The Cruelest Cut

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The population of kids who wake up this way is becoming increasingly diverse. The stereotypical cutter is a girl in her young teens suffering from discord at home and doing poorly at school, and there is some truth to that cliché. "Girls have a more conflicted relationship with their bodies," says Wendy Lader, clinical director of Self Abuse Finally Ends, a treatment program in Naperville, Ill. "They go after it and hurt it when they're angry." While such traumas as sexual abuse don't always precede cutting, they often do appear to be risk factors.

But cutting is becoming an increasingly democratized disorder. By some estimates, up to 30% of self-mutilators are boys, and many cutters of both sexes come from apparently stable, two-parent homes in which there is no evidence of abuse. Some of the kids have a history of suicide attempts, but many have no interest in ending their lives, no matter how self-destructive their behavior seems to be. How often they injure themselves generally depends on how acute the underlying psychological pain is. In one study, kids self-mutilated anywhere from once to 745 times a year. "They do it because it works better than anything else they've tried," says Hollander.

Few researchers doubt that there is a certain trendiness to cutting and that that is driving the numbers up. Celebrities including Angelina Jolie and Fiona Apple have confessed to past self-mutilation. Though it's true that such public disclosures encourage ordinary kids to come forward, it's also true that when glamorous people suffer from something, a bit of the glitter rubs off on the condition. "Cutting grew into a huge fad at school," says Michelle, 13, who is being treated at the Vista Del Mar clinic. "In seventh grade it seemed every single girl had tried it--except the really smart ones." Then there is the Internet, where cutting chat rooms are just a keystroke away. Many offer support for kids who want to stop, but just as many wink at the problem and even subtly encourage it.

The neurological roots of cutting are a mystery, but several theories have been put forward. When the body is injured, it releases natural opiates that help dull pain--a process that is behind the fabled runner's high. Cutting inflicts a very real injury, and self-mutilators may be seeking the neurochemical kick that follows. "When I would cut myself deliberately, I didn't even feel it," says Emily, 16, who is in her third week of treatment at Two Brattle Center. "But if I got a paper cut I didn't want, that would hurt."

The problem is that any time you chase a high, you risk getting hooked on it. "The longer kids cut, the more they need it," says psychologist Jennifer Hartstein of the Montefiore Medical Center in Bronx, N.Y., where Vanessa was treated.

Overcoming self-mutilation turns out to be less tricky than explaining it. Perhaps the most effective treatment is dialectical behavior therapy (DBT). Developed by psychologist Marsha Linehan of the University of Washington in Seattle, DBT is used as a frontline therapy for borderline-personality disorder. Because there appears to be a very significant overlap between borderlines and cutters, Linehan and others wondered if the same treatment might work equally well for both. It does.

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