Palo Alto Weekly

Cover Story - March 7, 2007

Secret scars

Awareness -- and concern -- rising over girls who cut themselves to relieve emotional pain

by Molly Tanenbaum

Amanda's best friend in seventh grade was the one who first told her about cutting.

Amanda, who asked not to be identified with her real name, had a turbulent home life and didn't know how to deal with her strong, negative emotions.

"I had told my best friend, and she told me she cut, so that's what I started doing. She cut herself because of the things that happened to her," Amanda said.

She started by using a safety pin to make scratches on her upper arm. She eventually switched to razor blades and began cutting lower down on her arm and on her thigh.

"I had a boyfriend for 10 months, and we had broken up, and it was really out of control. I started cutting more and more," said Amanda, now a freshman at a high school in Mountain View.

"It just made me feel better, the pain, I guess. It kind of helped me take my mind off stuff," she recalled.

Like Amanda, many who cut themselves, or "self-injure," use the physical pain to cope with emotional suffering, said Dr. Hans Steiner, a child and adolescent psychiatrist and professor at Stanford University.

"They usually have tremendously strong emotions that they're trying to control. It has a paradoxically settling effect," he said.

Gunn High School psychologist George Green said he's seen more self-injurers this school year than in previous years.

It could mean that increasing numbers of students are cutting themselves, he said, or that people are talking about it more.

"Maybe it comes out in the open a little more with adolescents communicating so much by text and MySpace," he said.

Steiner has also observed self-injury become more common among adolescents in the last few years. He said it often appears in youth with other psychiatric diagnoses, such as anorexia and bulimia, depression, bipolar disorder and post-traumatic stress disorder. It is frequently linked with sexual abuse in a person's past.

Self-injury statistics are difficult to come by partly because there are few studies on the subject and because self-injurers can be secretive about the behavior, Steiner said.

"It's a private, shameful event so that makes it tricky," he explained.

A 2006 study from Cornell University recognized this lack of wide-scale studies on self-injury in American youth, citing that studies from the last 15 years have estimated anywhere from 4 to 38 percent of youth have self-injured.

Palo Alto High School psychologist Wes Cedros said those who cut themselves make up "a small percentage of the students and it's almost entirely girls, very few boys."

"But that doesn't mean it's not a concern for the community," he said.

Though some boys also self-injure, Cedros said, they tend to engage in risk-taking behavior -- like punching, driving fast or drinking to excess "with the purpose of not feeling, not caring what happens."

Despite its appearance, self-injury is not the same as attempted suicide.

"Most people get confused," Steiner said. "They see cuts, and they think kids are trying to kill themselves. That's usually not what's going on. It's usually about controlling emotions or expressing real, real self-loathing."

However, adolescents who cut themselves can go too far and accidentally put their lives in danger.

The once-taboo and hidden topic of cutting has become something many adolescents know about, whether they try it or not.

"You always hear about it, like, 'Don't cut. Don't cut,'" said Gunn junior Aurelle Amram, who thinks educational, safety messages about self-injury can have the reverse effect on some girls.

"They know about it, and they know it helps certain people, so they try it," she said.

What used to be a private behavior is now finding increased social outlets. Groups of young girls who try cutting together are becoming more prevalent, Steiner said.

"When I was in training, this didn't exist as a group phenomenon," he said.

One Gunn freshman said she recalled a couple of her friends in middle school tried cutting when they were together.

"I think they were curious," she said casually, as if talking about experiencing a new type of music or food. They didn't try it again, she added.

Graphic portrayals of cutting both online and in film have contributed to an increased awareness about cutting.

Movies such as "Thirteen" and "Secretary" depict young women driven to self-injury. Popular social networking Web sites such as MySpace and Xanga provide a forum for being open about self-mutilation.

Amanda wrote a poem about cutting on her MySpace page -- which eventually tipped off her seventh grade teacher to the problem.

Some maintain that self-injury Web sites, which range from supportive forums to disturbing, graphic images, can encourage harmful behavior.

Steiner said they provide "huge validation from your peers about this thing being normal and good" and some go farther than that and "glorify" self-injury.

"That didn't exist 20 years ago," he said.

Through that validation on the Web, self-injury has even come to be associated with a certain, alternative image, teens say.

"It's become part of pop culture," said Gunn sophomore Maya Itah, who said it's easy to find "wrist-cutting art" on the Internet where self-injurers are "showing it off to people."

Her friend Danielle Edelman, also a Gunn sophomore, said teens have come to think of cutting as "under the general umbrella of 'emo' things to do."

The girls agreed that equating self-injury with image was counterproductive to helping those who are actually suffering.

"It makes the issue more trivial," Itah said.

Researchers, including ones at Cornell University and Stanford University, are just beginning to study the impact of self-injury Web sites, using work with pro-eating disorder Web sites as a starting point.

"We don't know the long-term effects of these Web sites," said Dr. Rebecka Peebles, an adolescent medicine instructor and researcher at Lucile Packard Children's Hospital.

"People report learning a lot of behaviors on these sites. That's a big concern with young, vulnerable kids going online," she said.

But the school psychologists at both Gunn and Palo Alto High Schools say there are benefits too.

"One the one hand," Green said, "they learn more often about cutting and some of them may imitate it. And on the other hand, it's more apt to be disclosed to adults."

Amanda no longer cuts or scratches herself, but it took going through two counselors, several months of therapy and getting worse before getting better.

Eventually, because a teacher had seen Amanda's revealing MySpace page, and because the cuts on her arms were not easy to hide during physical education class, the principal at her school called Amanda's mother, Sharon (whose name has also been changed).

"I lay awake all night trying to figure out what in the world I could do to make this better," she said. "That's the problem with being a mom: You want to fix everything, but sometimes you can't."

She sought out a counselor for her distressed daughter. This counselor proved ineffective.

Becoming more desperate, Sharon eventually found Dr. Tonja Krautter who practices in Los Gatos and specializes in self-injury.

Krautter said she gets 10 referrals a week from all over the Bay Area. Responding to the lack of research and resources for mental health professionals on self-injury, Krautter also travels to schools and counseling centers to provide trainings.

"People don't know how to intervene with this issue. No one knows how to support them," she said.

Two weeks ago, she trained a group of 20 counselors at the nonprofit Community Health Awareness Council in Mountain View. She has also come to nonprofit Adolescent Counseling Services in Palo Alto, which provides on-campus counseling at Palo Alto schools, and to Stanford.

With self-injury, the faster a person gets help, the better, Krautter said.

"People get addicted to the release of endorphins, so faster intervention means preventing the addictive process," she explained.

Therapy for self-injurers is generally two-fold: giving teens alternative, safe behaviors to deal with their emotions instead of injuring themselves, and addressing underlying personal issues that cause the teen to cut.

"She made me realize I could do all these things instead of hurting all my friends," Amanda said. "I would just try to go to sleep and listen to loud music. I actually got a punching bag."

When she thinks back on seventh and eighth grade when she was cutting herself, Amanda reflects on how cutting led her to a descent toward more extreme injury and feelings of depression even though it gave her immediate gratification at the time.

"You start doing it more and deeper because eventually what you're doing doesn't work. It doesn't affect you as much. When you do it, you feel even more depressed, just looking at your arms. You think things are so bad, and you're in the dark not seeing the things that are out there that are really good," she said.

Now, she feels like a different, healthier person.

"I'm really good," Amanda said, with clear relief. "After you stop, you feel so much happier and have so much more energy and everything. I'm so much better than I was back then."

School psychologists in Palo Alto advise students to tell an adult if they think their friend is self-injuring.

"The way it's going to be brought to light most often is by friends of the student," he added.

One Gunn sophomore said she and her friends know that one girl in their group self-injures.

"You can see fresh cuts every day. Any emotional pain she goes through, she cuts herself to relieve it," she said.

She added that her group used to worry about the girl and question her behavior, but they stopped after a while.

"Nobody asks her about it anymore. I don't think she realizes that she has a problem. She never talks about it," she said.

They haven't told anybody because they don't want to make her angry.

But telling a parent or an adult at school will be better for the friend's health and safety in the long-run, psychologists say.

"They really need to understand they're not betraying that person by telling a responsible adult," Green said.

Steiner advises parents to initiate open dialogue with their children, not just about self-injury but also about other hard subjects that face kids and teens today.

"The main tip is that you should always talk to your child about difficult topics, so when this rolls around, it's not difficult to do," he said.

"Your job is to essentially stay open to all these things. And you're always going to have one essential response: You're going to bring help to the situation. Not rage, fury, threat of destruction."

Philippe Rey, executive director of Adolescent Counseling Services, advises parents to educate themselves about the types of Web sites and other messages out there related to self-injury.

"Listen to their music, read their magazines, watch their TV shows with them and ask questions. There's so much on the Internet about adolescents' life and experiences," he said.

Sharon said she often volunteers to drive Amanda and her friends places so she can learn what the teenage girls are talking about.

"It's really important to listen," she said. "They're going to talk, and you can hear."

It may be difficult to know if a child is self-injuring because it can be kept hidden for a long time, Green said, but a sudden drop in grades could be a good reason for a parent to check in with the school about a child's overall wellbeing.

"It might have nothing to do with an issue like this, but it would at least be an excuse to have the school take a look," Green said.

Rey said Adolescent Counseling Services has held self-harm support groups in the past and provided parent education, but "not to the extent that we would like to do."

A tense discussion last month on the Palo Alto Weekly's online community forum, TownSquare, between concerned parents, teens and school counseling services signaled to Rey that more needs to be done in Palo Alto about self-injury.

"It sounds like this community needs to be educated, so we're looking into putting in some parent education groups or lectures about this topic," Rey said.

He said these might happen sometime in spring of this year.

Staff Writer Molly Tanenbaum can be e-mailed at mtanenbaum@paweekly.com.

Comments

Posted by Jeanette, a resident of another community
on Oct 24, 2007 at 10:44 am

Thank you for this article. I am an author, worshop teacher, and speaker who is currently writing a parents' guide to self-injury for a Christian publisher. As one who has struggled with self-injury it disturbs me to see sites and movies that glamourize such a painful issue. I found the information in this article extremely useful.

God Bless,

Jeanette Hanscome


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