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Dear Dr. Neil

I'm confused, i cut and scratch at my arms and 've moved onto my legs. I recently was in hospital due to an overdose of prescribed medication. does this mean I'm self harming?

I think I am, but it took me a while to realise it might be just that, but I'm still not sure, I 't do it every day, it just sort of happens, I can fight the urge sometimes, but if it happens in class and I cant get to the bathrooms to I'm reduced to stabbing pens etc into my arms and legs, I don't know what any of this means.

What made it all worse is when I was in the hospital because I'm almost 18 they weren't sure if I should see there adult psychiatric team or their adolescent and even then they didn't refer me on, my mum had to contact my GP, but everything has been so slow, and I don't know if I have the patience for all of it. I just want it to stop and yet part of me doesn't, I'm really confused please help.

Space
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Dear Space,

Yes, what you describe is self-harming both by self-injury and self-poisoning (the overdose). It’s good that you have recognised it and having a label for it can help you to understand more what you do, and get more information about it. Having made this first step, you will be able to start looking for the reasons why you may be doing this, as well as using the advice on the FirstSigns website to minimise the harm you do to yourself.

Confusion between child and adult mental health services about who deals with 15-18 year olds is unfortunately very common as there is no national agreement. I’m sorry that things seem so slow when you want to get something sorted, but sometimes the delay can be used to reflect on the issues that might be causing you to self-harm and once a service starts working with you, you will be in a better place to start work on those issues.

By using the harm minimisation advice in the FirstSigns handbook, you can start to take control over your self-harm – you may not be able to stop the urges, or stop the self-harm, but if you can reduce its severity and its frequence and look for the reasons behind it, you will be going a long way to stopping your confusion and taking control back.

I hope you get your appointments soon and you find someone able to help you through your problems.

Neil
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Dear Dr. Neil

I am in a situation that I can't get out of I have suicidal thoughts, I have attempted suicide twice before and I have only days before I attempt again I have been sexually abused from the age of 4 to the age of 15 then raped then physically mentally verbally abused by men all my life I am in an abusive relationship there is nowhere I can go I have tried all the rest, you are my only hope I do have a counsellor but got him for 4 week I am getting desperate I have told him that I will do it but he has not taken any notice. I just cant cope with all this heartache and pain at the moment I'm in a big black hole and I cant seem to get my self out of it please help thank you.

Butterfly
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Dear Butterfly

I’m sorry to learn that you have reached the point where you feel that I’m your only hope. I have a number of suggestions that you might consider to try and break the cycle of abuse you seem to have become trapped in. Firstly, ask your current counsellor ‘where do I go next for help?’ Secondly, consider contacting your local domestic violence officer at your local police station or any local charity supporting those people suffering domestic violence, asking them to assist you in getting out of the abusive relationship you are in (because it’s not always as simple as walking out).

I get the impression from your letter that you feel out of control of the situation, which is why suicide seems an acceptable solution to the issues you face. Instead, try taking control back from your abusers and make some choices for yourself. There is likely to be a local counselling service for women who have been abused within relationships and in childhood – your local Citizen’s Advice Bureau or phone book would have details. They will have specialist counselling knowledge and will normally be able to spend a lot longer with you addressing your problems.

I don’t believe suicide to be the only way out of your big black hole, and I hope that you are able to find other stepping stones to reach the top and to enjoy life again, free from abuse.

Neil
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Dear Doctor Neil

I am new to FirstSigns and hope you can help me.

1. I have self harmed for a number of years - I am aware of some of the reasons behind it - low self esteem, lack of confidence, experience of trauma (PTSD included) etc. I am trying to sort out these things with a counsellor. I am concerned that I am trying to sort out my life in two or more directions - by coming to FirstSigns as well as seeing the counsellor. What would you advise?

2. I have also had experience over the years of a small amount of "counselling" training and volunteering work. This has given me the ability to find a way of trying to help other people to help themselves - I know that I cannot always apply that knowledge to myself - but I am very wary of trying to help by saying anything on FirstSigns. Again I would welcome your advice.

I am a very good listener and have learnt a good deal about asking open ended questions.

If I could help others then I hope it will help myself.

Your advice on this would be most welcome.

Jean

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Dear Jean,

Regarding your first point: received wisdom states that someone should work with just one counsellor at a time. If you are using FirstSigns as a second route for counselling, I would suggest that you take time out from it until your face-to-face counselling has finished. However, if you are just reading information, or using FirstSigns as a social forum, there would be no conflict – indeed it may help to have this outlet and support from others while you go through your counselling proper.

Regarding your second point: again, received wisdom is that you should only work within your capabilities. At present, given you are in the middle of counselling, I would continue to be wary of giving advice. In regard to interaction in the forums, I would suggest you speak only of your personal experience and how you have come through it so that others can apply it to their own situations – in essence, encouraging them to become their own counsellor. Listening and asking open questions are often all that is needed to help someone realise the next step and no further advice need be given. One word of caution: be wary about remaining ‘trapped’ in your situation by a feeling of a need to help others, as this may not help you in the long term.

You clearly see the complexities of your situation, so I would suggest one further piece of received wisdom: keep things simple. Finish your counselling, appraise how you are using FirstSigns, appraise how you are contributing to FirstSigns and then make your decisions about how much and how deep your involvement will be.

I hope this helps you climb down from the horns of your dilemma.

Neil

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Dear Dr Neil,

I am a nursing student and have self injured for many years. This is something that I have discussed with my own GP and the Occupational Health department at the hospital are also aware. In the past 18 months I have been treated for anxiety and depression and have had 20 sessions with a counsellor (all of which have been great!).

My worry is that when I finish my training it has always been our plan to emigrate to Australia / New Zealand and I'm concerned that all my mental health problems may stop us fulfilling this dream. As Occupational Health already know about these problems there's no way I can deny it. I really don't know who to approach or what is the best way to deal with this. Any help would be most welcome, thank you.

Freedomfries
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Hi Freedomfries

I have an occupational health history too, and can understand your concerns. Firstly, my experience has been that their knowledge has been a valuable asset in my support, and the specifics of that support or the underlying problems have never been shared with my employer. Clearly your occupational health history will be sought by your new employers, and I personally would be upfront and honest, saying something along the lines of ‘yes, I had problems, yes, I have received treatment, yes, I have improved, yes, I know it may recur, but no, I don’t have those issues at present’. I would hope that any employer would respect that self-assessment and your integrity – if not, they’re not going to be supportive as employers, and would you want to work for them anyway?

My only other advice is to ‘go for it’. One worry I might have is that your concerns may grow to be a self-defeating fear and deflate your dream and potentially reinforce your illness fears. Stress the positives about it – you recognised the problems, and you have sought solutions and addressed them: what a fab employee to have!

In summary, denying it is, as you correctly point out, pointless and not in your best interests. Don’t let this worry you and follow your dreams – good luck Down Under!

Neil
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Dear Dr. Neil,

I have self-injured for sometime, off and on. I cut myself quite seriously recently, and I keep picking and cutting the scar and it's really itchy. Can you tell me why my scars itch if there's a treatment I should use on them please?

angeleyes
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Dear angeleyes

Healing wounds itch for several possible reasons: firstly, they may be infected – this is more likely if you’re picking and cutting at the scar. Signs of infection are redness and inflammation around the area with raised temperature of the area and possible pus/oozing areas. If this is present, see a doctor for suitable treatment (usually antibiotics are required). Second cause of itching is the natural healing process as the nerve endings re-establish themselves in the new layer of skin. This is typically more of a tingling sensation and entirely normal if a little aggravating. Third cause tends to be dehydration of the skin and scab which can delay healing.

My suggestions would be therefore to stop further damage to the wound – an occlusive (covering) dressing would help – you need a non-adherent, absorbent gauze – ask your nearest pharmacy for advice. If the wound is clean and closed then a light smear of an antiseptic cream will both keep it germ free and moisturised and hopefully reduce the itching. If there is any sign of infection, get it treated by a doctor. Also, keep your nails short and your hands clean if you continue to pick at the wound to reduce the risk of infection occurring.

Also, ask yourself why you keep picking and cutting at the scar – is it because of the itching, or because you’re continuing to gain benefits from the self-injury? If it’s the former- stop it, you’re only making it worse! If it’s the latter, then I would hope you can find someone to talk things through with, so that you can find ways to reduce the need to SI.

Best wishes,

Neil
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Dear Dr. Neil,

I don't understand why I hurt myself. Everyone else talks about cutting and scratching because of their mean parents or the stress they have over their grades, but my parents are OK and I love college and my grades are fine. I know I'm not happy, but I still laugh and have a good time every so often, so I know I'm not depressed. I bang myself when I get confused – people are so confusing, you never know what they mean or what they want from you. But I'm fine aren't I? My life's fine isn't it? So why do I bang?

ItsOnlyMe
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Hi ItsOnlyMe

The reasons you list for SI are the commonest, but by no means the complete list. The words that jump out at me from your post are ‘people are so confusing, you never know what they mean or what they want from you’. I wonder if you may have difficulties relating to others, either due to psychological reasons you’re not aware of, or perhaps an underlying developmental disorder, such as an unrecognised autistic spectrum disorder. I can’t tell from your paragraph if your life is fine – certainly doesn’t seem to be the worst, but neither is it all perfect (nobodies’ ever is). I suspect you become frustrated by not understanding relationships and social interaction, and banging is one way of expressing and releasing pent up frustration.

Frustration with people is not that uncommon an issue, and there are times when I have no idea why someone is cross with me or they can’t get hold of what I am on about! However in your case it seems more of an issue than normal, and I would suggest you seek a professional opinion about your confusion about people and social interactions – suggestions may be referral for further assessment of this, or counselling / stress / anger management course.

I hope you find a solution, and the advice helpful

Neil
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Get in touch with Dr. Neil

We know it's hard to go to your doctor, we know it's hard to talk about self-injury and the distressing things behind it. At FirstSigns, we believe that getting help and support is a brave step forward, and something that has benefited many of our members once they've found the strength to take that step.

We can now help you move towards seeking help by offering the services of our friend and colleague, Dr. Neil (MB ChB, Psychiatrist). Neil has been working in psychiatry for over 10 years with a special interest in self-injury throughout his career. We've worked together for several years now training doctors and developing the FirstSigns handbook. We're thrilled that Dr. Neil has offered to answer questions from our members in each edition of our Newsletter, LifeSHINES.

Dr. Neil will be happy to tackle any of your concerns relating to self-injury, and will be able to offer guidance on how to get help and support from the NHS, as well as offering general guidance about your mental state and self-injurious behaviour.

“Everyone’s situation is different, and there are no magic answers that can make everything or everyone better, but I hope my ideas and suggestions can help people reflect and take action to improve their health and well-being.”
Dr. Neil

The first questions and answers will be in the April edition of LifeSHINES, and you are invited to send your questions right now to letters@lifesigns.org.uk – please be as clear and concise as you can and start your letters “Dear Dr. Neil” so we can forward them on.

Dr. Neil stresses that it is important to talk to your own doctor about any mental, emotional or physical worries or problems your might have, and reminds all our members and readers that he won't be able to offer definitive answers, but rather general guidance and ideas to help you feel more confident to take action and look after yourself.

The Small Print

FirstSigns offers our members / Newsletter readers the opportunity to send their questions in, so that they can be read by a qualified and experienced Doctor.

We will only publish your firstname / nickname, and so you will remain anonymous. We reserve the right to edit your questions for the sake of clarity and conciseness.

Dr. Neil is not able to reply to emails directly, and any guidance he gives will be his personal opinion and should not considered as direct instruction, and should not be treated as a substitute for the medical advice of your own doctor or other healthcare professional. Always talk to your own GP or mental health professional if you are concerned about your health.

Unfortunately, it's unlikely that Dr. Neil will be able to answer every question we receive.