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Self harm - with Karina from 42nd Sreet
Our resident self-harm expert, Karina, usually answers question on askTheSite but now and again she pops in for a live chat. This time we talk about distraction techniques, what really counts as self harm and taking steps to get face to face support.
Karina: Hello everyone, we're ready for your questions.
Lindsay: Hiya. I'm 19 and have started self-harming again due to feelings and emotions becoming too much to handle. Self-harming relieves some of the pressure. I have managed to talk to someone about this and they're willing to come with me to the doctors to get some help. I'm just so worried about what is going to happen :( I don't know what to do!?
Karina: Well done for getting the courage to speak to your friend and getting the support to visit your GP. It's understandable that you feel worried, rest assured most doctors have an understanding of self harm.
What they will want to do is find out what your problems are and then direct you to the right support, which may involve getting some counselling. If you're unsure about what you want to say to your doctor you might want to write down some of the things you'd like to have answered.
Lindsay: Okay, will I have to show them?
Karina: No, you won't have to. You could ask for some basic first aid advice and he or she should be able to give this. When you say you don't know what to do - was that mainly in relation to the doctor or was this about self-harm more generally?
Lindsay: Okay thank you. It was more in general, everything.
Karina: If you don't get the support you deserve first time, please don't give up. Ask to see another doctor and there will be someone who can help you.
Karina: Just be sure to tell your doctor everything you can about what's worrying you. It's normal to feel overwhelmed when you have a lot going on and it's good to be able to talk it through.
Nadine: I've been self harming since I was 9 but over the years it's become worse and worse to the point where I've been in A&E. The thing is, I'm not sure I can stop doing it and I'm not sure I want to anymore. I've been to my GP but it's like an addiction now. I'm scared it's going to get to the point where it could be life threatening. Am I stupid?
Karina: Firstly no, you're not stupid at all. It's good that you recognise that it's escalating. Lots of young people describe self harm as becoming like an addiction. Until you can find something to replace it, it can become very difficult to give up. If you're scared it's life threatening then it's important to go to A&E as you have been.
Nadine: I've been to A&E a lot lately.
Karina: How old are you Nadine, and what support have you had in the past? I also wonder if you've had times in the past when you've been able to stop - and what has happened when you've been to your GP?
Nadine: I'm 17. I've only had online counselling. My GP put me on antidepressants.
Karina: A couple of therapies we could recommend are CBT (Cognitive Behaviour Therapy) or DBT (Dialectical Behaviour Therapy), both of which are recognised to help with self-harm and can be offered with referral from your GP.
It seems to me that because you're going to a GP and to A&E that there is a need for you to access face-to-face support to improve the level of support you're getting. Online support helps in first steps - but to move forwards getting that extra offline support is really important.
Nadine: He referred me to CAMHS but after six months with still no appointment they said there isn't enough funding.
Karina: Do you have a friend or advocate who can go back to the doctor with you as it sounds like it's really important for you to get this appointment.
Nadine: I don't really have friends in my city.
sara: My friend rung up and referred me to CAMHS, it took a lot of persuasion, but if you're willing to accept help, they'll do a risk assessment and hopefully see you. Well, that's how it was with me.
Karina: Thanks for that insight sara. It may also be that the hospital will give you a mental health assessment when you go to A&E.
Lisa: Don't hospitals have to give you one now?
Karina: Yes you're right Lisa, that's how it should be working in hospitals.
Nadine: We had a form sent out to fill in and we sent that back to them.
Karina: If you've sent the form then it's worth following it up with a phone call.
Nadine: I did (well my hostel worker did) and they said I've been dismissed because there isn't enough funding for me.
Karina: You could see if the hostel worker can be your advocate. Tell her about some of the things we've talked about tonight and see if she can help you find voluntary help in the area. Having said that, it's also worth going back to the GP to tell them what CAMHS have said to see if the GP can help you get the appointment
Patrick - TheSite mod: Thanks for sharing your experiences Nadine. It's really brave and helpful for the whole group to learn what to do in that kind of situation when you're trying to get the support you need.
daisy: Hello. Does the term self-harm constitute any action that causes injury to yourself or does self-harm only mean the more traditional sense of the word?
Karina: Hello daisy, do you mean accidental action as opposed to intentional?
daisy: No, I still meant intentional. I meant like punching walls in comparison to cutting, etc.
Karina: The 'What is self harm' article here on TheSite sums up our understanding of self-harm : "While self-cutting is the most common form of self-harm, perhaps affecting as many as one in 15 young people, it is not the only one. Truth Hurts describes self-harm as "a wide range of things that people do to themselves in a deliberate and usually hidden way, which are damaging".
daisy: Thanks :)
Karina: Really it's about intention and we recognise it serves a purpose. It's often transferring the emotional pain into physical pain. Although, this is by no means the only function.
daisy: I agree with that. I find I do things to vent my anger as well which is probably not the best idea.
"Understanding what the purpose of your self harm is can help you identify the kinds of distractions that suit you. If it's about anger and frustration then it could be doing something physical. If it's about attention for yourself then it could be about having a nice warm bath. If it's about needing a release it could be about phoning a friend or writing your feelings in a blog."
Lisa: How do you know when it's too deep or gone too far?
Karina: It depends on what the self-harm is but generally people tend to know when it's gone too far. If it's cutting and it won't stop bleeding no matter what you do then that's a sign it's gone too far. If you feel it's out of control and it links to suicidal thoughts, then that's often a sign it's gone too far and you need to get help.
Lisa: But some people don't realise?
Karina: That's true, if asking this question relates to feelings that things are getting out of control then it's important that you trust yourself and act on those feelings and get some help.
Lisa: Yes, I'm trying to access it, thank you :)
Karina: If you're feeling like things might be getting out of control then seeking help is a good next step - you deserve to do that no matter what stage you're at. It doesn't have to be at the most serious point for you to get help in managing things.
sara: Karina, would it be possible to go to 42nd street for advice etc? I've been there before for something else and it seems a really supportive place.
Karina: Yes, you're welcome any time :) In terms of long-term support we support young people in Manchester, Salford and Trafford - if you were to drop in though we would be able to have a chat.
Ben: Hi Karina, lately I've been hitting my arm when I've been angry with myself or felt that I've let myself down in a situation (I think this is still classed as self harm). Are there any methods I could use instead of this?
Charlie: I've self-harmed for years on and off. Things got better but now they have gotten worse again. I have used distraction techniques in the past but they don't seem to be helping at the minute. I have had quite a few relapses recently, I just don't know what to do anymore?
Karina: Thanks for your questions. The important thing is to try and understand why you're feeling the need to hurt yourself. So Ben, you talk about being angry with yourself - so it may be that you do something quite energetic as a distraction. Something physical, like hitting or punching through a martial arts class, or throwing stones into water - that kind of thing might help. Running is another good one.
Ben: Thank you :)
Karina: Ultimately it would be important to get some support around anger management and work through what might be causing it.
With you Charlie, well done for managing to stop self-harming. Often we focus on relapses but actually you've done really well to stop previously even when you've been doing it for years. When you're in emotional distress it can be really hard to focus on those distraction techniques.
Charlie: Yeah, I stopped but then started again, so it doesn't really feel like an achievement.
Karina: Understanding what the purpose of your self harm is (similarly to Ben), can help you identify the kinds of distractions that suit you. If it's about anger/frustration then it could be doing something physical. If it's about attention for yourself then it could be about having a nice warm bath. If it's about needing a release it could be about phoning a friend or writing your feelings in a blog - does that make sense?
Milly: There is also a reward method you can use to resist the urge to self harm. You buy a thread and a few pretty beads, every time you resist the urge to self harm you put a bead on the thread, eventually you end up with a bracelet/necklace and you've also resisted the urge.
Karina: That's a great technique Milly :) Also Charlie, try and think about the time that you did stop and the sense of achievement you felt at that time - this might inspire you to try and stop again.
sara: I light candles when I feel the urge to self harm.
Milly: You can also use a sort of emergency box for when you get the urge to self harm. Get a shoe box or something similar and put things that make you happy in there like photographs or letters, maybe a food you like (that won't go off) or a teddy or something and go to the box when you're feeling like you want to hurt yourself.
Sal: Great idea :D
Karina: Lovely idea. We'll share that with the young people we work with at 42nd Street
Charlie: Thanks for the advice guys.
Patrick - TheSite mod: Thanks all, time for one last question from Sal.
Sal: When two people are in love and they have a fight, they hit each other sometimes, is that also self harm? A friend of mine and her boyfriend are so much in love but, sometimes they fight and he hits her. Sometimes she would hit him back but now they don't hit each other anymore. Does all this fall under self harm? And, do people remember such things and hold grudges throughout a relationship?
Karina: What we don't want to do is label everything that people do as self-harm. Sometimes it's important that we define for ourselves what we want to call it.
Sal: I agree :)
Karina: It sounds like there's an abusive side to this relationship and maybe where you're coming from in terms of 'self-harm' is thinking about the harm someone causes for themselves when they abuse their partner... is that where you're coming from?
Sal: It's a friend of a friend. She and her boyfriend are now in long distance relationship and they hardly fight when they meet and no longer hit one another.
Karina: This sounds like it's more of a relationship issue than a self-harm one by our definition - it's good she has a friend to confide in.
Sal: Thanks Karina :)
Patrick - TheSite mod: You can see more information about where Karina works here: 42nd Street.
sara: Thank you, Karina & Patrick! :)
Sal: Thank you so much karina and Patrick for this lovely chat :)
daisy: Thanks :)
Charlie: Thanks Guys :)
Karina: Take care, bye bye :)