Happily married with two children, she was a popular schoolteacher and a pillar of her community.
But in secret, *Paula used a razor blade to slit her gums and the palms of her hands, pulled out clumps of her hair and binged on food and alcohol, often drinking herself to sleep.
"She was so high-functioning, so incredibly articulate and so highly respectable - but she had a whole secret life," recalls US psychotherapist and author, Lisa Ferentz, who has run a successful psychotherapy practice in Baltimore for 29 years and worked as a clinical instructor at the Department of Family and Community Medicine with the University of Maryland's School of Medicine until 2012.
"If you saw her on the street or in the classroom, you wouldn't suspect that she was cutting the palms of her hands."
*Paula, says Ferentz, is one of thousands of people who are outwardly high-functioning and successful - but who secretly engage in self-inflicted violence through binge-eating, cutting, hair-pulling (Trichotillomania) and other damaging behaviours.
"These people are well-educated. They have very good jobs, can be married with children and can be pillars of the community," explains Ferentz, a former adjunct professor in the University of Maryland School of Social Work.
Yet they engage in self-destructive behaviour, which she warns, is secretive and has a strong shame-based element - if anyone noticed a cut on *Paula's hands for example, she would explain it away by saying she accidentally cut it on a knife after plunging her hands into a sink full of soapy water
"The majority of people who do this are functioning well in the world - and that in itself is troubling, because they often fall through the cracks and don't get the help they need."
Many never seek help for the problem, which, Ferentz says, covers a wide range of harmful behaviour, despite a common public perception that it is primarily about cutting the skin.
Self-harming, she believes, can include everything from eating disorders like bingeing or purging, to many forms of addiction such as porn addiction, as well as Trichotillomania or scratching of the skin.
Although many people mistakenly confuse self-destructive behaviour with suicide attempts, she says it's actually not lethal - although it is deliberate, intentional, designed to cause physical pain and alleviate emotional distress.
It's a very complex issue, says Ferentz, who has just published a book on the problem, Letting Go of Self-Destructive Behaviors: A Workbook of Hope and Healing, which was written for several journals and publications.
"Here you are, doing something that is intrinsically harmful to the body, yet the number one motivation is to feel better. That's why it's so confusing," observes Ferentz, a clinical consultant specialising in trauma for 24 years and founder of the Institute for Advanced Psychotherapy Training and Education.
What drives these behaviours, she says, is a desire to relieve what she causes "terrible psychic pain and discomfort".
And short-term, simple biology means that people will indeed experience relief as a result of such self-destructive behaviour.
"The brain is wired to release endorphins - naturally occurring opiates - in the body. Therefore, if someone cuts themselves, for example, their brain releases endorphins in an attempt to stave off the pain.
"They get a kind of euphoric rush so there is a positive outcome."
Take another client, 15-year-old *Sonia, for example, a stunningly beautiful A-student and successful athlete.
Yet her wealthy, high-flying parents came home from a weekend away to find her lying drunk and incoherent on the floor.
Sonia had been cutting herself and picking at the skin around her lips until it was raw and sore for a lengthy period of time - but until that moment her busy, affluent parents hadn't noticed anything was wrong.
Children and teenagers may hear about a peer's engagement in self-harming - or learn about it on a website and engage in the practise when they are 'triggered' to feel anxious or overwhelmed.
*Joseph, a male nurse in his 30s, head of his hospital unit was an outwardly happy father-of-four - his method of self-destruction was to log on to Craigslist and hook up with male strangers for un-protected sex.
"It was an incredibly dangerous form of self-harm, and yet he was very intelligent, articulate and well-educated," says Ferentz.
Joseph also had an addiction to internet porn which only came to light when his wife discovered he'd charged thousands of dollars to a credit card.
Generally this behaviour has its root in a trauma of some kind, believes Ferentz - a child who is being intensely bullied or people who may have been sexually or physically abused or who experience domestic violence.
"About 50pc of people who self-harm have a history of trauma, abuse and neglect."
The other 50pc, she says will have a "pain narrative", which can involve something that causes hurt - it may be bullying at work for example, the incarceration of a family member, or bereavement.
"People don't do this for no reason, particularly people who do it chronically.
"Overwhelming numbers of these people don't get medical attention and they have been doing it for years," she says, adding that so many fly "under the radar" because what they are doing is not life-threatening.
"They may be cutting themselves, and cleaning themselves up or secretly bingeing and purging."
In the case of Paula, who is now in her mid-40s, it took years of therapy before she was able to recall that her father had sexually abused her between the ages of eight and 15.
"The way in which people cut themselves will often connect to their story. People show us their trauma with their bodies," she says.
Therefore, says Ferentz, Paula's obesity was a shield which she unconsciously felt made her sexually unavailable, and she cut her hands in particular as it related to the abuse she suffered.
Sonia was enduring extreme cyber-bullying - but because her parents were so successful, so busy and so deeply involved in the community, she was unable to talk to them about the torture to which she was being subjected, says Ferentz.
"She was cutting and excessively drinking to numb the pain, and started picking at the skin around her lips making it raw - to me, that was a metaphor that there was nobody to talk to. She also became quite sexually promiscuous."
Joseph was a former soldier who, it emerged suffered from Post-Traumatic Stress Disorder and who had grown up in a violent, alcoholic family in which he was viciously physically abused. His behaviour, says Ferentz, was a way of "enacting" a total disregard for his body.
A lot of these behaviours can become very pathological, says Ferentz, who warns that often the victim can be identified as the 'sick' member of their family, which they often are not.
Such people are often simply the 'squeaky wheels', she says, the ones who let us know there are serious issue to be dealt with.
But how do you deal with it?
First, Ferentz believes, the shame-based element must be removed. "When you hate yourself it makes sense to hurt yourself," she explains, and this then fuels the shame.
"The crucial thing is to help people move away from shame and replace it with self-compassion."
Ferentz approaches such behaviours not as a form of mental illness, she says, but as "inevitable creative coping strategies".
The client is then encouraged to focus on alternative protective coping strategies, which are brought into play when the self-destructive behaviour is 'triggered'. It's about finding new ways to soothe the pain, she explains.
An important part of dealing with all of this is to understand the triggers, and giving people new ways of coping with them.
"Trauma is not stored in the language part of the brain. It is stored visually and viscerally in the body," she explains, so it can take time to identify them.
It's important to understand, Ferentz says, that trauma is not stored in the language part of the brain, but visually, and viscerally, deep within the body.
Because the trauma is sensory, and not stored in 'language', talk therapy is not always appropriate, so therapy in such cases is often done through art. "This could be everything from choosing different colours, to something like scribbling or being able to do drawings of the pain narrative."
The objective of the treatment is to help the client find other ways to communicate, experience relief and self-soothe, she explains. Therefore, alternative methods of healthy communication could be through writing, drawing or speaking, while endorphin release can be achieved through hugging a pillow, holding a pet or even laughter: "I encourage patients to look at a YouTube picture of a baby laughing," she says.
To self-soothe, Ferenz will recommend activities such as listening to music, taking a warm shower, and repeating positive affirmations. "Your trauma is never your fault, but it is your responsibility to heal it."
*Not their real names.
'Letting Go of Self-Destructive Behaviors: A Workbook of Hope and Healing' by Lisa Ferentz, published by Routledge, €28.