"When I first started, I wish I'd have seen someone that had scars all over their arms that could tell me what it's like to live their life with scars, you know what I mean, 'cos I'd never heard that when I first started 'cos now that's exactly what's on my mind ... Like I haven't been to the beach in like so many years, you know what I mean, I haven't got in a bathing suit in front of anybody ... You know it was really hot last summer — I wore sweaters every single day. It's like a hundred degrees outside and I'm walking around in a sweater, you know."
Meet Jaime, 17, who is among the ranks of teenage girls who repeatedly injure themselves by cutting their skin — their arms, their backs, their bellies.
Jaime, whose problems started when she took a disliking to herself around the age of 12, lived with other "cutters" at L.A.-based Vista Del Mar — the nation's first residential program dedicated to treating adolescent girls who self-injure.
Studies, of which there are few on the subject, suggest that some 2 to 3 million Americans are self-injurers.
And that number is rising. Health-care officials report that self-injury cases have doubled in the past three years. And as life becomes more complex for teenagers, therapists expect the number will continue to rise.
"I believe it's of epidemic proportions now — it's far reaching into middle schools now," says Andrew Levander, clinical director of the self-injury treatment program at Vista Del Mar.
"Everybody's hand goes up when you ask them if they know someone who cuts themselves — everybody knows somebody. Every therapist has one on their caseload or has a colleague who does."
The Question Is Why...
...Would anyone deliberately want to hurt her- or himself?
"The short answer," says Levander, who developed the treatment program at Vista Del Mar, "is because it works as a coping mechanism. It immediately alleviates tension, stress and depression. It's like self-medication with a drug."
Who's Doing it?
Says Jayney Goddard, president of the Complementary Medical Association in the U.K.: "People deliberately hurt themselves for a variety of reasons and they may sometimes feel isolated and ashamed of their actions.
"Often self-harm is a way of gaining relief from overwhelming emotions and sometimes the person feels a great sense of release after they have hurt themselves," she adds.
Indeed, it's not unusual for cutters to report that the act of cutting makes them feel "alive," says Levander. "The truth is it makes them feel something and none of us are human beings being cut off from humans too long.
"It's almost difficult for anybody, and even me, to wrap my brain around the concept of purposely using a razor blade on my skin to feel better; it's hard to conceptualize how that would be helpful," Levander adds. "In my experience, I don't think that self-injury makes people feel better, I think that an act of self-injury makes people feel not so bad."
Different Forms of Abuse
Self-harm takes many forms. Eating disorders like anorexia, hair-pulling and burning are some of the conditions that co-exist with cutting. All, say health-care professionals, are ways of gaining control over the body.
The statistics look like this: cutting, 72 percent; self-hitting, 30 percent; hair-pulling, 22 percent; bone breaking, 10 percent and burning, 5 percent.
The majority of self-injurers are women. A 1986 survey compiled this "portrait" of a typical self-injurer: She's in her mid-20s to early 30s and has been hurting herself since her teens. She tends to be middle- or upper-middle class, intelligent, well educated and has a background of physical and/or sexual abuse, or is from a home with at least one alcoholic parent.
Why So Many Women?
Experts believe it's because women internalize anger while men externalize it. It's also possible that because men are socialized to repress emotion, they may have less trouble keeping things inside when overwhelmed by emotion.
In one study of self-injurers, women were likely to be diagnosed as suffering from "transient situational disturbance" while men were more likely to be diagnosed with borderline personality disorder.
What's more, the study found that men who self-injure are taken more seriously by physicians than are women.
Causes of Cutting
What's the Trigger?
In a 1991 study of patients who cut themselves, researchers found that sexual abuse, physical and emotional neglect and chaotic family conditions during childhood were "reliable predictors" of the amount and severity of cutting.
"The earlier the abuse began, the more likely the subjects were to cut and the more severe their cutting was," the study's authors noted. "Sexual abuse victims were most likely of all to cut." The study summarized that "neglect was the most powerful predictor of self-destructive behavior. This implies that although childhood trauma contributes heavily to the initiation of self-destructive behavior, lack of secure attachments maintains it. Those who could not remember feeling special or loved by anyone as children were least able to control their self-destructive behavior."
To be sure, cutters live in a world that seems far-removed. Physical wounds aside — the psychological wounds are so deep that it often takes years of therapy to get to the underlying root of the problem that drives self-injury.
Jaime sums up that world well: "I feel like I'm a lot different from like the people at my school and stuff because they haven't been through half the stuff that I have, you know, but no one knows that, you what I mean — like I keep a lot in my life to myself."