“Some people might hit other people or get violent” as a reaction to intense emotions, says Christine, now 17. “I would tense up and clench my fists. For me, it was almost like a habit."

The hand clenching started when Christine was about 12, but it soon progressed to cutting the skin on her arms with razor blades or pieces of broken glass; she felt she needed to inflict more pain just to feel the same release. She started cutting flesh farther up her arm so she could hide the scabs and scars with long sleeves.

Secret behaviour
Christine cut herself in secret but she was not alone in her silent suffering. A 2002 Canadian survey of kids in grades 7, 8 and 9 found 13.9 per cent had tried to injure themselves at least once, with some reporting they tried it as early as Grade 4. A study of Grade 9 students in London, Ont., found that 15 per cent of girls and 11 per cent of boys had deliberately hurt themselves in the previous three months.

Self-injury – whether in the form of cutting, bruising, head banging or hair pulling – is often a quiet cry for help. However, it should not be confused with suicidal or other attention-seeking behaviours, stresses Nancy Heath, a professor of educational and counselling psychology at McGill University in Montreal. “It's absolutely not about trying to get attention. The vast majority of these individuals never come forward,” says Heath.

Indeed, many go out of their way to hide what they're doing. Even though self-injury occurs in homes of adolescents right across the country, parents often never find out that their daughter or son is self-injuring.

Kept in the dark
Maria*, Christine's mother, was no exception. She was kept in the dark about Christine's self-injury for years and only found out about it when it was discovered that Christine had an even bigger, more painful secret: as a child, she had been sexually abused by a close family member.

The day Maria learned about Christine's secret slashing was a turning point for the family. “I didn't get upset or angry,” says Maria. Instead, she took the time to talk to her daughter to find out why she felt compelled to hurt herself and to tell her she loved her and wanted to help. “It's important to stay close to your child, reassure her and try to make her happier,” she says. It was an approach that made Christine comfortable talking about the issue.

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Professional help
At the time, Christine was already in therapy to deal with the abuse, and once the issue of self-injury was raised, the wheels were quickly set in motion to get proper professional help to target that problem, too.

Christine's history of sexual abuse is not necessarily typical of youth who hurt themselves. Research shows that people who self-injure come from all walks of life and are triggered into the behaviour for a variety of reasons -- some are dealing with a dysfunctional family life, while others are coping with feelings of low self-esteem.

Pressure to perform
Kids who have a deep-seated need to excel may also be drawn to acts of self-harm. “There are patterns of kids who are really high-achieving and who generally function really well,” says Claire Crooks, the associate director for the Centre for Prevention Science at the Centre for Addiction and Mental Health in Toronto and assistant professor at the University of Western Ontario's Centre for Research and Education on Violence Against Women and Children in London.

Some of these children are under a lot of pressure to perform. “Maybe they feel a lot of anxiety and aren't really in touch with their feelings,” says Crook.

It's clear that being an ideal parent doesn't guarantee that your child will not self-harm. “A whole bunch of these kids have very involved, caring parents, and there isn't that childhood abuse–trauma piece at all. There's something else at work,” says Heath.

Dealing with feelings
Whatever the root cause of this urge to feel pain, kids who harm themselves have one thing in common: difficulty dealing with their feelings. “They find their emotions unbearable,” says Heath. “Sometimes they can't name the emotion. Sometimes it's anger, and they feel their anger is so huge that it's scary. And they can't possibly express it.” In psychology lingo, it's called a maladaptive coping mechanism. Instead of externally venting their feelings or working them out, they turn to self-injury as a way of release, transferring internal hurt to an external part of their bodies.

Looking back, that inability to express emotions could have been a red flag that Chloe Schaffer* of Toronto was harming herself. “As a girl, she always internalized her feelings,” says Janet*, her mother.

Chloe's self-harm habit began when she was about nine. Kids were picking on her at school, and at the same time she felt an immense drive to get good grades. “It wasn't anything I ever really thought about,” she says today. “I didn't say, ‘OK, I'm going to do this.' It was just kind of what I did.”

Shocking behaviour
It started with banging her head against the window, and it was something she only did once in a while, when things got really bad. But as the bullying worsened she gradually switched to cutting. She would wait until late at night when the house was dark and quiet. She'd reach over to her bedside table and pick up whatever she had hidden there -- scissors or maybe a knife. She was often half asleep as she scraped the blade in small lines across her shoulder. There were times when she didn't even remember cutting herself.

Then her world got more tumultuous. In Grade 9, she was assaulted by a boy in her school. As anger seethed inside of her, the cutting became more frequent and the cuts a little deeper.

But again, her family had no clue about Chloe's secret self-injury. Janet didn't discover that her daughter was cutting herself until Chloe, now 18, was in Grade 10. A family friend, who had heard about it from one of Chloe's friends, called Janet to tell her about it.

It came as a complete shock. Janet couldn't accept that her daughter, a model child who always appeared confident and in control and excelled in school, was secretly using razor blades to make cuts on her shoulders.

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"Total chaos"
“That first night when my mom found out, it was total chaos,” recalls Chloe. But things calmed down after a couple of days, and the heart-to-heart talks began between mom and daughter. An added plus was that Janet took the time to read up on self-injury. “She just needed me to ask about it,” says Janet.

The family sought help immediately. Chloe had been to a therapist the year before to work out some issues related to anxiety and depression. “When I found out she was cutting herself, I recontacted the therapist,” says Janet.

Pathway to communication
Chloe was happy the issue was finally out in the open. It was the first step to getting the help she needed. “Having someone to talk to made a big difference,” she says. Learning how to communicate worries and problems to other people and finding other ways to deal with stress were keys to her recovery.

Today, four years later, Chloe no longer hurts herself. She has a list of stress-relieving activities she can turn to instead; she can play the piano, write in a journal, read or talk to someone close. (Eating a few of her favourite chocolate cookies also does wonders.)

Kids like Chloe and Christine generally start injuring themselves spontaneously and on their own. And while experts stress there is no “cool” factor involved in it, an increasing number are experimenting with self-injury after being told about it by peers. Bronwen Neal* of Vancouver, for example, started cutting herself at age 12 after a babysitter told her it was a great stress reliever. She even showed Bronwen how to do it. “She told me that this was the way you manage times that were hard,” says Bronwen, now 28. At the time, Bronwen was a vulnerable child; she suffered from depression and had a tumultuous family life.

Watch for clues
Some kids who self-injure don't do it for long, while others can essentially become addicted to the practice. In her research, Heath found many kids cut or otherwise hurt themselves for up to a year or two, then stop on their own. Others self-injure chronically, continue doing it into adulthood and may never stop without help. A small number may escalate to potentially more life-threatening acts of self-injury.

But while some kids may self-injure as something of an experiment, parents should never dismiss self-injury as a phase. Even temporary self-injurers have difficulty expressing emotions and are at risk of going back to it. Parents should watch for clues and act on their suspicions. It's thanks to the compassion and immediate intervention on the part of their parents that Christine and Chloe are healthy, happy adults today.

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Signs of self-injury
• Frequent unexplained (or poorly explained) scars or bruises
• Secretive and unusual behaviour (for example, hiding out in the bathroom or a bedroom at odd times)
• Wearing long pants or sleeves in warm weather
• Carrying sharp items, such as a razor blade or pins, possibly along with a disinfectant (this could be a self-injury kit)
• Artwork or poetry that expresses extreme emotions (especially if your child doesn't express these emotions outwardly)

What to do
If you think your child is self-injuring, remember the following.
• Stay calm. Blame or hysteria could raise the stress level your child is already feeling.
• Gently raise the issue instead of waiting for your child to approach you. And keep raising it; self-injury is such a personal and secretive practice that your child may not tell you about it the first time.
• Make it clear that it's OK to talk to you about it.
• Listen to your child.
• Tell your child that you care and that you want to help.
• Don't ask why she cuts or burns herself. She doesn't know herself, and that's part of the problem.
• Show that you understand that self-injury is a way of coping.
• Know that self-injury doesn't change overnight. It takes time for the behaviour to stop -- and for your child to learn to replace it with something more constructive.
• Encourage your child to express her emotions and feelings.
• Regularly tell her that you love her, even if she's not going through a crisis.

Where to get help
• Adolescent centres at local hospitals.
• Psychologists, psychiatrists, social workers and family doctors.
• Inside the Mind of a Cutter (Navpress, 2007) by Jerusha Clark with Dr. Earl Henslin.
• The peer-support organization Self Abuse Finally Ends (SAFE) in Canada (519-657-6570). This volunteer group, largely operated by people who have recovered from self-injury, provides resource, information, workshops and services.
• Online sources. Many websites provide information about self-injury and offer tips on how to help your child stop. A few that may be especially useful are:
• Self-Injury: You Are Not the Only One by Jan Sutton and Deb Martinson.
• Canadian Mental Health Association (416-484-7750).
• Canadian Health Network (search for "self-harm"); start with "Self-Harm: Pain from the Inside Out".
• Cool Nurse.

*Names have been changed.

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This story was originally titled "Bodily Harm" in the September 2007 issue. Subscribe to Canadian Living today and never miss an issue!