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Self-harm chat with Karina & Hannes
Karina and Hannes from 42nd Street drop in to answer your questions on panic attacks, self-harm scars, helping a friend who self-harms, confidentiality and more.
franki: Hi Karina, my question isn't directly to do with self-harm, but I was wondering if you had any tips on what to do if you can feel yourself getting a panic attack?
Karina: Hi franki. Panic attacks can be heightened by the fear you might die from or that you wont know how to stop it. The physical symptoms like feeling faint or confused can be really frightening.
franki: Yeah. It's more that I know it's coming and I don't really want it to, so I start getting worse because I'm worried about it. It's not very nice :(
Karina: Can you think about what might have helped you in the past? It helps to try and recognise those early feelings and think about making a plan to help yourself deal with it. Perhaps there are certain situations you're more likely to feel panicked in? Think about what those situations are and how you can get control back at those times.
franki: I don't really know. I try and just breathe slowly, but they've started happening more regularly. It's alright if I'm at home because they're rarely major, but I felt one coming on at work yesterday and I have no idea why it never actually arrived.
Karina: There are techniques that you can use that might help. It might sound obvious, but things like exercise, sleeping and eating well and giving yourself a pat on the back for the positive things you achieve.
franki : I wish sleeping was an option. I'm in a bit of a mess mentally at the moment and my sleep is all over the place. My appetite has completely disappeared along with my energy.
Karina: You mentioned the attack that never quite arrived at work - was there anything different going on at the time, a distraction maybe or something you told yourself at the time that helped? They may be more likely to occur at home as you feel safer there so you can let it happen. At work you might try harder to overcome it to avoid possible embarrassment for example.
If your sleep and eating patterns are all over the place it would be worth talking to someone about that or considering going to your GP.
franki: I saw my GP today but he wasn't very helpful, I kind of think I'm having a bit of a nervous breakdown.
Karina: You may have some physical symptoms from not sleeping and the lack of food that are similar to the beginnings of a panic attack - so focusing on getting those back on track and that will definitely help. Sorry to hear about the GP, I'd suggest trying to go back and maybe taking someone with you or asking to see a different GP. It's important that you look after yourself right now and get some support.
franki: I might do, he wants to see me again in two weeks, but all the advice he gave me between now and then is to go to the Citizen's Advice Bureau about my money and work issues. It's obviously much more than that going on.
Karina: I see. If those things are contributing though it may be good to try and get on top of them even if you dont feel like theyre the main problem. I also want to mention a helpline called No Panic, you can call them on 0808 8080545. They're open 10am to 10pm every day.
franki: I'm a bit phobic of phones but thank you :)
Karina: No problem, phones can be scary I know but the people on the other end are trained to help. All the best.
JimV: Thanks Karina, and cheers for the question franki - here's another question.
bleepy: Hey Karina, my friend self-harms and he doesn't know what to do to stop. Do you have any advice on how to stop self-harming?
Karina: Hi bleepy, thanks for your question. It's really great that you're supporting your friend. It's good to remember that people self-harm for their own very personal reasons, so it's about finding a solution that works for him.
There are a number of options he could try. First of all some one-to-one counselling or support if he feels like he can open up to his doctor. There's also the 15 minute technique - if he feels the urge to harm himself he can try and go 15 minutes without doing it and then try another 15 and carry on until the urge passes. Sounds simple but it can really work.
Other distraction techniques could be things like reading a book, doing something he enjoys or calling a friend he can confide in when he feels an urge. Even if he's just gone two days without self-harming then he should feel happy about that. Often people who self-harm will focus more on feeling bad about a relapse, encouraging him to think back to times when he wasn't self-harming and times when he's resisted the urge is a more positive approach.
Ultimately though, he needs to figure out the causes behind why he wants to self-harm. It's worth thinking about whether he has any triggers.
bleepy: He's said something about it being about the stress and pressure of school and he is always feeling down. I know he's told one of the teachers at school and it's taken a few months before they've even tried to do something. They're trying to find someone he can talk to in school, but he doesn't know if this will help him to stop.
Karina: That's really good to hear, he's obviously taking the right steps, that's brilliant. Knowing that he wants to stop is a really good place to be in and will get him a long way. Perhaps you could show him some of the articles on TheSite too about coping tips, distractions and getting help.
It's important that you look after yourself too bleepy, it's not always easy to support someone but just being there and offering a listening ear is really valuable. He's lucky to have such a caring friend. I hope that helps.
bleepy: Yeah it does thanks :)
Jim V: Yun was looking for advice about dealing with a combination of depression and psychosis - any advice on that?
Hannes: Sure. People who are struggling with mental health issues particularly with psychosis really need to get support from a mental health professional. Psychosis is surprisingly common in young people so mental health professionals and GPs are used to treating it.
The first stop should be your GP, who's likely to make a referral to a community mental health team in either an adult or child service. You'd then see a psychiatrist and they'd decide if there was a need for anti-psychotic medication which would help to deal with hallucinations or delusional thoughts or other symptoms.
They might suggest that you're treated with a psychologist and have psychotherapy. It's important to say that in some cases, symptoms can be severe enough for people with psychosis need to spend time in hospital for more intensive treatment and support. Other people cope well with being treated in the community by someone who might visit them in the week at a time and place that's convenient for them.
We know that psychotic experiences can be a one off and that catching the signs early produces the best outcomes. What we hear from young people is that talking to somebody who wont judge, like a counsellor or psychologist, can help to remind them that even though they're struggling with an illness they're still normal people and they can get through it.
Hellfire: Hi, I've got a question about scars, hiding them mainly. I self-harmed a lot when I was younger. Luckily I dont have a problem with that anymore; however I do have some very nasty scars on my arms. Due to my job it's not always possible to hide them with items of clothing etc., but I was wondering if you have any tips for scar reductions, especially in the cold they seem more obvious? I'd like to get rid of them before my son starts to ask questions.
Hannes: First of all it's great that you've managed to stop self-harming, it's nice to hear success stories! Understandably you're concerned about your scars and it sounds like you might be fearful of how to explain them to other people? Some people chose to try and cover their scars with clothing but you've said you can't always do that.
Hellfire: Other people not so much, however where I work it is not a subject best brought up. My son is my main concern really.
Hannes: There are various treatments, some are simple and some are more long term. A lot of people find that the simplest and easiest way is to use a camouflage cream which can be easily bought from a chemist. You can get advice from your GP about different ones. Are you worried about how to explain it, or do you not want your son to know that you self-harmed? Its worth thinking about that question.
Hellfire: I suppose it is. I don't really want him to know if I'm honest.
Hannes: Of course, it's hard to share something like this with your son but children are a lot less judgemental than we imagine.
Hellfire: Is there any long term option?
Hannes: No treatment can completely mask or remove scars, some treatments involve damaging the skin further to minimise the visibility of scars. I'd suggest talking to your GP and then you can weigh up the risks. A consultation with a dermatologist too might suggest different treatments like laser surgery for example.
Hellfire: Surely that's quite an expensive option?
"A lot of people find it hard to talk about how they're feeling, we've had young people write their feelings down and give it to us and it's more than fine to do. It can help to start the conversation."
Hannes: Some treatments can be expensive, but it's worth finding out what's available on the NHS as well, depending on how much the problem is troubling you in everyday life you may be able to get some treatments for free.
victoria: I was thinking about going to the doctors about self-harming because I'm finding it hard to cope. Would the doctor tell my parents that I had come?
Hannes: Thanks for your question victoria. Can I ask how old you are?
victoria: I'm 16.
Hannes: At 16 you have a right to confidentiality if you go to your GP. They wont be able to tell your parents. The only time they might is if they were really concerned that you were a significant danger to yourself or to someone else.
You don't even have to tell the receptionist what you want to see the doctor about you can just say it's a private matter.
bleepy: Would they tell your parents if you're 15?
Hannes: Not necessarily. You still have a right to confidentiality but if you're under 16 there may be child protection issues. However, your GP would discuss this with you before telling anyone at all, for example, if they thought you needed some more support in school or if they were very concerned about your situation.
victoria: What would the doctor say to me? I'm really shy and I don't know if I would be able to tell them what it was that was wrong anyway.
MM: I went to my GP about two weeks ago (not about self-harm) and she saw some of my cuts - the first person to ever see. She now wants me to see her once or twice a week. She's trying to get me to open up but I find this very hard. I do want to talk to her but I freeze and can't talk. Any ideas on how to overcome this or other ways I could tell her?
Hannes: Thanks for your questions victoria and MM, it can be hard to open up to the doctor for the first time.
Initially they will be asking you for facts to make sure you're not hurting yourself too seriously and they might also ask to see the injury. Their main concern will be how you're feeling and what might be going on for you emotionally and mentally. They might think it will be helpful for you to talk to someone and you might not feel ready, but it's OK to decline the offer if you want to.
They might also give you advice about harm reduction - that means not cutting near major veins or arteries for example - and they'll probably offer you a referral to another supportive agency or NHS health advice service. There's a video on TheSite about visiting your GP which is worth a watch. If you're finding it hard to open up then think about writing it down before you go in, it can help to plan it in your head a bit.
victoria: What if you dont want to show them the injuries? Also I'm worried they'll think that it's because of family problems that I'm feeling upset, but I was upset before that so I'm really confused.
Hannes: Your GP will want to examine your injuries but this is to make sure you get the best support and treatment that you might need. You don't have to show them if you're not ready though, no one's going to force you.
When it comes to talking, try to just be honest. Tell them you feel awkward or you're not sure what to say. Most doctors have come across self-harm in their careers, there's very little you can tell them that would be a big surprise to them.
You can also request another GP if you don't feel at ease talking to the one you've got or think that they're making assumptions about you. If you want to talk to someone else other than your GP, there are other confidential services you can use - like a youth support organisation you could find out about through something like Connexions - they might suggest the GP eventually but they'll support you in doing this when you're ready.
victoria: OK, thanks.
MM: Could I write something down and just give it to her?
Hannes: Yes, you can do that. Our experience is that a lot of people find it hard to talk about how they're feeling, we've had young people write their feelings down and give it to us and it's more than fine to do. It can help to start the conversation.
MM: I will try that when I see her next thank you :-)
Hannes: I hope that helps, we're going to get one last question in now I think.
anon: There's a boy in my year who self-harms when he's at school. I hate it, and really don't think its right that he does it in front of people. I spoke to a teacher about it, but she seemed to think I only found it a problem because I had self-harmed in the past. In fact I just think its wrong. I don't know what to do.
Hannes: Hi anon, that's a tough situation for you and it's OK to feel angry about it. Everyone's experience of self-harm is different, perhaps this boy feels very alone and it's a cry for help, he wants people to see what he's going through? What we do know is that telling people to stop or putting rules or limitations on someone's self-harm can make things worse. It's important for you to continue to share your concerns with your teacher, not only to make sure he gets the right support but that you do as well.
anon: He laughs and he jokes and says stuff like "ha ha, I've got an extension because I self-harm."
Hannes: My guess would be that's bravado speaking and possibly not how he actually feels, but of course it's no fun to hear.
anon: I just hate seeing how he manipulates people.
Hannes: It's alright for you to feel upset and angry about this. It's totally understandable and his behaviour sounds like it's quite hard to stomach, especially with your own experiences of self-harm. I'd suggest trying to talk to your teachers again, perhaps get another friend to go with you?
anon: OK then, thanks.
Hannes: Look after yourself anon and hope that helps a bit.
Hannes & Karina: Thanks a lot to everyone for coming I'm afraid we're going to have to wrap things up now. Sorry we couldn't get to everyone's questions.
wardy: My daughter is self -harming and I don't know how to help her.
JimV: Hi wardy, really sorry but we've just had our last question and we're out of time. TheSite has a number of articles on helping people with self-harm. For example why do people self-harm. If you're already at the stage of working with her counsellor it may be best to ask a question on our Q&A service askTheSite.
wardy: OK, thank you.
JimV: You may also want to look at our helpline page. There are some numbers where people can speak to you immediately.
MM: Thank you very much Karina & Hannes for your advice. I will be giving it a go.
victoria: Thank you for the advice.
bleepy: Thank you :)
JimV: Thanks a lot for coming along. For everyone who wasn't able to ask a question or get an answer - remember we have our Q&A service and you can always post on the discussion boards. Good luck with everything.