They look like cat scratches, but these nicks on the skin come from razor blades, pocketknives or the plastic utensils picked up in fast-food restaurants. Sometimes, they're raw marks brought on by such furious rubbing of an eraser that the skin wears off. Paper clips, unbent, transform into stabbing instruments. Cigarette lighters scorch concealed flesh.

        It's called self-injury or “cutting,” and almost every Tristate teen knows it's not about skipping class.

Annie Barkley rides horses as part of her therapy to recover from cutting. (Gary Landers photo) | ZOOM |

        Hospital officials and child psychiatrists in Cincinnati say these injuries, often expertly hidden and explained away as spills from cheerleading practice or a fall in Friday night's game, are part of a growing problem among teenagers.

        These kids, many of whom seem perfectly normal, are so psychologically distressed that they hurt themselves to cope.

        Officials at Cincinnati Children's Hospital Medical Center — where there are more evaluations for psychiatric emergencies per year than at any other children's hospital in the country — say roughly 20 percent of their 3,600 cases annually show some type of self-mutilating behavior. That could include burning or other types of self-mutilation, but cutting is the most common.

        In the past two years, the number of kids hurting themselves has doubled — to 720 cases. Psychologists say it's the fastest growing symptom of mental health disorders in Greater Cincinnati.

        “We are inundated with kids,” says Mike Sherbun, senior clinical director of psychiatry at Children's.

        Cutting is often part of a larger problem. These teens can suffer from depression, bipolar disorder or borderline personality disorder, a severe mental illness characterized by pervasive mood swings. But a cutter could be the popular, high school girl next door or the math whiz in your own home.

        They're more often girls than boys, and they hurt themselves for various reasons: To bring feeling to a body that is otherwise numb. To focus thoughts whirring so fast they can't control them. To show an outward sign of their inner pain.

        Local psychologists have a handful of theories about why cutting is on the rise. It's a way to cope with demanding social and academic expectations some teenagers find impossible to meet. There's the contagion effect: One student sees a friend doing it and thinks it an acceptable way of handling troubling emotions.

GETTING HELP

Help for self-mutilation or other problems related to mental illness is available.    In Ohio:    Mental Health Association of the Cincinnati Area: Serves Hamilton, Clermont, Clinton and Warren counties. 721-2910.    Children's Hospital Medical Center: Psychiatric Intake Response Center. 636-4124.    The Parent Helpline: 24-hour resource line. 961-8004.    Mental Health Access Point: For direction obtaining mental health assistance in Hamilton County. 558-8888.    Crisis Care Center: A Hamilton County crisis and suicide hot line. 281-CARE.    Child Focus: Clermont County counseling center for children 18 and younger. 752-1555.    In Kentucky:    NorthKey Community Care: Mental health/mental retardation regional board in Northern Kentucky. (859) 331-3292.    National help:    SAFE Alternatives: In-patient treatment program for self-injurers. 1-800-DONTCUT. www.safe-alternatives.com    Steven Levenkron: New York psychotherapist and self-mutilation expert. www.levenkron.com    Suicide hotline: 1-800-SUICIDE.

        And then there's this: Teenagers aren't getting the psychological counseling they need. Waiting lists are sometimes weeks long. And when teens crash, they end up in the emergency room.

        Over the past 10 years, Jewish Hospital, University Hospital and Millcreek Psychiatric Center for Children all closed inpatient programs treating adolescent, psychiatric problems. That's put a crunch on remaining programs at Children's, Mercy Franciscan Hospital-Mount Airy, Clermont Mercy Hospital and NorthKey Community Care in Northern Kentucky.

        And because insurance companies reimburse doctors less for teens with acute mental disorders than for those with physical ailments such as diabetes, the doctors leave and hospital programs can't stay afloat, Mr. Sherbun said.

        “There's a lot of kids out there whose needs are not being met,” says James Brush, a child psychologist in Monfort Heights. “That means kids' problems fester and grow. If there was adequate access to treatment, you'd have more kids in treatment instead of kids in the emergency room self-mutilating.”

A 16-year-old's story

        That's what happened to Annie Barkley, a 16-year-old high school student from Anderson Township. She had shown signs of depression since the fifth grade and started cutting sporadically after she moved to a new middle school.

        What sent her over the edge was the sudden death of her father, the chief photographer for Channel 5, from brain cancer in October 1999. By November, she was using a kitchen knife or scissors. She began picking apart razors to cut herself. It happened at home, at school. She'd walk into a room and start looking for something sharp. She even carved a “D” for Dad near the crook of her left arm.

        The medication she was on wasn't working, she says, and she already had waited three weeks to see a psychiatrist. But on Dec. 8, 2000, on what would have been her father's 54th birthday, she couldn't wait any longer.

        “I told my mom I was going to hurt myself,” Annie says.

        She spent five days in emergency treatment and then went for more than a week in the day-treatment program. But she relapsed in early January and was hospitalized again for several days. The second time she wasn't sure she wanted to live. Now, on three types of medication, she is more stable and hasn't injured herself in seven months.

        Sitting at a picnic table on her back porch recently, Annie fidgeted with a peach and white hand towel she used to keep hidden in her closet to stop the bleeding. She wears a bracelet on her left arm, which is tanned but still slightly scarred on the tender side. She talks about cutting the way a smoker might describe a nicotine habit. If she thinks about it, it can become an obsession.

        “It was a constant eating at me,” she says. “When I cut, I could feel better. I'd relax. This brought me physical pain. It was a sensation that felt good. But it was always, "This will be the last time.' I have to distract myself, or it will seriously consume my day.”

        When the cutting reached its peak, Annie became fearful teachers would notice. She got creative with bracelets and long sleeves, and she began to lie. In the beginning, she hid the cutting from her mom. Then, her therapist found out.

        “I wanted a quick fix, but as her therapist said, there isn't one,” says Elizabeth Bookser Barkley, Annie's mother, a well-known literature professor and author. “It's hard to be patient, but it's the combination of therapy and medication that works.”

Mostly teens, mostly girls

        Dr. Armando Favazza, a psychiatry professor at the University of Missouri-Columbia medical school and an expert on self-mutilation, calls the behavior a morbid form of self-help. It is not a suicide attempt, although mentally ill self-mutilators are at increased risk of suicide, he says.

        National statistics vary. But some experts estimate that habitual self-injurers make up roughly 1 percent of the population. Local psychologists say most of their clients range in age from 11 to 17, although some are adults.

        According to SAFE Alternatives (Self Abuse Finally Ends) — the nation's first structured in-patient program designed to treat self-mutilative behavior — people seeking treatment are usually from middle- to upper-class backgrounds, have average to high intelligence and low self-esteem. About half say they were physically or sexually abused in their childhoods.

        Steven Levenkron, a New York psychotherapist who has written six books on anorexia and cutting, says 85 percent of those who hurt themselves are girls. While boys direct their emotions toward others, girls turn their feelings inward.

        “She can be charming and outgoing and work the room, but she has no ability to think about herself,” Mr. Levenkron says. “She has a feeling and can't label it.”

        He's pushing for cutting to be recognized as a distinct mental disorder. “It's time we call it what it is,” he says.

        Once in a while teens cut too deep, but it's rare because most are in control, he says. Infection is not normally a concern because cutters are meticulous about washing with soap or peroxide.

        “They're not sloppy,” Mr. Levenkron says. “Infection means getting caught.”

        The danger is excessive bleeding from what Mr. Levenkron calls a “whoops cut” or when the adolescent cuts deeper than she intended. Cutting also can do permanent damage to nerves. But with treatment, most cutters can overcome the behavior.

        “As certainly alarming and heartbreaking as it is, within nine months, 90 percent give it up,” Mr. Levenkron says of his patients, adding that years of therapy then continue.

        Treatment may involve sessions with a therapist, group therapy or medication. It hinges on helping patients create a language to discuss feelings and develop ways to cope that don't involve hurting themselves, Mr. Levenkron says.

        The SAFE program, located at Linden Oaks, the behavioral health hospital of Edward Hospital in Naperville, Ill., receives about 1,000 calls a month for information, says Karen Conterio, SAFE's administrative director. A new, 19-minute video that discusses self-injury and self-esteem is just out for parents, teachers, social workers and others.

        “We're getting so many calls from around the country from schools,” Ms. Conterio says. “They say, "Can you come and present something to the social workers and teachers here?' or "I have a student who is self-injuring, what do I do now?' They don't know what to do, and it's a very provocative, scary behavior.”

A culture of shame

        Ron Clemons, a licensed independent social worker in North College Hill, has seen seven patients who hurt themselves in the past four years.

        “It's hard for families because they get embarrassed,” he says. “They don't want people to think they are doing something wrong as parents.

        “But most of the time parents don't know or the kids can explain it away. Most parents don't even fathom the possibility that their kids could do that.”

        That's how Ms. Bookser Barkley, Annie Barkley's mom, imagines some parents might feel.

        “It's like a kid coming home from grade school with lice and (the parents) say, "I'm a middle-class person. This can't happen to me,' ” she says. “I do think there is a whole culture of shame about mental issues that people have to get over or they're going to lose their children.”

        While cutting may not be part of homework conversation after dinner, students do see and hear about it in the classroom. And oftentimes it exacerbates the already intense stress of math tests, college applications and tryouts for the spring musical.

        Victoria Cash, a junior this fall at Dater High School, knew one classmate who would steal razor blades or art knives from the art department and head to the bathroom to cut at school.

        “Whenever she'd have a big problem she'd start cutting herself,” Victoria says. “Sometimes she'd do it real deep.”

        Eira Tansey, a 16-year-old who is home-schooled in Clifton, has seen it among her girlfriends. They're privileged kids, she says. Outsiders might think they have no problems.

        “If you go up to some kids and you say, "Well, what's wrong with your life?' It's body image problems, family issues. I know a lot more people now who self-mutilate. I think if you say "cutters' (teenagers) would know what you're saying. But it seems like adults are clueless.”

        Teachers, counselors and social workers are often the first to spot kids who hurt themselves.

        “When I've seen it, it's something that's disturbing,” says Liz Thole, a Western Hills High School teacher. “Sometimes I've noticed it and said something. In some cases friends come to me.” She refers all suspected cutters to the student assistance coordinator.

"I'm on my way there'

        Parents, however, often feel powerless to change a child's behavior.

        “It's one of these, "I hope it'll go away,' ” Ms. Thole says. “It's either inability to deal with it or lack of desire to deal with it. I don't think it's lack of concern but lack of knowledge.”

        Paula Hanley, dean of the Cincinnati Academy of Mathematics and Science, has seen cases of young adults hurting themselves, too.

        One student “told me, "If you do anything on this my mother will take me out of school.' She did, and we were her fourth school,” Ms. Hanley says.

        John Penrose, who teaches severe anger management students from across the district at McKinley School in Columbia Tusculum, says a provision in the 1997 Individuals with Disabilities Education Act requires teachers to identify students who have mental illness or learning disabilities. That may be why more are coming forward to help identify cutters and other self-injurers.

        “Before this,” he says, “it only came out when there was a severe crisis. Now there is a legal obligation for teachers to talk to the parents about an evaluation.”

        He adds: “Parents need to know where to go and what to do. Things like this can lead to bigger problems.”

        To take control, 16-year-old Annie has found a way to focus attention on something besides cutting. She rides horses at least once a week as part of her therapy.

        “To be able to fall off your horse and get back on, it says something,” she says. “You can't have control of your cutting, but you can have control over a 1,000-pound animal. Most people know about it, so I'm pretty open about it.

        “I don't think it's anything I'll ever get rid of. Cutting controlled me, and now I control it by having control of other things in my life. I can say I miss cutting. I can say that honestly.”

        But she doesn't want people to think she cut for attention or that she's crazy. She wants to be known as a strong rider, a funny person and someone who's fun to be with.

        “That's what I hope to be,” she says. “I feel like I'm on my way there. I don't want people to put me on a pedestal and say, "She's completely cured.'

        “But I want them to say, "She has come a long way.' ”

Related stories:
Reasons vary, but forms of self-mutilation date back centuries
       

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