LJWorld.com

They find relief in the pain, so they slash themselves with razors or knives. Or they might burn themselves with cigarettes.

Lawrence mental health workers say they are seeing an upswing in the number of young people -- mostly junior high girls -- who mutilate themselves. They are known as "cutters."

"It's getting to be an epidemic," said Tami Radohl, a Bert Nash Community Mental Health Center specialist assigned to Southwest Junior High School for the past six years.

Cutters deal with emotional distress by inflicting pain on themselves.

"Sometimes it's with a pen or a paper clip -- it can be anything, a razor, a knife," Radohl said. "They often start out scratching themselves and then get to the point where they cut themselves deep enough to leave a scar."

Some experts have estimated that cutters across the United States make up 1 percent of the population.

Lawrence has twice that percentage, Radohl said, noting that 1 percent of the school district's junior-high enrollment equals 25 students.

"When I say we have 40 kids who cut themselves, those are just the ones we know about," she said. "I'm being conservative. There could very easily be 50."

Radohl and other Bert Nash counselors say they don't know whether more students have started cutting themselves or if awareness has increased to a point where their friends now feel compelled to report it.

Southwest Junior High School social worker Tami Radohl believes the phenomena of "cutting," or victims self-inflicting wounds on themselves, is increasing in frequency among youths.

"It's not just cutting; there's a whole range of what we call self-mutilating behavior," said Christine Mann, a Bert Nash counselor who's worked with junior high and high school students.

"I've seen burns; kids burn themselves with cigarettes, or they get the top of a lighter real hot and burn themselves," she said. "I've seen kids burn themselves with ice and salt; they'll put salt on their arm and hold a piece of ice on it until it burns."

Mann said most self-mutilators are junior high-age girls. "I've seen a few boys, but not as many," she said. "And I've seen it on the high school and college level, but not as much. Over time, some kids learn other coping skills for dealing with the pain, the depression or whatever the other issues are that lie beneath the cutting."

Girls are more likely to cut because they tend to be more in touch with their emotions, said Wes Crenshaw, a psychologist with Family Therapy Institute Midwest.

"They experience pain more deeply, they have a greater sense of poignancy," he said. "So there's a need to cope with that."

Coping with conflict

For those who self-mutilate, it's seen as a way to offset the stress and insecurities that come with not getting along with parents, falling in and out of relationships, not fitting in, not having someone they trust.

Lawrence teen recovering from self-mutilation (04-25-05) Double Take: Adolescents who self-harm need alternative outlet for emotions (04-12-05) Bert Nash Center

"These are kids who don't handle conflict well," Crenshaw said. "They do it because they don't feel like they have a better outlet."

"Some do it because seeing blood has a way of bringing them back to reality. It helps them refocus," said Bert Nash's Radohl. "Others do it because the physical pain replaces the emotional pain. They can deal with the physical pain; they can't deal with the emotional pain."

Most cutters, Radohl said, aren't seeking sympathy or attention.

"It's not something they're proud of," she said. "They don't want to get caught; they don't want others to know. It's a very private thing."

To keep from being detected, Radohl said, cutters tend to cut themselves on their upper thighs, stomach or buttocks.

"Their clothes cover it up," she said.

'Out of options'

Generally, cutting is not considered a sign of suicidal tendencies, Radohl said, noting that cutters are trying to deal with life rather than end it.

"But it becomes very addictive. Once you start, it's very hard to stop," she said. "I've had parents tell me they've told their kids to just stop. That's not being realistic. It's an addiction; they can't stop without something to replace the behavior. They've run out of options."

Mann said it's imperative that cutters develop alternate coping skills, which may be as simple as replacing the urge to cut with the snap of a rubber band.

"That's an immediate technique," she said. "The other thing is to address the underlying issues, whether they're loss, grief, depression, perfectionism, body-image issues, substance abuse or whatever. And that may lead to things like keeping a journal, or exercising or entering a contract with themselves that says they will not hurt themselves."

Crafting these options almost always involves some form of family therapy.

"These are kids who are fairly internal," Crenshaw said. "They're not wallflowers, but they're not open to trusting relationships. They're often flying under the radar of family, school and friends.

"A lot of times, their families don't know there's anything going on -- ask them if they think their son or daughter is under a lot of pressure to succeed in school, and they'll say 'well, gee, no,'" he said. "Meanwhile, the kid is dealing with all kinds of anxiety and insecurity because she feels like she can't meet the demands of her family or of society in general. She's angry, but she's not found a way to express that anger."

Getting help

Crenshaw said he often encouraged the families of cutters to sort through their issues and realize that teenage anger isn't necessarily a bad thing.

"I know that's the last thing a parent wants -- having a mad kid around the house," he said. "But these are kids who don't handle conflict well. Anger is normal, but they don't feel comfortable being angry, so, not knowing what else to do, they turn on themselves."

Mann said parents who suspect their son or daughter is cutting should remain calm and contact the therapist of their choice -- they're listed in the Yellow Pages under Mental Health Counselors -- or the Bert Nash counselor at their child's school.

"The main thing is to get help -- to try to understand what's happening," Mann said, "rather than being afraid or getting into a power struggle or getting angry or blaming yourself."