Last year, school social worker Lisa Baker saw maybe two cases of it all year.

So far this year, she's seen 30.

"I would call it an epidemic at this point," she said.

The South Butler School District social worker doesn't mean drugs or alcohol abuse.

What's so alarmingly on the rise in her district is the act known as

"

cutting.

"

Cutting is a form of self-mutilation that tends to appear most in teens and young adults. Those who do it will cause deliberate cutting-style injuries to themselves as a way to release emotional stress.

"I have three or more cases of it being brought to my attention each week," Baker said. "It's really scary."

There's no one reason why people - especially teenagers - cut themselves.Research has shown most teens will do it when they are severely depressed or in great emotional pain."The emotional pain they're feeling sometimes is overwhelming, and I've had people tell me (cutting) is a way to be in charge of their pain," said Gretchen Crum, a child and family therapy services clinical supervisor for Children's Hospital in Pittsburgh.Through cutting, teens have control over how much they cut themselves, and how deep - and then will often watch it heal, Crum said. "They can't always heal so easily from emotional pain or trauma," she said.Other experts agree with Crum. "Cutting is usually a symptom of a larger problem," said Elaine Seth, Center for Community Resources behavioral health director. "If a kid is cutting, there's a problem."Neither Seth nor Crum has seen teens cutting as a means to fit in with their peers, but the STAR Center in Pittsburgh reports quite the opposite.The center is a service for teens at risk and is run through the Western Pennsylvania Psychiatric Hospital in Pittsburgh.In a publication about cutting, the center states that sometimes cutting is done as a means to imitate others that self-injure in order to fit in, to appear tough or to satisfy their curiosity.Baker agrees with that assessment."The bulk of kids who are doing it are doing it for the emotional release," Baker said. "But there is another group that are doing it to be a part of the crowd, or just to prove they're tough or just because they're curious and they want to do it if they've seen their friends doing it."Seth said while cutting is associated with other mental or physical conditions, cutting is one way stress from those situations is released."Most teens who are cutting are doing so because of an underlying depression," Seth said. "One out of every eight kids in their teens have clinical depression."Seth said three distinct emotions are expressed when kids cut themselves: anger, sadness and guilt. "They'll say the cutting relieves the pain, even if just for awhile," Seth said.Baker said she can usually tell the real cutters from the imitators. Imitators generally do not cut very deep or very often, while true cutters will cut deep and frequently."(Imitators) are able to stop more easily once they're confronted with it, because it wasn't really a release for them like it is with true cutters," she said.Whether she believes a student is a true cutter or just an imitator, Baker said she deals with all of them in the same way. First the student is brought to her office for consultation, and then the student's parents are called and told about the problem."Most of the parents, when they're told, are mortified, because they knew nothing about it and don't even know what it is," she said. "But they are very quick to get their kids help."

Doctors and clinicians used to believe cutting had only one reason behind it - sexual abuse."There used to be a belief that everyone who self-mutilated was sexually abused, and that's not the case anymore," Crum said.Seth agreed, saying cutting tends to occur mostly in teens and young adults, and often is the result of an underlying depression. That depression can be caused by more than sexual abuse, she said.Dr. Hari Vemulapalli, a psychiatrist with Butler Memorial Hospital, said dysfunctional families seem to be a common thread for teens and young adults who cut themselves.The National Mental Health Association reports most teens who cut also have low self-esteem.Some clinicians believe cutting is a precursor to suicide, while others say it is a way to avoid suicide while still escaping overwhelming emotional pain.The STAR Center stands by the belief that teens who cut are doing so because they want to relieve their emotional pain without taking the final step of committing suicide.Information published by the center says, "Rather than wanting to die, students report wanting the pain to go away. Self-injury temporarily may alleviate such feelings."Crum said she thinks some teens use cutting as a way to test the waters for suicide and see if it's something they could actually do."It's sort of a way for them to flirt with the idea of suicide," she said.Vemulapalli agreed. "This is typically what we call a para-suicidal personality," he said. "Historically, we believed (kids) were not capable of committing suicide, but now we're finding this is not true because suicides for ages 15 to 19 have quadrupled over the last few years."Baker said she has seen students cut for all kinds of reasons and there seems to be no set pattern."I have one student who cuts herself every time something in her life doesn't go well, be that a fight with her parents or failing a test at school," Baker said. "She feels something (when she cuts), and that relieves the emotional side of it."Friends, school and the pressures of being a teen often are the reasons Baker hears when counseling students about cutting."This can be like a self-medication for these kids," she said.

Cutting is not a new phenomenon. It has been around for decades. But many people still are unaware of its existence, including parents, teachers and other adults who often come into contact with those most likely to be cutting.Cutting is more likely to start in adolescence than in an older person, but it can continue into the adult years if not treated, Crum said.And although teens can go to great lengths to hide their cutting habits - including wearing long sleeves and pants in the summer - Crum said warning signals can indicate a child may be cutting."You need to be on alert for the signs of depression," she said. "You need to have time every day to talk to your kids … to make sure we have a relationship with our kids."Seth said cutting isn't the only way kids self-mutilate. Some of them also will bruise themselves repeatedly or cause small abrasions and not let them scab over and heal.Parents need to be on the lookout for the common signs of depression, since they are closely related to symptoms of cutting.Among those signs are unexplained frequent injuries including cuts, burns and bruising; wearing long pants and sleeves, even in warm weather; low self-esteem; difficulty handling feelings and explosive emotional outbursts; relationship problems; and the inability to function normally at everyday tasks such as school and work."You always want to pay attention so you can get the kid assessed and get them help," Seth said.Baker said teachers in the South Butler district have the opportunity to attend an awareness program on cutting this week at the school, but attendance is strictly voluntary."I hope many of them are interested enough to attend, because this is a serious issue, and they need to be aware of it," Baker said. "Many of them don't even know what it is. I'll say 'cutting' and they think I mean (students are) cutting class."Baker said she'd also like to have an assembly for the student body concerning the issue later this year."It's distressing how many new kids come in with this every day," she said.

If a parent, friend or teacher suspects a child may be cutting, there are steps that should be taken immediately, Crum said."They should get an evaluation by a qualified mental health provider right away," Crum said.A pediatrician may not be best equipped to handle such cases, so Crum recommended a mental health organization or a child psychologist.Seth said there are many places to turn for help, including the STAR Center, the Irene Stacy Community Mental Health Center in Butler and her agency, the Center for Community Resources in Butler.Vemulapalli said BMH has crisis counselors on call in the emergency room who are trained to deal with cutting victims. For those who are not treated at BMH, Vemulapalli recommends individual or group therapy and medication in some cases to help control the depression that can lead to cutting.More than just the emotional aspect of cutting is helping those afflicted with the disorder recover from the physical scars associated with it.Infection of cuts, spreading of communicable diseases such as hepatitis if kids share cutting devices and scarring are among the physical repercussions, Seth said."If you cut deep enough, it will definitely leave lasting scars," Seth said.Baker said a lot of her students, when confronted with the problem, will find many creative reasons for their injuries before admitting the truth."Some of them will finally admit it when I tell them I know the cat didn't really scratch them," Baker said. "But others don't, so that's why I get the family involved to get that child into counseling."While there are many acceptable reactions to finding out someone you know is cutting, Crum said ignoring the problem is not one of them."A lot of parents or people will say they're just doing it for attention, and that scares me," Crum said. "What they need is professional attention."