Kirsten Sage Steadman grew up in Mormon-dominated Utah, careful to keep her emotions in check. She said her father, a Vietnam veteran whose post-traumatic stress had gone untreated, was volatile and psychologically abusive.
By the time she was 19, Steadman said was cutting herself with scissors to relieve the isolation and emotional pain she didn't know how to express. At her worst, until she sought treatment, she sliced up both her legs with dozens of cuts in one session.
Now 28, Steadman has written her story, "Snowflake Obsidian: Memoir of a Cutter," hoping to help others. Her own experience led her to get a master's degree in social work, and to eventual work with troubled teens and adults.
Steadman goes by the pen name "The Hippie With Anger Issues," and writes in a sassy, colloquial voice. But her sense of self-hatred and social isolation speaks to the one in 200 teenage girls who cut.
She describes herself as a "ticking time bomb on the verge of explosion." Her father's behavior and a series of traumatic events led to Steadman's first cutting incident.
"I lost most of my friends because I started dating my friend's ex-boyfriend," she said. "I was isolated and alone and didn't have many people to talk to."
Her boyfriend became addicted to drugs and eventually broke up with her. At about the same time, a close friend was gang-raped, and Steadman said she began to feel like a victim, too. "That was the breaking point for me," she said.
Dr. Alec Miller, chief of adolescent and child psychology at Montefiore Medical Center in New York City, defines cutting as any nonsuicidal self-injury that causes destruction of tissue without killing the cutter.
"When sadness and emotion feels intolerable, it is a way to escape the pain," he said. "It can serve as a psychological distraction, but interestingly enough, there are biological studies that when one does this, there is an opioid release. The brain gets some degree of relaxation sensation from it."
Various methods are used in cutting: reopening scabs, burning the skin with a cigarette, punching the body. "I had one patient who ingested Clorox bleach to burn the esophagus," he said.
About 4 percent of the adult population engages in cutting, according to Miller. Among young people, it occurs in about 7 percent of preteens and rises to 13 to 18 percent in high schoolers. As many as 35 percent of college students may cut.
"It's the silent epidemic of the 21st century," said Miller. "It's a maladaptive way that people are coping."
Studies show that men and women cut in equal numbers, and cutting occurs in people of all socio-economic backgrounds. It is also associated with borderline personality disorder, and with those who have difficulty regulating their emotions.
"The stereotype is that it's just attention-seeking, but most do not do it for manipulation purposes," said Miller.
The dangers are that if a cutter gets temporary relief from self-injury, the person is apt to repeat the cut, perhaps causing permanent injury, even death.
"They don't intend to die, but they are at higher risk for suicide," Miller said. "They have crossed a threshold. ... It's a closer approximation to a completed suicide act."
Steadman's cutting began innocently when she was living at home and attending a community college. Before she even began to "saw" her skin with scissors, she experienced dissociation, or a sense that she was outside her body.