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Rachel is sixteen years old, and cuts herself. She takes whatever tools she can find - razor blades, utility knives, scalpels - and carves patterns on her skin. When she's finished, she stems the blood flow with toilet paper and carefully bandages the wounds. She has cut so many different shapes and designs into her arms that the scars are barely recognisable.

'I used to cut daily,' she explains, 'sometimes because of stressful events in my life, other times because of general depression and suicidal feelings, and after a while simply because I was bored and it became just something I did.'

An estimated 0.75% of the population are active self-injurers. That's one in every 130 people, a figure which excludes the culturally-sanctioned forms of mutilation such as tattoos, body-piercing and sado-masochism. It's a figure which is also comparable to the incidence of major mental illnesses such as schizophrenia and manic depressive disorders - yet the condition is rarely regarded as an illness, and sufferers are often treated unsympathetically.

Self-injury (SI) can be defined as an act which damages one's own tissue with the intent of causing injury or relieving tension. Typical behaviour ranges from biting, pulling hair, picking at scabs and punching walls, through cutting (by far the most prevalent method), burning and piercing skin, to breaking bones and rubbing dirt into open wounds.

Because these activities are rarely aired in a public context, plenty of myths surround them. For example, people assume that self-harmers are crazy or a danger to others, that they're attention-seeking and manipulative, or that they're trying to commit suicide. None of these assumptions is true, but all are efficient ways of dismissing what sufferers do rather than discovering why they need to do it.

Armando Favazza M.D., author of the ground-breaking book on self-injury, Bodies Under Siege, claims that self-harm is 'the opposite of suicide'. He was one of the first doctors to regard the condition as a syndrome in its own right, and emphasises its links with depression and compulsive behaviours such as bulimia, kleptomania and alcohol/substance abuse. These parallels are reflected in his research, which suggests that the backgrounds of self-mutilators 'often include child abuse (50-60%), and childhood illnesses and surgical procedures'.

Deb Martinson, administrator of the Bodies Under Siege (BUS) mailing list on the Internet, enhances this picture: 'The common factor seems to be an inability to deal with emotion. Self-injurers are often people who, when they were children, were told their feelings were bad, inappropriate, or inaccurate; and they have grown up not knowing how to handle feelings. SI provides a quick, dramatic release.'

She notes that studies often portray self-harmers as young, white, middle class and female, but her own experience contradicts this. 'I've talked to people on the list ranging from 13 to nearly 60, from both sexes and all walks of life. The one factor which shows up time and again is that these people didn't feel they mattered to anyone... They never felt special or important.'

In truth, there are a wide variety of factors which contribute to SI. Background influences include domestic violence, loss of a parent through death or divorce, lack of emotional warmth in childhood, hypercritical fathers, parental depression, and neglect. Common personality traits include perfectionism, disgust with one's own body, hypersensitivity to intense feelings, inability to express emotions and mood swings. There's no such thing as a 'typical' self-harmer.

It's generally accepted, however, that two to three times more women than men are likely to injure themselves. Favazza suggests this is 'because in most cultures women tend to turn their aggression inward'. Martinson sees the flip side of this argument: 'Men are socialised not to show feelings, so perhaps they have an easier time suppressing "bad" emotions...' She also offers a biological explanation. 'Serotonin abnormality is implicated in both depression and self-injury, and more women than men are depressed as well as self-injure.'

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