AN ESTIMATED 2 TO 3 million Americans hurt themselves by cutting or burning, breaking bones, pulling out hair or even ingesting dangerous substances. Even they admit it's hard to describe how any of this provides emotional relief. Some say it's similar to the impulse to violently hit something when you're really upset. Think of it, too, as an addiction. Many who self-injure do it for the same reasons others abuse alcohol, drugs or food. In times of crisis, it helps them cope.

"They feel so grandiosely horrible inside, so what they do to their bodies is never enough to show how much emotional pain they are in," says Wendy Lader, Ph.D., who along with Karen Conterio authored the new book "Bodily Harm: The Breakthrough Healing Program for Self-Injurers" (Hyperion/1998).

And it's a phenomenon that reaches beyond ethnic and gender lines.

According to Dr. Armando Favazza, author of "Bodies Under Siege: Self-Mutilation and Body Modification in Culture and Psychiatry," (Johns Hopkins University Press/1996) about 60 percent of self-injurers are female and 40 percent are male. Most, he says, begin the behavior during early adolescence.

Favazza says there is an important distinction between those who are self-mutilators and those who are suicidal. "People who are suicidal obviously want to end their lives," he says. "Self-mutilators do not want to die. They simply want to feel better and their act is one of self-help — although it's a morbid form of self-help." In the end, of course, it is a faulty coping mechanism that does not resolve a problem and can leave a person horribly scarred and disfigured.

It is precisely this contradiction between seeking relief through physical harm that makes it so difficult for many parents and loved ones of those who do this to understand. "Some patients describe themselves as being filled with emotion, filled with anxieties so tense, that they're going to burst open and they cut themselves," Favazza says.

Dr. Favazza says there are many factors — both psychological and cultural — that may lead people to harm themselves in this way. Some can't make the transition to adulthood responsibility. About 40 percent will have a history of eating disorders, and about half have a childhood history of abuse. But he stresses there is no single pattern or profile to the behavior. "Every person has a different life experience and some will end up being sick and some won't," he says. "They're just caught up in a behavior they cannot control."

The key is to find treatment. Lader and Conterio are also the directors of the S.A.F.E. Alternatives Program in Chicago. S.A.F.E. ( Self-Abuse Finally Ends) broke ground in 1986 as the first inpatient clinic to specialize in self-injury in the country. The 30-day program combines innovative counseling with medications, such as anti-depressants. Here, patients examine the painful reasons they disfigure their bodies and learn ways to continue healing once they leave the hospital. "If you continue to allow yourself to feel instead of immediately wanting to think about injuring," says Conterio, a patient can learn to control the impulse.

Lader and Conterio are just beginning to study their success rate. They say they've had the most positive results with the growing number of adolescents who've come to S.A.F.E. in the past two years. They also treat many people other therapists have given up on. Like heroin, self-injury is dangerously addictive. Eventually, it takes more severe harm to get the same fix.

"One of the major reasons people come to us is that they're afraid they're going to go too far and accidentally kill themselves," says Lader. "They're cutting deeper and deeper. They're going to sever veins and arteries and they're petrified of that."

But Conterio and Lader say the longer someone refrains from injuring, the greater the chance of conquering the disorder.

It's a sentiment that Dr. Favazzo would echo. "I do want to extend this message of hope that even the worst symptoms and symptomatic patients can get better," he says. "And I'm hoping we can come up with effective treatments that can hasten the process."