Playing with knives

Kelly Campbell was having a hard week. The 19-year-old had recently transferred to Liberty University and her classes were going poorly. She received a poor grade on a paper.

After committing to baking a cake for a friend's birthday party, the oven she planned to use wasn't available. When she met the other girls who were planning the party, one shouted at her, "Your only job was to find an oven and you couldn't even do that! Big help you are, how are we going to have a party without a cake?"

Miss Campbell apologized and pretended the comment hadn't hurt her. But she excused herself, drove back to her dorm room, and pulled out an Xacto knife. Soon, blood began flowing from cuts she made in her arm. She was not suicidal, though: She was deliberately injuring herself, as do perhaps 2 million Americans, according to Community Mental Health Journal and The Nation's Voice on Mental Illness. Self-injury, according to The American Journal of Psychiatry, is "the commission of deliberate harm to one's own body . . . and the injury is severe enough for tissue damage (such as scarring) to result."

Miss Campbell had begun hurting herself when she was 12, purposely bruising her body by running into things or hitting herself with blunt objects. In college, she said she felt "overwhelmed and really shy," and found that focusing on physical pain helped her to forget her emotional pain: "I didn't have to explode-it was easy and quick," and actually gave her a sense of exhilaration. Like many cutters, Miss Campbell tried cutting her stomach, chest, foot, and upper legs, but favored cutting her arms because they were less painful and because, "I wanted scars, and arms were something I could see."

Miss Campbell also cut herself because she wanted to feel special: "I wanted something that was unique about me. I knew other people did it so I felt a sense of belonging. It was my secret." Gradually, Miss Campbell began cutting herself every day. Other self-injurers also say that cutting helps relieve inner agony. Wendy Lader, a psychologist who co-directs SAFE (Self-Abuse Finally Ends) Alternatives, said about 50 percent of self-injurers have a history of sexual or physical abuse. Others have problems vocalizing their emotions-self-injury allows them to temporarily forget emotional pain.

Dr. Sony Khemlani, a psychologist specializing in self-injury at the Institute for Bio-behavioral Therapy and Research, told WORLD that cutting "becomes an addictive behavior very quickly," because cutters take pleasure in their action "and that results in the release of endorphins." She said cutters usually become addicted between the fifth and 20th times they do it. Cutting quickly formed a part of Miss Campbell's daily routine. After her last class, she would return to her room, run a safety pin under water, and begin slicing her left arm-usually between the elbow and wrist. Occasionally, Miss Campbell made specific designs. Once, she carved a Chinese symbol. Another time she wrote the word happy.

She also devised several "rules": "If I made one cut, I had to make three and they had to be even. If I made a cut above my elbow I had to use an Xacto blade and it had to be in a straight line. I never made a cut twice on the same place." These self-dictated guidelines illustrate another common characteristic of cutters-they are often perfectionists. Princess Diana admitted that she self-injured, and actor Johnny Depp has also acknowledged the practice. Dr. Khemlani notes that such publicity sometimes leads to copycat cutting behavior but also leads many cutters to seek help. One of her patients, a 50-year-old, had been self-injuring for 36 years: "A lot of other people can't explain where they got the idea."

Miss Campbell said she discovered self-injury during a speech class she found stressful: "When I got nervous I would dig my fingernails into my palms and the pain gave me something else to focus on." While Miss Campbell was cutting, her thoughts would often wander. "Sometimes my mind was racing so much and I needed it to stop," she said. "I would be in a daze and nothing seemed real." None of Miss Campbell's cutting sessions lasted longer than 30 minutes, but she would stare at her wounds until she felt better. Afterwards, she often felt guilty; she also realized that "cutting was only a temporary pleasure and it got so that each cut had to be worse than the previous. I would cut and I wouldn't feel anything."

Although Miss Campbell became an expert at hiding her cuts by positioning jewelry and armbands, her residence assistant at Liberty University discovered her secret. Miss Campbell had to sign a "safe-keeping contract" that stated she would attend counseling sessions and stop injuring herself. The university also confiscated her cutting tools. Five days later Miss Campbell began cutting herself again, this time with metal twist ties and the metal from a spiral-bound notebook: "I felt that they were trying to control my life."

Miss Campbell attended 13 counseling sessions that she said did not help much-except that she did not want to go, and the only way she would be allowed to stop going was to stop cutting. Now, she has cut herself only once in the past 2 years, but says that being in crowds and seeing Xacto knives still trigger a desire to start cutting again. Only now, whenever she feels the urge to self-injure, she tells herself: "Remember how long that road was? I'm not going down it again."

Healing deep wounds

When Kelly Campbell tried to stop self-injuring, she found that her recovery required tools stronger than willpower. So she began snapping a rubber band against her wrist, drawing on her arm with a red marker, and placing ice cubes against her skin.

Those tactics sometimes worked, but she says she also needed help from others: "During the day there was other stuff to do, but at night I was free to just hang out. I would tell my friends that I needed a distraction and they would say, 'Let's go do this.'" Health officials agree that interacting with friends and family is an important part of a self-injurer's recovery. According to The Healing House, a treatment center for cutters, "self-injurious behavior happens in the absence of healthy relationships with people."

WORLD talked with several self-injury counselors who explained how parents and friends should respond to self-injurers. "Offer a lot of love-hands-on hugging, positive affirmation, not just verbal, but touch," said Suzy Shellenberger, editor of Brio, Focus on the Family's magazine for teen girls, who receives several e-mail messages each week from cutters: "The reason they're hurting themselves on the outside is because they're hurting on the inside. It's the pain on the inside that needs attention."

Ms. Shellenberger recommends that parents make their child attend counseling: "Sure, she might balk, but if your daughter had a loaded gun, you wouldn't care if your daughter balked." Similarly, she advises friends to be firm in their love to a self-injurer. "Remind her, 'Your body is the temple of God. Every time you cut, you're destroying the temple.'"

Leslie Vernick, a licensed clinical social worker and author of How to Live Right When Your Life Goes Wrong, believes churches can help by having "a genuine response of compassion, interest, practical help, and community."

Parents, she says, should not yell or become hysterical, but should "take their child's behavior as a cry for help and talk about what's bothering him/her and seek to get the appropriate help. Cutting is a way of saying something without using words-I'm angry, I'm hurting, I hate myself, I can't cope, I need to feel something in order to know I'm alive, I don't want to feel emotional pain so I'll inflict physical pain, I want to feel better, I want to punish myself." Parents need to listen carefully and calmly to their child's words even if they don't understand."