The scars tell their stories, but they're not the whole picture.
People who hurt themselves can seek recovery at a new treatment center in Richmond Heights dedicated to self-injury.
Michelle Seliner, chief operating officer for S.A.F.E. (Self Abuse Finally Ends) Alternatives, opened the clinic in May as a branch of the Chicago-based organization. At the office on Clayton Road, people can receive individual and group therapy to learn how to overcome their self-destructive impulses.
"It's a choice and they can recover," Seliner said.
People who self-injure, most commonly by cutting, burning or picking their skin, use it as a coping strategy to deal with emotional pain or anxiety. The goal of the S.A.F.E. Alternatives program is to bring people to a point where self-injury only invokes pain, without the relief.
Six women have participated in group therapy since the center opened in May.
The women agreed to allow a reporter to sit in on a recent 90-minute session because they want people to know they're not crazy or threatening. They feel stereotyped as unstable, dark or suicidal, and asked that only their first names be used because of the social stigma.
"It's embarrassing because everybody judges you," said Hannah, a college student. "It's hard to get help when everybody's looking down on you for it."
Most people have a hard time understanding how someone can purposefully harm themselves, Seliner explained, since "even an amoeba will recoil from painful stimuli."
But the women say they're no different from people who hurt themselves by drinking too much, taking drugs or overeating. Kristen, 19, tried to explain why she takes her anger and aggression out on her own body.
"I would rather hurt myself than hurt other people," she said. "I do it sometimes so people don't have to deal with my problems."
At each meeting, the women fill out a questionnaire about their week - what they experienced, how they felt and whether they hurt themselves. While they all signed vows to abstain from self-abuse, the women aren't checked for fresh wounds so they're not gratified or punished for the injuries, which can be cries for attention.
Seliner teaches the women to use their words, rather than their actions, to ask for help or attention. She helps them work through the emotions that lead them to self-harm. Some do it to punish themselves and feel that they "deserve" to be hurt. Others use it as a way to relieve their anxiety in uncomfortable situations.
Not an addiction
The impulse to self-injure, Seliner tells them, is a choice and not an addiction. She urges the women to make different choices to cope with stress.
In their previous attempts at recovery, some of the women were told to let a piece of ice melt in their hand, to snap a rubber band around their wrist or to draw a red mark on their skin when they get the impulse to self-harm.
But those are substitutes, and not alternatives to injuring, Seliner said.
She instead helps patients create long lists of preferred alternatives to hurting themselves: lighting a candle, reading a poem, writing in a journal, taking a walk. The idea is to delay the action of self-harm and thereby dull the impulse.
Seliner, who earned a master's degree in social work from Washington University, is one of only a handful of therapists who specialize in the treatment of self-injury. She is working with a local hospital to set up an inpatient treatment facility for more severe cases.
Princess diana was affected
The S.A.F.E. Alternatives program started in the 1980s to address the growing field of self-injury. The program's research points to a 75 percent rate of success, defined as the percentage of patients who are injury-free a year after treatment.
The typical self-injury patient is female, since "men tend to turn anger outward; women internalize and turn anger in on themselves," Seliner said.
Self-injury patients tend to be intelligent and perfectionist. Many also suffer from eating disorders. While many patients are upper middle class, the mental illness transcends class barriers. Princess Diana famously acknowledged her struggles with self-injury.
People who self-injure rarely die from their injuries, but many have suicidal thoughts. A large number of patients have abusive backgrounds, and commonly have other diagnoses such as depression, anxiety or bipolar disorder.
"Self-injury is not the problem, it's the symptom of something else," Seliner says.
The patient population is getting younger. By some estimates, 20 percent of adolescents have intentionally harmed themselves. The rise in self-destructive behaviors in teenagers has some parents and teachers concerned that self-injury is contagious.
Seliner says that while a student may try hurting themselves because they are copying a classmate, it won't become a habit if it doesn't cause immediate feelings of relief.
"Self-injury hurts, so if you are not using it as a coping strategy you're not going to do it again."
For some people, hurting themselves releases endorphins - brain chemicals that reduce pain and stress.
Women in the therapy group say they don't feel the pain, or describe it as a good kind of pain. They report feeling an adrenaline rush, that the blood escaping their body represents a release of unwanted emotion.
But the highs are fleeting. Later they admit to feelings of shame and regret. And they have to wear that struggle on the outside, in the form of scars.
Kristen says her problems started when she was in eighth grade and her sister died in a car accident. Cutting herself provided a temporary respite from her grief. But afterward she always felt worse than she did before.
Therapy has helped her gain the self-confidence to wear short-sleeved shirts and make long-term plans. She dreams of moving to Chicago and becoming a nurse.
When people notice the scars on her arms, Kristen is upfront, saying she went through a hard time and made some bad decisions in the past.
"I'm ashamed of it but at the same time I'm not going to let it stop me from doing what I want to do," she said. "You have to outshine your scars."