Why She Cuts

The first time was with a broken glass. Becki Bagnato was 13, and struggling with the emotions typical of a girl her age: confusion, angst, insecurity. On top of that, her brother was battling drug abuse, and her father, who'd skipped town years earlier, had stopped sending child support. So when she accidentally broke a glass while she was cleaning her room one day, she wondered, "What would it feel like if I cut my hand?"

She dragged a shard across her palms—lightly at first, then harder—until she drew blood. It stung, badly, for a moment, as she stared down at the burgundy droplets splattered on her floor. But as the sharp pain eased, replaced by a singular throbbing, somehow, the teen felt a strange calmness and a sense of relief.

It started that way, the cutting. When Becki was feeling alone, or stressed, the cuts became a companion, each slice like a friend who understood her pain. She stole her first razor blade from her grandfather's tailor workshop in her family's home in Middletown, N.J. Later, she'd buy them in bulk—$1.99 at a local Target for a pack of 20. She'd cut in the morning before school, then cover up her arms with long sleeves. She'd take a razor with her on the bus, stored flat in her wallet or back pocket of her jeans, so that during class, when she couldn't handle the pressure, she could sneak into the girls bathroom and slide the edge across her forearm. She'd cut before she went to bed. Sometimes, in the middle of the night. "I wouldn't have a good day if I didn't wake up and hurt myself," Becki, now 22, remembers. "It made me forget all the crap going on in my life."

This is how it began for Becki. For the millions of others who hurt themselves intentionally, the story may start differently, but the result is often the same: What is at first just an impulse, a moment of relief, becomes a secret habit—a need for pain that medical science doesn't fully understand and can treat with only mixed success. Eventually, for Becki, the cuts became too much to hide, and her excuses—"I burned myself," "It was a cat scratch."—rang hollow. Her mother sent her to a therapist, then a psychiatric ward, where she was diagnosed with borderline personality disorder, and put on mood stabilizers and antidepressants. But the cutting didn't stop—it worsened. Years passed, middle school became high school, friends and interests changed, one therapist merged into another. Yet the cutting remained ritual, sometimes happening a dozen times a day—on arms, thighs and stomach. "Seeing the blood would give me a sense of being alive," Becki explains.

Self-injury has been documented for hundreds of years. Cases of women and girls, mostly teens, hurting themselves with blades or other implements, even inserting small objects under their skin, go as far back as the medical literature will reach. Though figures vary, researchers estimate between two and eight million Americans, most of them women, have engaged in self-injury at some point in their lives. Yet, while experts agree that this propensity exists, from there, opinions diverge. Is non-suicidal self-injury a diagnosable disorder, or simply a symptom of more profound mental disorders? Can it become an addiction? Does this behavior create changes in the brain chemistry of sufferers? And how do you treat it?

All these questions surfaced earlier this month when a team of radiologists presented new, graphic evidence of what they describe as an increase in the number of self-injurers who are embedding sharp objects underneath their skin. On Dec. 3, at an annual meeting of North American radiologists, Dr. William Shiels, the chief of radiology at Nationwide Children's Hospital in Columbus, Ohio, showed documentation and X-rays of eleven patients that had "self-embedded"—ending up in Shiels office for a surgical procedure more commonly used to remove shrapnel from war vets. One girl, he says, came in with an 8-centimeter bobby pin, three staples, chunks of No. 2 pencil led, glass and wood shards all lodged in her forearm. Another had taken two large paper clips, unfolded them so they stretched 7-inches long, and inserted one into each of her biceps. Others had implanted safety pins and chunks of crayon into their arms, necks and ankles. "They come in with pain, infections, and sometimes guilt," says Shiels. "The infections can be very severe—putting nerves, veins, even tendons at risk."

The 11 self-embedding cases had gone unnoticed in the 505 incidents of (usually accidental) embedding Shiels' team had treated since 2005. But last year, one of his research assistants, who was going back through past files, identified a trend. Shiels says he'd never focused much on the practice before, but when he looked back at these cases and talked to other radiologists around the country, he heard similar reports. This data, he is careful to note, is still anecdotal. To his knowledge (and NEWSWEEK's) there have been no other studies looking specifically at self-embedding, and it is unclear how many people nationwide have been treated for such injuries. Still, in reviewing the literature and talking with mental health professionals, Shiels has come to believe that the practice is increasing, and that it could be viewed as the "next phase" of self-injury. He has put together an interdisciplinary team and database to track its prevalence around the country. "We've been treating patients with accidental foreign bodies under their skin for 13 years, but before 2005, we never saw [self-inflicted] cases like this in adolescence," says Shiels. "We believe this is out there more than people think—it's just that we didn't know what to call it or understand its significance."

Despite its anecdotal nature, Shiels' report caused a sensation. X-ray images revealing the silhouettes of embedded objects lodged between bones were plastered across news sites and blogs. But the hubbub only fueled the debate over what is going on in the minds of those who hurt themselves deliberately, but not fatally. Shiels says embedders are different from other self-injurers in that they've taken the behavior to the extreme. He's dubbed their pathology "Self-Embedding Disorder" and is lobbying for its inclusion into the American Psychiatric Association's Diagnostic and Statistical Manual (the DSM), considered the bible of psychological disorders, which is currently under revision.