The Times (London)
February 10, 2003, Monday

Young lives endured at the razor’s edge
By Claire Gillman

Self-harm, particularly “cutting”, is a major problem among young people who internalise their unhappiness or respond badly to stress. Claire Gillman reviews the latest attitudes to treatment

As a parent, your fiercest natural instinct is to protect your child from danger.

Yet some have to face the appalling fact that the harm to their child has been self-inflicted.

“Hannah was about 15 when I first saw her arms, but the cutting must have been going on for a long time before that,” says Rosie Woods, a teacher from Cambridge.

“I saw those raw, gaping cuts and was absolutely horrified—and very frightened: my immediate reaction was that she’d tried to commit suicide. I was so shocked, I cried.

“When I asked her why, she said that it made her feel better and that it was the only way to deal with the stuff in her life when it got too much.”

According to the National Survey of Mental Health in Children and Adolescents, over 3 per cent of 13 to 15-year-old girls self-harm—which means that 35,000 children in this age group alone are self-harming. Girls are seven times more likely than boys to injure themselves. Cutting the arms or the backs of the legs with a razor or knife is the most common form of self-injury, but many self-harmers will burn themselves with cigarettes (in these same discreet areas), pull out their hair, or inflict large bruises on their bodies by hurling themselves at door jambs and walls. Often the self-harmer will use more than one of these tactics.

Contrary to popular perception, self-harm is not about wanting to die. As the support group Self Harm Alliance explains: “It is not a failed suicide attempt.

The majority of people who harm themselves are doing so in order to keep themselves alive. The release they gain enables them to carry on.”

Self-harm represents a way of dealing with difficulties or strong emotions with which the child feels otherwise unable to cope—in a distressed adolescent’s mind, steeling yourself to inflict pain brings a degree of control into a turbulent world. “Hannah told me that she felt overwhelmed by the things happening in her life and was impotent to change them,” says Woods. “The act of cutting herself was a way of owning and controlling her body.”

As one self-harmer explains: “It made me feel so much better so that I could carry on. I didn’t think of it as dangerous.”

But, as Dr Nick Goddard, a consultant adolescent psychiatrist at the South London and Maudsley Trust, points out: “It only takes a deep cut in the wrong place for something to go seriously wrong, so this behaviour must be taken seriously.”

Children suffering from depression, anxiety disorder or conduct disorders, or who are living in residential care, are more likely to self-harm. Another high risk factor is “adverse life events”: a recent report in the British Medical Journal showed that the incidence of self-harm rises to 9.5 per cent in 11 to 15-year olds who experience five or more such events, and a young person is at greater risk if they have a troubled home life (8.4 per cent in dysfunctional families compared with 1.5 per cent in families with no discord).

A specific trigger can start the self-harm—sexual abuse, bullying, bereavement and friendship or relationship problems are often cited—but it may simply be a desperate response to accumulated pressures. The expert consensus is that the problem is on the increase. In part, this may be attributable to the growing pressures that young adolescents experience in school, and the cogent need they feel to grow up quickly (self-harming featured recently as a storyline in the TV series Hollyoaks).

Most young people who self-harm express feelings of self-loathing or have very low self-esteem. As a former self-harmer explains: “I use a razor blade to cut my arms ... I feel totally disgusted with myself and totally worthless. And people are not listening to me or taking me seriously. I feel rejected and lonely—disappointed that I can’t achieve what I want to achieve.”

Boys-who generally externalise their feelings-are less likely to self-harm.

But although young girls with low self-esteem, depression and/or a low resistance to life’s stresses make up by far the largest group of self-harmers, there is a growing group of middle-class girls, often at single-sex schools, for whom self-harm is a badge of honour. For them, self-harm becomes ritualistic, a way to prove their courage to their friends.

This is nothing new, says the author Anabel Donald, who speaks with the experience of 36 years as a headmistress and housemistress at girls’ schools. “When we were young, the sort of girls who smoked behind the bike sheds would burn themselves with cigarettes to prove their valour,” she says, adding that self-harm is rarely about manipulating parents or attention-seeking: “I’ve known girls who self harm without parents ever knowing, which, to me, militates very strongly against self-harm being a form of manipulation.”

Parents who discover that their child is self-harming often describe feelings of betrayal and a deep sense of failure. “You beat yourself up and wonder, how could I have missed how unhappy she was?” says Woods.

“Parents tend to either go into denial and pretend it’s not there or go into overdrive, follow their kids constantly and start hiding sharp objects,” says Dr Goddard. “Of course, the young person just gets better at hiding things and it becomes a game.

“Adolescents need privacy and a degree of trust, so you have to find some middle ground if possible.” That means expressing your concern, then backing off a bit: “Don’t follow your child around and force her to talk-suggest that you are there when she wants to talk. Ask her to identify the trigger points, and to think about what else she could do when these occur.”

You may not be able to stop the self-harming, but you can make sure it is being done as safely as possible-facile as it may sound, this means trying to establish whether the self-harmer is using clean implements and how she is dressing the wounds.

Self-harmers report that it helps to find something that produces an intense sensation to replace the extreme of self-injury-squeezing ice, punching a pillow, taking a cold shower or biting into something strongly flavoured, such as lemons. They say that the intensity of such strong sensations can snap you back into the real world.

Poor communication about difficulties and emotions is often at the root of the problem, and talking therapies—particularly cognitive behaviour therapies (CBT)—are useful. Treatable conditions such as depression may be detected and need to be treated appropriately. “For a small proportion, medication may be indicated, but this is always in combination with some kind of talking therapy,” says Dr Goddard.

“All self-harm has to be taken seriously. This is a sign that the person is not happy and not managing the stresses of life, and that should be investigated further by someone experienced.” You may get advice on how you and the family can help yourselves, he says, but some self-harmers require “further intervention”.

Greater awareness of the problem is important, suggests Goddard. “Letting them know they are not alone in doing this can help young people. They often feel very guilty or ashamed, so to know that others feel that way too is good. The young often don’t think that their problems are serious enough for people to do anything about, but there are people who want to listen and are able to help.”

Some names have been changed

SELF-HARM LINKS

www.selfharmalliance.org
www.self-injury.info
www.youngminds.org.uk

Changing Minds CD-Rom: www.rcpsych.ac.uk

The Samaritans: 08457 909090 Childline: 0800 1111 Be Nice by Anabel Donald (Jonathan Cape, Pounds 10)


PR Newswire
February 10, 2003

Discovery Health Channel Reveals Secret World of Girls Who Self-Injure

CUTTERS: SELF-ABUSE Premieres on Thursday, March 27 at 8 PM (ET)

BETHESDA, Md., Feb. 10 /PRNewswire/—When reality overwhelms some adolescent girls, they turn to cutting themselves with sharp objects. Enter the secret world of Hanna and Michelle, troubled teenage girls who cut themselves several times a day but now are trying to stop.

For the first time, through intimate video-diaries and closed-door therapy sessions, Discovery Health Channel takes viewers inside the nation’s first residential treatment program for adolescents dealing specifically with “cutting,” a baffling disorder that medical experts estimate affects 10% of American teenage girls. CUTTERS: SELF-ABUSE premieres on Thursday, March 27 at 8 PM (ET) on the Discovery Health Channel.

For three months, Discovery Health Channel cameras were granted exclusive access to Vista Del Mar Child & Family Services in Los Angeles, California, a non-profit facility where girls receive around-the-clock therapeutic support to develop skills that lead them to reach out to other people and break the cycle of cutting. Alarmingly, medical professionals report that self-injury caseloads have doubled in the last three years. As life becomes increasingly complex for teenagers, therapists say they expect the numbers to continue to rise.

CUTTERS: SELF-ABUSE displays the strength the girls find in peer group therapy, creating an atmosphere that gives them confidence and encourages them to talk about the underlying problems that drive them to injure themselves. At Vista Del Mar, the girls try to live as other teenagers do; socializing and going to school on campus while attending daily therapy sessions. Each girl featured in the one-hour special reveals the continuous struggle that takes place every day when the desire to cut their own body becomes strong. The girls and their families requested that their last names not be used. Eating disorders, hair-pulling and skin-burning are a few of the conditions that co-exist with cutting.

“Not every cutter is going to be suicidal because people who cut want to relieve some kind of tension that has built up within them and they feel a relief once they cut,” said Elaine Leader, founder of Teen Line, who is interviewed during the program. “Once somebody uses that as a tension reliever or a coping mechanism, they tend to use it again and again and it becomes kind of an addictive behavior and that is the problem with cutting.” Teen Line has been providing outreach services to the California community for more than 18 years and is affiliated with Cedars-Sinai Medical Center.

CUTTERS: SELF-ABUSE is produced for the Discovery Health Channel by The Buller Company.


Spokesman Review (Spokane, WA)
February 24, 2003

Hidden scars; Some teens turn to cutting as a way to deal with emotional problems
By Jeanette White

She told her mom it was a cat scratch.

The high school junior didn’t want to admit the truth, that she’d cut her own forearm, on purpose. That she’d worn long sleeves from August to October to hide even more self-inflicted cuts in various stages of healing.

At 16, she knew few people would understand why, whenever she was angry or depressed, she sliced at her skin with a pocketknife to feel better.

Within a couple of years, she’d accumulated numerous cuts and scars on her arms, legs and stomach. “I never wanted anyone else to know,” said the woman, now a Spokane college senior. “I had to try to choose places no one else would notice.”

It’s a phenomenon more teens, parents and counselors nationwide struggle with as young people increasingly turn to self-mutilation to cope with strong emotions such as anger, depression and hopelessness.

“It’s very sad, but it’s definitely on the increase,” said Wendy Lader, clinical director at SAFE Alternatives, a self-injury clinic in Naperville, Ill. “Now we get a tremendous number of calls from high school guidance counselors. Most of my e-mails are from kids wanting help for themselves or friends.”

Dixie Costigan, a psychiatric nurse at Family Service Spokane, has seen a significant increase in cutting here, too. “A small part of that is just more openness to talking about the problem,” Costigan said. “It used to be more private.”

No one tracks the number of kids treated locally for cutting, in part because it’s a symptom of other problems rather than a diagnosis itself. But now there are entire books, Web sites and chat groups devoted to cutting, along with vocabulary to describe it. While some call the practice self-mutilation, self-injury or “the new anorexia,” the common term is cutting and participants are simply called cutters.

Cutting often signals a deeper emotional problem, such as clinical depression or borderline personality disorder—marked by a pervasive instability of moods, self-image, behavior and relationships. Cutters include homeless kids, middle-class honors students and celebrities such as actor Johnny Depp, who has talked about past struggles with self-injury.

While some cuts are shallow incisions made with paper clips, others are gouges requiring stitches or even skin grafts. Some teens hide their injuries, although Lader believes most subconsciously hope someone notices and acknowledges their pain.

Friends and parents are often shocked, appalled and afraid the cutter is suicidal. Usually, though, suicide isn’t the intention, experts say. Tom Flanigan, a counselor at Mt. Spokane High School in Mead, compared cutting to drinking or using drugs. “It’s a coping mechanism, but it’s not a healthy one. Kids use it to deal with overwhelming distress or anger.”

“For some, they’ve become emotionally numb,” Costigan said. “It’s a way to start to feel again. For others, there’s so much emotional pain that the only way to break the cycle is physical pain.”

The Spokane college student said cutting always hurt but gave her a vague independence from parents she considered overly controlling. “It was kind of like your own little secret, which sounds kind of twisted,” she said. “It might have given me a sense of power. No one can stop me from doing this except for myself. They couldn’t control whether I did it or not.”

Sometimes, she cut when she was angry and had no one to talk to. “I just decided to take it out on myself instead of breaking things.”

A 17-year-old Spokane high school student started cutting her stomach with a razor shortly after switching schools. “I just felt like a loser. I was new at school. I didn’t feel like I could talk to anyone,” she recalled. “I just remember hating myself so much, I just kind of wanted to hurt myself.”

Far more girls than boys turn to cutting because they’re taught to “act in” when distressed rather than act out, experts say. Up to half of cutters have suffered sexual abuse. They try to make themselves unattractive or punish bodies they believe betrayed them.

Spokane psychologist Mary Miller said self-injuring teens often perceive a situation as unsolvable. “They’re hopeless about it,” said Miller. “Often, it’s surrounding relationships, like ‘I’ll never be in a relationship’ or ‘I can’t get out of a relationship.’ Or ‘I’m an adolescent and I’m being abused or neglected or emotionally abandoned.’ “

Whatever the motivation, it’s important to get help early, because kids may cut too deep or cause infections. And they may move on to suicide if underlying problems are ignored, said Dr. Michael Manz, chief of the child and adolescent psychiatric unit at Sacred Heart Medical Center. One week this winter, half the unit’s six patients cut themselves “on a pretty regular basis,” Manz said.

Cutting doesn’t solve their problems, Manz said. “It really doesn’t work in the long run. It makes things all that much worse because then you have to deal with covering it up, explaining it or hiding it.”

They may also learn too late that endorphins released during cutting can be addicting. “I’d mellow out so fast after I did it,” said the 17-year-old student, who cut herself for a year and a half. “When it got to the point where I hadn’t done it for a couple months but I still wanted to, that’s when I thought it was an addiction.”

For the Spokane college student, cutting created an ongoing mental war. “There’s part of you saying, ‘Who cares? Just do it. No one will probably notice.’ Then there’s part of you saying, ‘You don’t want another scar.’ “

Like many former cutters, she’s embarrassed by her scars and tired of going out of her way to hide them. Manz always reminds kids who self-injure that someday they may have to explain their scars to an employer.

Caprice Morrison, a social worker at Spokane Mental Health, helps cutters explore their self-image, family dynamics and friendships. She looks for abuse or anger that kids haven’t dealt with. “They may not be able to realize why they’re (cutting),” she said.

At SAFE (Self Abuse Finally Ends) Alternatives, the nation’s first inpatient program for self-injurers, Lader urges teens to be aware of their feelings at the moment they want to cut. What just happened? What events set them off? Challenge any irrational thoughts, such as, “My boyfriend left me so I must be worthless.”

“Realize a feeling won’t kill you. An action could,” Lader said, “but a feeling won’t. The issue is being able to tolerate uncomfortable and intense emotional feelings.”

It helps when parents approach the topic with a caring, concerned attitude and are open to professional help, perhaps family therapy, Miller said. “Be willing to look at family dynamics and see if that contributes to what’s going on. Most of the time it does.”

With help, added Miller, there is hope. “The problem is complex, but there’s hope that it would be resolved and people can have happy, nonself-abusive lives. I see that a lot.”

Years after telling her mom a cat scratched her, years after she stopped cutting with help from a therapist, supportive friends and antidepressants, the Spokane college student considers her scars a painful reminder.

“It makes me sad when I look at them now,” she said. “During that time, I was sure I was living in hell.”

Help from the experts

For teens:

* Ask for help from friends, parents or a counselor.
* When a situation upsets or depresses you, ask someone you trust for a second opinion on your thoughts. Work on talking about your problems instead of keeping them inside.
* Look for patterns that set off the urge to cut. Make a list of five things you can do to distract yourself when you’re tempted to self-injure (music, art or sports, for example)
* Give yourself a break; don’t aim for perfection in life.
* Know there is hope. With proper help for underlying problems, most cutters manage to stop.

For friends:

* Don’t abandon or judge them.
* Encourage cutters to get help; tell a school counselor or adult you trust.
* Be respectful of your friend’s feelings and willing to listen.

For parents:

* Don’t ignore the problem in hopes it’ll go away.
* Tell kids you see they are hurting, and you want to talk about it. Resist being judgmental.
* Don’t condemn or punish teens for cutting. Instead, help your child learn to talk about what’s bothering her.
* Consider consulting a professional for help.
* Make sure your child doesn’t spend a lot of time isolated from others.

Resources for families:

* www.selfinjury.com, Web site for SAFE Alternatives program; information also available at 1-800-DONT CUT (not a crisis line)

* “Cutting: Understanding & Overcoming Self-Mutilation,” book by psychotherapist Steven Levenkron; $14.95; W.W. Norton & Co.

* “A Bright Red Scream: Self-Mutilation and the Language of Pain,” book by Marilee Strong; $14; Penguin USA


UK Newsquest Regional Press—This is Wiltshire
February 27, 2003

Helping stop self-harming

In Swindon every year, over 1,000 people pass through hospital Accident and Emergency following serious attempts to harm themselves or commit suicide. The problem is little understood by the general public who often wrongly assume these people are attention seekers.

In order to promote greater understanding, national charity Project SPEAR is holding a FREE ENTRY exhibition on Saturday 1st March 2003. It coincides with national Self-Injury Awareness Day and is at the Pilgrim Centre, Regent’s Circus, Swindon.

Mark Hebblewhite is a well-known artist and his work captures the essence and effects of self-harm, which is a way of coping with unresolved inner conflict and can have disastrous and permanently disfiguring consequences.

WARNING: Visitors may find some images and personal stories disturbing, therefore it is not recommended for children under 12 years.

People from all walks of life, including professional people may self-harm when they cannot cope. Project SPEAR exists to help people in distress, to raise awareness, combat prejudices and encourage personal responsibility.

Or go to www.projectspear.com where you can make a donation online through a secure web connection.

Contact: Project SPEAR, Pembroke Centre, Suite8, Cheney Manor, Swindon SN2 2PQ
E-mail info@projectspear.com
Phone 01793 520 111


Birmingham Post
February 28, 2003, Friday

Self Abuse Scars That Time Will Not Heal; It is More Common Than You Would Probably Like to Believe
By Paul Groves

On the surface, Simon has it all. He has the gleaming new sports car, the city living apartment, the successful career, the wide circle of friends.

He enjoys a comfortable, financially-secure life and is still two years off the big 30.

But the smiles and the trappings of success mask a dark secret.

Since his mid-teens Simon has suffered from a debilitating ailment—he feels he is unworthy of success and cannot come to the terms with the fact he has done well for himself.

From the age of 15, this ailment has manifested itself in the most brutal way. Simon’s arms, permanently covered by long-sleeved shirts and jumpers whenever he is in public-whatever the weather-bear the ugly scars of more than a decade of self injury.

‘I used to think ‘Why am I doing this to myself?’, but I’ve managed to trace it back to my boarding school,’ he reveals. ‘I won a school prize at 14 and got teased and bullied remorselessly. Ever since I’ve hated myself for doing well.

‘I got A and B-grades in all my GCSEs and celebrated by cutting myself 12 times, one for each subject. When I did well in my A-levels and got a place at Oxford University I cut myself so badly I had to go to the A&E department of my local hospital.

‘Every time something goes well for me, I feel I’m not worthy. I can’t express the reasons why and the only thing that feels like it works is to injure myself.’

Experts agree that self injury is normally done as a way of coping with overwhelming periods of emotion, to help deal with feelings of unreality or numbness, to make flashbacks stop, to punish the self and stop self-hating thoughts. Self injury is seen as more about relieving tension or distress than anything else.

Yet, in truth, the level of ‘expert’ awareness about self injury is very limited.

Simon, in common with many others like him, has needed hospital treatment on occasion after injuring himself. However, he has experienced a response bordering on hostility from medical staff.

‘There did seem an anger that I was taking up valuable time with something that was self-inflicted when people suffering injuries caused accidentally were having to wait. At no time did anyone ask why I was doing it. The attitude seemed to be to patch me up as quickly as possible and get rid of me.

‘It was only 18 months ago that someone offered me help. I now receive counselling and I’ve been given a few techniques to try when I find myself in difficult situations.

‘But it still bubbles beneath the surface. My counsellor complemented me a few months ago on how well I had responded to our sessions and I went home and made a deep cut in my forearm.’

Not surprisingly, Simon finds it almost impossible to talk about his self-injury. His family, closest friends and employer all remain unaware of the torment he feels.

But he does feel he is making progress and he wants to help raise awareness of what is happening to thousands like him.

Tomorrow is Self Injury Awareness Day and organisers hope to encourage people-from parents of sufferers to the medical profession—to find out more about the issue and try to begin to understand what lies behind the emotive title.

Most researchers agree that self injury is not done with suicidal intent or to gain some form of sexual pleasure.

Although cut-ting is the most common form of self injury, burning and headbanging are also very common. Other forms include biting, skin-picking, hairpulling, hitting the body with objects or hitting objects with the body. Although it is a crude and ultimately destructive coping mechanism, it works in the mind of the person doing it and so can have addictive qualities.

‘I felt unworthy and I felt that when I got any attention I needed to be punished,’ recalls Simon. ‘So cutting myself was a way of dealing with all those different emotions I was feeling.

‘In a strange way, it made me feel better about myself. So it did become addictive and I didn’t think twice about it.’

Simon knows the next big step is telling his parents and friends. And he feels the time is now right. As a result of the counselling sessions and self-help group he regularly attends, he feels more confident about revealing more about his self injury.

He has also embarked on a serious relationship, his first since his early twenties. Initially he used his normal excuse to explain away the deep scars on his arms to his new girlfriend—they were the result of a car crash in his late teens.

But he has now told his girlfriend the truth and no longer feels so self-conscious about exposing his arms to her. ‘She has been amazing, a lot more understanding than I thought possible.

‘It took me ages to understand all this, so I didn’t think anyone else would be able to cope. But she still loves me for who I am and I don’t feel any anxiety about the fact that I have a successful relationship.

‘We’re taking this slowly. It is a clich, but it is a case of taking one step at a time and taking very small steps.

‘The next step is to tell my parents. I’m 99 per cent sure they will react in the same way as my girlfriend, but until the moment arrives there will always be that nagging doubt.’

Simon has been amazed how many people attend the same support group as him and at their diverse ages and backgrounds.

‘It can affect anyone at any time,’ he adds. ‘This is not all about teenage girls struggling with growing up and spending hours in their bedroom.

‘It is not about suicidal young men who feel the world is passing them by.

‘The sooner people realise how widespread this is, the easier it will be for us to talk about it and deal with it.’

For information log on to www.selfinjury.org.uk, or contact the mental health charity Mind on 0845 7660 163.

Factfile

Most people who self injure dislike the term ‘self mutilation’ as it suggests an intent to harm and maim the body, which is usually not the case;

Self-injury is probably the result of many different factors, such as a lack of role models, or never learning appropriate ways of expressing emotion;

There is growing evidence to indicate self injury may be a result of specific problems within the brain that cause an increase in impulsive and aggressive behaviour. Impulsive aggression, combined with a belief that expressing it outwardly is bad, might lead to the aggression being turned inward;

Those who self injure come from all walks of life and all economic brackets. Some manage to function effectively in demanding jobs, such as teachers, lawyers and engineers;

Ages typically range from early teens to early 60s. The incidence of self injury is about the same as that of eating disorders, but because it’s so highly stigmatised most people hide their scars, bums, and bruises carefully;

Self injury is a coping mechanism, just as some turn to alcoholism, drug abuse, overeating, anorexia, bulimia and smoking;

Self injury is very rarely a failed suicide attempt. People who inflict physical harm on themselves do so as a way to keep from killing themselves;

Medications, such as mood stabilisers and anti-depressants have been tried with some success, but there is no magic pill for stopping self harm;

Therapeutic approaches like learning new coping mechanisms reflect a growing belief that much can be done to solve the problems and issues underlying the self-injury.


Library Journal
March 1, 2003 Saturday

Self-Injury; From Suffering to Solutions
By Kimberly Paone

Videocassette. color. 18:10 min. with tchr’s. guide online. SVE & Churchill Media. 2002. 97240-HAVTX. $89.95.

Gr 7-12-In this clear, concise presentation, teens tell their true stories of inflicting harm upon themselves-what led them to cut or burn themselves-and how they have overcome their problems. The multiethnic males and females, from varied socioeconomic backgrounds, had different reasons for self-injury such as depression, being abused or bullied, perfectionism, and having low self-esteem. The scenes are realistic, the delivery is not didactic, and input from a director at a rehabilitation center and a psychologist add to the video’s matter-of-fact, yet hard-hitting feeling. Viewers will learn the definition of self-injury, underlying causes, and strategies on how to help themselves or others. This solid, honest look at an affliction that affects so many young men and women is a must for guidance counselors, health teachers, and others working with potentially at-risk students. –Kimberly Paone, Elizabeth Public Library, NJ


Charleston Daily Mail (West Virginia)
March 27, 2003

‘Cutters’ looks at teenage girls in pain , Tracey Gold hosts documentary on painful affliction
By KEVIN Mcdonough

AFTER years of “Survivor” and “The Mole” episodes, you’d be forgiven if you never wanted to watch another “video diary.” But the hackneyed “reality TV” staple is put to powerful use in the documentary “Cutters: Self Abuse” (8 p.m., Discovery Health).

Tracey Gold hosts this look at a painful and secret affliction that affects adolescent girls. Overwhelmed by their emotions, they feel compelled to mutilate themselves with sharp objects, often several times a day. As several cutters and their therapists explain, this painful act helps them relieve tension. And once they resort to self-abuse, they often feel driven to cut themselves repeatedly. Compulsive hair pulling, eating disorders and skin burning are often related symptoms.

The makers of “Cutters” gained access to a treatment center where girls receive therapeutic treatment and learn to reach out to others rather than hurting themselves. Therapists interviewed here report that their self-injury caseloads have doubled in the past few years. Some contend that 10 percent of all adolescent girls turn to cutting.


The Halifax Daily News (Nova Scotia)
April 6, 2003

Covering the pain: People who cut themselves do it to mask deep emotional trauma, and their numbers may be growing
By Keith Bonnell

There’s usually a moment of hesitation before she does it. A few seconds when she weighs her guilt against the feeling she needs this to go on with her day. Then, most times, Jennifer gives in. She takes a razor blade and nicks her arm.

Jennifer (not her real name) is a short, striking brunette in her first year at Dalhousie University. She has a student loan, a part-time job and a boyfriend she loves.

She also cuts herself.

“I think it’s an escapist thing,” she explains. “Like I’m not really there when I’m doing it.”

She’s not alone in doing it. Self-injury is a struggle more and more Nova Scotians—especially young women—deal with daily.

It’s a method they try in order to control the stress in their lives, but it can end up taking control of them instead.

Local therapists and guidance counsellors say they’re seeing increasing numbers of incidents, in people as young as 11.

Allan Abbass, director of the centre for emotions and health at the QEII Health Sciences Centre in Halifax, says people will often self-injure as a way to cope when they feel emotionally overwhelmed by what’s going on in their life.

He says self-injury—whether it’s cutting, scratching or burning or people repeatedly and violently hitting their head—is a way to relieve the anxiety often caused by complex emotional issues and stress.

But how does this kind of self-induced pain help someone calm down?

When a person hurts himself, the body releases chemicals to ease the pain. It’s one of nature’s self-preservation instincts, meant to help the mind and body deal with the trauma of injury.

“Your body releases morphine, so there’s less pain. It’s a protective mechanism,” Abbass says. “There’s a rush out of it, a buzz, whatever you want to call it. There’s a bit of elation that happens in it.”

Abbass says the behaviour becomes addictive, and that’s where the torturous cycle of self-injury lies.

Jennifer often wears a dark band around her wrist. It looks trendy, in line with the current style for young urban women, yet for her, it’s not about fashion. It’s about utility.

It covers the cuts she’s been inflicting on herself almost daily.

Jennifer hadn’t cut herself in more than a year before this winter, until she started having trouble with her landlord midway through the year. Her schoolwork fell behind, and she considered dropping out, as everything seemed to go wrong at once.

The stress resurrected the ghost she thought she had left behind.

“You’re considering it, and you hate yourself for having considered it,” she says. “You decide where it would be best hidden.”

Tom Osborne, a clinical therapist at the IWK Health Centre, gave high school guidance counsellors a seminar earlier this year on how to deal with students who self-injure.

He estimates the number of cases he’s seen has tripled in the past 10 to 15 years.

“For every one person that’s reporting it, I suspect there’s probably five to 10 that aren’t,” Osborne says.

One of the reasons diagnoses of self-injury may be on the rise these days is that medical professionals have, for the most part, stopped considering it a suicide attempt.

In fact, most professionals say that while teens who self-injure may feel like committing suicide at some points, the actual cutting isn’t about ending their life.

Some say self-injury is only a symptom of depression and possible borderline personality disorders. Others say that, like alcoholism or other self-destructive behaviours, it deserves to be treated as its own distinct affliction.

Cutters can be unnervingly practical and deliberate. They’re also experts at keeping what they’re doing a secret, blaming the cuts, when they’re seen, on accidental scratches, and keeping their razors hidden.

“People who are doing it, they know it’s not OK,” says professor Linda Wheeldon of Acadia University, who also counsels self-abusers.

She says far from self-injury being a cry for attention, it’s usually an intensely guarded secret.

“Until they’re ready for it to be made visible, they’re very skillful at hiding it.”

Elizabeth (not her real name) is a Nova Scotia high school senior who was very good at hiding it.

She says she had been cutting for two years before anyone found out, always high enough up on her arm so that a short-sleeve shirt would hide it.

“The pain physically was better than the emotional stuff,” she says. “Physical pain made the emotional stuff kind of go away for a while.”

But in the end, the self-injury only added to her emotional stress.

“You feel pretty bad about yourself that you did it,” she says quietly. “You’re always asking yourself, ‘What’s wrong with me?”‘

Elizabeth didn’t even know anyone else cut.

It was her private, painful secret, until she saw an episode of a TV drama that featured a character who cut herself.

“It was a bit of a relief,” she admits.

Patricia (not her real name) is an 18-year-old first-year student at Mount Saint Vincent University who has nasty scars up and down her arm.

“It’s worse than being addicted to a drug,” Patricia says. “If you’re addicted to a drug, you have those 10-step programs and stuff.

“The day that I see a cutting 10-step program would probably be the best day,” she adds with a laugh.

Patricia was playing with her cat one night when it scratched her. The sensation stayed with her and opened a Pandora’s box.

“It got to the point where I couldn’t go to sleep without cutting,” she said. “It’s like an addiction: you crave it.”

Abbass says complex emotional issues are often behind self-injury. “A person has had trauma. They had mixed feelings toward the person who traumatized them. That causes them to have mixed feelings towards themselves—positive feelings and rage all mixed together and all stirred up together. And guilt about the rage, and they turn the rage inward on themselves.”

Norman McNaught, a counsellor at Park View Education Centre in Bridgewater, teaches a course on self-esteem and communication skills at the high school. He estimates that of the 950 students at Park View, between 30 and 60 are struggling with self-injury.

“I have a young lady who self injures,” he says. “She has a square on her arm. She only cuts here. The case with this young lady is one parent who refuses to acknowledge, to be positive, to say positive things. The parent will constantly emotionally abuse the girl.”

One student in the school started a peer-counselling group, offering self-injuring students a safe place to talk.

Patricia was a peer counsellor for years, offering to help other students with their problems, without dealing with her own.

She was suffering from depression and believed that she had been abused by her father—something that later turned out to be a delusion.

As friends found out about her cutting, it pushed many of them away, she says. And she felt guilty for burdening those who tried to help. The cutting caused her to become more and more of a loner.

She made her first cut in Grade 7, but it wasn’t until four years later that a friend finally dragged her “kicking and screaming” to a counsellor at Cole Harbour High School.

The counsellor told her cutting wasn’t that uncommon—even at the school.

“I looked at him and I realized, maybe I’m not the only one,” she says. “Lights came on.”

Osborne says people who cut themselves usually want to talk about it deep down, even though they may be petrified by the thought of how they may be judged by the people they love and care about.

He says getting upset and angrily confronting cutters is one of the worst ways parents, friends or guidance counsellors can express their concerns.

“Cuts, sometimes significant ones, are scary things for most human beings. Usually, we see them and we go, ‘Ugggh.’ It scares the kid, and she automatically thinks, ‘Hey, maybe I shouldn’t be talking with this person.”‘

He says his therapy sessions focus on finding out what role the cutting plays in a teenager’s life, rather than just trying to eliminate it outright.

“You have to stop and think what are you going to replace as a coping mechanism, rather than just a knee-jerk let’s get rid of this thing as soon as we can.”

Some anti-depression drugs, group day programs and various kinds of counselling therapies can help people struggling with self-injury.

However, at the QEII, Abbass says the impetus to end the self-harm must come from the patient themselves.

Patricia has similar views.

“You have to want to stop as much as you had wanted to cut,” she says.

Her school therapist referred her to the IWK. After struggling with repeated hospitalization for depression, she finally found helpful medication and is in therapy.

She hadn’t cut herself in seven weeks when this interview was done.

As for the scars still so evident on her arm, she says they’ve become a part of her.

“They’re like battle wounds,” she says. “They’re the direct result of something you were at war with.”

Meanwhile, Elizabeth is seeing a therapist and hopes to eventually study early childhood development and special education.

She says cutters should know they’re not alone.

“They should probably talk to someone because they can get help,” she says. “People aren’t going to think they’re crazy or anything.”

Jennifer has been contemplating seeking a therapist to help her try to deal with the cutting.

She says she’s most concerned about how it affects the people around her, such as her boyfriend whom she recently told.

“I’m with a guy who’s fun and great, and I feel accepted for who I am. I don’t want him to know these kind of things,” she says. “He doesn’t deserve that.

“Unfortunately, there wasn’t a point where I ever wanted to stop. Still, even now, I want to do it.”

Spotting the signs

IWK Health Centre clinical therapist Tom Osborne says the following signs may indicate that a person is cutting him or herself:

- Individual has unexplained scars.
- Individual repeatedly has unexplained cuts, scrapes or other injuries, especially in the same area.
- Individual has weak excuses for single or repetitive wounds.
- Individual is always wearing clothing to cover areas of the body that would usually, or at least occasionally, be exposed—i.e., long sleeves, arm bracelets.
- You find blood on clothing or towels without reasonable explanation.
- General signs of depression often coincide with self-injury.

Note: Many cutters work hard at avoiding discovery and will cut in less obvious areas, such as upper legs and arms.


Library Journal
May 1, 2003

Hidden Scars, Silent Wounds; Understanding Self-Injury
By Kimberly L. Paone

Videocassette. color. 25:07 min. with tchr’s. guide, student handouts. Prod. by Hourglass Prods. Dist. by Human Relations Media. 2003. ISBN 1-55548-269-4. $139.95.

Gr 7 Up-Set against the backdrop of one of the most successful self-injury treatment programs in the world, S.A.F.E. Alternatives (Self Abuse Finally Ends) located at the Linden Oaks Hospital at Edward in Naperville, IL, staff and current and former patients tell of their experiences with self injury. Forms of self-injury are discussed, as well as the causes, signs to look for, and treatment options and recovery. There are over two million Americans who engage in this usually secret activity, and the majority are teenage girls and young women. Many celebrities have admitted to using self-injury including Johnny Depp, Christina Ricci, and Angelina Jolie. The professionals in the video provide pertinent information, and offer good advice and wise commentary, but it is the stories of the patients and former patients that will touch viewers. One girl in particular, “Sam,” speaks to the camera while her horribly scarred arms are in full view. This and other scenes of cuts and blood may be difficult for younger teens to handle, but will certainly leave quite an impression. A former patient who successfully completed treatment at S.A.F.E. Alternatives says: “Self-injury is not a way to live, but a way to die.” This may be the impetus for those who are practicing self injury to seek help and for friends of “cutters” to step in and help. –Kimberly L. Paone, Elizabeth Public Library, NJ


Bristol Evening Post
May 23, 2003

Students’ Play Opens Minds to Issue of Self-Harm

Drama students at St Bernadette’s Secondary School have devised a 30-minute play aimed at breaking down the myths surrounding self-harm. The group of young people decided to tackle the issue as part of their GCSE final exam.

Drama teacher Alex Galvin said: “Self-harm is misunderstood by most people, so the play is a way of educating people about the subject.” Student Charlie Atere said: “One thing we learned was that every self-harm case is different.

“Our real break came when we contacted Self Injury Self Help. That gave us the idea of basing the play around a self-help group.”


Santa Fe New Mexican (New Mexico)
May 27, 2003

Teens Feel The Unkindest Cut
By Deborah Davis

Rise in reports of teens deliberately cutting themselves to relieve stress worries parents and counselors in Northern New Mexico

A 16-year-old girl from Espanola writes poems in her journal as a way to release her feelings without hurting herself.

The 16-year-old girl distinctly remembers feeling instant relief the first time she took a razor to her arms.

But she doesn’t know what made her think of cutting her wrists, arms and palms one night three years ago.

The soon-to-be junior at Espanola High School didn’t want to reveal her name for fear that her large extended family in the area would be hurt if they read about her behavior.

But she also considered it important for families to understand why people injure themselves in times of stress or crises. And she wanted other teenagers like her to know they aren’t alone.

“In the beginning, I would have liked to know there was someone else out there,” she said.

Cutting seems to be the most popular form of self-injury, but people also burn or hit themselves, pull their hair or break their bones. Studies have shown people who self-injure have mood-management issues such as depression, anger and anxiety. There are also strong links between self-injury and eating disorders, being victimized or being a witness to violence.

Overall, people who hurt themselves don’t have the ability to regulate their emotions or control stressful situations. Although people of all ages injure themselves, most people are in their mid-teens to mid-20s, said Kate Reynolds, clinical coordinator at the SKY Center.

“These are things people do in moments of terror, sadness or overwhelming emotion,” Reynolds said. “In some ways, it’s considered a coping skill—obviously not a successful one—for kids.”

The SKY Center, which provides affordable counseling to families and teens who are considered at risk for suicide, has received more questions and referrals in the past few months from school officials and families worried about teens who self-injure.

It’s not a new coping skill, and it’s hard to know if the increase in calls is due to a heightened awareness of the problem or a surge in the behavior, Reynolds said.

“I don’t know how prevalent it is,” she said. “But like suicide attempts or risky sex, there’s probably 10 times more than we know about.”

Just as the 16-year-old couldn’t explain her first moments of cutting, many people don’t recall how it starts, Reynolds said. The pain releases endorphins that help mask people’s physical and emotional pain, and some get addicted to that feeling.

“It produces a kind of high,” Reynolds said. “It brings them back inside themselves.”

The girl from Espanola said she had always tried to figure out why she was so sad, why she cried so much. “Feeling something physical makes you forget that your heart is hurting and your mind is about to explode,” she said.

The counselors at Capshaw Middle School were so concerned about an increase in girls and boys who cut themselves this year that they researched and presented information about self-injury to their students.

Nancy David, a counselor at Capshaw Middle School, said some of the kids who cut themselves are really good, well-behaved and socially mature students.

“I think more teens seem to be using cutting as a way of eliminating stress,” David said. “It’s become almost acceptable.”

David expects that the number of kids injuring themselves is more common than parents realize and it’s partially due to kids not knowing how to relieve their stress.

“I think it’s connected to world situations since 9/11,” she said. “There’s a lot more fear in our culture. I think the adults are equally feeling out of control and that filters down to our children. I think a lot of teens don’t have a lot of hope.”

Just as she is seeing more cutters, David has also noticed more students having risky sex, another way for them to assuage their pain or relieve stress.

“We, as adults, are not modeling healthy ways to deal with stress,” David said. “As much as teens want to rebel and reject our values, they are still looking up to us and watching us and what it means to be an adult in our culture.”

Karen Fiedler, a counselor at Santa Fe High School, hasn’t seen a rise in the number of students who self-injure. She believes more educators are becoming aware of the problem.

“We’re more aware as a society of stress and how people respond to it,” she said.

She also said by the time kids reach high school, some turn to drugs or alcohol to diffuse their stress, rather than hurting themselves.

The girl from Espanola described a mounting feeling of frustration and stress growing in her until she feels like a shaken can of Coke ready to explode. After she cuts, she feels like she can start over again. “There are other times you get into your own world and need to feel physical pain to get you out of it,” she said. “It’s like a key out of the worst place ever.”

She uses thin blades because they don’t scar skin as easily, and she covers her marks with long-sleeve shirts or colored bracelets.

“I didn’t want my family to know,” she explained. “They would get bothered. I haven’t found a good way to tell them this is my way to cope.”

One of her teachers took care of that for her after he noticed her arms and told her parents. Her mother, who attends therapy sessions with her daughter, had noticed slight scratches on her daughter’s hands, but she never imagined she would intentionally hurt herself. Her daughter always dismissed her questions, saying she was bored when she marked on her hand.

Her parents confronted her the night the teacher told them about her arms. “I told her we weren’t going to sleep until I got some answers,” the mother said. “I was worried and concerned.”

Her mom, who copes by praying and crying alone, still struggles to understand why her daughter would hurt herself to cope with stress. Her daughter said she felt stupid when her parents quizzed her about it. She wishes her parents would have tried to understand why she cuts herself rather than telling her how wrong it is.

People typically aren’t comfortable talking about self-injury and oftentimes feel incredible shame for doing it, Reynolds said. But secrets never help, she added. The worst thing parents could do is ignore the signs—long sleeves in hot weather, excessive bracelets on arms or sharp objects in their child’s bag.

“I would expect every teen would be angry about being asked about it, but having someone ask in a loving way can put a pin in the bubble of the secret,” she said.

She suggests parents say, “I’m worried you’re hurting yourself. I really care about you. What can I do to help?” If the teen denies there’s a problem, don’t give up, Reynolds advises. Ignoring it, getting angry, punishing a person or dismissing it as unimportant could exacerbate the situation.

The mother encourages other parents to stay vigilant and continue to ask their kids what’s going on with them. “Listen to them,” she said. “They’re going through something that parents probably don’t even know.”

The girl is trying to change her coping skills—writing poetry in her journal, listening to punk rock on her headphones or punching her pillow. It also helped her to learn more about why she hurts herself so she can control her triggers more. But she knows a razor is there if she feels the need, and she is careful about caring for her wounds.

The relationship between mother and daughter is stronger now, too, as the mom is more tuned into her daughter’s moods, and the daughter shares more of her feelings with her mom.

The key is paying attention to a combination of signs—sudden drop in grades, changes in mood, eating habits, sleeping and a lack of interest in activities—that could indicate something is wrong with your teenager, Reynolds said.

It’s important for parents to spend as much time with their teenagers as they did when their kids were younger, David said.

“I see it as the domino effect,” she said. “There’s more stress for adults economically with their jobs so more is demanded of adults in terms of time with work and that leaves less quality time and relaxation time with the family.”

(Sidebar)

Help for those who hurt themselves

Counselors, others services

* Youth Shelters and Family Services-983-0586, counseling for individuals and families
* Teen Health Center at Santa Fe High-989-5577, teen health issues, counseling, teen parenting issues
* Southwestern Counseling Center-471-8575, counseling for individuals, couples, families and children on a sliding-fee scale
* Catholic Charities of Santa Fe-424-9789, low-cost counseling teen-parent services, adoption issues, immigration services
* Santa Fe Rape Crisis Center-986-9111, crisis intervention and counseling for victims of sexual abuse
* Su Vida-954-8777, individual, group and family counseling, sliding-fee scale
* SKY Center-473-6191, closes from June until the end of August. Clinical counselors will be available for referrals until mid-June.
* Crisis Response of Santa Fe-820-6333, for emergencies

Resources: www.selfinjury.net (chat rooms and message boards) and www.palace.net/tilde llama/psych/injury.html (online support information)

What should you do if someone you love self-injures?

* Don’t take it personally. This behavior is more about the person who does it than the person around him or her. They are not doing this to make you feel bad, to annoy you or to make a point.

* Be honest about how this self-injury makes you feel. If you need help dealing with your feelings, find a good therapist. Don’t discuss the content of your therapy session with the person who self-injures. Therapy is a tool for self-understanding, not for getting others to change.

* Ultimatums and punishments never work. This might cause the person to hide injuries and could cause more destructive behavior. Confiscating tools used for self-injuries might make people more creative in finding other ways to hurt themselves.

* Be supportive without reinforcing the behavior. It’s important that the person knows you can separate who they are from what they do and that you love them independently of whether he or she self-injures. Don’t avoid the subject. Let it be known you’re willing to talk.

* Acknowledge the pain of your loved one. Let them know you understand their self-injuring is not about making life more difficult for you. If they’re open to it, discuss possibilities of counseling with them.

If you hurt yourself

* Try simulating pain in a way that is less destructive. For example, hold an ice cube for one minute or scratch yourself with a soft toothbrush. If you want to see blood, draw on your arm with a red pen or use red food coloring.

* Distract yourself. Listen to music that makes you happy, punch pillows, stomp up and down, slam doors or go outside and yell. Call a friend, your therapist or a crisis line.

* Learn to confront others about your feelings rather than holding them in.

* Write a letter to a person who has hurt you and express how you feel. You don’t have to give the letter to the person, but writing the letter can help you release your feelings.

* Write a list of all your positive points and why you don’t deserve to be hurt.

* Make a list of reasons why you are going to stop cutting. Every time you get the urge, read the list to remind yourself why you shouldn’t.

* Write in your journal why you want to hurt yourself and if you hurt yourself, what caused it to happen so you can prevent it from happening in the future.

* Instead of harming yourself, massage the area you want to hurt with oils or creams and remind yourself that you deserve to treat your body with love and respect.


Belfast Telegraph
June 19, 2003

Relationship problems trigger crisis; Shock rise in self-harm incidents by youngShock rise in self-harm incidents by young
By Nigel Gouldemail

COUNSELLORS warned today of an alarming rise in the number of self-harm incidents among young Ulster people.

They estimate around 100 young people deliberately harmed themselves last year.

And the problem is three times more common among girls than boys.

The Parents’ Advice Centre, which provides support and counselling for parents and children, said that for the first five months of this year the number of calls to its Belfast office more than doubled on the same period last year.

And they fear that even these statistics only form part of a wider picture.

The most common forms of self-harm are inflicting wounds, eating disorders (starving/bingeing), attempted poisoning or overdosing—and the action is prompted by problems with relationships, drug or alcohol abuse or school -related pressures.

Speaking before today’s PAC’s annual meeting, Pip Jaffa, chief executive of the Parents’ Advice Centre, said: “This is a problem experienced by families from all kinds of backgrounds and there can be different triggers for different people.

“Deliberate self-harm is linked to trauma or distress and is recognised as a high risk factor in suicide cases.

“Most often the person is in turmoil and without help. There is ‘emotional overload’ where he or she just cannot deal with the problem in question.

“We advise anyone who sees signs of self-harm to treat it seriously and seek the right support.

“As an organisation, we provide front line support for parents, helping them to understand and deal with this very complex issue.

“We can explain that self-injury is a symptom and so help parents to find the root cause.

“It is important to explore any unresolved issues with young people and help them deal with whatever is traumatising them.

“We stress that self-harm isn’t something that should be denied or dismissed.”

PAC stresses that while the rise in numbers is concerning, it also shows more people are prepared to come forward and get help.

Significantly, the organisation also found that a prevalent and recurring theme among calls to helplines was relationship breakdown.

PAC revealed that 50% of all the calls it receives are linked to separation and divorce issues.

Since it was set up in 1979, PAC—which provides a support and guidance service to parents and young people-has seen a dramatic change in attitudes.


New Straits Times (Malaysia)
July 18, 2003, Friday

Silent cry for help
By Anita Anandarajah

“SOMETIMES, I’d sit in my room, at my desk, and slowly drag the compass across my forearm. The pressure would subside ... I’d feel much better.” Miss J told us that she has been injuring herself in this way since she was 13. She’s now 18.

Like her, Molly was a very unhappy teen. She was constantly in her older brother’s shadow. To attract her parents’ attention she’d bang her head against her bedroom wall in the hope that they would hear her. They never did.

These two girls have one thing in common, which, we have discovered, is also shared by groups of youths; they take out their pain and hurt on themselves. They injure themselves to the point of mutilation. (see accompanying story on page 3) It’s really a cry for help.

According to consultant psychiatrist Dr Aili Hanim Hashim of the Department of Psychological Medicine in Universiti Malaya Medical Centre, “self injury” is the term used by the medical fraternity to describe acts inflicted upon oneself to cause pain. But acts like superficial or deep knife cuts, or ingesting pills are done without suicidal intentions.

But people who self-injure do not want to kill themselves. Let’s make that clear. When they scratch, cut, burn, pinch, slap, pull their hair or break a bone, it is a way of dealing with their troubles. It is an outlet for their frustrations. It makes them feel better, even if only for a while.

Although it is more common among girls, there is a small percentage of males who injure themselves. The fact sheet of the Royal College of Psychiatrists website states that only one out of seven self-injurers is male.

Consultant psychologist Paul Jambunathan refutes this statement. “In my years dealing with such patients, the incidence of males and females injuring themselves is spread evenly. Perhaps the reason for the seemingly higher presence of female self-injurers is that males are more likely to ‘injure’ themselves when rough housing, or on the football field. It’s more acceptable for a guy to come away with bruises than a girl,” he said.

“Whatever it is, this is a silent cry for help that needs to be attended to,” says consultant psychiatrist Dr Lee Aik Hoe.

“Self-injury is a symptom of a larger problem, like depression or a personality disorder,” says Dr Lee. “It is an action to relieve emotional pain, whether anger, depression or guilt,” he added.

Often parents are clueless about their children’s emotional distress. Some notice the initial changes in their child. “There is a noted state of helplessness, and worthlessness, sometimes triggered by a quarrel with the parent,” says Dr Aili.

“And even then parents would only see the psychiatrist as a last resort because of the stigma of taking a child to seek professional help and putting a child on medication. This forms a huge barrier to treatment.”

However, should a family decide to seek treatment, here is a brief list of things to do, and what to expect:

1. There is an emergency psychiatric unit in case urgent attention is needed. If the patient is sent by the school authorities, a referral letter is required from the school administration.

2. Both parents and the child are required to be present for therapy. Parents and the child will be interviewed separately during the hour-long session.

3. Post-therapy treatment includes joining self-help groups. The UMMC Psychiatric Unit holds a self-help group session, made up of eight to 10 people, every Thursday.

STORY ONE

Miss J is a sweet-natured 18-year-old who sat for her A-level examination in June. She is tanned, bright-eyed and a little shy. “Typical teen,” one might think.

Take a closer look and you’ll see fine scratches on her forearms, similar to those made by a pet cat. Scratches formed by gently dragging a compass across her skin.

Miss J is a self-confessed self-injurer. Although close friends knew what she was doing is a form of self-injury, no one spoke about it. Miss J deems her case mild, but she is aware that she needs help. She agreed to discuss her experience with YouthQuake so others like her will know what to do, and parents will be able to identify a child who is injuring herself.

The first cut

“I knew of friends in school who began cutting themselves before I even thought of doing the same. There was a girl who would carve deep wounds on her arms. I was horrified.

“Even then, I began cutting myself when I was 14. I was very upset because my mum had left home for a while. It’s terrible not being in control of the situation. This (cutting) was one thing I could control. I was in control of my pain.”

Miss J would sit in her chair in her locked room. Filled with anger, she would sit facing the wall, and reach out for the compass in her desk drawer. She would spend 10 minutes delicately carving her skin, up to 20 times on the same area. She would carve words like HATE and DEATH.

Whether a case of irony or brilliance, Miss J would dip the needlepoint of the compass in antiseptic and then clean the wound when she was done.

She would wait in her room for an hour or so until she calmed down. If necessary, she’d wear long-sleeved tops to hide the wounds. This exercise would take place once a week on average. She would experience a great sense of relief as the welts form. It is like an addiction.

Silent scream

“I want my mum to know what I’ve been doing. But I want her to find out on her own. Maybe she will after she reads this article. I just want to talk to her.”

Miss J’s mum is teacher, and her dad a retired pilot. They live in upper-middle-class Ampang.

She is aware that she needs help. She has written to the Befrienders three times. “They helped me stop for a while.”

Back in secondary school, she was found out by friends who were shocked by what they saw. “It was a relief being discovered. There was a lot of crying, and we talked openly,” she said. She stopped for three years, until her grandfather’s passing earlier this year which triggered another rash of cuts.

Whenever she starts to lose her grip, images of razors will swim in her head and she wishes she is back in the safety of her bedroom.

Overcoming the shame

Miss J is ashamed of what she does. She is trying to stop it, by employing curious tactics like snapping a rubber band against her wrist to distract her from her urge. Painting is another outlet of expression. Sometimes she gives in to the occasional cigarette. She also tries to talk to strangers about her experiences. “My friends wouldn’t understand me. They look up to me as a role model,” said the former cheerleading captain and prefect.

“I wouldn’t know how to deal with their disappointment.”

STORY TWO

At 20, Molly is a bubbly person who is working part-time as a clerk in a shipping company. But for four years, she would bang her head continuously against her bedroom wall.

She doesn’t remember exactly when she started, but her outbursts lasted from Standard Five until Form Three. There was sibling rivalry between Molly and her older brother who was the golden child. Her mother would praise him, which would leave Molly feeling ignored.

“I’d score 80 and even 90 marks but it still wouldn’t be good enough. I would pale in comparison to my brother,” she said. “I noticed that when my brother would get a lot of attention when he didn’t go to school-so I thought I’d match him.

“I would bang my head against the wall, and then realised that no one noticed the bruises.

“Then I began punching with my knuckles which would bruise and bleed, and still my family did not take notice. My friends did ask questions about my bruises but I would convince them that I had obtained them from a fall. They believed me.

“When my parents failed to pay attention, I would hit the wall harder.”

Eventually Molly confided in her church pastor. Religion became her saviour. She understood that her parents were not perfect.

“I turned to God to fill the emotional vacuum within me.”

Like Miss J, Molly knew of friends in school who also were victims of self-injury. And like Miss J, she did not have the courage to speak about her own experience. Until now.

EASING THE PAIN

Steps to avoid self-injuring.

1. Keep your room/home free from all dangerous items (razors, knives).
2. Have a handy list of friends you can confide in. This is so you can reach them anytime you need someone to talk to.
3. Talk to an adult you can trust.
4. Surf the Net for websites of other self-injurers. These include personal experiences, tips to deal with self-injury and avenues to turn to.
5. Find another outlet to express frustrations or pent-up emotions, like painting or running.

SIGNS TO LOOK OUT FOR: academic deterioration, refusal to go to school, difficulty in concentrating, irritability, withdrawn, persistent headache, backaches, poor sleep


The Courier-Journal (Louisville, KY)
September 28, 2003

Addicted to Pain; Self-injury over the centuries
By Katya Cengel

Although self-injury has been billed the “anorexia of the 1990s,” various forms of it have existed in cultures for centuries. In “Bodies Under Siege,” Dr. Armando Favazza takes an anthropological approach to the behavior, linking current forms of self-injury—such as cutting and burning—to age-old rituals aimed at cleaning, healing and establishing social order.

“The importance of self-mutilation is clearly demonstrated and encountered with great frequency in adolescent initiation rites,” said Favazza, a psychiatry professor at the University of Missouri-Columbia School of Medicine.

In his book, Favazza explains that adolescents in various cultures throughout history have voluntarily accepted rituals that include the loosening of teeth, mutilating of genitals and other painful procedures. They do this, he explains, to maintain social order and cleanse themselves.

The idea is that self-injurers are trying to maintain order by letting out the pain they feel inside. Other cultural cleansing and purifying rituals, which include atoning for sins, can be compared to the acts of self-injurers who cut and burn themselves to rid themselves of pain or to punish themselves.

Karen Conterio, co-founder of SAFE (Self-Abuse Finally Ends) Alternatives Program, also sees a historical connection between self-injury and cultural practices. She said there is a link between the striving for perfection of women who engage in eating disorders and self-injury and such deforming historical practices as Chinese foot binding.

“I think there is a weaving and overlapping of self-injury and culture throughout history for many centuries,” Conterio said.

Contemporary cultural practices can also be linked to self-injury. Louisville psychiatrist Varanise Booker said that religion and rituals figure centrally in many of the male self-injurers she treats.

“I’ve actually had some patients put big holes in their ears because it’s a cult type of thing,” Booker said.

Others, she said, have marked their bodies as a form of religious ritual. Some psychiatrists and therapists view multiple tattoos and piercings as current, semi-culturally accepted forms of self-injury.

“If you look at self-injury over the long term, it can be seen as a behavior that tries to establish spiritual and physical well-being as well as establishing order,” Favazza said.


Charlotte Observer (North Carolina)
October 13, 2003

I Cut Myself to Kill My Pain; Some Teens Mutilate Themselves to Ease Their Underlying Emotional Woes. In Charlotte-Mecklenburg, School Staffers are Learning About ‘Cutting,’ and Low-Cost Help is Available
By Kathy Haight

He cut himself for the first time in eighth grade, after an argument with his parents.

He was so angry he went outside and used a pocketknife to slice six lines, each an inch long, across his left forearm. It frightened him to see that it made him feel better.

“It numbs me down to a level that’s bearable,” said the Charlotte teenager, now a high-school senior. “It helps, if a lot of stuff is going through my head.”

He’s in the early stages of therapy for self-mutilation (and didn’t want his name used). You may have seen kids like him in the new movie “Thirteen” or heard about them in recent public radio talk shows. They’re adolescents who cut themselves to relieve emotional pain.

While research is scant, some therapists and school officials believe self-mutilation, or cutting, may be on the rise. Louise Jordan, lead social worker for the Charlotte-Mecklenburg Schools, said she saw about 25 cutters last school year compared with two or three students three years ago.

She’s asked Charlotte psychologist Dave Verhaagen to hold a workshop on self-mutilation for school social workers in January. School guidance counselors learned about it in a workshop last month.

Not a suicide attempt

Self-mutilation is different from a suicide attempt, experts say, although cutters are at a higher risk for suicide. They scratch or slice themselves deeply enough to cause scarring but not enough to cause serious harm.

Sometimes, though not as often, they burn themselves with cigarettes or bleach. The arms, chest and thighs are prime targets, places easily hidden by clothing. Knives, razor blades, paper clips and even shards of broken glass make the marks.

An estimated 7.5 percent of adolescent girls and 6 percent of boys self-mutilate, Verhaagen said. This includes kids who cut themselves regularly as well as those who experiment once or twice. Adults do it too: Princess Diana is probably the most well-known example. But the average age it starts is 13, and the behavior touches all socioeconomic groups.

Jordan said students seem more open about cutting than when she first started seeing the behavior three years ago. She used to catch only a glimpse of scars or scratch marks beneath long sleeves.

“Now they’ll wear short-sleeve shirts, they’ll push their sleeves up to make sure you’ll see,” she said.

Verhaagen said he’s noticed no increase in cutting since he first started seeing the behavior 12 years ago. He wonders whether kids are just more open about it now rather than more active.

Looking tough, copycat behavior

Experts say teenagers who cut themselves regularly do it as a way of coping with strong feelings. It calms them and may even release endorphins, a chemical in the brain that creates feelings of euphoria.

“If mood is in pluses and negatives,” said the Charlotte teenager, “instead of adding pluses, it more just takes away the negatives.”

He said he cuts himself every other day and that it helps him feel in control. He sometimes views it as a way of doing penance for things he believes he hasn’t done the right way.

Verhaagen compares cutting to drinking alcohol to ease worries, and it can be just as addictive. Although cutters often try to hide their scars, some, at least unconsciously, want to be found out so people close to them will see how distraught they are.

Then there are cases where teens try cutting not to feel better but simply to look tough around friends. During an after-lunch break at one CMS middle school recently, a student saw classmates scratching their arms with the metal end of a pencil bent into a point with the eraser popped out.

And some teens try it because they’ve seen someone else cut. That’s one of the controversies about the movie “Thirteen,” where a middle-school girl cuts herself when family pressures mount. Some experts fear it will create copycat behavior.

Verhaagen agrees that seeing the movie might increase the chances of cutting in a teenager who already has risk factors for the behavior. “But no one’s going to watch a movie like ‘Thirteen’ who doesn’t have risk factors for self-injury and start doing it,” he said.

Less tolerance for discomfort

Experts see cutting as a symptom of other emotional problems, such as depression or anxiety, rather than a diagnosis in itself.

Risk factors include:

High levels of distressing emotions.
Poor coping skills.
Poor family communication and support.
High levels of family conflict.
Physical or emotional abuse.
Perfectionism.

Wendy Lader, co-founder of the country’s first in-patient center for people who self-mutilate, sees adolescence as a challenge for even for the most healthy teenagers. They’re discovering who they are, separating from their parents, dealing with sexuality. Teens without strong family support are more susceptible to poor coping behaviors such as cutting.

“We used to all sit down at dinner and talk about our day, how we felt about it,” said Lader, clinical director of SAFE Alternatives (Self-Abuse Finally Ends) in Naperville, Ill. “That doesn’t go on much anymore. Everybody in the family is doing more individualized activities.

“With less mentoring, kids don’t know how to describe their feeling states as readily and also have less tolerance for emotional discomfort.”

Yet most teenagers make it through adolescence without significant problems. In fact, Verhaagen said young people are much more emotionally intelligent and healthy than they have been in decades.

“The extreme stuff gets more attention, of course,” he said. “But in general, kids are doing better.”

‘Reason to be hopeful’

For cutters, treatment involves learning healthy ways to manage stress and cope with emotions. Experts teach teens how to communicate more effectively, how to be more assertive and to identify situations that trigger the desire to cut.

In Verhaagen’s experience, most cutters respond well to therapy. But like any compulsive or addictive behavior, it takes time to treat and there are often ups and downs.

“Yes it is treatable,” he said. “There is reason to be hopeful.”

The Charlotte teenager who cuts himself every other day has been in therapy for more than two months. It was hard telling his parents about his habit, but he encourages other cutters to do so and says therapy has helped him understand his behavior and what he can do to change it.

“If it seems like you’re the only one feeling it, that’s not true,” he said. “There are other people in the same boat. You’re not alone.”

He’s taking antidepressants and learning that working out or talking to friends can help him handle his anger. He still has a strong urge to cut even though he knows it’s not healthy.

But he’s committed to getting better.


Los Angeles Times
November 7, 2003 Friday

MOVIE REVIEW; ‘In My Skin’ is a hurtful place to be; The grotesque imagery of Marina de Van’s film, which takes an intellectual pass at self-mutilation, is too much to overcome.
By Manohla Dargis

French director Marina de Van’s “In My Skin” opens with foxy calm. A young woman, Esther (De Van), sketches at home while her boyfriend (Laurent Lucas) nuzzles her neck and the two discuss moving in together. Then one night at a party, Esther takes a fall, tearing open one of her calves.

As if under a spell, she becomes transfixed by the injury, seemingly possessed. She begins crosshatching her skin with deeper, more violent wounds, a frenzy of self-mutilation that eventually leads her to chomp down on one of her arms, gnawing its meat as if it were a cob of sweet corn.

Spectacularly grotesque and literally nauseating, even for this usually intrepid moviegoer, “In My Skin” is among the more disturbing films in this blood-drenched cinematic season. Although it ultimately collapses under the weight of its repulsive imagery—at times provoking, as with the arm-munching, both giggles and gags—De Van’s film is one of the few features in recent memory that explores violence intellectually, rather than to employ it simply for easy entertainment. Our movie screens are crowded with violated flesh—bodies that are carved up by sham killers and real plastic surgeons—but rarely do filmmakers explore the more unsettling truths of body violence, including that for some self-mutilation can be an act of self-creation.

Although socially sanctioned forms of creative self-mutilation such as nose jobs, tattoos and belly piercing now generate yawns, others remain outside mainstream bounds. In a 1997 documentary, filmmaker Kirby Dick shone a sympathetic light on some of the more wincing examples with a portrait of the late performance artist Bob Flanagan, whose rituals of self-injury countered the more brutal ravaging of the cystic fibrosis that finally killed him. The spectacle of self-mutilation is nothing new for the avant-garde, but only recently did its pathological variant hit the mainstream in movies such as “Secretary,” “Blue Car” and “Thirteen.” In those films, the self-abusers are girls and women who carve their pain onto their bodies through “cutting,” if not to the degree expressed in De Van’s feature debut.

An emotional blur, Esther initially looks dazed by her everyday existence. She’s fast-tracking in both her personal and professional lives, but there’s something about her that seems disconnected, remote and a little lost. The first time Esther mutilates herself she’s typing a proposal at the public relations firm where she freelances. Suddenly, she stops typing and runs to the basement, whereupon she strips off her pants and begins rooting around in her wounds. When she returns to her desk it’s with the energized focus of a woman who’s just downed a double espresso. De Van may not have intended to make a horror movie—though her high-domed forehead and long dark hair evoke horror queen Barbara Steele—but few scenes are as squirmingly horrible as this furtive interlude.

A sometimes collaborator with filmmaker Francois Ozon, with whom she wrote the noxious “8 Women” and the very fine “Under the Sand,” De Van shows promise as a director. She imbues “In My Skin” with a believable, off-kilter naturalism and plays Esther with ethereal fragility, which makes the character’s disintegration persuasive if not especially meaningful. The filmmaker’s cool tone and preoccupations with the body’s terrors indicate an affinity with the early David Cronenberg, and there’s something undeniably witty about Esther checking into a hotel for an orgy of self-mutilation. It doesn’t take long to realize that this character, cut off from the world, is having an illicit affair with her flesh and blood. But why anyone except the maid should care is a question that De Van never manages to answer.


The Boston Globe
December 29, 2003

Quieting a ‘Storm’ That Rages Inside, Some Young People Try to Slice Out Pain, Stress
By Jenn Abelson

After turning in a history paper at Quincy College, Asha Mitchell walked quickly out to her car in a darkened parking lot. Slouching in the seat, she said, she snatched a disposable razor from the ashtray and dragged it across her left wrist three times. The cuts were deep enough to draw blood, but not enough to soak through her shirt.

Crying because she thought she had failed the midterm exam, Mitchell didn’t feel the razor slice into her skin, she said—only a warm rush that ran through her body, then a blanket of calm. “I felt like I was having a storm inside me, and everything was out of control,” she said. “Cutting was my only source of peace. Somehow, I had to get the pain out.”

Mitchell, a 19-year-old former honors student and track star from Scituate, is a “cutter”—one of an estimated 3 million people nationwide who engage in moderate or superficial self-mutilation. Her otherwise smooth brown skin is marred by 118 visible scars, some 3 inches long.

Self-mutilation, once considered a symptom of other psychological illnesses, is now viewed by many health professionals as its own severe and potentially progressive phenomenon, said Barry Walsh, executive director of The Bridge of Central Massachusetts in Worcester and author of the book “Self-mutilation: Theory, Research, & Treatment.”

High rates of self-injury are being reported across the country at middle and high schools and on college campuses, and while some administrators have been responding by training staff and students, health professionals say, most schools have been slow to address the issue.

Last month, the John Snow Research and Training Institute of Boston announced a health study that surveyed 1,550 students at Weymouth High School in which one in three sophomore girls reported feeling so angry, sad, or hopeless that they had burned or cut themselves.

Though statewide figures were not available, schoolwide, about 29 percent of the girls and 19 percent of the boys in the survey said they had deliberately harmed themselves. The question was added to the survey at the request of a Weymouth school nurse.

Several years ago, the Leominster school district was “inundated with freshman cutters,” said Paula Bulger, clinical social worker at the high school. In 2000, school officials identified 46 students who self-injured. Staff members were trained to recognize cutters, and the school started therapy groups for those students. This year, Leominster is starting self-injury support groups in the middle schools. “This is when it’s starting,” Bulger said.

Cutting is the most common form of low-lethal self-injury, followed by burning, scratching, poking, plucking of hairs, and bone breaking, health professionals say. Severe forms of self-mutilation, which involve extensive tissue loss, such as castration, occur less frequently.

Some health professionals blame the spread of self-injury on a contagion effect—similar to anorexia—in which friends learn from one another, and even compete sometimes.

Others contend that today’s high-pressure society encourages people to find quick fixes for everything, including overwhelming emotions. Rather than work through complicated feelings, some young people physically hurt themselves to numb the pain of failed expectations.

For Kaleigh, cutting offered a release from panic attacks that her prescription medications couldn’t provide. Several years ago, the 14-year-old Milford girl said she began repeatedly picking at scabs. That behavior escalated to slicing thin lines across her wrists with disposable razors.

During an interview in her family’s Milford condominium, Kaleigh said she began cutting her wrists after her dog died in March, then again several months later, when the school year began. After transferring to a more challenging private school, she was overcome by anxiety each morning and reached for the razor.

Like many self-injurers, Kaleigh hides her wounds. She wears pink and blue wristbands and a dozen black and red jelly bracelets on each arm.

“It’s more suicide prevention,” said Kaleigh, whose mother, Stephanie, asked that only their first names be used. “It’s saving me from really hurting myself. When I cut, I feel calm, relaxed, better.”

Health professionals say most patients report feeling no pain during self-injury. When people experience physical trauma, the body releases endorphins that bind to pain receptors to block these feelings, said Andrew Levander, clinical director of the California-based Healing House, one of the nation’s first intensive outpatient programs to treat self-injurers.

Often, he said, what self-injurers experience is an endorphin rush, similar to a runner’s high.

Although females—many the victims of sexual or physical abuse—are more likely to seek treatment for self-mutilation, health professionals estimate that 35 percent to 40 percent of self-injurers are men.

White females, in particular, have trouble directly expressing anger or frustration, and instead turn those feelings inward, whether to starve or cut themselves, said Wendy Lader, cofounder and clinical director of Illinois-based SAFE Alternatives (Self Abuse Finally Ends), the nation’s first inpatient program exclusively for the treatment of self-injury.

“Women have a much more hateful relationship with our bodies,” Lader said. “It’s easier for us to attack our bodies. Men have an easier time lashing out.”

Mitchell, the Scituate 19-year-old, said she began her self-injury three years ago. After a boyfriend ended their brief relationship, Mitchell cut herself. When her grandparents divorced, she cut. When her classes were too hard, she cut.

“And if it didn’t bleed, it wasn’t worth it,” said Mitchell, a slight woman, just over 5 feet tall. “Pain comes out in the blood.”

After Mitchell told her parents about the cutting, they cleared her room of sharp objects. They found disposable razors—like the one in her car—stashed under piles of clothes and beneath her bed.

Her parents even removed protruding nails from the walls. So she fashioned school materials into makeshift cutting objects. She broke a protractor in half and used the jagged edge to slice her skin. She punctured her legs with the point of a compass. The last three years have been a tumultuous journey of hospital visits, prescribed medications, and feeling completely misunderstood.

“I’m not crazy,” she said.

Medical professionals are divided on the best treatments. Some support replacement therapy, which includes snapping rubber bands against wrists when the urge to self-injure comes on. Others say that fails to directly address the real problem, which is what prompts self-injury in the first place.

In Quincy, Mitchell sought dialectical behavior therapy, an outpatient psychotherapy that teaches skills for tolerating distress, regulating emotions, and interacting effectively with others.