The nerves of the skin send pain signals to the brain to warn us of the danger from and impending injury. In the case of self-inflicted wounding, this pain acts as the body's own defense mechanism to stop one from proceeding in the effort at physical injury. If a person proceeds despite the pain, that means that he or she is motivated by something stronger than the pain, something that makes him or her capable of ignoring or enduring it.

Self-mutilation is a frightening barrier that keeps us from seeing a person who is lost, in pain, and in desperate need of help.

She began to be reassured by these pains, tangible symbols of her success in becoming thinner than anyone else. Her only identity was being "the skinniest." She had to feel it.

She ran her hands over her body as if to bid it good-bye. The hipbones rising from a shrunken stomach were razor-sharp. Would they be lost in a sea of fat? She counted her ribs bone by bone. Where would they go?

From the newsstands a dozen models smiled up at her from a dozen magazine covers, smiled in thin-faced, high-cheekboned agreement to Kessa's new discovery. They knew the secret too. They knew thin was good, thin was strong; thin was safe.

She'd lost two more pounds. A picture of the models she'd cut out of the magazine flashed through Kessa's mind. And the winner is... seventy-three!

Repetition brings familiarity, and familiarity is the opposite of the unknown.