Runny's parents first found out that she was cutting herself when they stumbled on her trying to wash the bloodstains from her clothes.

She was 15 then. Runny (not her real name) would cut herself three to five times a week while hiding in public washrooms, or in the bathroom at home.

For the past nine years, Runny, now 24 and married, has been cutting herself intermittently. She is candid about her condition.

'When I cut, I try to cut as close as possible, like kueh lapis, to save space.'

'I also buy penknife blades in bulk', she added.

Although the frequency of her cutting has decreased since her last hospitalisation in October last year, her left arm is still a battlefield, roped with scars that are a testament to her fight against depression with psychotic features, borderline personality disorder and dissociative identity disorder.

'It started off as a response to stress and after cutting myself I felt more mellow,' said Runny.

'However, it later became so ingrained that it was almost like a default response.'

One factor that may have contributed to Runny's cutting was her non-assertiveness when bullied in school.

'It was subtle. I would be purposely excluded from activities and it got worse after I started cutting myself. Some people would look and me and say 'she's freaky', or 'here she comes again'.'

Her negative experience in school was compounded by the lack of support from her family.

'Although we live together physically, we're separated emotionally. My family preferred to leave things to the health-care professionals, and they would say things like 'hang on, your next appointment at IMH is on Friday',' said Runny.

She first visited a psychiatrist at age 15, when her secondary school referred her to the Institute of Mental Health's (IMH) Child Guidance Clinic.

At 16, she began taking five types of medication for her condition: anti-psychotic drugs, anti-depressants, tranquillisers, sleeping pills and mood stabilisers.

At 17, she was warded against her will in IMH, following a regular check-up.

She has also undergone six cycles of electroconvulsive therapy (ECT), which she said helped her.

For ECT, a patient is anaesthetised and electrodes (electric conductors) placed at each temple. Electricity is then passed through the head to induce a seizure for therapeutic effect.

Today, she is still on medication and sees two different therapists once a week: one for psychotherapy and one for medication.

However, life has not been without its bright spots.

'Someone once researched mental health with me and used the information to show me that there is hope and that this can be treated,' said Runny. That 'someone' is now her husband, Kevin, 33. They have been married for seven months.

Dr Daniel Fung, chief of the department of child and adolescent psychiatry at IMH, said that with people who self-mutilate, the intention is more important than the action. 'They may not be trying to commit suicide, it may just be a maladaptive way of dealing with emotional pain,' he said.

He also cautioned against teenagers experimenting with such methods of release.

'Cutting may start off as an experiment, but turn into an addiction.'

This article was first published in Mind Your Body, The Straits Times on Mar 12, 2008.