" Since many cutters come from enmeshed families—where identity, family role, and boundary are confused—the task of establishing an independent identity is much more difficult. And if a girl has only a tenuous internal representation of herself to begin with, she may fear that the physical changes wrought by puberty will make her into someone else—a stranger unrecognizable even to herself. "

― Marilee Strong , A Bright Red Scream: Self-Mutilation and the Language of Pain