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Article #3 - The unkindest cut: Self-harm about relief, not suicide

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Article #3 - The unkindest cut: Self-harm about relief, not suicide

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Article #2 - Cutting: Why Teens Hurt Themselves

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Article #2 - Cutting: Why Teens Hurt Themselves

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Caia Pattynama hesitated the first time the scissors pierced her arm. "It really hurt," she says, "but I figured if I could tough it out, it would prove I could get through the other things happening in my life." In the seconds it took for drops of blood to appear, Caia, then 15, felt an odd sense of peace. "I knew it didn't make sense, yet I felt better," she says three years later. "For that moment, I was in charge."

Life started slipping out of Caia's control when her beloved stepfather, Daryl Simpson, passed away unexpectedly. She was just a few months shy of her 14th birthday. Though everyone in the Centennial, Colorado, family-mom Monica Simpson, older brother Jared Pattynama, then 16, and younger sister Kendall Pattynama, then 12-was reeling from the loss, Caia was having a particularly hard time. "She was angry and becoming increasingly withdrawn," Monica recalls.

Caia started high school in the fall, and Monica hoped her daughter's mood would improve once the stress of that transition passed. But Caia, a self-described introvert, struggled to fit in. When she did make friends, she was surprised to discover that several of them were into cutting. They said it was calming-which was all Caia needed to hear. In October she started scratching thin lines into her arms with scissors, safety pins and thumbtacks. Soon she was slashing the skin on her arms, belly and legs with whatever sharp instrument was handy. "Sometimes," she says, "the only thing that got me through the day was thinking about being able to cut when I got home."

Deflection Game

Caia's story isn't unusual-a third to half of kids ages 12 to 18 engage in self-injury at least once, according to a Psychiatry study. Actions include cutting, scratching, burning, repeatedly biting or picking at skin, or embedding small objects, such as paper clips or small rocks. Males also punch objects or themselves, or bang their heads against surfaces.

Destructive as this is, most kids-about 60%-aren't trying to end their lives, which is why mental health experts call it non-suicidal self-injury, or NSSI. "Most want to kill their emotional angst," says Janis Whitlock, PhD, director of Cornell University's Research Program on Self-Injurious Behavior. "It's not that they actually want to die."

Experts aren't sure why the act of inflicting physical pain helps, but self-injurers claim they feel more relaxed afterward, apparently exchanging inner angst for the strong physical sensation. Others, emotionally frozen, may want to prove they're capable of experiencing anything at all. Brain chemistry also plays a role-cutting releases endorphins, resulting in a pleasurable or numbing sensation. "Self-injury is a form of self-medication," says Whitlock. Though professionals fall short of calling the behavior a true addiction, it can be compulsive: The more a person cuts, the more she'll crave this relief when tension builds. Over time, the urge becomes impossible to resist.

As the fall progressed, Caia's sadness deepened. "Not only had Daryl died," says Monica, "but Kendall was less available, Jared was living with his father, and I started a full-time job. Everything in her life was pretty much turned upside down." Monica didn't know how upset Caia was, however, until she saw cuts on her daughter's arms. Caia convinced her mother it was a one-time thing, but Monica soon caught glimpses of fresh wounds. Concealing sharp objects didn't help. "She shaves her legs. She's got thumbtacks holding up pictures. I couldn't hide everything." In December, Monica took her daughter to the family doctor, who diagnosed depression, prescribed medication and suggested a therapist.

Antidepressants or anti-anxiety drugs like serotonin reuptake inhibitors (SSRIs) are commonly given to self-injurers. Unfortunately, in a small percentage of children, SSRIs may induce suicidal behavior (the FDA now requires a label warning). One night Caia told her mom: "If you leave me alone long enough, I'll do whatever I can to kill myself." Monica called 911 and Caia was taken to a psychiatric hospital. Her medication was changed, and she attended daily group counseling sessions. The therapy went nowhere, though. "I faked it," she says. "I told them what they wanted to hear so I could get out of there." Released after five days, she cut again. "I was flunking school and alienating my family," she says. "I felt awful, but I just couldn't find a way to care."

Rock Bottom

Two months later, after an argument with her mom over a messy bedroom, Caia grabbed a razor blade and carved grid marks into her arm. The next day Monica pulled Caia out of school-figuring she'd get less of a fight that way-and took her back to the hospital. Within days Caia's doctors insisted she needed the intensive assistance only a residential center could provide.

Monica launched into a major search for a facility. "I was on the computer all the time," she says. "I hardly slept." She finally hired an educational consultant who found Open Sky Wilderness Therapy, a program in Durango, Colorado, where Caia stayed for nine weeks while her mom continued looking for a year-round school. Open Sky wasn't a boot camp, but it did have a rigorous program integrating hiking and camping with individual and group psychotherapy, meditation and yoga. "Caia loves being outdoors, and this place had a strong focus on introspection and relationship building," Monica says. "Still, sending her away was the most difficult thing I've ever done." Caia loved Open Sky. "It was a slap in the face to be removed from everything that gave me comfort," she admits. "They take your clothes and issue you new ones. You do laundry with a plunger and bucket and carry a huge backpack. But it was what I needed."

With Caia gone, Monica toured several year-round facilities and finally chose La Europa Academy, in Salt Lake City, for its focus on fine arts. In addition to therapy, kids at La Europa learn to express themselves through photography, dance and music rather than resort to self-destruction. (They receive school credit, and take academic courses too.)

Caia was away for a total of 13 months, and the reentry was bumpy. "It was hard to transition to my old life," she says. A few weeks after she got home she cut, then immediately went to her mother to confess. "She was so sad and disappointed in herself," Monica says. "But I told her one moment doesn't undo all her hard work." And, in fact, slipups are common. "Many recovering people test the behavior, and the majority find that it no longer provides relief," says Wendy Lader, PhD, president of Self Abuse Finally Ends (SAFE). Caia, says her mom, is now part of that group.

With her daughter stable, Monica faced a different challenge: paying the $200,000 tab for Open Sky, travel and the La Europa stay. She emptied her retirement savings and borrowed the rest. Fortunately, most teens don't require such extensive-or expensive-intervention. "Kids who've just started to cut do well with outpatient therapy," says John Peterson, MD, director of child and adolescent psychiatric services at Denver Health Medical Center. Generally, this means 6 to 12 months of treatment at a cost of about $8,000, some of which may be covered by insurance. (Residential treatment runs about $10,000 to $45,000 monthly.)

Caia is still taking medication and gets overwhelmed and depressed at times, says Monica. "But now on a hard day she comes home and heads straight to the piano to play and blow off steam." The scars on her arms and legs are forever, but Caia has decided that's not always so bad. "A girl at school noticed the marks and showed me her fresh cuts," she says. "I told her I know what it's like to be sick of it all and just want the pain to stop. I was so thankful I could say there are better ways to deal with those feelings."

Signs of Cutting

Self-injurers are good at hiding evidence. Look for:

Mysterious bruises, cuts or wounds.

Wearing long sleeves, jackets or pants year-round, or using other cover-ups, like wristbands. Disney star Demi Lovato, 18, who admitted last spring to being a cutter, resorted to scar makeup and big bracelets to fool those close to her.

Unwillingness to participate in activities like swimming that expose skin.

Spending long periods of time alone, particularly in the bathroom or bedroom.

Bloodstains on clothing or tissues.

Razors, knives or other sharp objects hidden among belongings.

Withdrawal from family or friends.

If You Discover Your Child Is Cutting

Avoid overreacting or judging. Expressions of shock or horror and statements like "How could you do this?" add stress and discourage your child from confiding in you.

Seek professional help immediately. The more ingrained the habit, the harder it is to overcome.

Show respectful curiosity. In a matter-of-fact tone, ask leading questions to help your child acknowledge her problem and recognize she needs help. Try, "How do you feel before and after you cut?" or "What kinds of things make you want to injure yourself?" or "How does cutting help you feel better?"

Monitor computer usage. There are message boards that encourage self-injury by providing tips for cutting and concealing marks.

Be observant. Many kids go through cycles of cutting when they're feeling out of control, then stopping during periods of calm.

Don't use punishments (like grounding) or rewards (letting him stay out late). They rarely work. Cutting is a medical issue, not a disciplinary one.

Treatment for Cutting

Not just any therapy will do. Kids who self-injure occasionally stop on their own, but parents shouldn't count on it. "Cutting is only a symptom," says Lader. "They won't get better until they overcome their inability to handle emotions." And that usually requires professional assistance. The most promising approach so far involves dialectical behavior therapy (DBT), which teaches teens two things: how to deal with stress, and how to be more effective in relationships. "The focus is on mindfulness, recognizing and accepting whatever's coming up at any particular moment," says Dr. Peterson. "Patients learn to be at peace with negative thoughts and feelings as they arise, rather than do things to try to force them to go away." Family therapy is also an integral part of recovery. "Teens who feel distant and disconnected at home are much more vulnerable," says Dr. Peterson. "Kids who are able to decompress by talking to parents are far safer."
For more resources, and relaxation tips all kids need to know, go to familycircle.com/teenstress
Originally published in the July 2011 issue of Family Circle magazine.

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On the Edge - Cutting: Why Teens Hurt Themselves

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Caia Pattynama hesitated the first time the scissors pierced her arm. "It really hurt," she says, "but I figured if I could tough it out, it would prove I could get through the other things happening in my life." In the seconds it took for drops of blood to appear, Caia, then 15, felt an odd sense of peace.

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Article #1 - How Can I Help a Friend Who Cuts?

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Article #1 - How Can I Help a Friend Who Cuts?

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Be an Informed Friend

Anna was wearing long sleeves under her soccer jersey again. She told Monica she was worried about getting too much sun. But when Anna raised her arm, Monica noticed fresh cuts on her forearm. When she saw Monica looking at them, Anna said something about losing a fight with her mother's rose bushes.

You're aware that some people - both guys and girls - cut themselves on purpose. Could your friend be one of them? If so, what should you do?

It can be hard to understand why a friend might injure himself or herself on purpose. Cutting - using a sharp object to cut your own skin on purpose until it bleeds - is a form of self-injury. People sometimes self-injure by burning their skin with the lit end of a cigarette, a lighter, or a match. Their skin won't show cut marks, but it might show the small, round scars of a burn.

Some people turn to this behavior when they have problems or painful feelings and haven't found another way to cope or get relief.

Most of the time, people who cut themselves don't talk about it or let others know they're doing it. But sometimes they confide in a friend. Sometimes a friend might find out in another way.

Your Feelings

It can be upsetting to learn that a friend has been cutting. You might feel confused or scared. You may feel sad or sorry that your friend is hurting herself in this way. You might even be mad - or feel like your friend has been hiding something from you. You might wonder what to say, whether to say anything at all, or if there is anything you can do to help a friend who cuts.

It can help you to know more about cutting, why some people do it, and how they can stop. Sharing this information with your friend can be a caring act, and it might help her or him take the first step toward healing.

Understanding why a friend may be cutting can help you be supportive. But what can you actually do to help your friend stop?

The first thing is to be realistic about what you can achieve: As with any damaging behavior (such as alcoholism, drugs, or eating disorders), some people just may not be ready to acknowledge the problem and stop. So don't put too much pressure on yourself - your friend's problem could be a longstanding one that requires help from a professional therapist or counselor. Therapists who specialize in treating adolescents often are experienced in working with people who self-injure and can also help with other issues or emotional pain they might have.

Ways to Help

Here are some things that you can try to help a friend who cuts:

Talk about it. You've asked about the cuts and scratches - and maybe your friend changed the subject. Try again. Let your friend know that you won't judge and that you want to help if you can. If your friend still won't talk about it, just let him or her know the offer stands and you are open to talking anytime. Sometimes it helps to let a friend know that you care. Still, even though you do your best, your friend might not want to talk.

Tell someone. If your friend asks you to keep the cutting a secret, say that you aren't sure you can because you care. Tell your friend that he or she deserves to feel better. Then tell an adult in a position to help, like your parents, a school psychologist or counselor, or a teacher or coach your friend is close to. Getting treatment may help your friend overcome the problem. Your friend may be mad at you at first. But studies show that 90% of those who self-injure are able to stop within a year of beginning treatment.

Help your friend find resources. Try to help your friend find someone to talk to and a place to get treatment. There are also some good books and online support groups for teens who self-injure. Be careful, though: Although some websites offer useful suggestions about how to resist the urge to cut, the stories or pictures some people send in may actually trigger the urge to cut in those who read or see them. And some sites promote a sense of sisterhood or solidarity that might interfere with someone getting help. There's nothing cool about cutting - beware of people or websites that suggest there is!

Help your friend find alternatives to cutting. Some people find that the urge to self-injure passes if they squeeze an ice cube in their hand really hard, draw with a red marker on the body part they feel like cutting, take a walk with a friend (you!), rip up old newspapers, stroke their cat or dog, play loud music and dance, or find another distraction or outlet for their feelings. These strategies don't take the place of getting professional counseling, but they can help in the short run.

Acknowledge your friend's pain. Let friends who cut know that you get what they're going through by saying things like, "Your feelings must just overwhelm you sometimes. You've been through a lot - no wonder you hurt. I want to help you find a way to cope that won't hurt you anymore." Try to avoid statements that send the message you don't take your friend's pain seriously (such as "But you've got such a great life" or "Things aren't that bad," which can feel dismissive to a person who cuts).

Be a good role model. Everyone experiences painful emotions like hurt, anger, loss, disappointment, guilt, or sadness. These emotions are part of being human. Coping with strong emotions - instead of dwelling on them and continuing to feel bad - involves a few key skills, like knowing how to calm yourself down when you're upset, putting feelings into words, and working out solutions to everyday problems. Be the kind of person who can do this and your friend will learn from you.

Things to Avoid

Here are things to avoid doing or saying:

Don't deliver an ultimatum. The best thing friends can do is to be there for each other, accepting and supporting one another without judgment. Try to avoid issuing deadlines or ultimatums to people who self-injure (for example, don't tell them you won't be a friend if they don't stop cutting). This strategy doesn't work and it just puts pressure on everyone. Let your friend know that you'll always be there to talk to.

Don't accidentally reinforce the behavior. Among some people, cutting can have a certain mystique. If you're concerned about a friend who cuts, don't let your friend buy into the notion that the behavior is a sign of strength, rebellion, punk chic, or simply a part of his or her personal identity. Don't reward drama with too much attention.

Don't join in. A few people may try to get others to cut as a way to be part of the group or to seem cool. They might dare you or try to convince you to cut to see how it feels. Don't let peer pressure pull you into doing something you know isn't right for you. Someone who tries to pressure you probably isn't a true friend after all.

How Important Is It to Help?

People who cut usually don't intend to injure themselves severely, and cutting isn't usually a suicide attempt. Most of the people who cut themselves say they don't mean to die and that they know when to stop.

But even when suicide is not the goal, cutting can still cause severe injury or death. People who self-injure risk infections, scarring, and shock (from blood loss), and they can die as a result of extreme injury or bad cuts that don't get treated promptly.

Without help, people who cut also may continue to feel socially isolated and depressed. People who self-injure may have other problems (such as eating disorders, obsessive-compulsive disorder, bipolar disorder, borderline personality disorder, or severe depression) that require long-term professional care.

By helping a friend address cutting problems, you may open the door for him or her to resolve other issues, too. The first step to getting help is usually the hardest.

What If a Friend Rejects Help?

It's often difficult to help a friend who cuts. You may not see changes overnight, if at all. Some people aren't ready to face what they're going through - and you can't blame yourself for that.

Some people might not be ready to ask for or receive help with their troubles. You can encourage a friend to get help, but he or she might not open to the idea, at least not right away. You might need to be patient. Your friend could need time to think about what you've said.

People react in different ways when someone tries to help. But don't be afraid to try. Sometimes, honest concern is just what a person needs. By reaching out, you might just help a friend take the first step toward healing.

Sometimes when you try to help, your friend might be angry or say you don't understand. Or the friend might really appreciate that you care but still not be ready to accept help.

It's natural to feel helpless, worried, sad, or upset - especially if you feel you're the only one who knows what your friend is going through. Sometimes it helps to confide in an adult you trust about the situation.

It can be really hard when a friend just won't let you help. But don't take on the burden as your own or feel responsible for someone else's behavior. Sometimes even the truest friend may need to take a break from an intense situation. Be sure to care for yourself and don't allow yourself to be drained or pulled down by your friend's situation.

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Anna was wearing long sleeves under her soccer jersey again. She told Monica she was worried about getting too much sun. But when Anna raised her arm, Monica noticed fresh cuts on her forearm. When she saw Monica looking at them, Anna said something about losing a fight with her mother's rose bushes.

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How does Self-Harm affect Callie and the other characters in the book?

- Self-harm is defined as the intentional, direct injuring of body tissue most often done without suicidal intentions.

-Self mutilation, cutting, scratching, burns, body modification (intentional wounds)

- Not limited to self-mutilation but also concerns well being.

- Examples of other types of self harm: starvation, binge eating, drug use, alcohol abuse

- Not attention seeking, usually self harmers hide their scars

- Used as a coping mechanism to relieve emotional pain

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What kind of Help and Treatment is available to Callie and the other characters?

- Medical Treatment comes in many forms depending on the disorder.

-Long and short term treatment centers. In-patient (stay overnight), Out-patient (stay for the day)

-Medical Professionals - Psychiatrists, Psychologists, nurses

-Therapy - Group therapy, non-traditional or traditional therapy

-Medication

**How does Help and Treatment play a role in the novel Cut? How does it affect the plot of the story?

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What is Depression and how does it affect the main Character Callie?

-Clinical, medical condition

-Mental disorder

-Chemical imbalance; serotonin

-Feeling of hopelessness, helplessness, overall low feeling, deep sadness

**How does Depression affect characters in Cut? Is it an issue that all the characters face?