With the modern proliferation of self-expression and body-modification in the form of piercings, tattoos, implants, tucks and plastic surgery, another less-welcomed means of expression is on the rise. It's the trending practice of self-injury among teens, college students and even some adults.

“I'm going to hurl myself against the wall, 'cause I'd rather feel bad than not feel anything at all.” — From Warren Zevon song “Ain't That Pretty at All” She was just 13 years old when Elizabeth experimented with cutting for the first time. A gifted athlete and student, she'd had body image struggles from a very young age. At 31, Bethany can still remember the feelings that drove her, more than a decade ago, to throw herself against cement walls and scratch her arms and legs with sharp metal or stones. Samantha is a new mom who has grappled with various self-harming behaviors for years, including cutting, bulimia and burning her skin. Unlike Elizabeth and Bethany, it's a battle she still fights every day. With the modern proliferation of self-expression and body-modification in the form of piercings, tattoos, implants, tucks and plastic surgery, another less-welcomed means of expression is on the rise. It's the trending practice of self-injury among teens, college students and even some adults. But thanks to research that's underway to help understand and treat self-harming behaviors, along with a rise school and community response, people who have struggled like Elizabeth, Bethany and Samantha, whose last names are being withheld because of the sensitive nature of the topic, may find a light at the end of the tunnel. According to Janis Whitlock, director of the Cornell Research Program on Self-Injury and Recovery, the reasons for self-injuring are diverse. “Many who self-injure report overwhelming feelings of sadness, rejection, anxiety, or emotional numbness as common emotional triggers,” she said. According to Celeste Trickler, a prevention specialist at Canandaigua Middle School, she has seen a steady increase in the number of students involved in self-harming. Elizabeth's story Elizabeth G., an outstanding athlete and student, first experimented with cutting one year ago when she was 13. She had body image struggles for much of her life, and her first mode of self-harming was by restricting her eating habits. It didn't offer much relief. “I had all these feelings inside me that I didn't understand and I didn't know how to express,” said Elizabeth, who lives in Monroe County. “I didn't know how to explain them to myself or other people. So I used a razor blade and made shallow cuts in my hip area — I knew no one would ever see them.” Nobody gave her the idea or taught her how to cut, Elizabeth said. And it wasn't really that common among her friends. “Right when I started, I knew I wanted to stop, but I didn't know how,” Elizabeth said. “I knew I was experimenting, but I wasn't going to let it be a life-threatening thing.“ She had heard the horror stories and read the blogs of “when kids let it get out of hand.” It scared her enough that she didn't ever want that to happen. But still, Elizabeth secretly punished herself with thoughts that she should should be prettier or skinnier. She believed she “wasn't good enough,” and needed to “find a way” to hurt herself. Thanks to two very good friends who pushed her into confessing to her parents, Elizabeth continued cutting for only a month and a half. When she finally faced her parents, it took 30 minutes to communicate, through tears, what had been going on. The key for Elizabeth was talking things out and starting to understand that she didn't have to feel like she wasn't good enough. After four months of therapy, she and her parents believe she's got a solid plan in place. “I don't have to put pressure on myself to be perfect all the time,” said Elizabeth. “I learned to stop myself and stop worrying over everything.” She admits that cutting never became an addiction she had to overcome. “I just wanted to see if it would make me feel better, and it didn't,” Elizabeth said. “I realized it was really kind of stupid — there wasn't a point to doing it. I'm glad I got the help, and I've never had the urge to cut again.” Bethany's story Bethany M., 31, is now the mother of three and living in Ontario County, but she can still remember the feelings that drove her to self-harm more than a decade ago. “It was when I went to college and realized I didn't know who I was or why I was there,” she said. “I was disappointed with myself, and every time I wanted to do something, I felt like I couldn't. Every time I had something to say, it came out wrong.” Self-harming seemed like the only thing she could actually control, she said. “I used to toss myself up against concrete walls and bruise my arms up,” said Bethany. “I would also take little rocks and sharp pieces of metal and scratch my wrists and legs.” Concealing her bruises and scars with pants, long sleeves and thick bracelets, she isolated herself from potential friendships and positive experiences. “I don't think I wanted to stop,” Bethany said. “I continued because I knew what it felt like, what to expect, and it seemed to hurt less than other emotional realities. It made so much sense at the time.” Eventually a few people found out and “looked at her differently,” and she didn't like that feeling either. “My college roommate wrote me a note asking me about it, and I hated that,” said Bethany. “It was the same feeling of helplessness I felt before.” Ultimately, Bethany said she “fell in love with people too much to hurt someone they loved,” referring to herself. Her perspective turned around even more, and she learned to love herself more fully, when she became a mom and realized “her body wasn't just hers any more.” Samantha's story Samantha W., 22, is a new mom living in Ontario County who has struggled for years with various self-harming behaviors, including cutting, bulimia, and burning her skin, which she tried only once. She stopped immediately because it “was not the kind of pain that she wanted to feel,” and turned to cutting. “I was in fifth grade, about 13,” she said. “I was going through so much, and felt so much pain on the inside that I wanted to find anything I could do to get my mind off that kind of pain. I thought if I could feel physical pain, then maybe I could take away from the emotional pain I was feeling and thinking.” Unfortunately, it worked. Until the next time she felt pain — and the behavior became like a drug. “I needed something,” said Samantha. The cutting became an addiction, she said. It's one she still grapples with, even now. Most often she resists, but sometimes, she doesn't. “I don't cut every day,” she said, “but it's still a struggle and I battle it every day. I never cut just to cut. I'm truly in a bad place, and I don't know where else to turn except to a razor or scissors. When you're really really down or upset or angry, it's hard to see something sharp and not want to put it against your skin.” Today Samantha's left forearm is nearly covered in scars, as are her thighs. In her earlier years, she concealed those scars by wearing a hoodie non-stop, year-round, even on scorching hot summer days. “I've come to the point where I'm not ashamed,” Samantha said. “It's not me, but it is a part of me, and I've become stronger. ” Samantha remembers the day her dad first found out she was cutting. They were in their garage, weight lifting. “It was my turn to hit the bench,” she said. “I put my arms up on the bar — I would always try to make sure I had my sleeve tucked between my palm and the bar — but it fell down, and my dad saw. To this day I'm glad that he saw — if he hadn't, I probably wouldn't be alive today.” In April, Samantha will tell her story before a crowd of 300 and will sit on a panel, answering questions about her journey. “I've been through a lot that I wouldn't wish on my worst enemy,” she said. “I never want someone who's going through something like this to feel alone.” What motivates Samantha to keep her cutting in check today? It's knowing how close she has come to death, unwittingly, because a cut went too deep, or nearly nicked a main artery. It's also the thought that she'll have to explain her thousands of cuts to her daughter one day. “I think about when she grows up, and her seeing my scars,” Samantha said. “I want to be as strong as I can for her. I want to be as good a role model as I can be. I never ever want her to grow up and think that is even an option.” Why the need to self injure? Cornell's Whitlock said people who self-harm are often very sensitive — but not in a bad way, she said. They simply have a high emotional perception and don't know what to do with those feelings. Self-harming is actually a self-medicating coping mechanism that comes from a normal, good desire to feel better. “This is not about 'I want to end my life,'” Whitlock said. “The impulse is really a desire to feel better, it's just not the way to achieve that end.” For some, self-injury provides a way to manage intolerable feelings or a way to experience some sense of feeling, she said. It is also used as means of coping with anxiety or other negative feelings and to relieve stress or pressure. According to Whitlock, those who self-injure may be doing so to feel in control of their bodies and minds, to express feelings, to distract themselves from other problems, to communicate needs, to create visible and noticeable wounds, to purify themselves, to reenact a trauma in an attempt to resolve it, or to protect others from their emotional pain. “Regardless of the specific reason provided,” Whitlock said, “self-injury may best be understood as a maladaptive coping mechanism, but one that works — at least for a while.” When does it start? “Self-injury can start early in life,” said Whitlock. “Our research suggests that early onset self-injury is common around the age of 7, although it can begin earlier.” Most often, she said, self-injury behaviors begin between the ages of 12 and 15 and can last for weeks, months or years. For many, self-injury is cyclical, meaning that it is used for periods of time, stopped and then resumed. “People can go in and out of high or low engagement, which can be deceiving for observers,” said Whitlock. Further, college studies reveal that 30 to 40 percent of those surveyed began self-injuring when they were 17 or older. The majority of those surveyed also said they stopped within five years of starting, although the behavior can last well into adulthood, Whitlock said. The oldest self-harming person Whitlock has encountered was age 64. Who is at risk? It's commonly assumed that females are much more likely to self-injure than males, but there's no one unique profile, Whitlock said. It's not just middle class or upper middle class white females, or someone who has been traumatized. Some self-injurers come from stable, healthy homes and lives without that much of a trauma history. “It could be your neighbor, your kid, it could be your child's friend,” Whitlock said. “There's something in this particular behavior that reflects our culture — I don't know why. It speaks to young people now, and seems to be very accessible — probably because body-modification has become so accessible.” Tell-tale signs include scars and marks, or several fresh wounds or scars in clusters, especially on the arms, which is common for females. Guys tend to punch themselves or something else with the overt intention of hurting, Whitlock said, so look for damage to their hands. “There are definitely guys who cut in the same way girls do, but there are more men who will lash out with their fists,” Whitlock said, adding that some studies suggest males are equally likely to self-injure as females. Whitlock encourages those struggling with self-harming to “keep talking.” “And if you aren't talking yet, start,” she said. “Find someone you trust and share. Learning how to be OK with uncomfortable emotions is the first step in getting better.” Support at school? According to Canandaigua's Trickler, representatives from nine area school districts meet monthly in partnership with Ontario County. The group came together about 20 years ago with the initiative of reducing substance abuse, she said, and monthly meetings have been ongoing for more than a decade. Cutting is one of the subjects frequently addressed, she said. The first incidence of cutting that Trickler observed occurred in 1997, but it's a behavior that's definitely trending. In the last four years, she has seen a steady increase in the number of students involved in self-harming, with the highest number in 2013. Still, the percentage of students who cut and have reported it is very low — an estimated 18 out of more than 950 students. That number is in stark contrast with Whitlock's research, which indicates that in an average secondary school, about 10 to 13 percent of students may be chronically self-injuring, including cutting and self-scratching. About 25 percent, she said, report chronic self-injuring, one-time self-injurers and those who are flirting with the idea. “We are always meeting with kids, and we do see recovery,” Trickler said. The change is coming, she said, because schools are offering support and coping tools. A response protocol is now in place that includes notification of parents, a checkover by the school nurse who cleans wounds and checks for infection and a plan to replace the cutting, Trickler said. Students also do checkins as they move ahead, she said. If a student appears to move beyond experimentation and their behavior becomes chronic, Trickler said she links students and parents with local counselors or therapists. Teachers, likewise, are equipped to be on the lookout students who may be at risk and alert a school psychologist. The Butterfly Project Many students have found a positive self-management tool via “the Butterfly Project,” a non-profit organization founded by a Virginia teenager, Crystal Dameron, which provides help for teens who are suffering self-injury. Dameron said she was inspired to launch the Butterfly Project because of teen icon Demi Lovato, who confessed she started cutting at age 11. When individuals feel like they want to cut, Dameron encourages them, via Facebook and Tumblr, to take a marker or pen and draw a butterfly wherever the self-harm would occur. They may name the butterfly after someone they love or after someone who really wants them to get better. As long as the butterfly stays — no scrubbing off is allowed — it's a reminder and incentive for the individual to keep from cutting. “If you cut before the butterfly is gone, it dies. If you don't cut, it lives,” the Butterfly Project Facebook page says. “We try to use healthy aspects of the Butterfly Project as replacement therapy, whether it's in journaling or drawing or listening to music,” Trickler said. “One of our goals is to be clear with parents that cutting is not a suicidal gesture,” said Trickler. “It's been described as a cry for help, or 'silent scream.'” When parents are notified, Trickler said it's an opportunity to educate them about how to respond and how not to respond. “We encourage them to be as non-reactive as possible, and listen.” Advice to families No one can give advice to parents as well as the children they're trying so hard to understand and help. And although the words were different, the advice was the same from Elizabeth, Bethany and Samantha. “If your kid comes to you and tells you they're cutting — don't freak out,” said Elizabeth. “Don't get mad. Don't tell them they're a freak and there's something wrong. Just love and support them.” Samantha cautioned against getting angry, or upset, or judgemental. “Just be there,” she said. “And don't be afraid to ask questions. Tenagers will probably get so annoyed, but the best thing for parents and siblings to do is ask, ask, ask. And then pay attention.” Parents can be completely oblivious, Samantha said. They should take note if their child is shutting himself or herself in the bedroom or the bathroom, if they avoid talking to people, if they're always wearing a hoodie, if they say things like “I wish I were never born,” or “people would be better off without me.” Patience, love and understanding are crucial for someone who is self-harming, said Samantha. To those who cut … Likewise the best advice for one who wants to cut, is from someone who used to cut. “Get help, no matter how scary it is,” said Elizabeth. “Talk to a teacher, a sibling, find someone you trust. Try to figure out why you're feeling the way you are. Listen to loud music, write, paint, write songs — put your feelings on paper even if you can't put them into words.” Self-harming is extremely glamorized online, Elizabeth said, when in truth it's nothing like that. “It's not a good thing — it's harmful in the long run,” she said. “And you're not going to be proud when your future husband sees those scars.” For someone who typically pulls away from people in order to spend time alone, Bethany suggests taking that option away, and “being around other people, even if you're not talking.” Ultimately, she said, you need to reach out to somebody. Anybody. Think about the reasons you are happy, about the people you love and about the people who love you, said Samantha. “Then tell yourself that cutting is not an option — it's really not,” she said. “One little cut can change your life, and it's not something you can ever take back.” Signs of self-injurious behavior — Unexplained burns, cuts, scars, or other clusters of similar markings on the skin — Arms, fists, and forearms opposite the dominant hand are common areas for injury, however evidence can appear on every body part — Inappropriate dress for season (consistently wearing long sleeves or pants in summer) — Constant use of wristbands/coverings, — Unwillingness to participate in events or activities which require less body coverage (such as swimming or gym class), — Frequent bandages — Odd or unexplainable paraphernalia such as razor blades or other implements which could be used to cut or pound — Heightened signs of depression or anxiety. — When asked, individuals who self-injure may give evasive responses, or offer implausible stories which may explain one, but not all, physical indicators For more, visit www.selfinjury.bctr.cornell.edu/ Self-Injury Awareness Day SIAD is a grassroots annual global awareness event on March 1, where on this day, and in the weeks leading up to it, some people choose to be more open about their own self-harm, and awareness organizations make special efforts to raise awareness about self-harm and self-injury. Some people wear an orange awareness ribbon, write "LOVE" on their arms, draw a butterfly on their wrists in awareness of "the Butterfly Project" wristband or beaded bracelet to encourage awareness of self-harm. The goal of the people who observe SIAD is to break down the common stereotypes surrounding self-harm and to educate medical professionals about the condition. More online: The Cornell Research Program on Self-Injury and Recovery — www.selfinjury.bctr.cornell.edu/ To Write Love On Her Arms — twloha.com/ The Butterfly Project on Tumblir — butterfly-project.tumblr.com/ The Butterfly Project on Facebook - https://www.facebook.com/pages/The-Butterfly-Project/162488130484385