They say it eases their pain. That it clears their minds and makes them feel calm. But to those on the outside looking in, slicing your arm with a razor blade is the stuff of horror movies.
Young people who intentionally harm themselves, typically by cutting open their skin, are physically acting out extreme emotional distress. Experts say the behavior is becoming more prevalent among teenagers, forcing administrators, teachers, and other school staff members to confront the disturbing issue.
“Support personnel are overloaded with referrals for kids who present these self-injurious behaviors,” said Richard Lieberman, the coordinator of the suicide-prevention hotline for the Los Angeles Unified School District.
|See the accompanying resource page, “Dealing With Self-Mutilation.”
Faced with this manifestation of depression, schools are looking to professionals like Mr. Lieberman to lead training sessions that give educators a clearer understanding of why students would choose to hurt themselves and how to respond.
“It is a subtle, silent, and private act,” said Geoff McKee, the principal of the 1,800-student Boca Raton High School in Florida, “and that is frightening,” because it can easily go unnoticed.
Mr. McKee had never heard of “cutters” until he became a principal five years ago and his school’s nurse told him about the phenomenon. Since then, he says, he has known at least 20 adolescents who purposely injure themselves. At the moment, he has his eye on others he suspects are doing so.
Even so, cutting is not a topic of conversation among administrators, Mr. McKee said. “I’ve never discussed it with another principal,” he said, “and I’ve never heard it discussed in a professional setting.”
What’s particularly worrisome for schools is that self-injury has a tendency to spread from one troubled adolescent to another. “It’s a contagious behavior,” Mr. Lieberman said.
Experts estimate that upwards of 4 percent of adolescents in the United States purposely hurt themselves in some way. That means in a 1,000-student high school, some 40 students intentionally harm themselves. Still, the veil of secrecy and shame around the behavior makes exact numbers hard to gauge.
Girls are more likely than boys to harm themselves in such ways. But some experts say that could be changing, though it’s difficult to tell. “Boys can get away with showing up with bruises and cuts on themselves,” said Tracy Alderman, the author of Scarred Soul: Understanding and Ending Self-Inflicted Violence.
The behavior generally starts around age 12 or 13. Some experts believe that it can linger for years; others suggest that as the adolescent gets older, he or she finds other ways of coping with the stress that triggers the condition.
Young people who harm themselves are usually not suicidal, according to Ms. Alderman.
“The stereotypical self-injurer is bright, sensitive, helpful to other people, the caretakers of their friends and family, good listeners, above-average students, and invisible,” she said. “They are very creative, artistic, neat kids,” she continued, but ones who don’t make their own needs well known.
In the United Kingdom, where much more research has been done on the condition, investigators have found that it is not as limited to adolescents as it appears to be in the United States. Researchers at the National Children’s Bureau in London are conducting a long- term study, scheduled to wrap up this month, on how prevalent the problem is in Europe. More than a dozen countries have participated.
Julia Carter, who heads the National Self-Harm Network in Nottingham, England, started cutting herself in her late 20s. “It is people who have had past experiences that have left them ill-equipped to deal with stressful situations,” Ms. Carter said of cutters.
An overwhelming majority—roughly 90 percent—have suffered some physical, sexual, or emotional abuse, said Ms. Alderman, who is also a clinical psychologist working with the Psychiatric Emergency Response Team for the San Diego police.
Cutting is the most common way that people choose to hurt themselves, she added, followed by burning, bruising, excessive nail biting, breaking bones, and pulling out hair.
A Perpetual Cycle
Sixteen-year-old Elizabeth Smith, whose name has been changed for this story, first thought of cutting herself when she was in 6th grade.
At 14, she started acting on those impulses and cut her wrist. Three months later, Elizabeth began digging her fingernail into her arm while talking on the telephone with her father. “I knew I liked what I was feeling,” she said in a recent interview.
Soon, cutting became much more routine.
“I have a pretty stressful life,” she said, explaining that her mother is an alcoholic and that her older brother, who lives at home with her, is addicted to drugs.
When she has a fight with her family, or a bad day at school, Elizabeth locks herself in the bathroom, tears apart a razor, and sinks the blade into the skin on her thighs, stomach, or arms.
“I can’t feel the pain when I cut,” she said. “I’m so out of my mind at the time that I can’t feel what is going on.”
Some of the cuts have left thick red scars on her body.
Although she generally cuts herself in private, she occasionally does so in public. Once, during a lull in track practice at school, she took her keys out of her bag and casually cut herself on the bottom of her leg.
Even though Elizabeth and other self-injurers are seriously hurting themselves, they don’t experience the pain because they are in a state of “dissociation,” in which a person is mentally removed from reality, experts say.
“They are zoned out,” Ms. Alderman said.
In response to injury, the human body releases endorphins, hormones that have an effect similar to morphine. The release “makes them feel better, and it gets rid of the negative feelings they originally felt,” Ms. Alderman said.
After self-injurers cut, they feel calm and clear-headed—briefly—leading to a cycle of abuse and relief, according to Ms. Alderman.
Breaking out of that cycle can be very difficult.
“With adolescents, how they feel at the moment is how they [believe they] will always feel,” said Karen Conterio, the administrative director of the Self- Abuse Finally Ends, or SAFE, Alternatives program, located at the Linden Oaks Hospital in Naperville, Ill. SAFE Alternatives is an inpatient treatment program for people who harm themselves. The group has produced videos for teachers and health classes about self-injury.
Elizabeth said she also feels guilty for disappointing the people to whom she made promises that she would stop, such as the counselors at her school. “At the same time,” she said, “I feel good because I have something to do to take my mind off my problems.”
She is trying to stop, but the longest she has been able to abstain is 103 days, the teenager said.
‘You Don’t Own a Cat’
At Wheaton North High School outside Chicago, two psychologists and two social workers run support groups for students.
Nancy Meltzer Peterson, one of the psychologists at the 2,200-student school, knows of at least a dozen students at the school who injure themselves. Many of them are clinically depressed and desperately want to stop, she said, but don’t know how.
“Their pain is emotional and invisible,” Ms. Peterson said. “You would see them in the hallway or community and say that there is nothing wrong with them.”
Teachers are often the first line of contact for many of these students. As such, teachers should glance at students’ arms and wrists as they walk around classrooms, said Frank Zenere, a crisis-management specialist for the 370,000- student Miami-Dade County public schools in Florida.
“Sometimes, you will see scars, and that should send a warning off in your mind that this needs to be followed up on,” he said.
Of course, scars are often hidden. Principal McKee of Boca Raton High, for example, looks for students who wear wristbands on their shirt cuffs so that the sleeves won’t ride up, or consistently wear long pants or long-sleeved shirts to school, even though the weather in South Florida runs from balmy to sweltering.
If teachers suspect cutting or other self-destructive behavior, they should immediately get in touch with their school’s mental-health professional, Mr. Zenere said. The psychologist or other professional “will assess the situation and make recommendations for services,” he added.
Because of the stigma attached to self-mutilation, a student’s initial reaction when asked about the cuts on her or his arms is to lie about how the marks got there. The most common excuse is “my cat did it,” according to Ms. Conterio, who co-wrote the book Bodily Harm: The Breakthrough Healing Program for Self-Injurers.
So often has she heard that excuse, Ms. Conterio says, she was going to call the book But You Don’t Own a Cat.
To help teachers and administrators identify such students and refer them for appropriate treatment, Ms. Alderman makes presentations at educators’ conferences and conducts workshops in schools across the country.
Once suspected, students who are hurting themselves may deny their actions, but they really do want help and will eventually admit to their problems, said Ms. Alderman. “It may be days, months, or a year later,” she said.
She added: “Most of these kids feel isolated and alienated, and they want someone to talk to.”
That’s why Ms. Peterson at Wheaton North High counsels students who cut themselves to opt to come to school instead of staying home alone.
“Their behavior is so isolating,” she said, and school provides a connection for them. “We would much prefer kids to spend a half an hour in my office than miss a whole day of school.”
If the students are having associated panic attacks— hyperventilating and sobbing—they can’t go to class, Ms. Peterson points out. “How do you walk in the door if you think everyone is watching you and judging you?”
Unless they seek help, Ms. Peterson said that eventually, “their academics are going to suffer.”
Help at Wheaton North comes in the form of a “No-Harm Contract,” in which students promise in writing that they will not harm themselves. It also lists the names of three people the students can call for help, a hotline number, and a list of objects in the students’ home that they should avoid.
Often, teenagers who suspect a friend of self-mutilation will approach a teacher or a school official seeking help for that peer, Ms. Peterson said. Schools need to foster environments in which students feel comfortable enough to do that, she added.
Regardless of the techniques educators decide to use, the students who are harming themselves need to be approached with care and respect.
“We need to take it seriously and not judge kids,” Ms. Peterson emphasized. By looking for help, she said, “they are seeking something more positive in their lives.”