Dr. Sony Khemlani: We actually first had the idea to do a handbook for adolescents but then it turned into a parent guide. There's nothing like this out there, and we constantly get questions from parents on how to handle this issue.

Dr. Neziroglu: It's a step-by-step guide on how to talk to a child who self-injures and how to recognize symptoms of self-injury.

Dr. McVey: I think self-injury has existed since the dawn of time but in different forms. It existed prehistorically in tribal scarification rites that occurred at puberty. We see it in primitive cultures today, and I think it's always been around but been kept hush-hush.

In talking to kids, they tell us that media figures are coming out about their own self-injury. Once something becomes mainstream, people are more comfortable talking about it.

However, now that more people are discussing self-injury, there are those individuals who learn about it and have a predisposition for it. The idea of it resonates with them.

Dr. Khemlani: I actually had a patient who was in the same hospital room with her [referring to Dr. McVey] patient. She never had the idea to self-injure until she met Merry's patient.

Dr. McVey: [Sarcastically] Oh, great.

Dr. Neziroglu: I think in the schools it's the same thing. The kids see someone else doing it and then imitate the behavior.

Dr. McVey: That's why the schools are getting so panicked about it. Copycat-cutting seems to be a big phenomenon.

There are kids who will try it and it doesn't feel good to them; they're not biologically set up for it. Then there are the kids who try it and it feels a little too good, and by the 20th or 30th cut they are addicted, because it's tapping into the pleasure center of their brain. They're feeling relief, and they're feeling emotional release. And it becomes extremely problematic. Once it becomes a habitual behavior, it's harder to stop.

Dr. Khemlani: How to recognize if your child is cutting? It's not usually one symptom but a cluster. Watch for a change in the pattern of their behavior. Lots of the symptoms individually are normal for adolescents.

So watch for changes in their mood - they may be more isolative and begin socializing with a different group of friends. Look for changes in their clothing - wearing items that camouflage parts of their body, like big bracelets. They may quit sports and other activities in which they used to be very engaged. Not going swimming, refusing to go to the pediatrician …

Dr. Neziroglu: You'll see a lot of avoidance behaviors. These kids feel alone and isolated. They may appear to have lots of friends and have popularity among their peers, but they don't feel connected to anyone.

Dr. McVey: Watch if your child is showing impaired judgment, increased impulsivity and engaging in high-risk behaviors, like risky sex, alcohol or drug use, driving too fast - those are risk factors.

Also, when we see children with a history of eating disorders or sexual abuse, we immediately evaluate for self-injury. Kids with an eating disorder are at 35 percent more risk for self-injury. If they have been sexually abused, they are seven times more likely to engage in self-injury as adolescents.

Dr. McVey: Children who are very dissatisfied with their body - that seems to be one of the most common variables. There is the feeling that the body is the enemy. Kids who have extremely high anxiety about their appearance may be at risk.

Dr. Khemlani: Kids who are perfectionists - they're the straight A students, the best of the best. But they feel that nothing is ever good enough.

Dr. Neziroglu: What is most important for parents to know is that cutting does not involve just one type of kid, and it may not be for any one specific reason.

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