatric nurses have worked with self-harmers and given advice on how to cut safely and manage the wounds,” he says.

“The reason someone cuts themselves is to gain some sense of control. If we take away that control, what’s the benefit? But we would look to start with harm reduction and minimise the behaviour until they can stop. If somebody has a drug addiction, we provide an alternative to that drug—heroin users are given methadone. But with self-harm, we don’t have that substitute to offer.”

Not all mental-health professionals agree relaxing the boundaries of safe behaviour is the way forward. The Scottish Executive has no plans to introduce such guidelines, and promotes a policy of prevention.

Dr Jeanette Downie, a consultant psychiatrist and the deputy medical director of the Priory hospital in Glasgow, says: “We would certainly not encourage or condone self-harm in hospital. The route we choose is to show patients there is a better way to manage their feelings. Our ethos is to build self-esteem and healthy psychological coping strategies. We would argue that every time a patient goes back to their old ways, they undermine their ability to learn new ones. It is always traumatic to leave a long-standing coping strategy, but we work to support them through that difficulty. We lay reasonably strict boundaries at the start of the patient’s stay—taking away the opportunity for the harming behaviour and then gradually giving the responsibility back as we work through their issues together.”

The Priory’s position is supported by professionals at the Young Person’s Unit at the Royal Edinburgh Hospital. “We do our best to negotiate a contract which is around reducing the self-harm,“ says Dr Cathy Richards, a consultant psychologist at the YPU.

“People don’t suddenly stop—they get a release from it—but we don’t provide an environment in which they can harm themselves. It is a coping strategy. We try to help people find different ways of managing, but accept that takes time.”