MS. DIANE REHMThanks for joining us, I'm Diane Rehm. Most people wouldn't think of cutting or burning themselves, but what doctors call non-suicidal self-injury appears to be on the rise among young adults and teenagers and there's growing concern that internet videos showing self-injury could fuel the trend. Just what's behind the phenomenon and why parents are often the last to know, we'll talk about that in this hour. Joining me in the studio, Washington psychotherapist, Lisa Diamond-Raab and Rebecca, a psychiatric nurse who used to injury herself as a teenager. And joining us by phone from Ontario for the first portion of the program is Stephen Lewis, he's an assistant professor of clinical psychology at the University of Guelph.

MS. DIANE REHMAnd throughout the hour, we'll be taking your calls, your comments, 800-433-8850, your e-mail to drshow@wamu.org, join us on Facebook or send us a tweet. Good morning to all of you.

DR. LISA DIAMOND-RAABGood morning.

MS. REBECCA XGood morning.

DR. STEPHEN LEWISGood morning.

REHMAnd if I could start with you, Dr. Lewis, can you tell us about your YouTube study?

LEWISSure. So this is a study that was just published a couple of weeks ago and what we were interested in understanding was what is the content of the most commonly viewed videos, with respect to non-suicidal self-injury on YouTube. And basically what we found was that -- we looked at only 100 videos, so -- at the time of the study, there over 5,000 videos. We looked at just the 100 most viewed at the time of the study. And in that, we looked at two types of videos. The first of which were 50 videos that had a live character in it and a second of which had no live character. Typically, these videos had pictures or text or that kind of thing.

LEWISWhen looking at those videos without a live character, so those with pictures, we found that over 90 percent of these had graphic images of self-injury, typically in the form of cutting. And in the other video, those with the live person, we found that 14 of the 50 videos, so 28 percent, had live enactment of self-injury in the video itself.

REHMSo let me understand. For a portion of the videos you were viewing, these were young people or young adults who were injuring themselves and then putting themselves on YouTube?

LEWISYeah, so that was the case for either one, where either they photographed their self-injury after cutting or they filmed themselves cutting and uploaded that on YouTube.

REHMSo why would young people do this, Professor Lewis?

LEWISWell, we didn't look at...

REHMWhat I mean is, why would they put it on YouTube?

LEWISRight. We didn't look at the motives behind that by -- we didn't actually interview those individuals who posted the videos, we more looked at what was in the video. But some people might be posting this to communicate with other individuals, they might be posting it to chronicle their own experiences with the behavior. We know that people often interact about self-injury and there is some research that's been conducted which has shown that many young people who self-injure might go online to gain support about it or gain support for it and get understanding from other people who also engage in the behavior.

REHMSo for you, what are the main concerns that the study raises?

LEWISRight. Well, I think there's a few concerns that we do have and it's not to say that every single video is concerning in nature. Some videos had hopeful tones or themes where they tried to encourage people to get help. Other videos, though, had more melancholic themes or melancholic messages, maybe that self-injury is something that cannot be overcome. One thing that was concerning to us was that many of these videos had high levels of endorsements. So on YouTube, you can rate your video from one to five, in terms of how favorable it is and these videos had an average rating of four point six out of five. So one concern is that these videos may, in some cases, for some young people, work to reinforce or normalize self-injury.

LEWISAnd for other young people, it might also trigger the urge to self-injure if they themselves are trying to overcome self-injury and they see a graphic image of self-injury, this might trigger them to actually self-injure themselves.

REHMStephen Lewis, he's assistant professor of clinical psychology at the University of Guelph, he's in Ontario, Canada. Lisa Diamond-Raab, turning to you, who is the typical person who carries out self-injury?

DIAMOND-RAABThe typical person who carries out self-injury is any man or woman, the age doesn't matter. About one in every 100,000 Americans self-injure and it used to be believed that it was carried out mostly by women, however recent research indicates that men are hurting themselves as well.

REHMAnd when does it normally, if we can use that word, begin?

DIAMOND-RAABIt typically begins in early adolescence, about the age of 12 or 13, however, we're seeing it begin earlier than that, in middle school. And it -- in my practice, I see women ages -- women and men ages 16 to 25 hurting themselves.

REHMNow, considering these videos that Dr. Lewis is talking about, what is your greatest concern regarding them?

DIAMOND-RAABMy greatest concern is that people will turn to these videos and either feel that it's okay to continue injuring themselves, they will seek solace in watching these videos and not seek treatment or for people in early stages of recovery, it will actually trigger them and they'll hurt themselves more.

REHMAnd turning to you now, Rebecca, and we're not using your full name or your real name for issues of privacy, how old were you when you began hurting yourself?

XI was 13.

REHMAnd why did you begin?

XI think for me, I was always -- I was a really good kid, I was a real follower, I was the happy one and when I got into my teenage years, I stared having some emotional problems and just very intense, very, very intense feelings, a lot of feelings of anger and really almost rage. And for me, it wasn't an acceptable thing to show those emotions outwardly or to express them towards other people, get in fights with my parents or, you know, yell at my friends, so I think I turned that aggression that I was feeling inside on myself.

REHMAnd how did you begin injuring yourself?

XI did have a friend who had cut and so I think that's what kinda opened my eyes to it and I tried it and then it kinda became habitual and got a little out of control.

REHMWhat do you think happened to you in the way of relief, in the way of a sense of shame? What were the feelings involved?

XWell, I think after someone engages in self-injury, there is an initial release. It is calming and it kind of gives your mind something else to focus on, you focus on that physical pain for awhile and I think that's why people do do it and why it does become an addictive behavior because it does initially work. But I do want to stress that it quickly is replaced by this disappointment, feeling of failure. You know, I've failed, I've done this again. And a fear of being found out, too, and so those -- the feelings of relief and release are really short-lived.

REHMLisa, hearing Rebecca speak, I wonder if there is something chemical that's going on with this kind of behavior and whether there is a release of something or other that finds its way to the brain?

DIAMOND-RAABWell, it has been suggested that when you hurt yourself and you experience pain or tissue is cut, that chemicals are released in the blood stream that give you this sense of relief, but not enough research has been done on that to prove it.

REHMSo that young people may feel this relief or release, but there has been no or not intensive work to prove that that actually...

DIAMOND-RAABThere has been some research on this, but there's not been extensive research on this to prove it.

REHMStephen Lewis, do you know of any work being done on that area?

LEWISRight now, there is some work looking at sort of the different physiological mechanisms, which is, I think, what everyone's alluding to, that might be involved in self-injury, but I think, I mean, it's true that we don't have enough research to say conclusively that one thing is released versus another with respect to self-injury, but there are people looking into this right now.

REHMDo you see, Professor Lewis, any use of these YouTube films as a way of educating young people against that very habit forming practice?

LEWISRight. Well, some videos did have educational tones, with respect to often trying to dispel myths about self-injury, myths that maybe self-injury is all about attention seeking, which we know it's not, or that self-injury is suicidal, which we also know it's not. But I think what this speaks to is that if many young people prefer the internet as a means to communicate with other people who self-injure, that maybe this also offers an opportunity to reach them affectively and promote things like help-seeking, which may be thwarted by some of the messages in some of these videos.

REHMStephen Lewis, professor of clinical psychology. Short break and right back.

REHMAnd we're back talking with Lisa Diamond-Raab, she's a Washington, D.C. psychotherapist. She's treated more than 700 young people for self-injury. Rebecca is a young woman who engaged in self-injurious behavior as a young teen, she now works as a psychiatric nurse. She's requested that we use only a part of her real name. When we open the phones, I'm sure we'll hear a great many people -- from a great many people who perhaps have experienced this same kind of practice. But Rebecca, when you think back on it and you said that a friend of yours was doing this, so you got engaged because she got engaged and your parents had absolutely no idea you were doing this.

XThat's right. It took -- maybe actually about a month I had been engaging in the behavior before my mom did find out.

REHMAnd how did she find out?

XShe saw -- she saw marks on my arm.

REHMAnd that's where you were hurting yourself...

XYes.

REHM...was on your arms. And what, you were keeping your arms covered up?

XI had been and I think that was kind of one clue. I was wearing a jean jacket to a school function at Six Flags and it was about 85 degrees outside.

REHMSo you took your jacket off and she saw.

XShe did, yes.

REHMDo you think you wanted her to see?

XAt the time, no, I don't think that I did. And in fact, after I had been kind of found out on my arms, I no longer injured on my arms because I wanted to hide it. I am glad that she found out, of course. It led to my getting help, but at the time, I -- no, I did not want my mom to find out.

REHMBut what you're saying is rather than injure yourself on your arms, you turned to other parts of your body.

XYeah, more inconspicuous places, yeah.

REHMIs that typical?

DIAMOND-RAABThat is very typical. We find that people are injuring themselves on their upper arms, on their ankles, on their hips, especially when the weather starts getting warmer and you don't want people to see your scars, you find other places to do it and hide it.

REHMAnd how do young people get to you? Is it mostly because their parents bring them to you?

DIAMOND-RAABNo. I think a lot of times, the pediatricians that conduct wellness checkups see that somebody's been hurting themselves. School counselors, a lot of kids worry about their friends and go to school counselors and, you know, express their concerns and they often call parents and they're given names of clinicians who work in this area.

REHMRebecca, do you remember that moment when your mother discovered that you were cutting?

XAbsolutely, absolutely. It was very frightening. There was a lot of emotion. I can't imagine the thoughts that were going through my mom's mind when she first found out. She -- her first -- her first emotion that she showed was anger. At first, I think she didn't really know what to think or what to feel. She was very, very supportive, of course, afterwards, but she was shocked, she was very shocked and I was embarrassed and afraid.

REHMDid she ask you why?

XYes, yes, she did ask me why and I don't think that at the time, I could really verbalize why I was doing it. I think it really took me a long time and a lot of therapy before I really could recognize myself why I was doing it.

REHMWhat do young people tell you, Lisa, as to why?

DIAMOND-RAABWell, initially, I mean, for a variety of reasons. They want to do it to take away intense emotional pain that they feel and to feel a sense of control over their mind and bodies. They want to relieve stress or tension. They want to punish themselves for not getting the grades they should be given or from being rejected by friends at school. And they feel like they're not hurting anybody else, they're just doing this to themselves and that it helps them handle life's stressors.

REHMDo you then involve the family in the therapy?

DIAMOND-RAABI educate the family about why they're hurting themselves and that they shouldn't be punished and they shouldn't be grounded and that parents shouldn't be angry with them, that they're using a coping mechanism. And that the best thing that they can do for their child is get them treatment.

REHMCan you describe for us the various ways in which young people hurt themselves?

DIAMOND-RAABTypically people cut their skin with razor blades, scissors, knives. Lots of times they use paper clips, any household object. Some people burn themselves, put cigarette butts out on their bellies or on their arms. They can hit walls, they can bang their head against the wall. Many different ways.

REHMDid you, Rebecca, resort to a number of different ways to hurt yourself?

XMainly cutting and burning, but yes, I think that when people are cutting, they'll resort to anything. They'll take anything to cut with. Parents take away razors, they'll find something else that's...

REHMAnd all the time you were injuring yourself, can you tell us the kinds of thoughts going through your head?

XYeah, I think that oftentimes, I would injure myself to punish myself. I had very, very, very high expectations of myself and if I felt that I fell short of those, if I -- as Lisa had said, if I didn't get a good grade, if I was having some tension with my parents, if I thought that I failed at anything, then I felt the need to punish myself. So a lot of kind of self-degrading thoughts oftentimes. And then also, like I said before, I had these really intense rage -- feelings of rage inside.

REHMWhat about your siblings? Did they have any idea you were engaging this?

XI have an older brother and I did tell him about it. I told him about it because when my mom found out -- my brother had been seeing a psychiatrist and when my mom found out, she actually took me to his psychiatrist. So I told him so that he would know why I was going to see his psychiatrist.

REHMOh, I see. And then that psychiatrist perhaps got you to a specialist?

XWell, I actually went to a couple different people, a couple different therapists and didn't like them. I really was starting to think that therapy wasn't for me. These people can't understand me, this isn't going to work. And I had almost kind of given up on treatment. And then one day I went to my pediatrician who recommended Lisa and, you know, thankfully she did because it was a wonderful fit and that was what really began my recovery.

REHMThat's got to be such an important factor in recovery, finding the right person...

XAbsolutely.

REHM...to understand what you're going through. How did you know she was the right person?

X(laugh) It's hard to say. Well, I originally even accepted going to see Lisa because I heard that Lisa was doing group therapy and I was kind of under the impression of, you know, therapists are -- I don't wanna say quacks, but they -- you know, I didn't think that they were for me. But the group therapy was something that I was interested in. So I went for an intake appointment with Lisa and by the time I left, I said, mom, I want to do individual sessions with her, too.

REHMInteresting.

XShe was just very open and accepting. And Lisa does art therapy, which was something different that I had never seen before. And it was just an automatic fit. It was just something I knew.

REHMLisa, talk about the various ways you think can be helpful to young people who are engaged in this kind of behavior.

DIAMOND-RAABWell, first and foremost, I think somebody just needs to find a therapist they trust and who they click with and that you feel like you can think out loud with because that's what therapy is about. It's about thinking out loud. And if somebody has a hard time putting emotion -- putting words to emotions, you can offer art, you can allow them to write if they're writers, so I don't feel that there's one way of doing therapy, that you have to really meet the person you're working with and find what's going to work best for them.

REHMGive me a sense of the art therapy and how that might help that person.

DIAMOND-RAABWell, I remember with Rebecca, when I first met her, she couldn't articulate why she was doing it or what she was feeling. And I had figurines in my office and I asked her to choose a figurine that would most represent how she felt at the moment and she could alter it with any type of art material. And she chose an infant and she took a piece of fabric and taped it around the mouth and said, you know, I'm not allowed to talk about how I feel. In my family, I had to be perfect and keep everything in and that was the beginning of (unintelligible).

REHMThat's pretty graphic.

DIAMOND-RAABYes.

REHMFor others, group therapy. How and why does group therapy work better or less well for some?

DIAMOND-RAABWell, for others, group members empower one another. You always feel like you might be alone in what you think and feel and in your -- no one else's situation is like yours. But when you are in a group with other people your age and you find out other people experience the same thing, have gone through similar experiences, you have a sense of support and empowerment and it frees you up to not feel so alone and isolated.

REHMI wanted to ask you, Rebecca, about that sense of power over your own body, the gratification in terms of power over your own body. Why was that so important to you and how did hurting yourself demonstrate that to you?

XIt's hard for me to answer that question 'cause I don't know that I necessarily fall in that category. I really felt pretty out of control throughout the whole ordeal. I really did. I know that a lot of people cut to feel in control, but that really wasn't the case for me. I felt pretty out of control throughout the entire thing. And really, for me, gaining control was overcoming the self-injury.

REHMHow frequently were you hurting yourself?

XJust about every day.

REHMEvery day.

XYeah.

REHMAnd would that have been in the morning?

XIn the morning, at night, any time, really. Any time there was a stressor. Little things. Any type of stressor.

REHMI mean, would you even be injuring yourself while you were at school?

XYes.

REHMYou'd go into the girls' room.

XYeah or I've done it in class as well through my jeans or whatever, yeah.

REHMAnd did any of your teachers have any idea?

XNo, my teachers did not know.

REHMAnd yet your grades stayed high.

XYes.

REHMThat was remarkable, wasn't it? You were meeting your own self-expectations and yet failing to believe that you were meeting those expectations.

XThat's right, yeah.

REHMTough, tough place to be. You're listening to "The Diane Rehm Show." We're going to open the phones now, 800-433-8850. First to Allison in Mesa, Ariz. Good morning to you.

ALLISONGood morning.

REHMHi. Go right ahead, Allison.

ALLISONWell, I'm so encouraged to know that there is hope out there now. I started injuring myself in 1981 when I was 14 and I remember so distinctly the first time. I was not a cutter so much or -- you know, I burnt myself once as an adult, but banging my head into the basement wall and having my mother, who was mentally ill, open the door and yell at me to stop. And, you know, my family's response was anger and I was told to go to my high school guidance counselor and divulge this information and nobody did anything. The guidance counselor was a very kind person who wanted good things for me, but people couldn't understand what I was doing and it was 1981.

ALLISONBut I think in part because my father was extremely well established in his profession, we were a very upper middle class family and, you know, the fact that I walked around with massive bruises on my body that were all self-inflicted, bite marks, you name it and nobody did anything.

REHMHow did you finally get help?

ALLISONWell, over many years of counseling and therapy and I think -- I'm married to an unbelievably wonderful man who was the first person who expressed fear for me or love, that I wasn't a bad person when I did this. And when he said to me once, Allison, people are going to believe that I have done this to you, that was the first time I had a check to say, oh, there could be bigger implications here. Because every single bruise, every single everything on my body was self-inflicted. My husband's never, ever raised a hand.

REHMSo you clearly had an incentive to stop doing what you were doing. Lisa, what should a parent do if they discover a young person is self-injuring?

DIAMOND-RAABI think a parent should not overreact and they shouldn't be punitive and they shouldn't respond in anger. They should offer their child the opportunity to listen to them. They should ask if they're in pain and they should take them to a professional to get help.

REHMAllison, I'm glad you found help. To Knoxville, Tenn. Good morning, Casey.

CASEYHello. Yeah, my experiences were quite different. I started more for fun and the look of it. I would write my favorite band names and stuff on my arms and it was always with a razorblade. I hate burns. I never burnt myself. But I never done it deep and I always made sure I had peroxide and alcohol and Betadine, so I guess it wasn't really an attempt to actually harm myself, but I liked the way it looked and I'm afraid of needles, so I never was the kind of person to get a tattoo. And sometimes, though, it would have that aspect of if I was real depressed, a little cutting would give me a physical pain to distract me from my emotional pain.

REHMHow real does that sound to you, Lisa?

DIAMOND-RAABWell, that sounds very real. It sounds like you used that cutting to help you with depression and probably feelings of sadness and that it did what it does for a lot of people.

REHMBut he says he liked the looks of it.

DIAMOND-RAABWell, a lot of people who hurt themselves like the looks of it. Actually, they don't want their scars to go away. They hold onto them and become very sad when they start to fade. The scars for them are like memorials. They're reminders of the pain they were able to endure. They often feel a sense of power from holding onto it.

REHMLisa Diamond-Raab, she's a Washington, D.C. psychotherapist. She's treated more than 700 young people for self-injury. We'll take a short break here. More of your calls when we come back.

REHMWelcome back. We are talking about young people, young adults, teenagers and even younger who injure themselves for psychological relief, for perhaps even some chemical release that may occur with a kind of cutting, a kind of banging or burning that various people do. Our last caller, Lisa, was a male. Is the percentage of men who self-injure much smaller than women?

DIAMOND-RAABWell, it has been said it is been smaller, but, you know, latest research indicates that men hurt themselves just as much as women do. In my practice, the men that I see that injure themselves have had a sexual abuse history and they're hurting their bodies in an attempt to reenact the trauma.

REHMI don't understand that.

DIAMOND-RAABWell, they're taking back, they're becoming them the abuser to themselves in order to understand what happened to them, so it is a way of almost reliving their experience, but with a different ending.

REHMWow. That's pretty complex. I must say a number of people have sent in e-mails asking if there are alternative therapies to psychotherapy. Lisa, what would you say?

DIAMOND-RAABWell, alternative therapies, a lot of people practice mediation and yoga. A lot of people find help in, you know, exercise and art therapy, which is a form of therapy that allows you to express yourself through art. There are new types of therapy such as dialectal behavioral therapy that helps change the way you think. So I think, you know, there are all different methods and techniques available for people who hurt themselves.

REHMRebecca, do you think you could have healed yourself without the kind of therapy that you got from Lisa?

XPersonally, no, because I think that I really needed to find out why I was hurting myself and what was causing it. Now, the other things I think are very helpful, yoga, writing, I did a lot colloguing and -- but that was really a supplement because -- and that would help through times when I had urges to hurt myself, but in order to decrease the urges and really figure out why I'm doing this, I really did need the psychotherapy.

REHMHow long did the self-injury last?

XA couple years.

REHMA couple of years, even though your mother had known about it and even though you were already seeing a therapist?

XYes, it decreased in frequency and overall severity, but it did, it did persist. I think it is similar to drugs, to alcohol.

REHMHow so?

XIn that it's addiction. I think that it's an addictive behavior and it takes a lot to stop.

REHMIt became addictive for you?

XIt did, it did, yes.

REHMSo the regularity, you needed to get back to it?

XMm-hmm, mm-hmm.

REHMAnd continue it?

XYes.

REHMVery interesting. All right. Let's go now to Pittsford, N.Y. Good morning, Norman.

NORMANThank you. I have a son who is somewhat autistic and moderately retarded and in the care of an agency with which I have worked closely for many years. We take care of people with various degrees of mental handicap, ranging up to the extremely severe. And among them, self-injurious behavior, or SIB as it is known, is very common.

NORMANIn my son's case, he suddenly developed a habit of gauging his skin with his fingernails and we were lucky enough to have a psychiatrist who was very familiar with brain chemistry and provided him with a drug meant for anxiety and it cured him immediately and without any side effects.

REHMThat's very interesting. Lisa, to what extent are prescription drugs perhaps used in therapy?

DIAMOND-RAABPrescription drugs are used in therapy when you’ve identified that there is an anxiety disorder or major depression or another psychological condition. Often someone who is hurting themselves also experiences severe depression and that may be when I refer them for an evaluation for medicine to a psychiatrist.

REHMSo how frequently would you say that a young person cutting her or himself would benefit with the use additional to psychiatry or therapy of prescription drugs?

DIAMOND-RAABIf I feel my client is very depressed. Probably 50 percent of the time.

REHMReally?

DIAMOND-RAABYeah.

REHMI see.

DIAMOND-RAABI think it does help with anxiety and it does help with depression, but it doesn't take it away. It just makes it easier to work with.

REHMWe have an e-mail from Christian who says, "My daughter started cutting and burning herself in 9th grade, she's almost 20 now, and has been dealing with an eating disorder, binging, purging and anorexia for the last five years. I'm sure the two are connected. Lisa?

DIAMOND-RAABWell, there certainly is a link between self-injury and eating disorders. A lot of people have co-morbidity with both, meaning they can experience an eating disorder and hurt themselves as well. And they can also experience major depression or anxiety and have all of these going on at the same time.

REHMSo it's the underlying dissatisfaction with one's self, Rebecca, that you think can move an individual into all of kinds of situations?

XAbsolutely. And I think that most people who injure themselves or engage in eating disorder behavior or whatever it may be, usually have some sort of underlying -- whether it's an actual diagnosable mood disorder or not, they have some sort of unhappiness mixed with a lack of coping skills and so they're turning to these negative coping skills, such as cutting.

REHMHow did you find better coping skills?

XI think through therapy. I also was on medication for awhile. I was diagnosed with major depressive disorder, so I really had a lot of things working with me. I had the medications, I had the psychotherapy. I learned how to distract myself, go out with friends, just treat myself well.

REHMThat's what I was going to ask. Surely you must have been tempted at times to go back to self-injurious behavior. What did you do?

XDistractions, definitely.

REHMGive me an idea.

XIf I had any urges, I'd call someone, talk to someone and all of these things were available to me at the time when I was self-injuring. It just, I didn't see them. I wasn't able to see them and use them. Calling people, taking a warm bath or a cold shower or whatever it may be that just helps dissipate that emotion.

REHMDid your friends know?

XMost of my friends did know, yes.

REHMThey did?

XMm-hmm.

REHMWere you encouraged to tell them?

XYeah, I think so, I think so. My friends were pretty supportive. Of course, some of them also engaged in self-injurious behavior and I think that that may have at times re-enforced it in a negative way, but overall, my friends were supportive.

REHMLisa?

DIAMOND-RAABWell, friends learn from each other, unfortunately, and if you have a friend that says, oh, I was feeling really bad, but I hurt myself and I feel better, then, you know, that plants a seed and they try it at a time when they're feeling bad. So I think 52 percent of young children learn about self-injury from their friends or from the media.

REHMTo Arkadelphia, Ark. Good morning, Tiffany.

TIFFANYGood morning. I used to self-mutilate when I was in high school and when my dad found out, he threatened to put me in a mental institution. But other than that, the issue was not a drug. So what suggestions do you have for young people who self-mutilate and don't know where or how to find the support that they need?

DIAMOND-RAABI think you can ask your internist or your pediatrician. You can go to your school's counselors or either nurses. You can go on the website to -- the website called SAFE, www.selfinjury.com, which has wonderful resources for people who are looking for help and actually help people find therapists.

REHMI hope that helps, Tiffany.

TIFFANYYes, thank you.

REHMAll right. To Tacoma Park, Md. Good morning Kathleen.

KATHLEENGood morning. I want to know how long this has been recognized as a phenomenon. I graduated in 1965 and of course, everything has changed since then and I just wanted to know, you know, if it was recognized before the internet became, you know, such a daily part of our lives and then after? So that's it.

DIAMOND-RAABI think it's really become recognized and I've seen an increase beginning in 1990 and that's the same time that people started really using the internet and I think that they got a lot of information about self-injury by using the internet.

REHMBut, you know, I have to tell you, I have a friend who is 65 years old who confessed to me that she had been cutting for all of her life, so clearly, this has been around for a long time.

DIAMOND-RAABCertainly.

REHMBut as you say, now on the internet, more and more people are seeing it, are your friends seeing this, Rebecca? Are you worried that having this on the internet is going to spark more interest in trying it?

XI think that it could and my main concern is that it'll make it seem acceptable, I mean, well, it's not something that someone should get punished for doing, it's also not something that should be okay. I don't think that any form of abuse should be acceptable, even if it's directed at one's self and that's my main concern is that putting it on the internet, forming communities around self-injury could make it acceptable. I was part of a community, but it was in therapy, it wasn't -- it was towards treatment.

REHMAnd you're listening to "The Diane Rehm Show." Let's go to Falls Church, Va. Good morning, Allison.

ALLISONHi, I just had a question. I've experienced this and I have a friend who experienced it, medication-induced cutting. When I was -- it was about five years ago, a doctor diagnosed me with bipolar disorder and put me on (unintelligible).

REHMYou know, I'm afraid you are breaking up on us, Allison, but you're talking about medication-induced cutting?

ALLISONYes, medication-induced cutting. I’m sorry, I'll see if I can be more clear. I was put on a medication, Lithium, and a month after I was put on that medication, I became self-injurious. I never had this happen before and I -- basically, there was no clear skin on my arms or on my legs. It was obsessive. I've also had this -- a friend of mine had this happen, she was put on a different medication and she became -- she started cutting almost immediately...

REHMAllison, I wonder if you have been diagnosed with bipolar disorder?

ALLISONI was, that's why I was put on the medication. I stopped the medication after about six months. This was five years ago. I never had another episode of cutting.

REHMLisa?

DIAMOND-RAABI've had a lot of clients on Lithium and who have, but I have not heard this reaction. In my practice, I have not seen it.

REHMInteresting. I wonder whether her own situation right from the start was simply not being addressed by Lithium? One cannot know. Okay. And finally, to Clearwater, Fla. Good morning, Ruth, you're on the air.

RUTHGood morning, Diane. I have one question for your guest and that is how many of these girls and maybe the guys, too, have ever had hormonal studies done. They all seem to be somewhat young, questioning hormones and/or birth control pills for young girls.

DIAMOND-RAABI don't know of any that had hormone studies or of -- that I can speak to. I am not familiar with that.

REHMAll right. Thanks for your call, Ruth. And we have an e-mail from Lisa in Indianapolis who says, "I have an adult family member who self-injures, but she refuses to seek treatment. Is there anything that can be done for such individuals?" Lisa?

DIAMOND-RAABI would just tell your family member how concerned you are and empathize that they must be in a great deal of pain and ask if you can be a part of maybe taking them to therapy. Sometimes when you offer that, you will go it makes it easier and if they won't go, maybe you should go and get advice from a counselor about the best way to support your family member.

REHMRebecca, did you feel any shame initially about going to therapy for help?

XI think I felt shame about the self-injury. I think that therapy was really liberating and I thought I was really positive all around for me, so I really wasn't too shameful of going to therapy.

REHMHave you taken your experience and used it as a psychiatric care nurse?

XAbsolutely. I think I'm more empathic to some of the patients and their situations and I can see past a lot of the stigma that's sometimes attached to self-injury and see the person underneath and what they're really going through.

REHMWell, I want to thank you so much for participating in today's discussion. I'm sure you've helped lots and lots of people.

XThank you.

REHMRebecca, who once engaged in self-injurious behavior as a young teen, she now works as a psychiatric nurse. Lisa Diamond-Raab, she's a Washington, D.C. psychotherapist who's treated more than 700 young people for self-injury. Thank you both.

DIAMOND-RAABThank you very much.

XThank you so much.

REHMAnd thanks for listening, all. I'm Diane Rehm.

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