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.
Cutting 'Like Addiction'
"There was no thinking involved, it was just instinct," she said. "I made one cut and saw the blood and it startled me. Then I came back to myself and realized what I was doing."
But cutting soon became pleasurable. "You go into a trancelike state, very much like addiction, and it feels very good and doesn't feel like you're hurting yourself," said Steadman.
As the cutting spiraled, so did her appearance. Steadman dyed her blond hair black, wore a nose ring and started to let go of her body hygiene. And the cutting took on new forms.
"I'd hit my head against things spontaneously," she said. "The pressure and emotions were weighing on me so heavily. I would run and try to [write in my] journal and then run the pen against my skin and make it bleed."
Steadman got back together with her boyfriend, dropped out of school and moved to Wyoming, falsely thinking "a change of scenery can change what's going on in your head."
But she got worse, and so did the guilt and shame. The night she attacked her legs, Steadman said, "I couldn't stop. I had to keep going because I felt so out of control and a really deep-seated feeling of self hate."
Her boyfriend returned to find blood running down her legs and called her mother. Steadman went back to Utah and began treatment, which included unconventional rapid eye movement therapy, and "mindfulness" -- a mix of cognitive therapy and Buddhism -- among other techniques.
The most common treatment for cutting is dialectical behavioral therapy, which Marsha Linehan pioneered at the University of Washington.
Linehan and Miller co-wrote a book on the therapy, which teaches cutters self-soothing skills, ways to feel the sensation they are seeking without the self-destruction.
"Instead of reopening scabs and wounds, you put hand lotion on your hands, or some people snap a rubber band to get the physical sensation without the permanent tissue damage," said Miller. "Some throw cold water on their face. Other people put on soothing music or go out for a run. Males do push-ups and sits-ups, exhausting themselves."
As for Steadman, the cutting incident in Wyoming was a turning point, and today she has a better understanding of why she became so vulnerable.
"I did have a form of abuse with my father," she said. "He never hit me, but there was an underlying theme. I didn't know how to express my emotions.
"Oftentimes, we want to be the strong one, the perfect one, and it's hard to let go and tell people what's going on," she said. "I was afraid of my feelings."
Today, Steadman is married to the boyfriend who had his own addictions to overcome but saved her. He has since given up drugs.
Her memoir, she said, is a gift to others. "I want people to feel validated for their own experiences, whatever that struggle is," she said.
"Growing up in Utah, you keep skeletons in the closet. You put on appearances and keep the darkness to yourself," she said. "But if people aren't taught to deal with the dark side of themselves, eventually it will own you."