Caia Pattynama hesitated the first time the scissors pierced her arm. "It really hurt," she says, "but I figured if I could tough it out, it would prove I could get through the other things happening in my life." In the seconds it took for drops of blood to appear, Caia, then 15, felt an odd sense of peace. "I knew it didn't make sense, yet I felt better," she says three years later. "For that moment, I was in charge."
Life started slipping out of Caia's control when her beloved stepfather, Daryl Simpson, passed away unexpectedly. She was just a few months shy of her 14th birthday. Though everyone in the Centennial, Colorado, family—mom Monica Simpson, older brother Jared Pattynama, then 16, and younger sister Kendall Pattynama, then 12—was reeling from the loss, Caia was having a particularly hard time. "She was angry and becoming increasingly withdrawn," Monica recalls.
Caia started high school in the fall, and Monica hoped her daughter's mood would improve once the stress of that transition passed. But Caia, a self-described introvert, struggled to fit in. When she did make friends, she was surprised to discover that several of them were into cutting. They said it was calming—which was all Caia needed to hear. In October she started scratching thin lines into her arms with scissors, safety pins and thumbtacks. Soon she was slashing the skin on her arms, belly and legs with whatever sharp instrument was handy. "Sometimes," she says, "the only thing that got me through the day was thinking about being able to cut when I got home."Deflection Game
Caia's story isn't unusual—a third to half of kids ages 12 to 18 engage in self-injury at least once, according to a Psychiatry study. Actions include cutting, scratching, burning, repeatedly biting or picking at skin, or embedding small objects, such as paper clips or small rocks. Males also punch objects or themselves, or bang their heads against surfaces.
Destructive as this is, most kids—about 60%—aren't trying to end their lives, which is why mental health experts call it non-suicidal self-injury, or NSSI. "Most want to kill their emotional angst," says Janis Whitlock, PhD, director of Cornell University's Research Program on Self-Injurious Behavior. "It's not that they actually want to die."
Experts aren't sure why the act of inflicting physical pain helps, but self-injurers claim they feel more relaxed afterward, apparently exchanging inner angst for the strong physical sensation. Others, emotionally frozen, may want to prove they're capable of experiencing anything at all. Brain chemistry also plays a role—cutting releases endorphins, resulting in a pleasurable or numbing sensation. "Self-injury is a form of self-medication," says Whitlock. Though professionals fall short of calling the behavior a true addiction, it can be compulsive: The more a person cuts, the more she'll crave this relief when tension builds. Over time, the urge becomes impossible to resist.
As the fall progressed, Caia's sadness deepened. "Not only had Daryl died," says Monica, "but Kendall was less available, Jared was living with his father, and I started a full-time job. Everything in her life was pretty much turned upside down." Monica didn't know how upset Caia was, however, until she saw cuts on her daughter's arms. Caia convinced her mother it was a one-time thing, but Monica soon caught glimpses of fresh wounds. Concealing sharp objects didn't help. "She shaves her legs. She's got thumbtacks holding up pictures. I couldn't hide everything." In December, Monica took her daughter to the family doctor, who diagnosed depression, prescribed medication and suggested a therapist.
Antidepressants or anti-anxiety drugs like serotonin reuptake inhibitors (SSRIs) are commonly given to self-injurers. Unfortunately, in a small percentage of children, SSRIs may induce suicidal behavior (the FDA now requires a label warning). One night Caia told her mom: "If you leave me alone long enough, I'll do whatever I can to kill myself." Monica called 911 and Caia was taken to a psychiatric hospital. Her medication was changed, and she attended daily group counseling sessions. The therapy went nowhere, though. "I faked it," she says. "I told them what they wanted to hear so I could get out of there." Released after five days, she cut again. "I was flunking school and alienating my family," she says. "I felt awful, but I just couldn't find a way to care."