Why She Cuts

But the assertion that self-embedding is a new trend, or a disorder at all, has caused a stir among many mental health experts, who say embedding is a known method of nonsuicidal self-injury and a symptom of a larger problem and not itself a psychological disorder. Though it's often believed to be a common behavior among those with bipolar disorder—and is described in the DSM as such—self-injury of any kind does not appear in the manual itself as a diagnosable disorder. As Bessel van der Kolk, the medical director of the nonprofit Trauma Center, in Boston, and an adviser for the updated DSM, puts it: "Self injury is part of a larger picture; it should never be seen as an isolated thing."

Wendy Lader, a clinical psychologist and cofounder of S.A.F.E. Alternatives, a Dallas-based treatment center for self-injurers, says that people who harm themselves almost always suffer from larger mental conditions, often the result of emotional trauma, or in extreme cases, physical or sexual abuse. Though she estimates five percent of her patients this past year have been embedders, she doesn't distinguish between the two kinds of behavior: self-injury of any kind, she says, is a physical coping mechanism used to deal with or distract from extreme emotional distress. "I think a lot of people tend to look at the behavior versus what the behavior represents," she says. "But these are all just methods of trying to maintain some emotional equilibrium."

The way self-injurers describe the relief the practice gives them varies. For some, it's about control: the ability to create and end physical pain amid emotional turmoil. Others see the blood as a physical release of overwhelming stress. Some say it causes an almost euphoric feeling, the way an addict might describe a much-needed fix. Lader says that people who engage in self-injury are nine times more likely to attempt suicide than non self-injurers—but it's a common misperception that self-injury itself is an attempt to die. In fact, say experts, it's in many cases the exact opposite: an attempt to feel more alive. Van Der Kolk, a leading expert in self-injury, explains it like this: self-injury is almost always associated with emotional stress or trauma. To deal with stress, the brain secretes opiates that can shut down our pain perception. A lack of pain perception can cause feelings of numbness. Self-injurers often say they hurt themselves to avoid feeling numb.

Whatever the feeling, medical literature is rich with tales of mentally ill people who inflict pain upon themselves. In 19th century Europe, some women became known as "needle girls" because they would injure themselves with sewing needles. In 1875, a New York woman serving time in an asylum for insane criminals had at least 150 foreign objects removed from her body, including pieces of glass, wooden splinters, needles, pins, shoe nails and a piece of tin. Another woman, at a nearby lunatic asylum, had 300 needles withdrawn from her body. "This is nothing new," says Joan Jacobs Brumberg, a social historian and professor of human development at Cornell University. "But the early writing on this was of the tone that this was just another lunatic, hysterical female behavior."

It wasn't until 1995 that self-injury made its way into the mainstream consciousness—and with a sympathetic protagonist—when Princess Diana told a BBC interviewer that she had often cut her arms and legs, explaining, "You have so much pain inside yourself that you try and hurt yourself on the outside because you want help." The behavior has since been referenced in film (1999's "Girl, Interrupted"), music (the 2005 Garbage album, "Bleed Like Me") as well as dozens of written analyses, including 1999's "A Bright Red Scream," by Pulitzer-prize winning journalist Marilee Strong. Today, there are dozens of websites devoted to self-injury education.

Nevertheless, scientific research on self-injury is still its infancy. Recent studies show that it is most common among teen girls. (In one survey by researchers at Brown University of 633 high school students, 46 percent had injured themselves in the past year on multiple occasions). But it may be growing among college students, and even men. (A recent study of 1,000 self-injurers by UK mental health charity SANE found that 10 percent of respondents were male and that some didn't start until they were in mid-life.) Clinicians like Shiels believe more research is urgent—and that inclusion in the DSM as a diagnosable and treatable disorder could help free up funding. (It might also make obtaining insurance coverage less of a battle—as many insurers will only reimburse from conditions listed in the DSM.)

While there's not enough evidence yet to call self-injury a true addiction, its characteristics are addiction-like: the high a self-injurer may get from the blood flowing from their wounds; the obsessive, often agitated need to engage in it is not unlike that of a junkie desperate for a hit. Some studies do suggest that self-injury releases endorphins to the brain. "Everyone deals with problems differently: some people take drugs, some cut," says 27-year-old Sarah Brecht, the co-author of a book of essays on self-injury called "Beyond the Razor's Edge" (iUniverse, 2005).

Becki describes it as an obsessive battle, and one she often lost. At her worst, she says she spent every hour living and breathing self-injury. She dreamed about it. She'd think about it at school. She bought every book published on it. She searched for self-injury Websites, and compiled what she found into a 13-page Website of her own. "I was cutting 10-plus times a day, and still, if I didn't do it, I would feel like I was missing something," she says.