Paula is 12. She doesn't get on with her parents because they dislike her friends and complain that she stays out too late. Lately, they have been having huge, ugly rows which leave Paula feeling angry and upset. She will go to her room and take the razor she uses to shave her legs out of the drawer. Then she will drag it along her wrists or upper arms, cutting deep into the flesh until her blood pours. It makes her feel better, less angry and raw.
Her friends know she does it and understand why. Several of them cut themselves too.
What is most shocking about Paula's story is not that she regularly mutilates her body but that in doing so she is not unusual. For girls like her - and less commonly, boys - self-harm is a normal, almost banal response to emotional pain. Last week, the BBC Six O'Clock News released the results of a survey of 50 accident and emergency departments, which found that 66% of staff believed cases of child and adolescent self-harm were increasing.
They reported seeing an average of 13 cases per month, with one department reporting three a day. More worryingly, most thought the age of self-harmers was falling. The average age of those treated was just 11, but children as young as six were admitted with self-inflicted injuries.
Since hospitals only see cases which require medical attention, the true number of child self-harmers must be countless times higher. Earlier this year, the Samaritans commissioned a study of teenage self-harm, conducted by the Centre for Suicide Research at Oxford University. After quizzing 6,000 teenagers it concluded that more than one in 10 adolescents has deliberately cut themselves at some time. Girls were almost four times as likely as boys to do so. Only 13% of self-harm incidents had led to a hospital visit.
These statistics do not surprise me. As an agony aunt for the teenage magazine CosmoGIRL!, I receive between five and 20 letters and emails each week which either mention or allude to self-harm. In most of these letters, from girls aged between 15 and 17, self-harm is not seen as the primary problem. Often it is mentioned halfway down the letter, almost as an afterthought.
One girl said she couldn't cope with the pressure of choosing between several different sixth forms and asked me to help her decide which one to pick. Later she mentioned that the stress was making her "feel like I want to cut myself, which I haven't done in a year". Another detailed her experience of bullying, before revealing that her coping mechanism was to cut herself with scissors.
If, like me, you cringe at the mere thought of tearing off a plaster or pulling out a splinter, the concept of slicing or burning your own skin deliberately in order to cause injury and pain seems both abhorrent and alien. How can so many young people find it so easy to hurt themselves?
According to Dr Michaela Swales, a lecturer practitioner in clinical psychology at the University of Wales, the answer is that self-harming is not as far from normal behaviour as we might believe. "Cutting oneself is simply an unhealthy habit, not that different from drowning one's sorrows in a few drinks, drug taking or smoking cigarettes to relieve stress," she says. "Rationally, we know that smoking is bad for our health and will harm us in the long-term. But in the short-term it makes us feel better, so we do it. It's the same for those who cut themselves."
Swales says children and teenagers who cut themselves do not necessarily have mental health problems: "There are many and varied reasons why people self-harm, but broadly there are three explanations. The first category describes young people who use cutting as a way of coping with a situation, as a way of releasing tension or changing an unpleasant emotional state. For some, physical pain is more bearable than emotional pain.
"Second, some young people use self-harm to give them a sense of control over a situation which they can't control, such as bullying for example.
"Finally, self-harm is used by some young people as a way of validating their suffering. A child who has been abused may feel that nobody believes them because they don't show any visible marks. By harming themselves they create a physical manifestation of their inner pain."
Experts are not sure why so many more young people are harming themselves than in the past, if indeed they are. According to Joe Ferns, emotional health promotion manager for the Samaritans, "It's hard to be sure if teenage self-harm really is on the increase or whether we're just more aware of it now, looking for it and asking the right questions so we find it. Some believe that the more you talk about an issue the more acceptable it becomes to come forward and talk about it.
"Young people are certainly under more pressure than in the past, particularly because of the education system, with its emphasis on coursework and targets. Children are having to take more responsibility for their futures from a much younger age. This could explain an increase in self-harm."
Ferns believes that modern coping strategies - or the lack of them - may also be to blame. "Whereas in the past we used to rely on support networks, we now tend to cope alone, as individuals, retreating into our rooms, listening to music or escaping through TV. Alone and in pain, a person is more likely to take out their feelings on themself."
Images of self-harm are all around us, particularly in religious iconography. Christianity is founded on the notion that Christ suffered for the world's sins and there have been sects which practised self-flagellation and mutilation throughout history. Pain and the spilling of our own blood are seen as ways of cleansing ourselves. Likewise, when teenagers cut themselves they often say it is a release, a way of punishing themselves or others.
The difference nowadays is that teenage icons are more likely to be pop stars or celebrities. Before he vanished in February 1995, the Manic Street Preachers' Richie Edwards famously carved the words "4 Real" into his arm as a public expression of his mental torment. Ferns says such images glamorise cutting, romanticising the practice. "Some self-harm websites actually seem to encourage young people to experiment with self-harm," he adds.
Ferns also worries about the effect of peer pressure on teenagers. "Our research shows a high correlation between people who self-harm and family members or friends who engage in the practice. People who have friends who self-harm are more likely to do it themselves." This suggests that publicity about the practice - even when it is well-meaning, such as a recent storyline in the teenage television soap Hollyoaks - might actually be counterproductive.
The general perception is that we live in a more violent, dangerous society than that of the past. But statistics fail to support this impression. Perhaps the truth is rather more disturbing. In modern Britain the only real increase in violence is in that which we inflict on ourselves. If our children do come to harm it is more than likely to be at their own hands.
'The pain proves you're human'
Josephine Lowe (name changed) is 16. She began self-harming at 13. "I started cutting myself when I could no longer cope with being bullied about my weight and the way I look. It had been going on for 18 months and I was so desperate that the only way out I could see was to commit suicide. But when I tried to slit my wrists I couldn't go through with it. So I cut my arms instead. I was angry at myself and my body and it was a way of punishing myself.
I felt totally calm and rational when I did it, like I was finally in control of my life. And the whole experience was such a relief. The pain is so intense that it gives you something to focus all your energy on - it helps you prove that you are still human and still have feelings.
From that point on it became my release. Whenever things got on top of me, when I was angry or upset, I'd go into my bedroom and cut myself. I'd use a knife or razors, whatever was handy. Sometimes I'd just make surface scratches and at other times, cut really deep, depending on how sharp the blade was and how I felt. I'd clean up the blood and hide the cuts and scars under long-sleeved tops.
It got to the stage where I was harming myself every day and it was completely spinning out of control. It was like an addiction. Every time I cut myself I felt a tremendous buzz, a high. I wanted to keep feeling like that but I also hated myself for doing it. I knew it was dangerous - that I could cut an artery by mistake or get a serious infection. I tried really hard to cover up the marks and made up loads of lies about how I got them, pretending I'd fallen over or that the cat had scratched me.
Eventually, my dad saw the scars. He got really upset and started hiding the knives and razors and checking my arms every day. I know he was only trying to help but it just made things worse. My lowest point was when people at school found out. It felt like everybody was looking at me and loads of people kept coming up to me and asking why I wanted to slit my wrists.
In December 2001, when I was 14, I couldn't cope with things any more and took an overdose. Cutting myself was no longer releasing my pain and I just wanted it all to end. I was referred to an adolescent mental health unit for treatment. I still see a psychologist there.
I haven't self-harmed for several months now and my scars have largely faded. I realised I had to move on and stop being self-destructive. I've just passed my GCSEs and I really want to be a journalist. I'm also planning to set up a bullying helpline next year."
Sources of information and support
· Read the Signs (mental health awareness campaign for young people):www.readthesigns.org
· Self Harm Alliance: 01242 578820
· National Self Harm Network: www.nshn.co.uk
· Samaritans: 08457 90 90 90 (UK), 1850 60 90 90 (Republic of Ireland)
· ChildLine: 0800 1111
· Mind: 08457 660 163
· YoungMinds: www.youngminds.org.uk
· YoungMinds parents information service: 0800 018 2138
