This is a tricky topic. I believe it is a symptom, not a cause. That said, I still feel the shame and stigma. I'm an adult; I mean, really, an adult, and I should have given up such behavior as a teenager. At least, I tell myself this, until I do something drastic; again. I use this as a means of coping with the anger, the anxiety, the hate, and the hopelessness. I find that once I see blood, I can take a few deep breaths, and function again. The problem is the tendency is engrained in my mind, and when I do something truly drastic, such as drinking, my actions of 'making blood' become much more detrimental. I am interested to know if this is a common occurrence amongst adults of advanced age (which group I have to place myself in, though I still think I'm twenty-one half the time). Perhaps I simply don't want to feel so alone.