The self-injury progressed until, in her early 20s, she cut herself for the first time. "I was admitted to a hospital, it was on my wrist and I couldn't control the bleeding, but even at the time, it was almost like I couldn't get enough. While I was in the hospital, I fantasized about doing it again."
"When I started cutting, my goal was simply to get a mark that matched the inward pain I was feeling. It wasn't so much the blood. It was to get a scar or amark." Duffy explains how she would use a butcher knife or razors to cut herself deeply, never in the same spot. She would stitch up and bandage her wounds, hiding them long after they scarred, many still visible today.
"The relief I felt when I cut consumed me. I had so many things from my past that were just there, it was just as if nothing (else) worked. It wasn't aconscious thing, but when I discovered cutting, I thought, 'This takes away the internal pain.'" Duffy's self-injury would progress further when only a few months later, she burned herself for the first time. She landed in the hospital again, this time with third-degree burns and nerve damage to her left forearm. All she could think about as her arm was treated and she was asked about her injury was to get out of the emergency room as fast as she could. She would return six months later with a similar burn on her other arm. "The fear for most people who cut or burn is to be judged," she says.
To many, Duffy's tale of self-injury -- also called self-harm, deliberate self-harm, self-mutilation or self-inflicted violence -- might seem bizarre but it is not entirely uncommon.
According to Karen Conterio, administrative director of the S.A.F.E. Alternatives program at Linden Oaks Hospital, in Naperville, Ill., a nationally recognized self-injury treatment program, about 1 percent of the U.S. population engages in self-injurious behavior, which can also include scratching, picking wounds, burning, punching, breaking bones and hair pulling. Excessive body piercing or tattooing is not considered self-injury.
Based on studies on self-mutilation Conterio coauthored with A.R. Favazza, a cutter who seeks treatment is usually female and begins hurting herself in her teens. She is usually intelligent, well educated and comes from a middle to upper class background.Information provided by SAFE Alternatives also states that about 50 percent of cutters in the program report physical or sexual abuse. Many struggle with substance abuse and eating disorders. The behavior can result in medical complications or death but could also besymptomatic of a concurrent mental health disorder, including depression or other mood disorders.
But also typical among cutters is the trouble to which many go to avoid help and hide their wounds, typically targeting their arms, chest or abdomens. As a consequence, estimates beyond those provided by the Conterio and Favazza studies are hard to come by.
That said, experts agree that self-injury appears to be on the rise. "There is a curiosity factor, but it's a curiosity that overcomes a self-preservation drive that checks many people from doing it in the first place," says Deborah Matthews, a psychologist and director of crisis services and clinical operations for the Child Guidance Center of Southern Connecticut, an outpatient mental health facility that serves children and adolescents in Greenwich, Stamford, Darien and New Canaan.
"There is a desperation. I think of a contagion effect that makes it somewhat acceptable, regardless of what the consequences might be. It is rationalized. If others are doing it, maybe it doesn't hurt that much, maybe it's a good way to deal with pain. They wonder if it will work for them. If people find that it works for them, they keep doing it." "They keep doing it," says Matthews, "because the behavior can provide a sense of relief and calm." Cutting or burning, as in Duffy's case, becomes an extreme coping strategy that helps offset mental anguish, eases tension, relieves anger and in some cases, provides a feeling of euphoria. "All of self-injury is about communicating emotion and unfortunately, quite a few people are not adequately able to do that verbally," explains Matthews. "For some kids who cut, they do it because they feel numb. They are so cut off from emotion that they don't feel anything and they want to feel something. For other people, they are so overwhelmed by emotional pain, that to cause physical pain lessens the emotional pain." Important to note is self-injury is not considered suicidal behavior, but because of its addictive quality, can eventually lead to suicide attempts.
Duffy remembers when she first believed her behavior was out of control.
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