By Virginia A. Smith

Inquirer Staff Writer

She also has about 250 scars on her wrists, forearms, thighs, calves and biceps, reminders of a turbulent history of burning herself with lighters and cigarettes and cutting herself with razor blades and knives.

Most of the scars are faded now, more white than red, but some are screamers - like the 5-inch by 3-inch, third-degree burn on her left forearm. That's from 1993, when she ground lighted cigarettes into her skin 13 times and then scorched it all with a long lighter.

It would be comforting to think that Duffy is an anomaly, someone once so mentally ill her experience stands alone. But self-injury - especially cutting - is more common, more talked about, than ever before.

"It's in the mainstream now. It's considered a normal coping mechanism," said Margarita Pebley, program director of child and adolescent services at Friends Hospital in Northeast Philadelphia.

Many doctors and therapists say they have seen a surge of cutting cases in the last five years. And they report that younger children are coming in for treatment, augmenting the traditional ranks of high school students and young adults.

Others caution against hyperbole, suggesting that just as anorexia and bulimia were once kept hidden, so it may have been - until relatively recently - with self-injury.

"It's probably more common than most adults think it is, and not as common as the hype is playing it to be," said Kenneth R. Ginsburg, adolescent medical specialist at Children's Hospital of Philadelphia.

Current data are hard to come by, but a study published in the British Medical Journal in 2002 found that 7 percent of 6,000 English high school students surveyed had tried to harm themselves within the previous year. About two-thirds of those incidents involved cutting, with girls four times more likely to try to hurt themselves than boys.

There are cutters like Duffy, who suffered repeated sexual abuse, including rape, growing up in Seaside Heights, N.J., and later. Over time, she exhibited many pathological behaviors in addition to compulsive cutting: She punched herself, flung herself into door frames, hit herself with bricks, binged and purged and starved herself, pulled her hair out, and, in one episode, ripped the metal braces off her teeth, one by one, with pliers.

For two years, Duffy obsessively cut, drawn to it again and again by the euphoric feeling it gave her. One theory is that cutting prompts the release of endorphins into the bloodstream, causing a numbing or pleasurable sensation.

"I couldn't break from the feeling that I felt from cutting," she said. "I couldn't wait to cut again. I was fantasizing about how deep I'd go, how long I'd go, what kind of cuts they would be... . That's all I thought about." 

Although feeling overwhelmed and alienated, cutters don't always have serious psychiatric problems or a history of abuse. Sometimes, kids try cutting because they have heard about it or seen someone's scars.

"For some, it may not even be a sign of distress," said Jane W. Hyman, author of Women Living With Self-Injury. "For some kids, it becomes the 'in' thing to do, some kind of fashion... but it's still very real."

References to cutting abound on TV, in popular music and movies, in books, and all over Web sites and chat rooms.For example, the movies Thirteen, Secretary, and even Harry Potter and the Chamber of Secrets show characters deliberately harming themselves. The Goo Goo Dolls' hit song "Iris" contains the lyric, "And you bleed just to know you're alive" while "All My Life" by the Foo Fighters has this reference: ";another reason to bleed, one by one hidden up mysleeve."  Increasingly, too, celebrities acknowledge cutting themselves, among them the late Princess Diana, Johnny Depp, and Angelina Jolie. In a sense, it has become glorified, even glamorous.

PAGE 2 >