Ann was only 12 years old, a frazzled girl from a middle-class suburban family, when her bizarre behavior began. She slashed herself with razor blades.
The pressures of life were squeezing her from all sides. She had just missed five months of school because of an illness and was having trouble with her studies. She was struggling to adjust to a new school where she had very few friends. And her beloved grandfather recently had died.
For reasons that she can't fully explain, she began making short, shallow cuts on her arms and legs, drawing a few drops of blood each time.
For Ann, focusing on the physical pain made dealing with her problems a bit easier.
"After a while, I became addicted," recalled Ann, now 16. "The bigger a problem I had, the more I would cut myself. Sometimes I was punishing myself. Sometimes I just used it to help me forget about my other problems."
Ann is among hundreds -- if not thousands -- of young people in the Buffalo area who have used cutting as a coping device, psychologists and counselors say.
Officials of Crisis Services of Erie County estimate that counselors spend a third of their time on cases that involve cutting or other self-mutilation by young people.
"It is a serious and growing problem. We get calls and referrals for help from school districts all over this area," said Sandra L. Reinhold, a child psychologist from Child & Adolescent Treatment Services of Western New York.
Although cutters are rarely suicidal, self-injury is a harmful and self-destructive form of behavior, said Reinhold, whose not-for-profit agency runs a counseling program in Buffalo for self-injuring teens.
"It's a coping mechanism, like abusing drugs or alcohol," Reinhold said. "It does help them to cope, but if they keep doing it for too long, it can get out of control. You can do serious damage to yourself. If it goes too far, there's the risk of death."
Solid statistics on the extent of the problem are difficult to obtain. Some studies estimate that up to 20 percent of high school and college students -- mostly girls -- have engaged in cutting or some other form of self-injuring behavior, Reinhold said. A national group called Mental Health America estimates that 2 million Americans injure themselves, mostly by cutting.
A Cornell University study conducted last year found more than 500 Internet message boards that teens use to share intimate secrets about cutting, burning and other self-injury behavior.
"Adults are uncomfortable with it and very surprised to hear about it, but the kids are very aware of it," said Janis Whitlock, director of the Cornell Research Program on Self-Injurious Behaviors. "In schools all over the country, it's part of their world."
"It's still a taboo subject with a lot of people, but we're very familiar with it," said Pamela Embury, coordinator of kidscrisis.com, a Web site that Crisis Services operates.
The site received more than 447,000 hits in the first three months of this year, and self-injury by young people is one of the most popular topics, Embury said.
Some of Reinhold's patients cut themselves several times a day -- at school and at home. Some do it only occasionally, in times of extreme stress.
The worst case Reinhold ever encountered was a deeply disturbed 40-year-old woman who cut herself for years. Ultimately, the woman had to be hospitalized after slashing her stomach and trying to cut off her breasts.
"That is an extreme, unusual example, but the danger of real harm is there," Reinhold said.
Reinhold sees 37 girls and three boys in her program, and other teens are on a waiting list. They come from all over Erie County -- Buffalo, suburban areas and rural areas, she said.
A wide variety of sources produces the stress that can lead to self-injury.
"It can be an honor student trying to keep up, or a very poor student who never goes to school," Reinhold said. "It could be a kid who was molested, a girl having trouble with boys, a girl with body image problems, or someone who thinks her parents hate her."
She urges parents, guidance counselors, teachers and others who deal with young people to watch for the following signs:
* Fresh cuts or scars.
* Constant wearing of long sleeves, baggy clothing, jewelry or wrist bands to hide scars. Awkward body posturing to hide scars.
* Frequent use of bandages, ointments or other first-aid supplies to treat cuts. Bloody tissues or broken razors found in the home.
* Unusual mood swings or spending an inordinate amount of time alone.
Ann, the suburban girl who spoke to The Buffalo News on the condition that her full name would not be published, is one of Reinhold's clients. After cutting herself for three years, she stopped eight months ago, after her mother discovered some of her scars, became alarmed and found help.
"Once my mom found out, I broke down and told her everything," Ann said. "I knew she was someone who could get me help. At that time, I was doing it every day. I realized I was hurting myself and people around me, and I needed help."
A bright, energetic honor student with an engaging smile, Ann does not give the appearance of a girl with psychological problems. But she showed a reporter four light scars on her left arm and said her clothing covered many more.
Ann said she once wanted to be a fashion model, but now, because of her scars, she feels that opportunity is gone.
When she was cutting regularly, using razor blades, scissors and other sharp instruments, Ann tried desperately to hide the scars from her parents and friends. She wore long-sleeve shirts on hot summer days.
"You're very paranoid about people finding out," she said. "You feel like, if someone finds out, they're going to hate you, make fun of you or think you're some kind of idiot."
Ann had suicidal thoughts at times, but she said she never seriously considered it and never intended to seriously hurt herself.
"Cutting gave me some relief from my problems. It gave me a euphoric feeling," she said. "I still have urges to do it now, once in a while. But I don't."
Counselors from Child & Adolescent Treatment Services bring clients together to share their experiences during group discussions. They urge them to stop cutting and use less harmful "self-soothing" methods when they feel intense pressure.
"I'm finding other ways to deal with anxiety and depression," Ann said. "I'll call friends to talk, or I'll listen to some of my favorite music. It's helping. Until about a month ago, I would say, 'I cut myself.' Now I say, 'I used to cut.' That's a turning point for me."
>Where to get help and information
Experts say young people and their parents often are embarrassed and reluctant to seek help with cutting and other self-injury issues.
"This is a problem that can be beaten," said Sandra L. Reinhold, a child psychologist with Child & Adolescent Treatment Services of Western New York, "but it's hard to do that without talking to a professional and getting some help."
One of the best sources for information or help referrals is Crisis Services of Erie County. The agency can be reached at 834-1144 or (877) KIDS400, or through its help Web site, kidscrisis.com.
"We can even put kids or parents in touch with a counselor, through the Internet," said Pamela Embury, Web site coordinator.
The Web site also has information about other issues that affect young people, including school bullying, depression, drug use, eating disorders and suicide.
Embury also advises young people to go to a guidance counselor or some other responsible adult if they know of a friend who is inflicting self-injuries.
"At first, your friend might be angry for reporting you, but in the end, they'll probably wind up thanking you," Embury said.
Other helpful Web sites include kidshealth.org, teenagerstoday.com and crpsib.com, the site run by the Cornell University Research Program on Self-Injurious Behavior.