University Wire
June 6, 2006

College Students Self-Injuring at HighRates
By Daniel Stone, Daily Texan, U. of Texa
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A new study released Monday in the June issue of Pediatrics indicates that self-injury among college students is at alarmingly high rates.

The report, conducted by Janis Whitlock, director of Cornell University’s Research Program on Self-Injurious Behavior, found that in his study of more than 2,875 students, 17 percent of those surveyed were victims of self-injury.

Self-injury includes behavior such as cutting, mistreatment of wounds, physical attacks and breaking of bones.

“I wasn’t expecting the percentages to be so high,” Whitlock said. “There’s a whole lot of anecdotal evidence and studies that focused on smaller numbers of subjects that indicate this is a growing problem.”

Laura Ebedi, a psychologist with the University of Texas Counseling and Mental Health Center for the past five years, said she deals with people who engage in self-injury by attacking the cause.

“A patient’s self-injury case can be very specific, but generally once the cause is identified, the number of incidents can be reduced and in some cases eliminated altogether,” she said.

Whitlock isn’t the only one to find such a prevalence of self-violence within the college age group. Laura E. Gibson, clinical assistant professor of psychology at the University of Vermont, compiled a series of studies that concur with Whitlock’s data for the National Center for Post Traumatic Stress Disorder. Among those interviewed in Gibson’s study, 38 percent had a deliberate history of self-harm, and 10 percent acknowledged harming themselves 100 or more times in the past. Gibson also found that the largest number of self-inflicted injuries occur in females rather than males.

“In general, there is more depression in females than males and also a general expectation for women that men don’t have. Men are expected to get an education, preferably a college degree, and get a job,” said Austin social worker Cathy Rider. “Women have very conflicting life expectations. They not only have to get an education and a job, but have children. This can make life at home very difficult economically, especially with today’s conditions. Some women take out their frustrations with these kinds of problems through self-injury.”

Another extensive study conducted by a series of researchers including Victoria White, Heather Trepal-Wollienzer and James Nolan further the claims made by Whitlock and Gibson. The report also points to the high number of self-injury cases that have a history of sexual abuse.

“Self-injury is most often associated with childhood sexual abuse and subsequent post-traumatic stress disorder reactions—thus a history of sexual abuse is one of the best predictors of self-injury,” according to the report.


The Early Show
June 6, 2006 Tuesday

Young People, Such as Alicia Moore, Struggle with Cutting, Also Known as Self-Injury

JULIE CHEN, co-host:

Self-injury is one of the most disturbing issues young people face. It has lived in secrecy and shame, but now more people are bringing it out into the open. EARLY SHOW national correspondent Tracy Smith is here with that story. Good morning, Tracy.

TRACY SMITH reporting:

Good morning, Julie. A study published this week shows 17 percent of respondents at two Ivy League schools have self-injured, and 75 percent of those have done it more than once. As I found out, self-injury can become a dangerous addiction.

Ms. ALICIA MOORE (Used to Cut Herself): (At dinner table with family) He’s my boyfriend. We wave to each other in the halls.

Unidentified Girl: (At dinner table) No, I—I’ll have you know...

T. SMITH: Looking at Alicia Moore at 17, it’s hard to see the traces of a troubled little girl, but they are there. Did you get teased a lot?

Ms. A. MOORE: All the time. All the time.

T. SMITH: From a young age, Alicia was exceptional—a brilliant student, a talented musician and dancer—and she hated herself for it.

Ms. A. MOORE: I’d get made fun of for being smart, getting As on tests, stuff like that. It was devastating. I thought there was something wrong with me and that I was never—that it was always going to be like that.

T. SMITH: Isolated and alone, Alicia found the only way she felt better emotionally was to hurt herself physically. The first time she cut was in fifth grade.

Ms. A. MOORE: I ripped the soda can in half and just cut myself right here, almost on instinct.

T. SMITH: When you saw the blood, what was it that went through your head?

Ms. A. MOORE: I remember just having kind of this euphoric, “Everything’s OK.”

T. SMITH: Alicia started down a dark path...

Ms. A. MOORE: I was addicted to hurting myself.

T. SMITH: ...where self-mutilation became her only solace.

Ms. A. MOORE: There was no thought behind it anymore. It was, “I feel the smallest amount of anything,” and it was, “OK, I can cut myself, and it will go away.”

T. SMITH: Alicia found plenty of ways to cut herself, some obvious—razor blades, safety pins, scissors—and some took creativity—broken CDs, even ordinary buttons—all acts of a desperate and hurting girl. A secret video Alicia recorded captures her despair.

Ms. A. MOORE: (From excerpt of videotape) I hate being me. That’s the bottom line.

Ms. KAREN CONTERIO (Co-Author, Bodily Harm): The internal pain is real hard to articulate.

T. SMITH: Karen Conterio, co-author of Bodily Harm, says self-loathing is typical for self-injurers.

Ms. CONTERIO: Self-injury can be used as a punishment. It’s intentional. Self-injury can be used as a way to say, `Look how much at how much I hate myself.”

T. SMITH: Were you trying to kill yourself?

Ms. A. MOORE: No. I didn’t cut myself to kill myself. I didn’t cut myself to try to kill myself. I cut myself to release all this emotional pain that I felt like I couldn’t—I couldn’t handle anymore.

T. SMITH: Alicia was not alone. In a study of more than 2800 college students published this week in Pediatrics, a little more than one in six reported having self-injured, and of those, nearly 40 percent said that nobody knew about their behavior.

(Graphic on screen)

Self-Injury

Survey of 2875 College Students

1 in 6 Self-Injured

Nearly 40% Kept Self-Injury a Secret

Ms. A. MOORE: (From excerpt of videotape) I’m sick of being a loser.

T. SMITH: Alicia tried to keep her cutting a secret, but her parents knew something wasn’t right.

Ms. MINDY MOORE (Alicia’s Mother): I took it upon myself to investigate, which—you know, another word for snoop—and I...

T. SMITH: But you wanted to find out what was wrong.

Ms. M. MOORE: Right. And I knew she was writing.

T. SMITH: The Moores found Alicia’s online diary and pages of bloodstained poetry with chilling macabre lines: “Can’t take the anger, can’t take the pain, must relieve the only way I can, cut, cut, cut.”

Ms. M. MOORE: It was just hard. You want so much for your kids, and to have them go through something you have no control over is really hard.

Ms. A. MOORE: (From excerpt of videotape) Guess I’ll talk to the camera later. Just, Lord, please help me.

Ms. AMY SIMPKINS (Social Worker, Catholic Charities): It’s a request, a child saying, “Please pay attention to my pain. Please get me some help.”

T. SMITH: Amy Simpkins, a social worker with Catholic Charities, counseled the Moore family. To keep Alicia safe, Amy suggested she take out aggression on objects like her desk instead of herself.

(Points to scarred desk) When you look at some of these that are so deep...

Ms. A. MOORE: Yeah...

T. SMITH: ...can you believe that you did that to yourself?

Ms. A. MOORE: I look at these, and I can just feel the anger that I felt when I did them.

T. SMITH: After years of working with Amy and her family and getting on antidepressants, Alicia slowly overcame her negative image of herself. She stopped cutting and began to move on. Today, the scars are barely visible.

You’re wearing short sleeves, and I can’t see.

Ms. A. MOORE: Yeah. Yeah, I mean, there’s a couple, like here and here and there, but, you know, they’ve faded a lot, and I’m so thankful for that.

T. SMITH: And the internal scars are fading, too.

Ms. M. MOORE: She’s a great young lady, and I think she’s finally starting to realize that.

Ms. A. MOORE: I don’t think that I’ll ever fully be able to say, “I’m completely done with it, it’s completely over,” but I’m at a point right now where I’m stable, I’m happy, I can function. I’m pretty sure that this is where I’m going to be.

T. SMITH: Now, the major warning sign for parents: unexpected cuts and injuries. And experts say you should confront your child. It’s better to ask and be wrong than to not ask at all.

CHEN: Wow. Tracy, help explain the why behind Alicia’s story. Because looking at her from when she was a little girl—smart and attractive...

T. SMITH: Mm-hmm.

CHEN: ...why did she have all this self-loathing?

T. SMITH: Self-injury’s usually a symptom of a mental health issue. So in Alicia’s case, she seemed to have everything going for her, but she didn’t feel like she did.

CHEN: Wow, incredible. Thanks for...

T. SMITH: And now she does.

CHEN: Yeah, thanks for exposing us to this disturbing trend.


China Daily Source
June 10, 2006

Students Injure Themselves to Relax

One in six young adults have injured themselves intentionally at least once, according to the largest US survey to investigate the practice among college students.

Self-injurious behaviour can include scratching and pinching oneself, cutting, swallowing poison and even breaking bones. People who injure themselves say it helps relieve distress.

“It’s a harbinger of distress, in all likelihood, and inability to cope positively,” said Dr Janis Whitlock of Cornell University in Ithaca, New York, the study’s lead author.

“There’s a fair degree of consensus that self-injury is fundamentally self-medicative,” she added, noting that injuries trigger the release of natural opiates known as endorphins, resulting in an immediate sense of calm.

Whitlock and her colleagues surveyed 2,863 students at two northeastern US universities, 17 percent of whom said they had harmed themselves intentionally at least once.

While there have been numerous reports that self-injurious behaviour is becoming more common, Whitlock said: “I don’t think I expected it to be quite that high.” Most of the students who reported injuring themselves 71 percent—said they had done so at least twice.

On average, they had injured themselves for the first time at age 15 or 16, the team reports in the medical journal Paediatrics.

While 20 per cent said they had injured themselves more severely than they intended and should have gotten medical help, just 3 percent of the self-injurers had told a physician.

Thirty-six per cent said no one knew about their self-injurious behaviour.

Repeat self-injurers were more likely to be female, bisexual or unsure of their sexual orientation, and were also more likely to have been abused sexually or emotionally, Whitlock and her colleagues found. They also were more likely to have considered or attempted suicide and were more psychologically distressed.

Given the reluctance of people who injure themselves to get help, the researchers write, it was “critical” for health professionals to find ways to recognize, treat and prevent self-injury.

Based on the findings, they add, medical and mental health providers might make it standard practice to ask their older adolescent and young adult patients about self-injurious behaviours.

Signs that a young person may be harming themselves may include dressing inappropriately for the season, for example wearing long sleeves and long pants in the summer months, and wearing adornments that cover the wrists, Whitlock said.

Parents who do discover that their child is injuring him or herself should try not to react with “horror or incredulity,” she added.


Wisconsin State Journal
June 12, 2006

Treatment of Cutters Varies Widely
By Elizabeth Wachowski

Traditional therapy is one of several possible treatments for self-injurers, but experts say it’s difficult to find an effective way to help people who want to stop cutting.

According to Dr. Michael Witkovsky, what kind of treatment will work for a patient may depend on what is behind that person’s cutting.

One-on-one therapy can work for people who use cutting to deal with the outside world; for others, whose cutting may stem from problems with friends or family, group therapy may be the best choice. A person with a neurological imbalance, such as depression or bipolar disorder, might benefit from using Prozac or other anti-depressants.

Someone who cuts or burns to “feel something” can find less destructive stimuli, like rubbing ice cubes on their skin. Because cutting is usually caused by multiple factors, most treatment requires a combination of two or more of the above.

However, Witkovsky said, for some reason, these methods haven’t been widely successful in treating self-injury. Several new techniques show some promise, like occupational therapy, Brian Holmquist’s specialty.

Holmquist said occupational therapy for self-injurers doesn’t focus on getting them to stop hurting themselves. Instead, he said, occupational therapy helps patients look at how they interact with the world and how their cutting is helping or hindering their goals. If cutting is being used as a coping mechanism or a way to manage stress, occupational therapists try to help patients who want to stop cutting find new ways to cope.

Another new technique is naltrexone therapy. Naltrexone mimics the effects of the endorphins released by cutting, much in the same way methadone mimics heroin’s effects, according to Witkovsky. People on naltrexone therapy will get no endorphin buzz from cutting.

Other cutters find ways to stop without using professional help. Amy Kinard, a 33-year-old Madison woman, has mostly stopped cutting over the past few years by using a number of techniques. She has tattoos over the areas where she used to cut most, to help her think twice before doing it again and ruining expensive work. She has also found that crocheting is an effective way to keep her mind off cutting when things are going badly.

Psychiatrists trying to help cutters, Kinard said, need to concentrate on the problems behind the cutting instead of just trying to fix the symptoms.

“I think a lot of people who do it don’t want to do it, and want to find ways to stop,” she said.


University Wire
June 14, 2006

Ivy League Students Admit Self-Abuse
By Tara Funk, The Daily Vidette, Illinois State U.

According to an article published on CNN’s Web site, nearly one out of five students at Ivy League schools say they have injured themselves on purpose by cutting, burning or using other methods of self-injury.

The study was conducted at Cornell University and Princeton University with 2,875 randomly selected male and female undergraduate students. Seventeen percent of these students said they have purposely injured themselves at some point in time and among the 17 percent, 70 percent of those students have injured themselves on purpose multiple times.

The Director of Psychology Service Center, Brenda Huber said there are a variety of different reasons males and females decide to inflict pain on themselves.

“Normally the main problem is the people who are engaged in this behavior do not have the coping skills and strategies to regulate negative, strong or unpleasant emotions, such as anger and grief,” Huber said.

Counselors say students of all ages from middle school to college are participating in this disturbing trend.

“When people do not have the necessary skills to deal with these emotions, they resort to self injury,” Huber said.

The results are similar to other reports of adolescents and young adults inflicting injury on themselves in the United States, but slightly higher than reports in Australia and the United Kingdom.

Huber said a possible reason so many students are engaged in self injury is because when someone cuts, burns or injures themselves in anyway it may feel like a quick fix to solve their problems, even though it is an unhealthy way of coping.

“It is almost like a runner’s high because when someone cuts themselves or burns themselves, there’s a shift of the brain chemicals that release endorphins throughout the body, so it may actually make the person feel better,” Huber said.

Huber said one of the many dangers when someone starts using self injury to deal with problems is it can turn into the number one way that person copes with strong emotions.

“One of the best ways to avoid or stop injuring yourself is to develop the coping skills necessary to deal with strong emotions,” Huber said.

Huber said sometimes someone will cut themselves where other people can see the mark because they want other people to see what a hard time they have coping, whereas other people will cut themselves where no one can see it.

Sandy Colbs, the Director of Student Counseling Services, said people normally engage in this type of behavior when they want to manage or control their feelings.

“Sometimes the person wants to dull an emotion or pain and make themselves feel numb, so they inflict pain on themselves. Other times, a person wants to feel pain or a deep emotion, so they will cut themselves to un-numb their emotions. It can have a calming effect on the person and can release feelings of anger and sadness because it is chemically driven,” Colbs said.

Colbs said the best way to deal with and overcome self injury is by talking to someone.

“The first step is opening up about it and then, hopefully understanding why this behavior is happening. Then, learn proper ways of dealing with different emotions,” Colbs said.


The Stuart News/Port St. Lucie News (Stuart, FL)
September 17, 2006

Teen coping with ‘cutting’
By Geoff Oldfather


At first I didn’t really appreciate what the woman on the other end of the line was telling me.

Her teenage daughter—a normal girl in every other respect—hurts herself.

“It’s called ‘self-injury.’ Some people use the term ‘self-mutilation,’” but that’s falling out of favor, she told me.

Her daughter began exhibiting symptoms when she was 14. She’s 17 now. The young woman told me in a very matter-of-fact way some of the things she and other “SI” victims do.

“There are many ways to ‘SI,’ cutting, burning, breaking bones or pulling hair. Picking skin until it bleeds,” the girl told me. “I mainly cut,” she said.

The reason I’m telling you this is because Margie and her daughter, who didn’t want her name used, are trying to reach out to other people with the condition and other parents.

But they’ve had a hard time connecting with anyone in Martin County or on the Treasure Coast.

That’s because there are no support groups or organizations in the area for people like Margie or her daughter.

I find that surprising.

I told them I wanted to write about what they’ve been through so others who are experiencing this will find a way to come together; a way to help each other cope.

They agreed.

“It’s mainly a coping mechanism,” Margie said. “When she was depressed or hurting she’d use thumbtacks or needles, or cut herself, and she tells me it’s easier to cope with the external pain than the internal.”

For her daughter, it’s a matter of control.

“I can’t really handle emotional pain basically because I can not control it. But I can control my physical pain. When I do this, it makes the emotional pain feel numb like I can’t feel it at that time, and it puts me back in control,” she said.

Her mother—trying everything she knows to help her daughter—“kind of” understands the control thing.

“They have control over how seriously they hurt themselves,” she said.

The daughter has been seeing a counselor and a psychiatrist and is on antidepressant drugs. She’s making progress. A big part of it is learning nondestructive ways to deal with things, something most of us take for granted, but which could be hard for someone as emotionally fragile as this young woman.

As if “SI” itself weren’t bad enough, people often treat the daughter as a “freak” when they learn of her condition.

“And it’s really a problem at school. They say every time my daughter has an episode she has to be evaluated, and that’s not true. She’s been evaluated, she’s being treated,” she said.

If you or anyone you know has been dealing with this, get in touch with me. E-mail me or call or write to me and I’ll put you in touch with Margie and her daughter.
They’ll start a support group even if it’s only a few other people, a group where they can share experiences and find other ways to cope.

Ways that don’t hurt.


The Indianapolis Star (Indiana)
November 5, 2006

Self-injury gets more scrutiny; Teens who hurt themselves surface as major health problem
By Cindy Mangan


The Indiana University Health Center estimates that one in 10 people in their late teens and 20s will self-injure at least once during adolescence or early adulthood.
And Butler University reports that cutting injuries among middle-school and high-school students is a “growing concern.”

As a result, they offer educators a professional development workshop called “Helping Those Who Hurt Themselves.” Other colleges and health centers in Indiana also report increasing numbers of young people who deliberately cut their own flesh or hurt themselves in other ways.

“Self-injury is rampant,” says Linda Martin, a clinical social worker in private practice and at a day therapeutic school. She is an expert on helping young people who purposely injure themselves. Martin now works in Chicago but did similar therapy work here until recently.

There were no newspaper articles about self-injury in 1984. But in 2004, 210 newspaper articles reported on the problem. And a Cornell University study found more than 400 self-injury message boards on the Internet.

Yet, the reasons behind these statistics are often overlooked.

“I think I started cutting just because I felt like nobody or nothing cared about me, and it felt better to hurt myself than to not be cared about at all,” says “Clarissa,” a 16-year-old former self-injurer. (Her name and the names of others who have deliberately injured themselves have been changed in this article to protect their privacy.)

When Clarissa first decided to cut herself last January, she thought: “I want to escape from where I am right now, and I want to hurt myself to the point that I feel better.”

“Erin,” 17, is another former self-injurer. “I felt like everyone around me was disappointed in me, that I could never measure up to everyone else’s standards.”

She began using self-injury as a form of emotional release in September 2005. “I had been dealing with depression for a while, and then it got to the point where I didn’t know how to handle it. I’d heard from other people about self- injury, and I was like: ‘Well, I guess I can try, see what that does.’ And then it’s kind of addicting,” she says.

Peer pressure can also affect a young person’s decision to self-injure. “It’s not right, but a lot of people think that it will make them accepted,” says Erin. “But if you have to put a mark on your arm to make people be your friends, that’s a problem.”

A specific incident may trigger a self-injurer’s first act. Clarissa first cut herself after failing a drug test last January. “I failed the drug test and my family life came crashing down,” she says.

In Martin’s experiences with clients, “the majority of self-injurers have been sexually abused.” (Neither Erin nor Clarissa has been a client of Martin’s.)

Self-injurers often feel overwhelmed with some aspect of life before they begin injuring themselves, Martin says. Beyond sexual abuse, they may be neglected or physically abused. It may be a breakup with a boyfriend or girlfriend. It may be the parents’ divorce or a death in the family. It can be something simpler, but upsetting as well, such as doing poorly in a class.

The person who cuts is devastated or overwhelmed emotionally, Martin says.

Clarissa tried to hide the cuts from her friends and family, but at the same time, she wanted them to understand how she felt.

“There was a part of me that was doing it for attention, because I had been trying to tell my mom for such a long time that I wasn’t happy. And I’d been trying to tell my boyfriend that I wasn’t happy, and no one seemed alert to my feelings. And by cutting myself, I was like: ‘If you’re not gonna listen, then I’ll just show you how I feel.’”

Eventually, Clarissa’s friends saw the cuts and told her parents.

“When I came home from work one night, my parents got really mad at me for it and threatened to send me away. That just made all the emotional hollowness 10 times worse and made me want to keep doing it,” she says. From that point, she began to use self-injury as a coping tool.

Erin tried to hide her cuts, as well, but eventually confessed to her mom that she had been injuring herself after her mother saw the marks on her arm.

“When my mom finally found out, I was like: ‘Oh my God, I’ve let her down again.’”

Young people who injure themselves are often ostracized and misunderstood by their own peers, as well as adults.

People often stereotype self-injurers as “emo.” The term emo originated in the mid-1980s as an abbreviation of the music genre “emotionally driven hardcore punk.” Now it is often used to describe fans of this genre as well as certain styles of dress.

“A lot of people say that it’s just emo kids trying to get people to pay attention to them. And it’s not that at all for me. It’s nothing to do with me wanting to get attention from anyone,” Erin says.

Clarissa faced the same obstacle: “People just assumed that I was cutting myself so that I could be considered emo and be cool.”

She says it is that kind of stereotyping that can pressure kids to injure themselves. “When teens start to get labeled in a certain group, like the whole emo group or whatever, you just start falling into what everybody wants you to be,” Clarissa says.

Other kids see cutting as some sort of joke; they don’t take it seriously, say Clarissa and Erin.

More openness and discussion about self- injury will help it to become better understood, say the girls and Martin, the social worker.
Therapy has played an important role in both girls’ recovery.

Clarissa began seeing a therapist after she first cut herself. Now, she visits the therapist every few months. “It helps because the therapist wasn’t gonna judge me. I could say whatever I wanted to say,” she says.

A lack of coping skills can force people to continue cutting themselves, Martin says.

“And that’s where therapy comes in,” she says. “You learn to cope by talking about it and learning different behaviors. For example, if you feel like you want to injure yourself, then instead, you take a walk, do something with your hands, like counted cross-stitch or go to your computer and just hang out there.”

Erin says it’s critical to find the underlying reasons for self-injury.

“They should probably talk to someone whom they can trust, and go see a doctor, because people cut because they’re depressed,” says Erin. “I can tell you that once you get help, you start getting better, you are happy, and it feels so much better.”

Facts to know about self-injury



Tribune-Review (Greensburg, PA)
November 13, 2006

A silent scream
By Laura Urbani


There are days when Judy Welty does not enjoy her job. As the child and adolescent inpatient unit nurse manager at Excela Health Latrobe Hospital, she finds that achieving rewards in her work often means navigating painful and sometime horrifying experiences with her patients.

One problem, in particular, stands out. Welty has noticed a disturbing increase in the practice of self-mutilation, especially among teens.

And she’s not the only one to notice. So many teachers and medical professionals have expressed concern over self-mutilation—sometimes called “cutting”—that Excela Health recently held a seminar to explain the behavior.

“We are responding to a community request for (information about) self-injurious behavior,” Welty said. “Schools are very concerned. We’re happy that the community has asked us to explain it.”

“There was a spike (in this behavior) a few years ago, but it has remained at the increased level,” confirmed Donna Kean, executive director of the St. Vincent College Prevention Project, which provides school-based programs. “This area definitely requires a student assistance liaison. We’re the link between the schools and the professional services.”

Trying to explain why teens would deliberately hurt themselves is difficult. Self-mutilation—which professionals also call self-injury or self-abuse—is hard to discuss.
People hurt themselves precisely because they can not talk about their intense feelings or emotions, experts say. This inability to communicate keeps the behavior shrouded in secrecy, and makes it difficult for cutters to ask for help.

“Self-injury is a deliberate mutilation of the body or a body party,” Welty explained. “It’s not to commit suicide, but it is a way of dealing with painful emotions. It is a substitute for words.”

Seventeen percent of college students—about one in six—have injured themselves, Welty said. Of those, 75 percent have done it on multiple occasions, and 25 percent need a doctor’s care to treat the injury.

More than 40 percent begin to harm themselves between the ages of 17 and 22.

Self-injury is a bigger problem than most people realize. The Mayo Clinic estimates that between 3 percent and 5 percent of Americans have deliberately harmed themselves at some time. Although women seek help more often than men, people of every economic status, race and religion may practice self-injury. Even celebrities are susceptible.

“You never want to see this behavior,” said Kean. “It’s a hidden activity. It can go on for awhile before it’s recognized.”

When she talks about the problem, Welty often uses Diana, Princess of Wales, as an example. Diana revealed that she was a “cutter” during a BBC television interview in 1995. She said she had cut her arms and legs, using a variety of instruments from razors to shards of glass.

“You have so much pain inside that you try and hurt yourself on the outside because you want help,” Diana said in the interview.

Like Diana, most self-injurers cut themselves repeatedly. Others scratch or burn their skin or pull out their hair. In severe cases, some even break their own bones or blind themselves.

Any behavior that damages one’s own tissue is considered self-injury. And although troubled teens may bury their own emotions, they can see the scars even on high-profile celebrities.

Actress Christine Ricci still sports scars from burning her hands with lighters or scratching her forearms with soda tops. Actress Angelina Jolie continues to answer questions about her scars caused by cutting, a practice she began at age 13.

“Initially they will probably use scissors or razors,” Welty said of young cutters. “Keep a close eye on those things.”

Most self-injurers claim they discover the behavior inadvertently. They find the physical pain dulls an emotional one.

“They usually start it by accident,” Welty said. “They cut themselves and they felt release. Then they start to do it and it becomes an addiction. The purpose of cutting is to anesthetize themselves.”

This unhealthy coping mechanism is used most often by teens who feel unloved or have low self-esteem. Many self-injurers also have an eating disorder or problems with drugs and alcohol, therapists say. A number are the victims of physical or sexual abuse. And some begin the behavior after surviving a disaster, such as a hurricane or car accident.

“If we have somebody who is a cutter, we’re likely to see someone with depression or a thought disorder,” Welty said.

“There is a biological component,” she added. “Many have parents who have been cutters or have self-abused, or have some sort of addiction.”

Singer Fiona Apple has admitted that she started hurting herself after reading a bad review for her album “Tidal.” She already was struggling with an eating disorder and the aftermath of a rape when her music was trashed by critics.

Apple said she began scratching her left wrist with the fingernails on her right hand. There are still scars from where she dug too deep. She also habitually bites her lips until they bleed, because she says it “makes her feel”—a reflection of the emotional numbness patients often report.

Women tend to be self-injurers more often than men, and most professionals say it is because they internalize their feelings.

“One of the reasons we think women do it more is because males still direct their anger outward,” Welty said.

That doesn’t mean men are immune from self-injury.

Actor Johnny Depp has several scars on his left forearm from cutting. He told Talk magazine “it was ... good times, bad times, it didn’t matter. There was no ceremony. It was like ‘OK, this just happened, I have to go hack a piece of my flesh off.’”

Actor Colin Farrell is well known for his troubles with drugs and alcohol. But he also practiced self-injury while he was a teenager.

“I’m a hair puller-outer,” he told GQ, the men’s magazine. “I loved the sensation.”

But the pain is real—both for the self-abuser and for the professionals who work with them.

“This is a difficult illness to treat,” Welty said. “It is very sad and it is very horrifying. You’re almost repulsed by it. I’ve seen children lacerate every part of their body.”

Treatment is especially hard because often the behavior is not noticed for a long time.

“There are warning signs,” Welty said. “One of them is if you see scars that are unexplained. You’ll see people who wear long sleeves in the summer.”

A teen or young adult also may seem depressed or withdrawn.

“Around half of the children have a co-morbidity, which means they are depressed and self-abusing or are abused and self-abusing,” Welty said. “There’s a whole host of reasons, which are no different than if students are involved in other risk taking behaviors,” Kean added. “This is another vehicle for students to feel a release.”

Getting them to admit to self-injury is the first and biggest hurdle for treatment.

“This is a person who can’t speak about it,” Welty said, “but they are trying to communicate that their feelings are out of control.”

In the end, talking is the heart of the two most common treatment approaches. In cognitive behavioral therapy, trained therapists help patients unravel their bad thoughts. In dialectal behavioral therapy, therapists take a matter-of-fact approach to what is happening, receiving the patient warmly and teaching other skills for coping with stress.

Drugs usually are not used unless the patient needs help with depression, sleep impairment or obsessive-compulsive disorder. Occasionally, in-patient treatment is advised.

“It really does warrant family involvement,” Kean said.

The behavior is clearly dangerous. Cutting can lead to infections, scars, numbness, hospitalization or even death. If cutters share their tools, they are at increased risk of HIV or hepatitis infection.

But with the proper help, self-injurers can be cured.

“Usually they do not go back to it,” Welty said. “You certainly can get better. You have to make someone feel safe and ... help them use words to express themselves. We call it ‘finding a voice.’”



The Independent on Sunday
November 19, 2006

Why teenage girls resort to self-harm; Largest ever survey reveals emotional pressures that drive youngsters to cut themselves;
By Jonathan Owen


A new survey of people who deliberately harm themselves reveals that more than two-thirds say they have been upset by the negative reactions when family and friends find out. According to the as-yet unpublished report, some 40 per cent have had “a negative experience” with doctors and other medical staff, adding to the distress of self-harmers over what they see as “a lack of any real empathy or true understanding.” Sightings of the actress Lindsay Lohan this week, apparently bearing a number of cut marks on her wrist, once again turned the spotlight on the record numbers of young people who harm themselves as a way of coping with mental distress. Lohan’s agent denies that she self-harms.

The largest ever study of self-harm among 15- and 16-year-olds in England revealed recently that one in 10 teenage girls deliberately cut or hurt themselves each year. More than two-thirds of sufferers admit to cutting, while the other third take overdoses.

The findings of the latest survey, conducted by the LifeSIGNS charity and to be published next year, provide an insight into why young people resort to self-mutilation. Overwhelmingly, it is a coping mechanism.

Commenting on the findings, a spokesperson for the charity said: “We know why we hurt ourselves; it’s to cope with the difficult situations and overwhelming emotions that life throws at us.”

Seventeen-year-old Jennifer Cross from Hastings was just seven, she said, when she first started to cut herself: “Have you ever been so angry that you want to scream? Well, that is what it’s like, it’s a way of screaming in silence.”

By the time she was at secondary school, Jennifer had progressed to cutting herself with razor blades as part of her daily routine and hiding her scars by wearing long-sleeved tops. “I would wake up every morning, cut myself and then go out. Over time it evolved into how deep the cut was and how much blood came out.”

School was an unhappy time for her—she suffered from bullying, which brought on bouts of depression. “I used to wake up in my room in the morning with cuts on me and not even remember doing it. I’d always feel really guilty and upset afterwards. I do it to cope with everyday life. When you are in the grip of it ??? nothing else matters until you cut.”

About 25,000 self-harmers are admitted to hospital every year but, since the vast majority don’t set out to hurt themselves so badly that they require hospital attention, the true scale of the problem is likely to be far higher.

Common factors in people who self-harm tend to be a background of being bullied or suffering some form of traumatic abuse at a young age. More than 80 per cent of sufferers agreed that it would be easier for them if more people understood about self-injury.

CASE STUDY

‘There was no pain, I just felt calmer’

Jennifer Cross, 17, pictured, started harming herself when she was just seven years old.

“I remember the first time so clearly. I was feeling really wound up and angry and just stood and pulled a chunk of my hair out. I liked the sensation it gave me. I felt the hair coming out but didn’t feel any pain. It is the strangest thing and very hard to explain, but it was like all the pressure that I had been feeling was coming out at that moment. I was so surprised that it didn’t hurt and soon started scratching myself with my nails as well. I didn’t think anything of it at the time, I just thought it helped make me feel calmer. I do it to cope with everyday life, it’s as simple as that. It would be great if one day I woke up and didn’t want to harm myself again.”


The Chronicle of Higher Education
December 8, 2006

Are We Facing an Epidemic of Self-Injury?
By Joan Jacobs Brumberg

“When I was cutting myself,” Natalie told me in a matter-of-fact way, “I wore big bracelets, and because I like to sew, I had lots of fabric in my room which I tied in bands around my wrists.” Over a lengthy lunch at the Moosewood Restaurant, in Ithaca, N.Y., the articulate 18-year-old from an affluent suburb spoke confidently about plans to enter Boston University and study child psychology, all the while narrating her personal history as a “cutter.”

Natalie seemed to be at ease talking with me, a college professor whom she knew only casually, about the ways in which she used safety pins, razors, and eventually scissors to pierce her own skin. That confirmed what I had gleaned from teaching and advising over the past decade: Cutting, in the form of repetitively slicing or puncturing one’s own flesh (especially the arms and thighs) without intending suicide, is no longer alien behavior among college students.

In fact, some students speak openly of their own cutting behavior and that of others, including celebrities like Angelina Jolie, Johnny Depp, and the late Princess Diana. A 1995 report in the Journal of the American Academy of Child and Adolescent Psychiatry indicates that cutting exists primarily among “popular” high-school girls who perform well academically. Many observers suggest that cutting and eating disorders often exist in tandem, casting both as diseases of the rich and pampered.

Although cutting is still characterized as a symptom and not an independent diagnosis in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, the bible of mental-health clinicians, self-injurious behavior, or SIB, appears to be on the rise among students at American colleges and universities. Two new studies, led by Janis L. Whitlock, a developmental psychologist at Cornell University, document that growth and provide a richer picture of such behavior.

The first study, conducted and written with John J. Eckenrode, a professor of human development at Cornell, and Daniel Silverman, chief medical officer and head of health services at Princeton University, randomly surveyed 3,069 undergraduate and graduate students at the two institutions. Published in June in the journal Pediatrics, it is an important bellwether: the first epidemiological study to give us a sense of what is actually happening on campuses. Whitlock’s data showed that 17 percent of the students had purposely tried to injure themselves by cutting or burning, and that almost 75 percent of those had done so multiple times. Both men and women seemed to be self-injuring, although women outnumbered men. When Whitlock controlled for parental-education levels, she found no correlation between social class and SIB.

In another study, published a month earlier in Developmental Psychology, Whitlock and her co-authors, Eckenrode and Jane Levine Powers, of the Family Life Development Center at Cornell, demonstrated that cutters, once a highly isolated group, now participate in a virtual community, incorporating more than 400 Internet message boards to share thoughts and experiences. The Internet provides support—sometimes to stop the behavior, sometimes to continue it. (Although the study doesn’t mention it, there is also a secretive culture of girls in the know who signal one another with orange plastic bracelets when they are actively cutting and white ones when they are trying to stop.) Whitlock’s pioneering work raises larger questions about what she calls the “social contagion” effect that has played a role in the spread of eating disorders among young women during the past 30 years.

In both self-injurious behavior and eating disorders, communicability is a social rather than a biomedical process. Neither cutting nor eating disorders involves a micro-organism, yet both seem to spread, as psychogenic illnesses often do, in response to cultural stimuli. On the contemporary college campus, cutters—like bulimics and anorexics—can usually find a group of people who understand their behavior. If not, they can turn to Web sites for people with SIB or eating disorders—a new opportunity that raises a host of questions for those in public health who are concerned about the process of current and future “psychic epidemics.”

Along with their laptops, cellphones, and iPods, students now arrive on campuses with an awareness of self-injurious behavior and a greater tolerance for it than in previous generations. Yet for psychological-services professionals, residence-hall staff members, deans, and faculty members, the addition of cutting to the contemporary repertoire of collegiate psychiatric disorders constitutes a significant clinical challenge.

Whitlock, who sees the behavior as an emerging public-health issue, is committed to providing mental-health professionals with strategies for intervention in this largely underrecognized disorder. As a social historian, I have somewhat different concerns: What are the origins of self-injurious behavior? Why do we see so much of it now on campuses? And how does it reflect American culture?

Medical literature is rich with cases of mentally ill people who enucleated their eyeballs, cut off limbs and sex organs, and ground glass between their teeth. According to Armando R. Favazza’s wide-ranging 1987 survey and analysis in Bodies Under Siege: Self-Mutilation and Body Modification in Culture and Psychiatry, most forms of self-mutilation represent an attempt at self-healing. Although it’s often hard to tell what exactly was wrong with such people without the benefit of modern case records, it is clear that the meaning of the behavior, as well as the diagnosis, changes over time along with medicine, psychiatry, and culture. Psychogenic illness in one culture may be characterized by nausea, in another by headaches and dizziness, and in still others by dancing, trances, appetite manipulation, or cutting.

In looking for the antecedents of contemporary campus cutters, I first searched the historic record for repetitive female cutters who were not suicidal. I found a telling early example in the case of Helen Miller, a 30-year-old “German Jewess” who was a patient of Walter Channing, a 19th-century asylum doctor (not to be confused with the famous Boston obstetrician of the same name). In 1875, after a history of both illness and crime in her 20s, Helen began to “cut up”—her term—when she re-entered the New York State Asylum for Insane Criminals, in Auburn, where she had already spent two years for burglary. For stealing a stuffed canary and a microscope lens, she was sent back to the asylum, where she became depressed and began to use sharp pieces of glass to periodically slash her wrists and arms. The details of her self-injury were of enormous interest to Channing, who counted at least 150 foreign objects that were removed from Helen’s body, including pieces of glass, wooden splinters, needles, pins, shoe nails, and a piece of tin. Although she sometimes cut her arms almost to the bone, Channing claimed that Helen felt no pain when she cut, and that she “apparently experienced actual erotic pleasure” from the medical probings that followed those disturbing incidents of self-mutilation.

Channing’s understanding of cutting reflected Victorian ideas about sex differences and medical reports in the American Journal of Insanity, the most up-to-date periodical in his field in the late 19th century. Apparently, at the nearby Utica Lunatic Asylum, a single female had an astounding 300 needles removed from her body. Such women were regarded as “hysterical,” and Victorian medicine cast their cutting behavior as a deliberate, typically female strategy for attention. Channing wrote of Helen Miller: “The wounds were made as lacerated [deep] as possible, the garments were covered unnecessarily with blood and a time of day was chosen when help was sure to be at hand. Everything was done to produce as much effect as possible.”

Many doctors, in many locations other than upstate New York, reported cases of “needle girls.” It is not surprising that sewing needles were a popular instrument of self-mutilation in a society where sewing was a regular domestic activity. Ernest Hart, a physician at a hospital in London, reported the case of E.G., a “young girl of good appearance and superior education” who “willfully introduced” and broke needles into her flesh, particularly her fingers. Hart, like Channing, was suspicious of his patient: “The records of surgery include many remarkable cases in which patients suffering under a morbid and commonly hysterical condition have inflicted various injuries on themselves, with the view of exciting the sympathy of friends, and of deceiving their surgeons.”

By the early 20th century, medical reports dropped the ghoulish focus on the number of cuts and moved away from the idea of an innate female propensity for attention-seeking behaviors. (Most of the cutters in the clinical literature were still women and girls, however, and that remains true today.) In 1913, in the work of L.E. Emerson, an influential Boston psychologist on the staff of the Psychopathic Institute at Boston State Hospital, a female cutter emerged for the first time as someone responding to a complex mix of unfortunate life events and circumstances, including what we now call “sexual abuse.” Emerson’s presentation of the case of Miss A., a 23-year-old who cut herself on the breast and legs as well as arms, was revolutionary for its detailed attention to the family environment.

Emerson—one of the first Americans to practice psychoanalysis—chronicled the sad story of Miss A., who, beginning at age 8, was “masturbated” on an almost daily basis by an uncle who lived in her home and also attempted to rape her. In her adolescence, she became “abnormally stout,” failed to menstruate regularly, and developed intense headaches. At 20, after a frightening sexual assault by her cousin, she discovered accidentally that self-mutilation eased her headache pain, thus beginning a pattern of repetitive self-injury which she found soothing. “Before I cut myself I had what I called a crazy headache,” she explained, “and I thought that the cutting of my wrist, and letting the blood flow had cured it.” Unlike earlier reports, Emerson gave Miss A. a great deal of voice, and, in doing so, contributed to the understanding that cutting could bring people relief, that it might be a way to cope with emotional pain.

Because the skin is the canvas for self-mutilators, cutters apparently ended up in the offices of skin doctors as well as psychiatrists. However, when they presented their symptoms to dermatologists, they usually lied about the etiology of their festering lesions to avoid the stigma associated with the behavior. For dermatologists, it was a clinical challenge to be able to recognize the handiwork of cutters, burners, and hair pullers. In 1929, at the moment when phonograph needles joined sewing needles as an instrument of self-injury, two Philadelphia dermatologists, John Stokes and Vaughn Garner, explained their diagnostic technique: “The bizarre and at time fantastic shape both of the individual lesion and of the arrangement of the group of lesions is, then, a suspicion-arouser of the first order.” Apparently, self-inflicted lesions tended to have regular and angular outlines rather than rounded ones. Dermatologists classified Jazz Age cutters under many rubrics: neurotic excoriations, dermatitis factitia, dermatitis artefactus, feigned eruptions, and hysterical dermatoses.

By the 1930s, psychiatry was able to offer a new understanding of repetitive self-injury. Karl Menninger, the Kansas-born psychiatrist who argued that the mentally ill were only slightly different from other people, suggested that even the most severe acts of self-mutilation were really just points on a spectrum. All of us, he asserted, participate in some self-injurious behaviors—nail-biting and picking pimples are familiar examples. But Menninger distinguished between psychotics and neurotics in terms of their patterns of self-mutilation. Psychotic patients, he asserted, make no effort at concealment, and neurotics rarely mutilate “irrevocably.”

Although he had worked with college students in a counseling center at Washburn Collegenow Washburn Universityin Topeka, Menninger’s 1935 address to the American Psychiatric Association on the subject of self-mutilation did not mention cutting on campuses. Either collegiate cutters did not exist then, or they were hidden and covert. Menninger certainly never envisioned that cutting would be talked about so openly by “normal” individuals like Natalie, my young confidante.
In my college generation in the 1960s, we spoke in hushed tones of girls who had experienced “nervous breakdowns,” but we were not in the business of sharing and comparing mental diagnoses the way students do today. I had never even heard of anorexia nervosa, and cutting seemed “sick” enough to preclude someone who did it from ever attending college, let alone living in the room next door and talking about it. Many of us read Joanne Greenberg’s 1964 I Never Promised You a Rose Garden, an emotional blockbuster based on the author’s experience at Chestnut Lodge, a private psychiatric hospital in Maryland where, I learned later, Greenberg was treated by the well-known psychoanalyst Frieda Fromm-Reichmann. In that powerful illness narrative, published under a pseudonym, the adolescent protagonist repeatedly burned herself and cut her wrists—behaviors that seemed wilder, crazier, and more exotic than they do now.

Cutters receiving treatment in that era were almost always patients in closed adolescent units in hospitals, there because they had been diagnosed as schizophrenic or with borderline states. And when one patient began to cut, others often followed. Some psychiatric facilities even witnessed “epidemics,” which they linked to the well-known adolescent propensity for copycat behavior, especially among those who were mentally ill.

On the basis of those reports, some proposed a “wrist-cutting/slashing syndrome” (also known as “delicate cutting syndrome”) involving young women who cut their arms and wrists repeatedly but without suicidal intent. Yet despite a broad consensus that the syndrome does exist—that it is more an impulse disorder than an attempt at suicide—the effort to get a distinct diagnostic category accepted in the third or fourth edition of the DSM has not yet succeeded.

Today we use a bland generic term—“self-injurious behavior”—but we should probe, more than ever, the troubling “contagion” issue raised by Whitlock’s studies of the generative, social, and electronic environment that surrounds contemporary cutting. Psychic epidemics simply will not be as local as in the past—when they were confined to one school, convent, or town—because of the ways that our young people communicate and use the Internet to explore themselves and their world.

A historical perspective also sheds light on how colleges have changed in their capacity—and willingness—to deal with self-injurious behavior. They began to recognize that students might have mental problems only in the early 20th century. According to Heather Munro Prescott, a historian at Central Connecticut State University, in 1910 Princeton was the first collegiate institution to offer psychological services. In 1921 Dartmouth put a psychiatrist on staff because its president, Ernest Martin Hopkins, believed that colleges should “stabilize minds” and make them “healthful” in addition to sharpening intellects. After World War II, mental-health services expanded to assist in the adjustment of veterans who flooded college campuses under the GI Bill of Rights.

In the 1960s, clinicians in campus psychological services confronted a rising tide of problematic social behavior—notably, increased sexual activity and substance abuse. Many students regarded psychotherapists as suspicious adults in those days, perhaps even stool pigeons for university interests and odious in loco parentis policies. Yet by the 1980s and 1990s, although in loco parentis was a curiosity of the past, the commitment to caring for the mental health of students had actually escalated. Students and their parents expected colleges to have accessible, sophisticated mental-health services just as they had libraries, career counseling, and physical education. In part, that reflected a decline in the social stigma associated with mental illness. Many people who rejected authority and expertise in their youth had turned, as adults, to psychotherapists and other mental-health professionals to help cope with issues like divorce, child custody, and “coming out.” So, too, many of their children had experience with therapists as they grew up, a growing number with eating disorders.

A conspicuous increase in anorexics and bulimics during those years forced health and psychological services to confront problematic eating behavior—to work cooperatively with residence-hall staff to both identify and prevent it. The National Eating Disorders Association also began to sponsor lectures, films, and workshops to educate the public about the dangers of those widely discussed disorders that were becoming popular fare in media like People magazine. Such efforts have been relatively successful in raising awareness of the dangers of anorexia nervosa and bulimia as well as the need for therapeutic intervention, but the number of eating-disordered collegians has not notably decreased.

Today college health professionals confirm that there are more students in need of psychological services than ever before, in part because of the Zoloft, Paxil, and Xanax carried in many backpacks. Contemporary psychopharmacology, combined with consumer advertising of psychotropic drugs, makes it possible for young people with emotional problems to attend college, maintain their equilibrium, and do their academic work. In 2000, 80 percent of a national sample of counseling-center directors reported increases in students with severe psychological problems.

If cutting is one indication of a more troubled collegiate environment, what might account for the prevalence of that particular symptom now? Is there something about cutting one’s own skin that is related to the ideas and values of contemporary Americans?

At the moment, transforming and enhancing our bodies is a major American cultural imperative supported by both commerce and medicine. “Body modification” businesses operate in most cities and towns; teenage girls are sporting belly-button jewelry and eyebrow rings. The growing popularity of such “body projects”—ranging from garden-variety piercing and tattooing to bizarre forms of cosmetic surgery—suggests a new mind-set about the malleability of the body as well as its ability to withstand violation and penetration. For many in the younger generation, not just those who think of themselves as “Goth,” the body is a critical message board, a way to convey information about the self. In fact, in some niches, arms and thighs that bear scabs can be badges of honor. Heavy-metal and punk bands valorize cutting, but even reasonable adults have gained some vicarious experience with the behavior in films like Fatal Attraction (1987), American Beauty (1999), and Thirteen (2003).

S urely the violent nature of our society provides a hospitable climate for self-mutilation. Countless social-science studies have shown that our children grow up accustomed to violence of all kinds, and that it has harmful, desensitizing effects. As children mature, their imaginations are shaped by cultural scripts picked up from brutal television shows, video games, and movies as well as sadistic real-life crime and gruesome war reportage. By the time they are adolescents, when cutting usually begins, some are intrigued—rather than revolted—by the thought of putting razor or scissor to flesh.

At Hobart and William Smith Colleges, in Geneva, N.Y., Debra DeMeis, dean of William Smith College, and a staff of experienced psychotherapists spoke with me about what they had seen on campuses over the past five years. “Cutting is not as pathological as it once was,” explained Bonnie Lambourn-Kavcic, a clinical psychologist at the counseling center. Part of its new “normality” is the growing understanding among clinicians that repetitive self-injury is not usually suicidal and that it can be a short-term response to unhappiness, stress, and depersonalization.

Because cutting is often preceded by some physical tension, like a headache or a sinking feeling, campus clinicians generally work to help the self-injurer break the connection between that somatic trigger and picking up a razor. In therapy cutters not only receive drugs, they are counseled on ways to become less impulsive, and to find alternative means to self-soothe.

Although some clinicians have posited that cutting is a response to the stress of college life—new people, less structure, anxiety about intellectual performance—DeMeis was certain from her experience that some cutters come to campus with the behavior already established. She suggested that families desperate to market their children to college recruiters are not likely to disclose such behaviors. Unlike learning disabilities or attention-deficit hyperactivity disorder, which can dictate special educational privileges, SIB carries no such advantage.

In fact, from the perspective of college health services, this latest “psychic epidemic” carries special problems. Mental-health professionals need to assist people who engage in self-injurious behavior, but they also need to protect other students whose social relationships and academic performance can be affected by the high drama of a behavior that still raises the fear of suicide. With young women, in particular, friends get very involved, they often become frightened, and many take on caretaking roles far beyond their experience and responsibility.

Despite the greater tolerance for mental-health problems today, “psych services” confront some inherent conflicts about how to handle cutters. Although most cutters will stay in college and see therapists, some may be asked to leave when their behavior becomes flamboyant (such as leaving blood repeatedly in a communal bathroom) or troublesome enough to negatively affect the daily lives of friends. In the words of DeMeis, an academic dean as well as a psychologist: “What may be therapeutically good for the cutter may not be best for the institution, or for other students.”

Clearly, this is new terrain for campus clinicians. Will cutting escalate and plateau the way eating disorders have? Will medicine be able to come to grips quickly with the complicated mix of biology, individual psychology, and culture that generates this behavior?

In the end, Menninger was probably right. Mental disorders really are only points on a spectrum, and those who are troubled almost always choose symptoms that borrow from the cultural material of the times in which they live. Ideally, more self-injurious behavior can be averted by wise multidisciplinary collaboration about how to treat the cutters in our midst, most of whom, according to Whitlock’s study, still do not seek medical or mental-health attention. Despite the new tolerance and the cultural chatter, many cutters remain secretive and feel considerable shame about their behavior.

With a population highly vulnerable to peer suggestion, as college students are, we need to develop a sensitive, nonpunitive response that does not condone or excite others to do the same. And whether cutting behavior begins in high school or college, whether it involves girls or boys, it should provoke parents, mental-health professionals, and educators to consider the ways in which this longstanding symptom mirrors our violent, troubled times.

 


University Wire
December 14, 2006

U. Iowa students deal with cutting, self-harming tendencies
By Brigid Marshall, The Daily Iowan

Three years ago marked the beginning of the end for Samantha. She was sitting on the dark gray carpet of her boyfriend’s Stanley Hall single dorm room studying for a Russian exam.

“I was in his room making flash cards, and I was holding scissors,” the University of Iowa senior said.

She began the ritual that she had followed for five years during periods of stress.

“Subconsciously, I just started scraping my arm open,” Samantha said.

Samantha, a pale-faced, blonde young woman was a cutter for her entire high-school career in the tony Chicago suburb of Hoffman Estates, Ill. She continued the habit into her freshman year at the UI. Like the majority of self-harmers, she had a history of physical abuse—in her case, at the hands of her father—and cut to relieve its emotional anguish.

“He never did anything to my sister or to my mom, so I thought, ‘There’s gotta be something wrong with me,’“ she said.

Stress from broken romantic relationships and academic pressures at school were some of her first triggers.

That night in Stanley Hall was the last time Samantha said she cut herself.

“[My boyfriend] turned around and saw me, grabbed the scissors from my hand, and threw them across the room,” she said, motioning dramatically with her own hands. “Seeing him like that, so affected by what I was doing, made me want to stop.”

She began to take strides with her boyfriend to move past self-harming and onto non-abusive ways to help herself. Whenever she felt the pressing need to feel the blade tear away her frustration and self-doubt, she said, she would call her boyfriend or go for a walk around campus at any hour of the night.

Like most self-injurers, Samantha wasn’t cutting to end her life, although Sam Cochran, the director of the University Counseling Service, said, “We do consider cutting and burning as quasi-suicide attempts.”

But Samantha said she just couldn’t handle it—the pressure, the pain, the stress—and cutting was something that she could always turn to until her inner turmoil subsided.

“It was always so easy for me,” she said. “I didn’t think it was completely wrong, because I wasn’t cutting by my veins. Looking back on it now, I do realize it is a bad thing—it is self-mutilating.”

She is not the only UI student to cope with stress in such a drastically unhealthy way.

By the deliberate cutting of arms, ankles, and stomachs, the burning of body parts, swallowing things, banging one’s head, punching things with the intention of hurting fingers, overdosing on over-the-counter drugs, or even neglecting to take prescribed medication, up to 17 percent of college students—most of whom are young women—hurt themselves on a semi-regular basis. And, with rates of professional treatment among self-harmers low, many of them are left feeling alone, isolated by the stigma associated with their behavior.

Members of the UI medical community typically notice that the number of reported instances of cutting and burning is highest at the end of each semester, as final exams and projects crowd students’ calendars.

Self-harm is not a diagnosis, in and of itself: The Diagnostic and Statistical Manual of Mental Disorders lists it as a symptom of a variety of contributing illnesses, particularly borderline personality disorder.

“When they cut or hurt themselves, it’s a release,” said personality-disorder specialist Don St. John, a physician’s assistant and co-leader of the Systems Training for Emotional Predictability and Problem Solving group at the UIHC adult outpatient clinic.

The group only treats those self-harmers who are diagnosed with borderline personality disorder—people with other diagnoses, such as depression, are referred to University Counseling Service or to Student Health. One of the nine different criteria for borderline personality disorder is deliberate self-harm, and St. John meets with three or four college-age self-injurers every day. The three different mental health agencies at the UI do not keep any centralized records of the numbers of self-harming patients they treat, their recovery rates, their ages, or their sex.

Paul Natvig, a Student Health staff psychiatrist, said, “[Self-harmers] are not one group; you can’t lump people together.”

The three groups believe separating self-harming students out according to their contributing disorders makes for better treatment, and they regularly refer patients to one another.

The student group National Alliance on Mental Illness, which has a 3-year-old UI chapter, holds regular meetings for students affected by mental illness, including self-harmers. They don’t distinguish among diagnoses—nor do they claim to be a formal treatment program.

“If people feel comfortable with us, they’ll volunteer information, but we don’t interrogate,” said UI junior Renee Loth, a UI chapter member.

Common among self-harmers is the notion that “it’s a way of dealing with your emotion,” said Loth, who is also a recovering self-harmer, “of expressing it—so that it’s not just inside, so there might be a physical representation of their emotional state.”

Self-harm is a relatively unstudied symptom of mental illness, although in various forms, it is as old as human culture. From devotees of the god Attis castrating themselves in first-century Rome to the early medieval Catholic tradition of the mortification of the flesh as practiced by saints, such as Bernard of Clairvaux, from Oedipus Rex to King Lear, self-harm is far from being the white, wealthy, female-attention-seeker’s problem it is often portrayed as being.

In 1986, Dr. Armando R. Favazza completed a study devoted entirely to self-harm and its adverse effects. In his book Bodies Under Siege, he estimated that 750 out of every 100,000 people exhibit self-injurious behavior. Although most (around 75 percent, according to more recent research) self-harmers are female, certain behaviors—such as punching—are strongly identified with males. A 2006 study by researchers at Cornell University found that 17 percent of undergraduates reported at least one instance of self-harm. Of that group, 75 percent self-harmed regularly. The same study found that 36 percent of self-injurers had hidden their symptoms so carefully that no one knew about the behavior. Only 3.29 percent said that a physician was aware of their self-abuse.

Often self-harmers don’t seek help because of the high stigma attached to their contributing disorders.

“I think it’s not talked about because of the shame involved in it,” St. John said. “The professionals don’t want to deal with it—so the patients learn not to deal with it.”

Another possible reason for self-harmers not seeking medical attention is a history of negative experiences at the hands of judgmental medical professionals.

In the United Kingdom, an agency of the National Health Service put out guidelines for the sympathetic treatment of self-harming patients in 2004, following reports that the punitive attitudes of some Health Service staff extended to stitching up wounds without anesthetic and waiting to treat self-harmers until after other emergency-room patients had been helped.

St. John has worked as a clinical psychologist at the University of Wisconsin-Madison, treating many self-harm patients who were passed onto him by unwilling doctors.

“Anyone can fix a sprained ankle or strep throat, but this is a whole different ball game. You can really make a difference in someone’s life,” he said. The UIHC has no across-the-board policy governing how to treat patients whose injuries appear self-inflicted, enabling medical professionals to react to them as individuals, St. John said.

Medical intervention is all the more important, because self-injury can lead to more serious problems, such as suicide.

Samantha’s friends noticed the thin slices on the outside of her forearms one day in high-school gym class, when she wore a short-sleeved gym shirt without the black studded armbands she used to cover her wrists. Suspicions were raised, parents were notified, and school psychiatrist appointments became mandatory. The crackdown at home was so severe that at the age of 14, she said, she felt as though she was being followed around every corner. Instead of feeling loved and protected, she felt smothered and would use the few moments before or after a shower to carve into her ankles.

“I think people need to know about [self-harm], beyond sending them to a mental institution and being medicated,” she said.

Although she was diagnosed with depression and put on medication for it, the treatment didn’t end her desire to cut. She didn’t think she had a problem.

People who self-harm “don’t know how to deal with life stressors,” St. John said. “We can all remember that adolescence was a stressful time, and if you don’t have proper coping skills, then a lot of [kids] give into those stresses.”

It’s a difficult habit to break. Not least because those who do get past physical harm still face the latent internal troubles which first pushed them to self-harm.
During Loth’s fall semester last year, right around midterms, the art-history major burned her forearms repeatedly with a lighter. The month and a half period was the first and last time she harmed herself.

“I’m lucky I’m not habitual,” she said. “I’m not in its grasp.”

At the end of 2005, the shy brunette became one of the rare self-injurers to directly seek help when she called her psychiatrist and requested hospitalization.
When she was burning herself, like most self-harmers, she took care to keep her ordeal private. Which is why, now that she is past self-harming and working on her ongoing depression, she said that the most important thing for self-injurers is to not be alone.

“If you’re not alone as often, you’re going to have less time to self-harm,” she said.

Natvig agrees. “Being by someone else makes for less time to cut.”

But there is no way to tail someone who self-harms habitually. Any moment alone can be used to cause injury: Samantha’s cutting continued well after her parents thought she had conquered it. She would even feign sleep and cut in the dark, alone.

“People make choices and define themselves,” Cochran said. “If this is part of their identity, then it can be hard to give up.”

Adolescents are particularly concerned with developing and maintaining an identity independent of their parents’—and if self-harm becomes a part of that sense of self, it can be extremely difficult to shake. The oldest self-harmer recorded in Favazza’s study was a woman in her 60s. The ritual of self-inflicted pain can be physically addicting because of the endorphins released by the body.

However, while self-injury has long-lasting negative effects, the short-term gain of feeling “alive”—of reconnecting to the world through a pain that focuses the mind—is what turns people who feel numb and disconnected to it for the first time.

Medical professionals who deal with self-injurers say that the most important aspect of recovery is learning new positive coping mechanisms—so that the same stressors won’t induce the old, harmful results.

Reminders of past self-harm episodes are as omnipresent as the triggers recovering self-harmers must train themselves to ignore. Samantha recalls just last week getting dressed for an evening out and seeing once again the bloodstains on the backs of her bracelets.

These days, with the help of the freshman-year boyfriend, who is now her fiance, Samantha said, “I still have hard times where I’ll start to get really upset at myself—stress with school, job—it’ll get to a point where I have to ...” she breaks off and sighs.

Now, instead of slicing away her anxiety, she has a raft of alternative activities which she half-jokingly calls her “ice cream”—walking, photography, writing, listening to an eclectic mix of gothic music from the 1980s, and having conversations with friends about her stress—and the occasional indulgence in cotton candy ice cream.
Three years on from her last cutting experience, her range of stress-relieving activities reads practically like any other college-age person’s.

Because talking was one of the things that helped her own recovery most, Samantha spends time conversing with other victims of self-harm on the Internet.
“I’ve learned my tendencies, and that way, I can help others.”