Cutting away the pain

Self-injury is a secret plague among young people as a way to cope with inner turmoil

Sunday, March 14, 2004

By Dennis Romboy

      He sat at the desk in his darkened, upstairs bedroom fooling around with a pocket knife the first time he cut himself on purpose. He made a small slit on his forearm. Then another and another. Before long, he had doodled an hourglass shape into his flesh. Drops of blood trickled across his skin like the tears he could not shed.

A feeling of relief washed over the troubled eighth-grade loner. It made him momentarily forget that cruel classmates called him fat and spread false rumors that he was gay.

The cuts filled the hollowness inside. It was a rush but not a high. He was no longer numb. He felt alive.

His mother's voice shook him from his trip to normalcy. She needed him to take out the garbage. He didn't bother to hide his fresh wounds. She saw them and scolded him. She told him it was satanic and to never do it again.

Bruce Howell, now 19, can't explain why he drew a blade across his arm that first time. But it gave him a feeling he came to desire.

"It's like someone going out and having a cigarette," he said.

Self-injury, particularly cutting, is a secret plague among young people across the country as a way to cope with inner turmoil. Some burn themselves. Some hit. Most cut. They say it eases their emotional pain, clears their minds or calms them down.

Some use cutting as self-punishment. Others do it to assert control when everything seems to be spiraling out of control.

Utah teenagers like Howell are no different. Chances are high school students can point out a peer who cuts as easily as he or she could score a bag of marijuana.

"It does happen. It is a growing concern," said Pam Jacobson, a Clearfield High School counselor and president of the Utah School Counselor Association. "I can't tell you the prevalence."

Many cutters sort of stumble into the behavior, said John Waterbury, a Bountiful licensed professional counselor. They might start with scratching and pinching away what they feel inside. It then escalates to cutting on the wrists or arms and then to the thighs or stomach.

Cutters go to great lengths to conceal their wounds, which usually are superficial and not life-threatening. They'll often say a cat scratched them. They also will wear long sleeves and pants, even in warm weather. They will avoid swimming pools and beaches.

"A lot of them feel really ashamed," said Karen Platis, a child psychologist with Valley Mental Health. "They know something about it isn't right."

Bruce Howell shows the scars on his upper arm from cutting. He said he has sliced himself no less than 500 times, mostly with a blade from a disposable razor.

Lisa Marie Miller, Deseret Morning News
Whether cutting is happening more or whether people are becoming more aware is hard to say. Mental health professionals say a little of both.

Research suggests an estimated 2 percent of people, or about 3 million nationwide, purposefully hurt themselves, said Cheryl Cozzens, a licensed clinical social worker at Utah Valley Regional Medical Center. The behavior often starts in the teenage years but may persist much longer.

The rate increases dramatically for teenage girls, jumping to about 10 percent of that age group, she said, adding her practice reflects that number. Cutting is so common among young women with eating disorders that it's sometimes called "new-age anorexia."

Though females appear to cut more than males, there is growing evidence that men and boys do it more than once believed.

Cozzens has also noticed a disturbing trend.

"I'm seeing younger and younger patients that are engaging in it. . . . I hate to use the word cult. It is taught and passed on in their peer groups." Her youngest client is 12.

Cutting is complex behavior and not well understood, even among mental health professionals. Sometimes it is mistaken for a suicide attempt.

 "It's still kind of a mysterious thing," said Ruta Mazelis, who publishes "The Cutting Edge: A Newsletter for People Living with Self-Inflicted Violence," based in Ohio. "The secrecy surrounding the behavior remains quite intense."

Cutters typically have deep-seated emotional problems. Many are the victims of childhood sexual or physical abuse. Cozzens says about 80 percent of her patients were abused.

Abuse victims might see themselves in competition with their tormentors, said Rob Pramann, clinical director at Shepherd's Staff Christian Counseling Center in Sandy.

"They inflict the injury on themselves to show they are in control of the pain. It's a kind of re-enactment of the abuse."

Self-injurers also may suffer from a number of mental illnesses, including major depression, borderline personality disorder or post-traumatic stress disorder. They have extreme mood swings and trouble maintaining relationships.

"A lot of it is just a self-hatred thing," Howell said.

Rondi Sorensen said her self-injury began at a young age. She recalls banging her head against walls and giving herself eraser burns in elementary school. As she got older, the problem became much worse.

Ravell Call, Deseret Morning News

Howell, a college student studying electronics, figures he has sliced himself no less than 500 times, mostly with a blade extracted from a disposable razor. He bears the scars of a chronic cutter. His upper arms, especially the left one because he is right-handed, look like well-worn cutting boards. The last time he cut was seven or eight months ago, about the time he was diagnosed with borderline personality disorder.

He did most of his cutting during his high school years when he was particularly depressed.

He had few friends. He wanted a girlfriend but couldn't get one. He was devastated when a girl he'd dated a few times dumped him.

But he always had a steely friend to soothe his empty soul. He carried a razor blade in his wallet.

"It's like having a tool kit in the back of your car," Howell said. "If you need it, you got it."

For most people, injuring themselves to feel better is incomprehensible. Usually a bowl of ice cream or a favorite movie will provide comfort. Occasionally, a traumatic experience like the sudden death of a loved one may cause a person to punch a wall or pull his hair. But those episodes are isolated, and the triggers are obvious.

There is no easy answer to why someone chooses to purposefully bruise, burn or cut his own flesh over and over again.

"That's a really good question. It's one that's with me all the time," said Pamela Sorensen, whose daughter has cut in the past. "I can't imagine anyone cutting themselves or hurting themselves in any way unless they have some kind of mental illness."

Mazelis answered the question this way in one of her newsletters:

"So, why do people cut their arms, burn their stomachs, punch their faces? Because they hurt. Hurt more than the cut, the burn or the punch. It is all relative. And when those who wish to be helpful understand this, and attend to the deeper pain, to the much more tragic wounds, then great possibilities for healing become available.

A certified nursing assistant, Kristin Hasna spends her days caring for others. She is always looking to improve her life, including time at a renowned California retreat offering a path to inner peace, clarity and happiness. She is kind and gentle, except when it comes to herself.

"I wouldn't hurt another person, but I hurt myself," she said. "When I feel hurt, when I feel angry, when I feel not real, that's when I do things to myself."

      The wounds from the last time Hasna cut her own flesh are scabbing over. They will eventually turn to scars like the dozens of others on her upper left arm. And on her right arm. And on her thighs.

She had gone about 18 months without putting a blade to her skin. Therapy, medication and enjoyable diversions like visiting her nephews or helping someone kept her mind off cutting.

But getting fired from a job recently was more than she could handle. Co-workers, she said, whispered about her and told the boss things that weren't true. Whatever the circumstances, Hasna felt rejected.

Though she is learning to handle her anxiety-panic disorder, that was too much for the 40-year-old who has cut on and off for about 25 years. Her stress meter shot to the top. She went home, took a Xanax and climbed in bed.

The feelings of worthlessness persisted, triggering her post-traumatic stress disorder. Horrible memories of being brutally sexually abused as a child haunted her. And the black-and-white thinking of her borderline personality disorder made her feel unwanted, unlovable, alone.

"It's like a domino effect," she said.

When the last domino fell a few days after getting the pink slip, Hasna reached for a pair of scissors. She always cuts with scissors.

"My experience is that sometimes the emotional pain gets beyond. . . . It's too much. It's like emotional overload. It's so intense and you're so into it you feel like you're going to break up."

Then the sharp edge breaks her skin and she is bleeding.

"You just look at your arm. . . . It's like the emotional pain is distracted into 'Oh, no. I've got to take care of this.' "

But the blood just brings a new round of negative thoughts.

"Look what you did. You thought you were past it and now you do it again. You know better."

Hasna was awash in shame and guilt. "You beat yourself up for that backslide."

Recovery for cutters may take years.

"It means coming up with a new philosophy of life that works," said Waterbury, who specializes in post-traumatic stress disorder.

The person not only must redefine himself or herself but reframe the world so it becomes less threatening, he said.

Those who work with self-injurers disagree whether cutting is addictive. "I think it can become a habit but not an addiction," Mazelis said.

Some cutters experience a pleasurable almost euphoric feeling after hurting themselves. In response to injury, the body releases endorphins, which have a pain-relieving effect similar to morphine. Cutters come to crave that feeling much like a drug addict aching for a fix.

"I think it's both," Pramann said. "I have some cutters where it's a habit. I have some cutters where it's definitely an addiction."

Either way, quitting is extremely difficult, not unlike trying to kick a cigarette or drug habit.

"When you tell people to stop doing that, it's like telling us to stop breathing," Waterbury said.

Furthermore, cutting is just one symptom of many.

"It's never going to be their only problem," Mazelis said. "People who are hurting themselves are going to have a lot of different things going on."

Candace Lowry, a licensed clinical social worker at LDS Hospital, says cutting must not go unnoticed or overnoticed.

"It's a very tricky thing and always has to be evaluated in context," she said. "How does that one thing fit into the big picture?"

Pamela Sorensen's introduction to cutting was a phone call from her son. He had driven his 19-year-old sister, Rondi, to a hospital because the wounds in her arm were so deep. It wasn't the first time she had hurt herself. Nor the last.

"At first, I was in shock and disbelief," she said. "It was very frightening. . . . The first thing you think of is suicide."

Sorensen couldn't get answers from her daughter as to why she would hurt herself, so she called a crisis line. The voice on the other end was calm and reassuring. "I just took a deep breath and tried to deal with it."

Cutting was another in a long list of self-destructive behaviors in which Rondi, now 22, had engaged. She used drugs. She had numerous body piercings. She burned herself with heated safety pins. She frequently ran away from home.

Deseret Morning News graphic

Self-inflicted violence
She also suffers from borderline personality disorder, panic/anxiety disorder and ADHD.

Pamela Sorensen and her husband, Rolf, immersed themselves in the study of mental illness to better understand how to help their daughter. They now lead a weekly discussion group as volunteers for the Utah chapter of the National Alliance for the Mentally Ill.

 "I wish I would have known then what I know now," she said.

Rondi Sorensen said her self-injury began at a young age. She recalls banging her head against walls and giving herself eraser burns in elementary school. It worsened with age.

Sorensen struggled to find herself in her teenage years. She didn't know who she was. She wondered why bad things happened to her. She was depressed. She didn't feel like her parents listened. She turned to drugs, but that only amplified her sadness and anger, and then she would burn or cut her skin.

"I would forget about the emotional pain for a while, quite some time actually, depending on what I did to myself."

The last time Rondi Sorensen cut herself was about year ago after she pushed her dad during an argument. She stormed across the street barefoot. She found an old can and sliced her wrists.

"It seems like that makes me stop crying," she said.

The police picked her up on the road a short time later. She spent three nights in jail and remains on probation for assault. The ugly scene proved to be a turning point in her life.

Rondi Sorensen said she has not cut herself since. She also said she is now drug free.

"Really, cutting yourself is a very selfish act. I believe you're really not thinking of the consequences later. But it's a very easy thing to fall back to. I have thought about it. I keep myself occupied. I tell myself it's not worth it."

She credits her turnaround to medication, cognitive behavior therapy, positive thinking, willpower and her pit bull Boomer. She rescued the dog from an abusive home, nurtured him to health and trained him. He senses her anxiety or anger and licks her face until she laughs. Boomer, she said, has helped her to learn to care about herself and that others care about her, too.

Rondi Sorensen, Kristin Hasna and Bruce Howell struggle at times but are making great strides toward better lives. They agreed to share their stories because they believe it will raise awareness about cutting and inspire others to seek help. All three take medications for their mental illnesses and have regular individual and group sessions with therapists or doctors. Hasna and Howell participate in Bridges, a support program sponsored by NAMI.

Hasna, who describes herself as a survivor, is training to become a discussion leader in the program. She has come a long way and now wants to reach out.

"When people find out someone has cancer, they all swarm around them. If someone finds out that you have a mental illness, they all stay away from you. It's just as much an illness as cancer. And people need to understand that. People treat you very unkindly," she said.

"I'm 40. I just want to be better. I want to heal."