Saturday, January 31, 2004
Kelly needed a release from the intense pain built up inside her, pain that her 12-year-old mind wasn't capable of handling.
Taking a cue from a friend, she scraped a razor blade across her skin until blood flowed.
The euphoria that followed cutting herself eased her mind and hid her troubles, albeit temporarily. When the next crisis arose -- and at that age just about anything is a crisis -- she would cut again.
"There was so much emotional pain that cutting was a way to relieve that pain," said Kelly, now 21, whose name has been changed to protect her identity. "I felt I couldn't deal with how emotionally charged I was."
Kelly's story isn't unique; by some estimates, as many as 10 percent of teenage girls injure themselves. But it's a problem many say flies under the radar, especially in smaller cities such as Steamboat Springs.
"This isn't a new behavior," said Carla Portigal, a Steamboat Mental Health Center therapist who addressed the issue at a Steamboat Springs Middle School forum on self-destructive behavior last week. "This has been going on for years."
Every year, Steamboat Springs High School counselor Joan Allsberry is confronted with the issue of self-injury. She's known kids who took X-Acto knives to their skin every class period.
"It can be very scary," Allsberry said.
The problem is slightly less common at the middle school, where principal Tim Bishop and counselor Margi Briggs-Casson recently discovered a group of eighth-grade girls who are cutters.
"We've always had cutting," Briggs-Casson told parents at Thursday's forum. "The thing that I've never dealt with is the social clique part."
Many parents don't know about cutting and other forms of self-injury, and coming to an understanding of what the issue means and how it's caused can be terrifying but necessary, experts say.
Self-injury, also known as self-mutilation, self-abuse or self-inflicted violence, is the deliberate, repetitive, nonlethal harming of one's body.
It can take many forms, though it's most commonly manifested in cutting, scratching, picking scabs or wounds, burning, punching and bruising or breaking bones.
Self-injurers often conceal their cuts from plain view, and find excuses such as "my cat scratched me" when asked about their injuries.
Most self-injurers come from middle- to upper-class backgrounds, are of average to high intelligence and have low self-esteem, according to the National Mental Health Association.
Though experts aren't sure why, girls are more likely than boys to self-injure, and the onset is usually at puberty.
What is known is that cutting and other forms of self-injury are coping mechanisms for people dealing with severe internal pain, said Dr. Wendy Lader, author of "Bodily Harm: The Breakthrough Healing Program for Self-Injurers."
Self-injury is a release from that internal pain. The numbness and euphoria after self-injury is a temporary way to forget the underlying problem, ex-cutter Kelly told parents at Thursday's forum.
"So many schools and families focus on the self-injuries being the problem," Lader said. While cutting can lead to issues such as infection and scarring, it's not the wound on the outside that's the major problem.
"It's a clue there's something else going on that needs attention," Lader said. "It's a temporary Band-Aid, and the real problem continues to fester underneath. (Self-injury) isn't really getting rid of their emotions."
The reality, Lader said, is that cutters often don't know why they're doing it or how to stop.
Not an attempt at suicide
Nearly half of all self-injurers who seek treatment report physical and/or sexual abuse during childhood. As many as 90 percent report they were discouraged from expressing emotions, particularly anger and sadness, according to the NMHA.
Self-injury is not an attempt at suicide, experts stress, but it can be an indication of serious depression, which eventually could lead to suicidal tendencies.
"This is not suicidal behavior," Portigal said. "This is a self-soothing behavior" intended to reduce the tension of emotionally overwhelmed children.
Though cutters tend to use the behavior to try to achieve the same release no matter what the cause, the causes themselves differ greatly depending on the individual case.
It could be a painful romantic breakup, a divorce in the family or any number of stressors that become too great for an adolescent to deal with on his or her own, said Steamboat Mental Health Center therapist Bobbi Beall. Issues of alienation, abandonment and perfectionism also have been identified in many self-abusers.
Self-abuse can be an indication of more serious psychiatric illnesses such as personality disorders, bipolar disorder, major depression and anxiety disorders. This, however, isn't always the case.
Breaking the cycle of self-injury usually is only accomplished once the cause is identified. But before parents and others can work toward a solution, they must understand how to handle the realization that their son or daughter is a self-abuser, experts say.
Horror and anger
After two decades of working with self-abusers and their loved ones, Lader knows the two most common reactions parents have. She also knows how harmful those reactions can be.
"Parents are usually devastated," Lader said. "One (response) is horror, and the parents wants their kid in the hospital immediately. The other is anger."
Showing empathy' not sympathy -- is the most helpful reaction, she said.
"Really, the healthiest response is to say, 'It's frightening you're doing this, and we need to find out why,'" Lader said.
Dr. Rob Danoff, an East Coast family physician with experience dealing with self-injurers, stressed the need for parents to remain supportive of their children.
"It's scary for parents," Danoff said. "(But) the child is in so much psychological pain. They really need the parent to be there for them. The last thing they need is to be berated. Assure them you love them and that you will help them."
Telling self-abusers simply to stop hurting themselves is a common demand from parents but not a helpful one. It's akin to telling an alcoholic to stop drinking, Danoff said.
A bad reaction from a parent can worsen the situation, ex-cutter Kelly said.
"I'll never forget my parents' faces when they first found out I cut (myself)," she said. "If I was depressed before, it was like being shattered afterward."
Beall told parents to stay calm when confronted with the issue.
"Our overreaction fuels it more than it helps it," she said.
Parents shouldn't punish their kids for the self-abuse or blame themselves for their child's actions.
Don't keep the secret of self-abuse, she said, and be sure to get the self-injurer counseling. Parents also can't expect their child's school to handle the situation. Through professional help, the self-abuser and a therapist can determine the cause and work toward a solution.
Self-abuse usually is a time-limited behavior that is curable if the correct steps are taken, Beall said.
Many self-injurers stop within a year of receiving help; some cases can continue 10 years or longer if proper measures aren't taken.
There is hope for all self-abusers and their families, experts say.
"It's very curable, but it is serious," Lader said.
At 21, Kelly is a college student with strong grades and a good job. And her relationship with her parents has never been better.
"(Cutting) is not the end of the world," she told parents Thursday night.
That can be hard for parents to believe when they see their children doing something to harm themselves.
Middle school Principal Tim Bishop has dealt with several devastated families during the past month.
"Their parents are lost," Bishop said. "Some kids have stopped (cutting), and others have started to cut themselves in other areas harder to check."
But the school, through its counseling program and forums such as the one it hosted last week, is doing all it can to correctly address the issue, Bishop and Superintendent Donna Howell said.
"We need to approach this not as an isolated incident but as a community issue," Howell said. "We have to wrap all the resources we have in this community around our adolescents."