Self-mutilation: For children the problem is worse than you think
BY ROGER SCHLUETER
Fri, Nov. 05, 2004--Belleville News Democrat, St. Louis MO

It's so repulsive, so unthinkable, that parents can't imagine their children doing it.

But they are -- and more frequently than most adults would think.

It's called self-mutilation -- using pins or knives or razor blades to purposely cut one's own body. Cut it deep enough to draw blood and leave ugly scars. Cut it over and over and over, sometimes for years if not discovered.

Usually, suicide is not the intent of these "cutters." Ask them, and they'll tell you the physical pain of the cutting helps them overcome some emotional pain in their life or exorcise some other personal demon. But the longer they're allowed to continue, the more they risk doing serious harm.

Kathryn "Kitty" Klee knows this behavior pattern all too well. As a licensed clinical professional counselor, Klee has worked with several cutters in her private practice in Swansea. Now, she wants to get the word out to the community during the second annual conference on "Piecing It All Together: How Children's Mental Health and Mental Illness Affect Family, School and Community."

The conference was inspired last year by Kim Adams, a Fairview Heights mother whose 10-year-old daughter suffers from bipolar disorder. For years, they were caught in a medical maze as expert after expert misdiagnosed the girl, which led to treatments that failed to stop her frequent troubling outbursts. Only three years ago was it determined she was manic-depressive, an illness many still may not consider a childhood disorder.

Adams' years-long runaround prompted her to seek a communitywide meeting to educate parents and experts alike about childhood mental illness so that other families wouldn't have to go through what hers endured. So, she contacted Sharon Gage at Star Net, who again has brought together more than 30 state and area agencies and organizations to sponsor the second conference Nov. 12-13 at the Sheraton Hotel in Fairview Heights.

"It's much larger than we want to know," Gage said of mental illness among children. "I mean, it's huge. I hear more and more parents calling just saying they're at their wits' end. They don't know what to do, and they don't know where to turn for help."

Self-mutilation is one of those topics that needs both public education and caring, thoughtful intervention by parents, teachers, counselors and medical staff, Klee said..

"Self-mutilation is a real tough problem that we're finding is occurring actually quite frequently, more frequently than people had imagined," Klee said. "I think it has become popularized by the media and, with the popularization and the commercialization of it, a lot of kids have done some copy-cat stuff, which is really ... that's tough. It's really nasty stuff."

Children who practice the behavior vary. Some come from abusive and dysfunctional families; others may have loving, supportive families but get caught up in it from copying peers. It usually begins to emerge in junior high school and, unless discovered, it may continue into the 20s or beyond.

Reasons vary as well, but most complain they have a difficult time handling their emotions.

"Many of them will state to you that they cut in order to feel like they're alive," Klee said. "If they see their blood running, then they see they're alive. That's a statement I get from many. Some of them say the cutting actually takes away the emotional pain."

Usually, it starts small with a safety pin, paper clip or even a spring from a ball-point pen. Some will cut their arms and actually show what they've done to their friends. Others will keep their behavior hidden, cutting themselves on the upper legs, which can be covered up year round.

Although those initial scratches may not be dangerous, the behavior can become unintentionally life-threatening if allowed to continue. The cutter may graduate to steak knives and razor blades, cutting deeper, repeating cuts for a certain "look," sometimes even carving words or figures into their flesh.

"The problem becomes pretty serious when they really get into it as a behavior that's really embedded," Klee said. "As the problem becomes more embedded, it's almost like they have to get themselves into a really intense focusing state. And many of them get into that focusing state to such a degree where they don't watch very carefully where they're cutting. That's where the problem seems to come because they can hit some arteries depending on what part of the body they're cutting."

The prognosis can be good, particularly if the child wants to be helped. Klee usually tries to help the child substitute an enjoyable activity for the cutting. She tells of one child whom she convinced to play video games every time he felt an urge to cut.

At the conference, Klee will try to convince parents to be compassionate if they find their own children engaging in the practice.

"It's very repulsive to people to want to inflict harm -- it's very misunderstood," she said. "When they encounter a person who has a problem with this, they really don't know how to talk to them. It's like they're condemning them when they talk to them. So part of the reason of the seminar is to try and help people understand them and get inside their mind so they can get a little better insight on how to deal with the problem."

In another talk, Klee also will address what she calls "emotional regulation." As children develop, they may internalize their feelings and become depressed, externalize their emotions and become aggressive or learn how to "regulate" their emotions -- learn how to handle them and move on.

"What I want to talk about is the importance of parents teaching their children effective emotional regulation," Klee said. "And, if they do see signs of children externalizing or internalizing their behavior, to know the kinds of things they need to do to prevent some of those things that happen, especially, by the time they hit adolescence."

In addition, Klee will display pieces of art created by children who took her classes in building self-esteem and socialization skills. Particularly interesting are several masks that children fashioned to show how they truly felt about themselves.

"I'd love for people to come because I think there's just going to be a huge amount of information available," Klee said. "These are people who are not just academicians but people who are actually working in the profession. I really think you can get your best information from the people who are out there working with the people with the problems and the disorders every day."