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"I think what the film does is portray very well the life of a disturbed teenager," said Dr. David Feinberg, a UCLA child psychiatrist... 

Even among 13-year-olds, around 80 percent have no problems with family or peers, says Feinberg. "It's really a small minority of people, but those are the kind of people I see."

"Some girls go through this. Most don't," agrees Don Elium, a Walnut Creek family therapist and the co-author, along with Jeanne Elium, of the book "Raising a Daughter."

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Evan Rachel Wood [left] says the sexual moments [she portrayed in "Thirteen"] ended up being the least difficult.

There is a moment where her character cuts herself "and those cutting scenes were really, really difficult because when somebody does that, it's something that's really private which you do by yourself, and you're also at your most vulnerable point. So to do that in front of a lot of people is really difficult."

She explained in a 2000 Maxim article, "You're young, you're crazy, you're in bed and you've got knives. So sh*t happens." 

But in 1999 Access Hollywood interview she explained it more in-depth, "I was.. trying to feel something.... I was looking at different things.. thinking romantically about blood. I really hurt myself," and also said, "I was just.. a kid. I was like 13, 

"And, I was saying that it is not something that is cool. Its not cool. And I understand that it is a cry for help..."

In a 2000 Jane interview she said, "I met somebody who said they'd seen movies of mine and then showed me where they had cut themselves. 

I had to explain, first off, not to do that. But it made me really f***ing angry at the people who represent me in a way that would get that person to do that and show me.

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Angelina has the Japanese symbol for "death" tattooed on her shoulder, and the Latin words, 'Quod me nutrit me destruit,' on her stomach, meaning "What nourishes me also destroys me."

We all do things that aren't good for us and that may harm us. We also do things that inflict injury but that are primarily intended for other purposes. Some self-harm is culturally sanctioned, while other types are seen as pathological. Where does one draw lines?

An easy line to draw is that of deliberate, immediate physical harm being done. For example, cutting your arm or hitting yourself with a hammer are clearly self-injurious acts. 

Things like overeating, smoking, not exercising, etc., are harmful to a person in the long run but immediate physical damage is not the desired effect of the behaviors. 

What, then, about things like tattooing and piercing, where physical modification of the body is deliberate and is the desired effect?

The first step in classifying self-harm, as demonstrated by Favazza (1996) [book: Bodies Under Siege..], is to sort out what makes a type of self-injury pathological, as opposed to culturally-sanctioned. 

Socially sanctioned self-harm, he found, falls into two groups: rituals and practices. Body modification (piercings, tattoos, etc) can fall into either class.

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"I was convinced I had absolutely no talent at all. For nothing. And that thought took away all my ambition too." 

Even today he still has feelings of insecurity about himself. In 1999 he said, "My self-image it still isn't that alright. No matter how famous I am, no matter how many people go to see my movies, I still have the idea that I'm that pale no-hoper that I used to be." ...

He dropped out of high school at the age of sixteen so that he could concentrate on being a musician. He continued to have problems with drugs and drinking into his twenties.

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In a Talk magazine interview he said, "It was really just whatever [times when he hurt himself] -- good times, bad times, it didn't matter. There was no ceremony. It wasn't like 'Okay, this just happened, I have to go hack a piece of my flesh off.'"

In a 1993 Details magazine interview Johnny explained his self-injury, "My body is a journal in a way. It's like what sailors used to do, where every tattoo meant something, a specific time in your life when you make a mark on yourself, whether you do it yourself with a knife or with a professional tattoo artist."

The study, commissioned by the Samaritans and conducted by the Centre for Suicide Research at Oxford University, found youngsters were more likely to harm themselves if they had friends who had already done so. 

Each year in the UK more than 24,000 teenagers are admitted to hospital after deliberately harming themselves. 

In total, more than 6,000 pupils aged 15 and 16 were quizzed from 41 schools across England. They were asked about suicidal thoughts and self-harming behaviour. 

The survey found that young people who harm themselves often have difficulty coping with everyday problems.

Rather than employing positive strategies such as talking to someone about the situation, they were more likely to blame themselves, sit in their room or drink alcohol. 

They also felt that they had fewer people to turn to for help. For example, only 20% of those who self harmed felt they could speak to a teacher about something that was really bothering them.

People who self-harm were shown by the survey to be more anxious, depressed and to have lower self esteem than those who do not.

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The most common problems faced by the pupils related to schoolwork, followed by difficulties with parents.

Only a small proportion - 13% - of self-harm episodes result in a hospital visit The favoured method is cutting or overdosing Girls were nearly four times as likely to engage in self-harm as boys.

Marjorie Wallace, chief executive of mental health charity Sane, said: "Sadly these findings do not surprise us. Results from our own research shows that while over half of those who self-harm were on medication, less than a fifth were receiving counselling or therapy. Clearly, the underlying reasons for people self-harming are not being addressed."

That was messed up. I was a zombie for a while. Over the years, they've put me on and taken me off of different medicines. ... I definitely think prescription drugs have helped me. ...  Alison, age 17

In addition to Shirley Manson and Elizabeth Wurtzel, other public figures that are reported to have engaged in self-injury include Angelina Jolie, Christina Ricci, Princess Diana, Johnny Depp, Courtney Love and Fiona Apple [right].           [PR Newswire, May 30, 2000]

In an US magazine interview Christina Ricci explains a small, smile-shaped scar on her hand.

"I was trying to impress Gaby [Hoffmann, her best friend]. So I heated up a lighter and pressed it on my hand."

She reveals other burn scars on her arms and says, "I wanted to see if I can handle pain. It's sort of an experiment to see if I can handle pain."

In another interview she reveals that she sometimes puts cigarettes out on her arms.

When asked if it hurts she replies, "No. You get this endorphin rush. You can actually faint from pain. It takes a second, a little sting, and then it's like you really don't feel anything. It's calming actually."

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Scratches on her forearms come from fingernails and soda tops. She explains, "It's like having a drink. But it's quicker. You know how your brain shuts down from pain? The pain would be so bad, it would force my body to slow down, and I wouldn't be as anxious. It made me calm."

It is always February in the seventh grade, that terrible border year, that dangerous liminal interlude.

Until the moment of my apprehension, I didn't once think, People will find this odd. How could they?

The way it courses through its endless circuit of comings and goings, slipping and rushing and seeping down to the cells of us, the intimate insider that knows all the news, that's been down to the mailroom and up to the boardroom. ... 

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There was a very fine, an elegant pain. In the razor's wake, the skin melted away... then the blood welled up... the chaos in my head spun itself into a silk of silence.

I kept cutting because it worked. When I cut I felt better, I stopped cutting because I always could have stopped cutting.