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Bipolar News

March 14, 2006

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Mood-swings impair attention and memory
innovations report - Bad Homburg,Germany
A review on the neuropsychological.phpects of bipolar disorder (alternations of mania and depression) by the group of Eduard Vieta (university of Barcelona ...

Bipolar disorder harder to assess in teens
Lawrence Journal-World
Dear Dr. Wes & Marissa: Could you do an article about bipolar teens and the illness?

Bipolar disorder: Life can turn tragic when patients don't take their medicine
Miami Herald
Despite years of therapy, despite knowing that guilt and self-blame are futile, that what happened to one son, what still is happening to another, can only be explained by the stark vocabulary of a medical diagnosis, Linda Pardo wrestles always with a mother's grief, remembers with a mother's heart.

Business News
Sharewatch
SAN FRANCISCO (AFX) -- Pfizer said Monday that the U.S. Food and Drug Administration approved its antipsychotic drug Geodon. Geodon is used for the treatment of acute bipolar mania. Shares of Pfizer traded 16 cents higher to $31.90 in the midday session.

Mood-swings impair attention and memory
News-Medical-Net
A review on the neuropsychological.phpects of bipolar disorder (alternations of mania and depression) by the group of Eduard Vieta (University of
Barcelona) points to impairments in intellectual functioning in this patient population.

Dance/movement therapy helps patients express themselves
NorthJersey.com
The dance therapy program at Barnert Hospital in Paterson is meant to go where words can't. "It's a lot of fun," says Blanca Marr, who is 59. "It makes me feel relaxed," says Jean Hook, 71, who, like Marr, lives in Paterson.

The Pritzker Neuropsychiatric Disorders Research Consortium Incorporates Ingenuity Pathways Analysis Into Its
SYS-CON Media
The Pritzker Neuropsychiatric Disorders Research Consortium (PNDRC) and Ingenuity Systems today announced that they have entered into an arrangement for the licensing of Ingenuity Pathways Analysis, assisting the PNDRC's gene expression efforts on neuropsychiatric disorders. The Consortium will utilize the newest release of the Ingenuity Pathways Analysis to illustrate significant differences in

Use of restraint chairs under fire after mentally ill inmate's death.

Orlando Sentinel (Orlando, FL); 3/12/2006

Byline: Stephen Hudak

Mar. 12--TAVARES -- Concerned about a sister who had struggled with drug abuse and mental illness, Dawn Edgar called from California two years ago to ask a favor of Lake County deputy sheriffs: Please check on my sister and her kids.

Edgar said she sought a "well-being" check because her 39-year-old sister, Denise Ossick, was leaving a bully of a boyfriend and suddenly couldn't be reached by phone.

She now regrets that call.

That same day, deputies found Ossick and a warrant for her arrest. She was wanted for skipping probation appointments and not paying fines levied against her for filing a false police report. Deputies arrested her and -- after she struggled with corrections officers at the jail -- strapped her into a chair used to restrain unruly prisoners.

An hour later, Ossick was brain dead. She was accidentally choked on a strap that had been "negligently secured" around her, according to a newly filed lawsuit on behalf of her three children.

"They were supposed to make sure she was safe," said Edgar, 36.

The lawsuit challenges the use of a restraint chair, which is widely used in Central Florida, though county jail and state corrections officials are split on its value.

Osceola County stopped using them after a handcuffed inmate was beaten to death in one in 1997 by a corrections officer, who was later convicted of manslaughter. But jails in Lake, Orange, Volusia and Brevard counties use them regularly.

"It's been a valuable tool for us," said Michael Brickner, accreditation manager for the Brevard County Jail, which used restraint chairs to control inmates 112 times last year.

The chairs allow jailers to restrain thrashing, violent prisoners until they calm down, sparing injury to officers and inmates, Volusia County spokesman Dave Byron said.

He said the county's policy manual forbids use of a restraint chair for punitive measures and requires that inmates secured in one be "in sight and/or sound of an officer at all times." Other counties have similar policies, requiring visual checks every 15 minutes. Byron said Volusia County uses its chairs more than once a week.

State prison officials, on the other hand, have never used them. "There were several safety concerns," said Gretl Plessinger, a Florida corrections spokeswoman who listed.phphyxiation among the possible risks posed by the device. She said prison staffers also feared the chairs might be inappropriate for inmates with mental-health issues.

Restraint chairs also have come under fire at the prison in Guantanamo Bay, Cuba, that houses foreign detainees with alleged ties to al-Qaeda. Detainees taking part in a hunger strike there have been strapped into the chairs and force-fed through a tube. A lawyer for one detainee has asked a federal judge to ban their use, calling it torture.

According to an investigation by the Lake sheriff's office, Ossick was escorted crying into the jail March 3, 2004, complaining that she had been arrested twice before on the same charges. She resisted staff orders to disrobe and shower and declared she would kill herself when she got out of jail. The remark prompted jail staffers to give her a "suicide smock," a padded gown fastened with Velcro.

She refused to put it on and struggled with officers who wrapped it around her.

Ossick retracted her suicide remark but continued to be combative. Corrections officers decided to put the 5-foot-2, 100-pound woman in a restraint chair.

The slightly reclined, armless metal seat was bolted to the cell floor.

Hands cuffed behind her back, Ossick was tied onto the chair with a leather belt around her chest and a nylon strap around her waist. Her legs were shackled and ankles cuffed.

Prisoners are typically secured with crisscrossing, automobile-style safety straps that lock on the seat. The sheriff's investigation did not explain why a leather belt was used instead of crisscrossing straps.

Sheriff's records show corrections officers began routine checks about 6:30 p.m., peering through a glass window on the cell door and logging observations at 6:41, 6:55, 7:02 and 7:20.

At 7:31 p.m., a corrections officer found Ossick had wriggled off the chair, though her ankles and legs were still secured to its base. The leather belt was around her neck. She had no pulse. She was pronounced dead the next day at Florida Waterman Hospital.

Ossick strangled on the belt, Medical Examiner Steven Cogswell said.

The sheriff's investigation found no fault with corrections officers or the jail's medical staff. The lawsuit, however, does.

"I don't think they should have put her in it," said Nathan Carter, a partner with the Orlando law firm of Colling Gilbert & Wright. "But once they did, they had a duty to carefully watch her, which clearly they didn't do because when they found her she was dead."

Ossick, a former Miss Congeniality in a beauty pageant in her native Rhode Island, had difficulty adjusting to life after her husband died. The state Department of Children & Families had taken her two youngest children. She suffered from arthritis, asthma and multiple sclerosis and had been diagnosed with bipolar disorder, a psychotic disorder complicated by her abuse of methamphetamine and cocaine, according to court records.

Cogswell listed cocaine as a contributory cause of her death.

County Attorney Sandy Minkoff would not comment on the suit. Sheriff Chris Daniels referred calls to Bruce Bogans, a lawyer in Orlando who is representing the office.

Bogans said he could not comment.

Daniels was not sheriff at the time of Ossick's death -- J.M. "Buddy" Phillips was. The lawsuit names both Daniels and Phillips, corrections officers Detara Wesley, Bria Britten, Tracy Ferguson and Brian Wardingley, and jail nurses Lisa Wilson and Fay Angles.

All but Angles still work in the jail. Daniels said none of them would comment.

Stephen Hudak can be reached at shudak@orlandosentinel.com or 352-742-5930.

Copyright (c) 2006, The Orlando Sentinel, Fla.

Distributed by Knight Ridder/Tribune Business News.

For information on republishing this content, contact us at (800) 661-2511 (U.S.),

(213) 237-4914 (worldwide), fax (213) 237-6515, or e-mail reprints@krtinfo.com.

COPYRIGHT 2006 The Orlando Sentinel

Law enforcement faces psychological dilemma: Most officers get minimal training to handle mentally ill.

Record (Stockton, CA); 3/12/2006

Byline: Karina Ioffee

Mar. 12--STOCKTON - Kristopher Marroquin had grown tired of his parents' ongoing custody dispute and was even more weary of how often police were called to his home to settle fights.

So when San Joaquin County sheriff's deputies visited yet again in November, the 12-year-old boy panicked. He grabbed a steak knife and threatened to hurt someone. Then he went a step further and doused himself with gasoline and prepared to strike a match.

It took deputies more than an hour to calm the boy, who was booked into juvenile hall on charges of making terrorist threats, brandishing a weapon and refusing orders from police. But his mother thinks a more appropriate response would have been to have her son evaluated by a mental health expert, not hauled away in handcuffs.

"He did a drastic action because he felt unprotected by the Sheriff's Office," Debbie Marroquin said, adding that he was taken from juvenile hall to a foster home. "But only now are they finding that out now that he is suicidal."

With people suffering from mental illness making up more than 15 percent of inmates in jails around the country, according to the Department of Justice, and as much as 50 percent of the homeless population, according to mental health advocates, police are encountering similar situations with greater frequently.

Yet they receive only minimal training. Only six hours out of the required 600 in the police academy focus on dealing with the mentally ill. After officers are sworn in, the state does not mandate additional training in the area, even though many agencies offer it.

In San Joaquin County, training on the issue ranges from two-hour training sessions to instruction by San Joaquin County Behavioral Health Services. The Lodi Police Department has held about four sessions on the topic in the past decade, while the Sheriff's Office holds training sessions every 18 months.

"We have a myriad of areas we are constantly struggling to find adequate training time for," said Lodi police spokesman Lt. Bill Barry. "We could literally keep officers in the classroom for 40 hours a week and not put them on the street and still not be able to cover all the topics."

Split-second decisions

Harrison Jerome Mitchell was a mental health patient in September when he was shot numerous times by Stockton police officers.

Officers said the 39-year-old man had knives in both hands and was walking toward them near the bus depot at California and Channel streets. They say Mitchell ignored orders to stop and didn't react when shot with a Taser stun gun. He survived the shooting and was charged with assaulting a police officer and assault with a deadly weapon.

His doctors and case workers declined to give specifics about Mitchell's mental condition, citing patient confidentiality.

The shooting elicited criticism by some witnesses who questioned the police officer's actions. But law enforcement officials say some situations don't leave them room to guess whether a person may actually attack.

"People on the street are expecting officers to make the same judgment a psychologist with eight to 10 years of training would make, and after two or three assessments," said Robert Werling, a professor of criminal justice at California State University, Stanislaus, and a former Texas police officer.

"Officers literally have a matter of moments to make a decision in a very fluid, very dangerous environment," he said.

Many mental health advocates say most officers are sympathetic to the mentally ill and are well-trained when encountering them on the streets. But they also agree more regular training would help officers.

"We all want to help, but training doesn't get scheduled as often as it should," said Becky Gould, deputy director of crisis and specialty services for San Joaquin County Behavioral Health Services.

Gould's staffers sometimes go on ride-alongs with police and attend meetings at the Stockton Police Department and Sheriff's Office. Officers also carry reference cards with tips on how to communicate with people suffering from illnesses such as schizophrenia, depression or bipolar disorder as well as phone numbers for outreach workers available for a quick consultation.

The problems in responding to the mentally ill aren't unique to San Joaquin County. Calaveras County officials have struggled to recognize signs of illness and direct patients to appropriate care, according to a recently released report by the county's Mental Health Advisory Board. The board suggested making a psychiatrist available for inmate evaluations, offering more training to sheriff's deputies and having a mental health worker accompany deputies on some calls.

Escalated response

Law enforcement agencies around the country follow an "escalated-response formula" for dealing with potentially violent situations, said Ken Cooper, a national police force expert who has advised the New York Police Department.

In potentially lethal situations, that response usually starts with a person reaching for a weapon. In that case, the officer is instructed to reach for his weapon, Cooper said. If the person continues to head toward the officer after being stunned by a Taser or pepper spray, the officer could fire, Cooper said.

But that formula can backfire when dealing with irrational people, he said. The police uniforms, flashings lights atop police cruisers and wailing sirens can agitate an unstable person.

"The police officer starts to look more and more like a monster," Cooper said.

If the mentally ill aren't identified right away, there are occasionally mental health experts available, as was the case at the San Joaquin County Jail until funding ran out in 2004.

While there, the expert made recommendations on whether charges should be dropped or if inmates should receive additional mental health care. Today, many of the mentally ill remain in jail until either their public defender, judge or someone else advocates on their behalf, said Linda Collins, a court liaison for Behavioral Health.

"When a person has a serious illness, the focus needs to be on treatment, not punishment," Collins said. "It does no good to put them behind bars."

Treatment is what Marroquin wants for her son. Four months since the incident, the teen has been transferred to a home for the emotionally disturbed and is taking antidepressants. But his mother still agonizes over the fact that things might have turned out differently if he was evaluated sooner. "I am still going through hell," Marroquin said. "I don't want this to happen to another mother."

Contact reporter Karina Ioffee at (209) 546-8279 or kioffee@recordnet.com

Copyright (c) 2006, The Record, Stockton, Calif.

Distributed by Knight Ridder/Tribune Business News.

For information on republishing this content, contact us at (800) 661-2511 (U.S.),

(213) 237-4914 (worldwide), fax (213) 237-6515, or e-mail reprints@krtinfo.com.

TICKER SYMBOL(S): NASDAQ-NMS:TASR

COPYRIGHT 2006 The Record

One patient, one hospital, one long wait: Surge in mental health crises has put strain on local ERs.

Saint Paul Pioneer Press (St. Paul, MN); 3/12/2006

Byline: Jeremy Olson

Mar. 12--It's been 18 hours since police took John Edmond to the Regions Hospital emergency department, and the schizophrenic is getting restless.

He walks to the door and back. He flips his hat atop a lampshade and then back on his head. He flicks the light switch up and down. He jumps onto a couch to rest but leaps up seconds later. He can't stop moving. He can't stop talking. In the next room is the family of a car crash victim, and a hospital worker quickly tries to hush Edmond. Emergency rooms throughout the Twin Cities are the front door to the mental health system for people such as Edmond. But lately, the front door has been stuck. Too many patients are suffering crises and end up in the emergency room for days because there are no inpatient psychiatric beds available. Sometimes, the extended stay allows people to overcome their suicidal urges, or just get some sleep, or restart medication that reduces their despair or hostility. But too often, the patients just sit -- occupying space and distracting doctors.

The Pioneer Press spent a Monday morning in the Regions emergency room, one of the busiest in the Twin Cities. It provided a rare, firsthand account of the growing strain that mentally ill patients are placing on local hospitals. The crowded emergency room also can be dangerous. That was apparent in December, when a physician at Fairview Southdale Hospital encouraged a mentally ill man to seek care at another hospital because no beds were available. He instead went home and decapitated his stepmother, according to police reports. Leaders of other Twin Cities emergency departments admit they are vulnerable to similar tragedies. State leaders are concerned as well. Improved handling of psychiatric emergencies is a significant part of a $109 million mental health reform plan that Gov. Tim Pawlenty wants the Legislature to approve this session.

LONG WAITS On the worst days, psychiatric patients take up more than half of the 35 beds in Regions' emergency room. That delays treatment for others. Sometimes, the emergency room is so full that it closes to ambulances carrying nontrauma patients. A Regions official estimated that the emergency room could have treated 482 more patients last year if it discharged mentally ill patients without delay. The Regions emergency room gets so busy that families who bring suicidal patients must sometimes sit in the waiting room for hours, said Susan Dean, a clinical social worker in the Regions emergency room crisis unit. "It's only been in the last couple years that it's been this consistently bad," she said. Dean's job is to assess the needs of incoming patients at the Regions emergency room. If they need psychiatric confinement, she'll seek open beds in the Twin Cities, but she'll try hospitals in Duluth or Rochester or even the Dakotas if she has to.

Edmond, 51, was one of nine mental health patients in the Regions emergency room Monday morning. The staff calls them "sleepers," because they often stay a night, or two, or three. One is a schizophrenic in a catatonic state. Two have been transferred from detox facilities, where they were acting suicidal. Three are depressed and suicidal. One has stopped taking medications for bipolar disorder and has made threats. One has severe anxiety. The longest wait, so far, is 52 hours. Mondays are the worst, because many mental health facilities can't admit patients on the weekends and many people with mental illnesses can't see their therapists. They can always come to emergency rooms, though, because they are legally required to treat all comers. "The ER is really the only place in the (mental health) system that can't say no," said Dr. Brent Asplin, medical director of the Regions emergency room. A GROWING PROBLEM Sleepers are nothing new for Minnesota hospitals. Four years ago, the state tried to address this issue by funding mobile teams to respond to mental health crises. Thirteen years ago, a nonprofit group created the Hewitt House in St. Paul, which is a short-term residential facility for patients in crisis.

Yet the pressure on emergency departments is escalating. Regions handled about 450 crisis cases every month last year but now sees more than 500 of these patients a month. Their stays are longer, too.

Mental health advocates believe some people don't know about alternative crisis services or still need the emergency room because their problems require medical attention. Crisis centers don't take patients who appear violent, so police take them to the emergency room as well. Minnesota is trying to move more mentally ill patients out of state institutions and into the community but hasn't created enough support programs to minimize patients' need for hospital care, said Mary Brainerd, chief executive officer of HealthPartners, which provides health insurance and operates Regions Hospital. Paying nonmedical staff to simply visit people and ensure they take medications has been proved to keep people stable, she said. "When people talk about mental health care in community settings, they're actually talking about a set of services and resources that don't exist today." One solution in Pawlenty's mental health reform plan is a computerized tracking system that all hospitals could use to monitor the availability of psychiatric beds statewide. Another is to make crisis services and other grant-funded mental health programs available statewide and to all people receiving public health benefits. POSSIBLE SOLUTIONS Edmond has spent time in a state mental health facility in Anoka but is trying to adjust to daily life in the community. His trip to Regions started with a confrontation in a local grocery store, where workers were disturbed by his appearance -- a black cowboy hat and white shorts that looked to them to be underwear. Police took Edmond first to his group home and then to the emergency room because he remained belligerent. Edmond is at the edge of his door when a sheriff's deputy leads the tearful relatives of the car crash victim into the adjacent room.

Dean, the crisis worker, quickly escorts Edmond into his room and encourages him to stay quiet. "It's kinda hard for me to just sit here and shut up!" he retorts. Regions is planning to expand its emergency room and create a better holding area for mentally ill patients. Hennepin County Medical Center in Minneapolis is doing this, too, and Fairview's University of Minnesota Medical Center opened a unit in August. Getting the mental health patients out of the noisy and busy emergency room could help them de-escalate from a crisis. But mental health advocates point out that this won't address the rising number of patients needing emergency help. A task force of mental health leaders and state human services officials is meeting to determine the best solutions. Maybe more inpatient beds would reduce the pressure on emergency rooms. Maybe there are plenty of beds but not enough psychiatrists to staff them or to see patients on an outpatient basis. Maybe new community services would prevent mentally ill people from needing crisis care as much -- and be cheaper than hospital care. THE CYCLE CONTINUES

Early Monday, Edmond was in white boxer shorts and yellow socks. Now he has his cowboy hat, blue jeans and leather shoes on, hopeful that he can return home soon. Traci Boser, a caseworker from South Metro Human Services, which operates his group home, sits down with him to make sure he is ready. "If you go back to the house," she says, "do you know what people will be expecting of you?" Edmond nods. "It's gonna be different this time," he says. Edmond grabs a plastic bag full of belongings, adjusts his hat and follows Boser out into the busy emergency room. He has new prescriptions and an appointment with a psychiatrist. It's almost noon. Another patient has moved upstairs to the hospital's psychiatric unit. Seven others are still waiting, and a police squad is bringing in a new patient. Out front, the waiting room is starting to get full. Jeremy Olson can be reached at jolson@pioneerpress.com or 651-228-5583.

Copyright (c) 2006, Pioneer Press, St. Paul, Minn.

Distributed by Knight Ridder/Tribune Business News.

For information on republishing this content, contact us at (800) 661-2511 (U.S.),

(213) 237-4914 (worldwide), fax (213) 237-6515, or e-mail reprints@krtinfo.com.

TICKER SYMBOL(S): NYSE:STA

COPYRIGHT 2006 Saint Paul Pioneer Press

Scars relate stories of teenage torment: Emotional pain drives some to cut themselves.

Blade (Toledo, OH); 3/12/2006

Byline: Ryan E. Smith

Mar. 12--Ruthanna Clinger's bedroom is full of things that have made her happy: pictures of horses, inspirational quotes, some stuffed animals.

And one razor blade.

Hidden on top of a bookcase next to her bed, it doesn't make her happy anymore. But on innumerable days darker than any 16-year-old should know, it once did.

On those occasions when she would cut herself - little surgical slices along her wrist or arm - the happiness was red and dripping and all too brief.

"It didn't feel like any cut or scrape I had before," said Ruthanna, who lives in Upper Sandusky. "It felt really good, relaxing, and just the sensation of the pain and the blood for a minute kind of made me happy."

Only for a minute. The more she did it, the deeper she had to cut and the shorter time the feeling lasted, unable to adequately cover up the pain of family troubles and the stress she felt of being forced to grow up too fast.

Ruthanna isn't alone. She's part of a population that is growing, especially among adolescent girls.

Just how many cutters are out there is hard to say, but experts suggest that at least 1 percent of the general population in the United States, including adults, has engaged in some form of self-injury, which could be anything from cutting to biting, burning, or hitting oneself.

Considering only adolescents, those numbers could be much higher. Studies cited in the February, 2005, issue of the Journal of Abnormal Psychology indicate that anywhere between 14 percent and 39 percent - a broad range, no doubt - could engage in self-mutilative behavior.

Dr. WunJung Kim, a child and adolescent psychiatrist and professor emeritus at the Medical University of Ohio, said two-thirds of them are girls, and he's seen some younger than 10. They are being identified earlier than ever, sometimes because specialists are more aware of the problem and sometimes because cutters seem to be more open about the practice.

It's out there for those who aren't afraid to see it. Celebrities like Angelina Jolie, Christina Ricci, and Courtney Love have admitted to self-injury, and there are numerous Web sites with titles like "Razor Blade Kisses" dedicated to telling personal stories about cutting, sharing pictures of scars, and offering words of encouragement to those who need help.

Jolene Siana, a pseudonym used by a Waite High School graduate, recently wrote the book Go Ask Ogre, detailing her adolescence as a cutter in the late 1980s. It's filled with letters she wrote to a rock star at the time, providing images of depression and pain.

"I found my razor blades. I cut my wrist just enough for it to bleed," she wrote. "I couldn't stop crying. I wanted to be able to dig the blade into my arm, but I kept crying. I wanted to die so badly. I wanted to bleed. I was clenching my wrist with my other hand and I could see the blood gushing between my fingers."

Why?

If you don't know about cutting, your kids probably do. At times, the practice has even become a kind of fad among schoolchildren.

"It's contagious, infectious. It has to do with the suggestibility of the kids," Dr. Kim explained.

One former self-injurer who recently graduated from Perrysburg High School said it's more common in the area than adults might like to think.

"I know at least 30 girls who did it," she said. "A lot of the girls at our school were actually cutting just to cut, just to be popular like that. I guess it's just they feel like they're not getting enough attention and that other people who are doing this are getting attention."

This woman, who requested that her name not be used, cut herself a few times but preferred using a lighter to burn her fingers.

Perrysburg High School Principal Michael Short said the girl's estimates don't shock him.

"I have not seen it here, although I'm certain it goes on because of the prevalence of it nationally," he said.

But why cut or burn at all? It may be hard for most people to conceive how someone could bear routinely rubbing against a razor's edge, let alone enjoy it.

"It's kind of a weird thing," Dr. Kim said. "It varies from one individual to another in terms of motivation."

For many people, the practice can be a sign of different conditions, anything from depression to bipolar disorders. There can be a correlation to physical or sexual abuse too.

Cutting for the first time tends to be an impulsive act, often as a way of coping with intense emotions. Some say they use a knife as a release valve to let out pain that builds up inside. They may seek the opposite as well, inflicting pain on themselves so that they feel something - anything - to combat an increasing numbness to the world.

"[For them,] it's a control issue. I can't control the pain that people are bringing into my life, but I can control this," said Mark Anderson, a licensed counselor at St. Charles Mercy Hospital in Oregon.

Some cutters even talk about it being addictive, suggesting the act of cutting generates internal opiates called endorphins, sort of like a "runner's high."

"The kids will talk about that incredible release and rush of doing it. It's really just [being] addicted to the feeling of letting that tension out," Mr. Anderson said.

That's exactly how Shirley Manson of the rock group Garbage described her experience during a 2000 interview with the Scottish newspaper The Herald.

"I wouldn't say that cutting was pleasurable, but there is a sense of euphoria that follows cutting yourself," she said. "The quick pinch of pain and the sight of blood snaps you back to the surface and you start to appreciate being alive."

Most people who cut start between the ages of 12 and 16, experts say. They are more likely to be girls because they internalize pain and anger instead of acting out.

"I think for teenage girls, there's a lot of change in that period of life - hormonal, social pressure, expectations of parents, family, getting good grades, society's pressure to act a certain way, look a certain way. You put that all together in adolescence and you really have a lot of people who have difficulty coping with that," said Jennifer Fabrizio, a clinical psychologist at Children's Safe Harbor, a collaboration between Harbor Behavioral Health Care and Toledo Children's Hospital.

Cutting seems to be less common among minority children, which some experts say could be because of a closer family structure and support network among those groups.

"It's mostly more affluent, white, middle-class kids," Mr. Anderson said. "It's typically kind of the quiet kid," he continued. "They're usually not your serious acting-out kids. It's the ones who are internalizing it."

Call for attention

When Brittany, a Bowling Green State University freshman who asked that her last name not be used, first cut herself, it was a reaction to events in her life that she saw spiraling out of control as she entered college. She'd read about cutting in Elizabeth Wurtzel's Prozac Nation and felt like she'd run out of options.

"I guess I got depressed when I got here," she said. "I didn't know anybody. I was having problems at home and problems with a certain guy I was seeing. I didn't have anybody here that I could talk to about it, so one day I just picked up a pair of scissors and I mostly just cut my forearms."

A few months later, she had 30 scars.

"It didn't hurt," she said. "Actually, it made me feel better. I guess it's just kind of a way to release your feelings without yelling."

Cutting doesn't have to be a call for attention, but that can be part of it. The first time Ruthanna cut herself a few years ago, it was at her family's dining room table with a kitchen knife while her family was home.

"I kind of wanted to see if anyone would notice," she said.

They didn't. It took more than two years before others saw beneath her cuff bracelets and makeup and her excuses of being scraped by a dog or getting in a fight that she used for cover. By then, there were horizontal scars most of the way up her arm, and she started cutting in less obvious places, like her stomach and legs.

It became a kind of ritual. She cut herself a few times a week, usually in her bedroom or bathroom with clothes or bandages nearby to sop up the copious amounts of blood. Sometimes she did it away from home when the urge became irresistible. On those occasions, she would use a sharp object she kept in her pocket or grab a knife from someone's kitchen.

It's not that she and other cutters are trying to kill themselves. That can be an issue for cutters - Ruthanna did have suicidal episodes and said she once swallowed a bottle of pills - but many who end up in the hospital only do so because they've accidentally cut too deep.

"The intent is: I don't want to end it, I just want to reduce it. I want to reduce the pain that I'm experiencing," said Mr. Anderson, the licensed counselor.

It's usually a hidden practice - cuts in places that aren't readily seen, wounds that won't heal hidden by long sleeves in the summertime.

That's why Dr. James Kettinger, a physician at BGSU's Student Health Services, suspects there are many more than the five to 10 students he sees with the problem each academic year. He brings it up especially when he's talking to students with mood disorders.

"I ask the question a lot these days," he said.

Getting help

Treatment often includes counseling and coping strategies. Clean your room, listen to music, write things down, exercise - anything to deal with the internal pressure without resorting to razors. Identifying and treating the underlying condition at the root of the cutting are important too.

Karen Conterio and Wendy Lader, authors of the book Bodily Harm, have established a clinic in Illinois tailored to the problem. The program, S.A.F.E. (Self-Abuse Finally Ends) Alternatives, is a small one that works for 30 days with people who have a history of self-injury.

It provides a psychiatrist for medical management, requires writing exercises that ask cutters to outline alternatives to their behavior, and facilitates communication and family therapy.

"I tell parents not to understand it per se but to appreciate anyone who would go to that length of masking pain or managing pain. They're in a lot of pain," Ms. Conterio said.

The BGSU student said she decided to stop cutting when a friend said how much he worried for her.

"That's when I realized that I couldn't keep going on like this," she said. "It's college. I'm supposed to be having fun, not sitting in my room cutting myself."

Ruthanna never sought help until she was caught.

"I've started seeing about how my pain affects other people, how people I didn't know cared, actually cared," she said. "I want a lot more than cutting myself for the rest of my life."

She hasn't cut herself in months, but she was admitted into the Kobacker Center's inpatient program at the Medical University of Ohio once when she didn't think she could hold off much longer.

When she made those first cuts a few years ago, she never would have guessed it could come to this.

"I never really thought I would actually do it until it happened, and it shocked me that I did it," she said. "It became kind of something I enjoyed. Most people, they need a cigarette. I would need to cut myself."

Now she's discovered, too late, it's not the kind of urge that goes away easily.

"For a long time, I would just be in school and I'd sit there and I'd fantasize about how wonderful it would feel to just cut away and have the thrill of it again," she said. "It's actually a really hard thing not to do it."

Contact Ryan E. Smith at: ryansmith@theblade.com or 419-724-6103.

Copyright (c) 2006, The Blade, Toledo, Ohio

Distributed by Knight Ridder/Tribune Business News.

For information on republishing this content, contact us at (800) 661-2511 (U.S.),

(213) 237-4914 (worldwide), fax (213) 237-6515, or e-mail reprints@krtinfo.com.

COPYRIGHT 2006 The Blade

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