Despite the growing attention to self-injury in recent years, there’s nothing new about body modification.

From ancient rituals practiced among Australian Aborigines to the decorative scarring still seen today among African tribes, body modification has its place in history, most often in the context of adolescent rites of passage.

“In most cultures and most societies, there always is some type of a mark that is left on the individual as they go from childhood to adulthood,” said Eric Kuntz, a child and adolescent psychiatrist at Acadia Hospital in Bangor.

Ranging from mutilation of the body to the pre-Vatican II symbolic slap on the cheek of Catholic confirmation ceremonies, adolescent initiation rites are a public display designed to establish one’s place in society. The increasingly popular body art of today, such as tattooing, skin piercing and even branding, similarly is meant to make a statement about one’s individuality.

That’s where self-injury and body modification diverge.

People who intentionally hurt themselves typically act impulsively to relieve emotional distress, often secretly and with great shame, Kuntz said. Though self-injurers sometimes show their wounds to a loved one or trusted professional, showing off rarely is a motivation, he said.

Those who tattoo or pierce their bodies do it for adornment, a visual statement for others to witness.

The role of society in the recent rise in body art and self-injury is hard to ignore, said Pam Braley, a clinical therapist and licensed social worker at New Horizons for Young Women, a camp near Lincoln for troubled adolescent girls.

“Tattoos and piercings are so in, in some ways [self-injury] seems like an extension of that,” she said.

“We have a peer culture that supports skin piercing, tattoos, going back to our early primitive primal instincts,” she added later.

While the arms are most often the site of self-cutting, injury to other areas of the body, such as the genitals, can signify an attempt to deal with specific emotional trauma, such as sexual abuse, Kuntz said.

A more recent form of self-injury is the use of an eraser for excoriation, to scratch or rub off a layer of skin, Kuntz said.

“That is actually something that is fairly recent, just over the last couple of years,” he said. “And it appears to be almost a contagion effect, so we will not see it for a number of months, and then we’ll see … one episode; then we’ll see five or 10 more [cases], 20 more, and then it will kind of drop off again.”

Treatment for people who self-injure varies depending on the root of the trauma, Kuntz said.

In all cases, however, patients must develop another way to cope with the emotional pain that drives them to hurt their bodies, he said.

“You have to find out what is the one reason or five reasons for the cutting,” Kuntz said. “And just stopping the cutting behavior itself often will not resolve the problem. It will re-emerge in another form.”

“A lot depends on whether they want to stop,” Braley said.