A: Chances are, your friend is in a lot of emotional pain and is hurting herself physically to get some kind of temporary relief from that pain. Self-mutilators inflict physical pain as a desperate way to release the emotional pain they're feeling.

Self-injurers usually say they feel empty inside, lonely, misunderstood by others, and they try to make these feelings go away by hurting themselves physically.

People who self-injure might also struggle with anxiety and depression, eating disorders, drug and alcohol abuse, and fears of being abandoned. And nearly half report being physically and/or sexually abused during childhood.

You can help your friend get help. The best solution is for her to talk to her parents or another trusted adult, such as the counselor at school.

If your friend refuses to get help, you should tell an adult you can trust. We know this sounds like going against your friend, but self-injury is serious. She can end up cutting herself so deeply that she inflicts serious or even fatal wounds. That means she can die from cutting herself. Too often, people cut a little too deeply and end up in the emergency room.

Let your friend know that you'll be there for her. But be sure that you don't keep this a secret. Even if your friend gets mad because you told someone, in the end, she will understand that you helped her through a tough time.

If you're in a crisis and are hurting yourself physically, call 911 or 1-800-SUICIDE (784-2433). To get more info on self-injury sent to you, call 1-800-DONT-CUT (366-8288) or check out the S.A.F.E. Alternatives Web site.