Corin (a pseudonym), a 19-year old teen from central south Connecticut, can remember the first time she cut herself. She was 15 and watching a Disney movie. She picked up a razor and sliced into the veins on her right foot.
"I discovered cutting by attempts at killing myself," Corin wrote me in a recent e-mail. "As early as seventh grade I had been slicing at my veins, with the intention of killing myself. I realized that sometimes just cutting the skin away from the vein made me feel better. And I began to do it more and more often."
Corin is one of thousands of female teens logging on to hard-to-locate Internet chat rooms. Many users keep their chat room addresses private or for use by a select few, yet some go so far as to create personal Web sites. One such site, Self Injury: A Struggle, was started by Gabrielle, a 19-year-old, eager to share her experience with self injury "to let others know that they are not alone in their struggle," she writes.
"It started as an attempt on my part to contribute my voice and my opinions in the then growing awareness of self-injury," she writes. "To use my voice to say that self-injurers are valid individuals and that they are more than a label."
Although no current data exist to prove their hunches, analysts and clinicians say that the incidence of self-injury, which consists most commonly of behaviors such as cutting, burning, and hair pulling, may be increasing. They point to the emergence of a culture in which it is acceptable—perhaps desirable—to talk about it.
Research from the Atlanta-based Centers for Disease Control and Prevention indicates that 1-in-4 adolescents in the United States thinks about suicide each year and by the end of high school at least 1-in-10 has made a suicide attempt. In 2000, suicide was the third leading cause of death among 15-to-24 year olds. Data from the National Institute of Mental Health in Bethesda, Md., indicate that between 1995 and 2000, though four times as many men as women died from suicide, women attempted suicide two-to-three times more often than men.
Existing research indicates that during adolescence, female teens are twice as likely as teenage males to suffer from depression, often with self-injury as a related behavior. The research also indicates that people born in the last two decades are likely to experience depression earlier in life than in previous decades.
Dr. David Fassler, a child and adolescent psychiatrist in Burlington, Vt., warns, however, that self-injury has been difficult to research due to its secretive nature.
"For many years self harm was something that kids kept to themselves," says Fassler. "Now it's something that they're more likely to talk about."
PARTICULARLY FEMALE AFFLICTION
Linda Lebelle, director of Focus Adolescent Services based in Salisbury, Md., agrees. She says that, among professionals working with teens, most are aware that cutting is a particularly female affliction and there is a growing sense that, during the past few years, more female teens have begun to call help lines to talk about hurting themselves.
"Traditionally boys are able to express anger outwardly more directly. Girls live in a much more body-focused culture," says Dr. Wendy Lader, clinical director of Safe Alternative, a hospital-based program in Naperville, Ill., that caters exclusively to the treatment of self injury.
"Skin is a bulletin board," Lader says. "They're saying, 'Can you see how much pain I'm in?'"
Lader believes the behavior is increasing for several reasons. "A lot of kids are feeling very invisible these days," she says. "There are many reasons for this—higher rates of divorce, more isolated activities such as computers." Self-harm makes their experience more visible, she adds, and sometimes there is the contagion effect. "Movies are showing beautiful girls who are self injuring. There is a desire to glamorize this."
Last year, the movies Secretary and Thirteen portrayed adolescent females cutting and burning themselves in response to loneliness and family neglect. Sexual abuse was hinted at, but never made explicit. The play Cut, adapted from the four-year-old book of the same title by Patricia McCormick, ran at a playhouse in Laguna Beach, Ca. Local newspapers have covered the subject and Tracey Gold's documentary, Cutters: Self Abuse, ran last year on the Discovery Health Channel. This month, one of the main characters on a MTV series, The Real World, San Diego, Frankie, revealed a habit of cutting.
Whatever their cultural cues, teens who cut themselves are indicating a state of mind and perhaps a personal history—tough childhoods, mental illnesses or peer pressures—that call out for medical attention, says Lebelle, from Maryland's adolescent services. "It seems to be that a high proportion of kids who cut or self injure have suffered some sort of trauma: abuse, molestation or rape."
Both Fassler and Lader regard self-harm as a symptom rather than a diagnosis.
"The goal is to get people to recognize that self injury is a clue," says Lader, the self-injury specialist. "There's some kind of a feeling that they don't want to experience. And they need to figure out why at that moment they are having that impulse. And rather than self medicate it with self injury, we want them to understand what they are feeling, label their feelings and challenge those irrational thoughts."
Lader has her clients keep "impulse control logs" in which they track every time they feel an impulse to injure.
The teens who responded to a Women's eNews posting openly described lives of enormous sadness, little-understood emotions and an inexplicable attraction to the thrill of self-inflicted pain.
Corin was just one of many girls who responded to a posting on the Web site operated by Focus Adolescent Services. Teens from the ages of 14 to 26, from Colorado to Connecticut, wrote introducing themselves with lines such as "Hi, my name is Abby. I am 17 and I am a cutter."
Corin says she was sexually abused as a child and that she has seen therapists, psychiatrists and been in a hospital outpatient program for suicide attempts. She writes she is grateful not to have had access to weapons more serious than razors and Tylenol.
"All I have to say is that I am very lucky that my parents don't keep a gun in the house," she writes. "I am convinced I would not be here today if they did."