The unkindest cut: cutting is a sign of serious pain: in a recent survey of high school students, 14 percent of boys and 23 percent of girls said they had hurt themselves on purpose in the previous year.

Fifteen-year-old Alicia first pushed staples into her legs in seventh grade. She went through phases of self-harm over the next several months. "I couldn't help it," says Alicia, who is from Arizona. "It's an addiction." She wasn't trying to get attention, and she didn't want to die. Rather, self-harm had becoming a "way of coping" that got out of control.

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Self-harm or self-injury happens when someone intentionally hurts himself or herself without intending to die. People sometimes talk about cutting. Hair pulling, head banging, punching, and burning are other forms of self-harm. More teens than you might realize do it: In a 2005 Massachusetts Youth Risk Behavior Survey of high school students, 14 percent of boys and 23 percent of girls said they had hurt themselves on purpose in the previous year.

Some "emo" cliques and music glamorize cutting, but teens who have problems with self-injury see nothing cool about it. "[We] will do anything to hide it," says 17-year-old Nicole, from New Jersey. "[We] are the ones who need the most help."

Trying to Cope

When we get hurt, our brains release certain chemicals, called endorphins, that temporarily mask the physical pain. For a minority of people, those chemicals also relieve emotional distress. "The physical pain takes their mind off of emotional pain that they're experiencing," explains Dr. Kent Bullis at Ball State University in Muncie, Ind.

By hurting themselves, some people grow calmer while others feel a soothing numbness. However, self-harmers know that way of getting relief is not socially acceptable. Hiding their self-injury compounds teens' pain. At minimum, self-harm indicates emotional distress. Experts say even one event means that someone probably needs help.

Some self-harmers have suffered sexual, physical, or emotional abuse. Others have no obvious problems. All lack healthy ways to deal with negative feelings such as anger, frustration, or loneliness. But the relief self-harm offers is only temporary. "Sometimes self-injurers can do a lot of damage to themselves without even being aware," says psychologist Wendy Lader, clinical director of the S.A.F.E. Alternatives treatment program. "Like a drug, people tell us that they end up needing more and more to be able to feel OK."

That feeling of need comes at a price to health. Accidental death is a real fear for many teens who self-harm. Infections can set in too. "As I became more confident using a blade, I became more of a danger to myself," says 15-year-old Adeel, from England. Once, he cut himself too deeply, and he couldn't control the bleeding.

Self-harm scars can linger for life, but the biggest wounds are psychological. Frustration about the behavior's addictive nature can worsen depression and feelings of worthlessness. That, in turn, may cause real suicide attempts. People who injure themselves might also be more likely to suffer from eating disorders or to abuse alcohol and drugs, which intensify physical threats to their health.

Facing the Pain

Self-harm may mask emotional pain. But it doesn't deal with the causes. "I needed to find a better way to cope with my problems," notes 17-year-old Steffani, from New York.

Treatment addresses the situations and stressors that can produce emotional pain. "The goal is not to get rid of uncomfortable feelings but rather to understand them and work them through directly," says Lader, "so that they don't come back to haunt you." Otherwise, teens can find it tough to form healthy relationships and lead productive lives.

Is self-harm a sign of another mental illness or a separate condition? Though some therapists disagree, the American Psychiatric Association regards self-harm as a symptom of an underlying mental disorder. Thus, therapists consider whether someone who self-harms also has a condition such as depression or obsessive-compulsive disorder. In those cases, medication might help.

Treatment for self-injury also teaches teens to recognize events that trigger the behavior. People in therapy learn to examine the beliefs and attitudes behind destructive thoughts. They find healthier ways to respond to their feelings. "While I recovered, I learned other ways to cope with nay emotions and that I had to talk to people if something was bothering me," says Nicole. Better coping skills help teens choose alternatives other than self-harm.

Dealing With Feelings

We all need to know healthy ways of handling emotions. If you're tempted to take your pain out on your body, you can resist that impulse. First, figure out what you're feeling. Then choose appropriate responses.

Talk back. Did someone cause your bad feelings? Tell that him or her with "I" statements: "I feel angry/sad/frustrated when you--." If talking to the person isn't possible, you might pretend he or she is there and speak out.

Express yourself. Talk with friends when you're upset. Writing in a journal also helps.

Get it all out. Punch pillows or shred newspaper to vent frustration without hurting anyone. You can even sing song lyrics that match your mood--loudly.

Relieve pent-up tension. Exercise releases feel-good endorphins. It's great when you're angry, frustrated, or down.

Seek something calming. A shower or bubble bath surrounds you with soothing sensations. Listen to relaxing music in a comfy chair. Yoga and meditation relieve stress too.

Carry some comfort. When you're away from home, bring along tokens to remind you that you're not alone. Look at wallet photos, or touch a small gift from a friend.

Find an outlet. Consider hobbies such as art, music, or crafts. They stimulate the senses while providing creative emotional outlets.

Helping a Friend

If a friend tells you about self-injury, try to stay calm and supportive. Avoid being judgmental or blaming yourself. "We aren't crazy. We aren't monsters," says 15-year-old Jasmine, from Ontario, Canada. "We just don't know how to deal with negative emotions in a healthy way."

Many teens need professional help to deal with the emotional problems behind self-injury. You might offer to help your friend check out possible resources. "My therapist and I just click, and I can trust him," says 15-year-old Aly, in Maryland, "and my boyfriend is there to support me."

You can encourage a self-harming friend to talk with a trusted adult. If the person's home environment is safe, he or she might talk to a parent. "My parents know, and throughout everything, they have been amazingly supportive," reports Annie, age 15, from Pennsylvania.

Alicia's friend persuaded her to talk with a woman at his church. "She's been a huge help and just great," says Alicia. Teachers, counselors, and staff at community health clinics are other possibilities.

Beyond that, just be a good friend. "The best way for someone to be supportive is to listen, not minimize problems, and not judge," says Annie. After all, self-harmers are hurting. Sometimes we all need understanding and help to feel better.

In a recent survey of high school students, 14 percent of boys and 23 percent of girls said they had hurt themselves on purpose in the previous year.

Warning Signs

Self-harmers often keep their actions secret. Talk to a trusted adult if someone you know shows these signs:

* Frequent unexplained bruises or scars

* Possible cover-ups, such as always wearing long shirts even in summer

* Unusual fascination with fire or sharp objects

Struggling With Recovery

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"Something just 'clicked' in my head the first time I self-injured, and I became psychologically addicted, says Gabrielle, who started hurting herself at age 15. Although most people thought she was "normal," Gabrielle suffered from depression. She had a history of abuse and other family issues too. Self-injury became her "coping mechanism" but not a healthy one.

"It really isn't the way to go," says Gabrielle. "It's a temporary way of coping that tends to bring on more misery and cause more problems down the line." During the years she self-injured, Gabrielle made three suicide attempts. She also wound up in the hospital more than a dozen times.

Now 24, Gabrielle is committed to recovery. She also started a Web site for others who struggle with self-injury. Gabrielle wants teens who self-harm to know they can change. "There is hope ... you can learn to deal with the issues behind self-injury," she adds. "It's a hard journey to recover, but it can be made."

Before Reading

* Find out whether students have heard of cutting.

Discuss

* What is self-harm or self-injury? (Someone physically hurts himself or herself on purpose.)

* What are warning signs that somebody might be self-harming? (unexplained scars, covering up even in warm weather, unusual fascination with sharp objects)

* What treatments help people who self-injure? (recognizing triggers, working through feelings, and sometimes medication)

Resources

* The documentary CUT: Teens and Self Injury features interviews with teens, celebrities, and health professionals. The film is for use in schools and clinics. www.cutthemovie.com

* S.A.F.E. Alternatives www.selfinjury.com