‘Cutters’ Learn How to Heal Their Scars

The teenager tugs at the sleeves of her oversized sweatshirt and pulls them over her hands. She wants to make certain that the scars on her arms do not show.

“You don’t want people to know,” said 14-year-old Danielle Opremcak. “People who cut themselves feel really guilty and ashamed afterward. You’re not proud of it.”

Danielle knows. For three years, she has repeatedly sliced her arms and legs with razor blades and pieces of glass.

The ritual of self-injury began as an attempt to gain the attention of her parents, Danielle said. Later it became an addiction. Now, however, she is sitting in the dimly lighted office of a therapist, learning all over again how to live.

She doesn’t realize it, but she is a pioneer in a crash-course effort to help teens overcome a habit that for decades has puzzled parents and experts alike.

Danielle is participating in the nation’s first residential self-injury treatment program--a year-and-a-half-old effort to assist emotionally disturbed youngsters at the Vista del Mar children’s home in West Los Angeles.

Physically injuring oneself is emotionally satisfying to some youngsters--most often girls--who say they feel cleansed and in control when they cut their skin and bleed. Many liken the euphoria they feel to that created by drugs.

The self-injurer is often left feeling worthless and ashamed when that feeling wears off, however. So the cutter repeatedly reaches for a knife or shard of glass. Short-term psychological counseling for adolescent “cutters” has been offered for years at psychiatric hospitals and clinics.

But treatment has not been available at children’s homes that cater over a period of months to troubled youngsters sent by court order--or by frantic parents who no longer can handle their teenagers.

“In the past, we’ve thought these kids were self-destructive, suicidal. As soon as a kid experienced self-mutilation, we would hospitalize them. It would be interpreted as a suicide attempt,” said Gerald Zaslaw, president of Vista del Mar Child and Family Services.

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Behavior Not Suicidal or to Get Attention

But that was before studies in the late 1990s suggested that adolescents who cut themselves are not trying to kill themselves. Instead, experts concluded, cutters are teens caught up in a habit that to them is alternately a crutch and a curse.

“I’ve been seeing these self-injuring kids for 30 years,” Zaslaw said. “It wasn’t until 18 months ago that someone sat me down and identified to me this is a specific type of behavior that needs specific treatment. It’s not suicidal, it’s not an attention-getting gesture.”

Vista del Mar residential counselor Andrew Levander agrees. He has spent 41/2 years working with the home’s 30 teenage girls. The private, nonprofit center, with 114 beds, also serves troubled boys elsewhere on its 17-acre campus.

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Counselor Gets New Insights

“Before, the first thing I’d think when I saw a girl cut herself was that it was a suicide gesture or it was poor impulse control or attention-seeking,” Levander said. “The girls would tell me, ‘You have it wrong: I’m not trying to kill myself. It’s what I do to stay alive.’ They’d say it angrily. I felt completely ineffective.”

Vista del Mar administrators launched their treatment program by dispatching Levander to Chicago to study a self-injury treatment regimen devised by experts at a psychiatric hospital. Back in West Los Angeles, he organized a program designed to teach alternatives to cutting for the teenage girls.

The 45-hour curriculum treats self-injurers with respect as they are encouraged to replace their impulse to harm themselves with better ways of feeling they are in control. Levander has a list of 58 alternatives, ranging from listening to music to planting flowers.

At the same time, the teens are taught to recognize the roots of their obsession. Typically, previous sexual or physical abuse or continuing parental or school problems have led to a loss of self-esteem that is to blame. Experts believe the habit is reinforced by the euphoric effects of endorphins released in the brain as a reaction to the injury.

Twenty-seven girls have participated so far in the program, which is voluntary for Vista del Mar residents. Mandatory treatment would not work, Levander and other experts said.

Danielle, an Agoura Hills resident who has lived at Vista del Mar for six months, is one of five girls now taking part. With permission from her mother, she freely discussed how she was introduced to cutting.

“I was 11 and in the hospital for depression when I saw my roommate do it,” she said. “My parents had divorced, we had moved away from my dad and I was failing at school. My roommate in the hospital cut herself. I thought I’d see if it worked with me.

“In the beginning, I wanted mom or dad’s attention. I wanted to talk about why I was doing cutting. But nobody caught me doing it until weeks afterward. After a while, I was doing it as an everyday thing. I’d have sharp things in my backpack in school and go to the restroom and do it.”

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Low-Key Approach Is Nonjudgmental

Danielle said Levander’s low-key, nonjudgmental approach to dealing with self-injuries keeps her coming to hourlong therapy sessions on Mondays, Wednesdays and Fridays.

“Years from now, I really don’t want to be a 20-year-old going into the bathroom and cutting myself,” she said.

Another participant, Jamie Valade, 16, also began cutting herself at age 11. She said she tried it after seeing it depicted in a movie.

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Depressed Over Sexual Abuse

Jamie said she was depressed, in part, because of past incidents involving sexual abuse by nonfamily members. Soon, she was regularly slicing her arms and legs with razor blades, glass and knives.

“I was mad at myself. I blamed myself--I was punishing myself,” she said. “I’d feel better for about 15 minutes afterward. I probably went 50 times to the hospital. The guy at the emergency room knew my name. He’d ask, ‘Is there anything we can do? No? OK, goodbye.’”

San Dimas resident Rikki Valade said it was heart-wrenching to see her daughter harm herself. “Her therapist said to be supportive and not make a big deal out of it. It was very frustrating watching her do it,” said Valade, who placed her daughter at Vista del Mar in part because of the self-injury therapy program.

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Plans to Expand Program for Boys

Vista del Mar officials say they hope to expand the program to boys’ units. Although most self-injurers are girls, some experts feel that up to 40% of those who harm themselves are boys.

Operators of other children’s residential homes, meantime, are closely watching the West Los Angeles project. Six months ago, Levander presented a paper outlining the program at an Atlanta conference for professional therapists. He made a similar presentation to California therapists last month in San Rafael.

So far, operators of nearly 300 residential treatment centers across the country have contacted Vista del Mar officials seeking more information. They, too, may have mistakenly been labeling self-injurers as suicidal and shipping them off to hospitals.

“We’re thinking,” Zaslaw said, “that there are a lot of kids all over the country who are being treated for something they don’t have.”