TW ed !! -active oct 2021

Before You Self-Harm

[Pt: Before You Self-Harm]

Safe Kits and First-Aid Kits

[Pt: Safe Kits and Firs-Aid Kits]

A safe kit is what its called when you keep first-aid supplies with what you use to self-harm, what you use to clean your tool, things to use instead of self-harm, or anything else that helps you be safer when you self-harm or have self-harm urges.

Here are some ideas for things to put in a safe kit...

First-aid supplies (see the "Caring for Injures" section)

Clean tools for self-harm

If you use blades or something sharp, a metal or hard plastic container to put used sharps in (like a empty pill bottle or sharps container), throwing away blades lose or flushing them down the toilet put sanitation workers at risk.

Isopropyl/rubbing alcohol for cleaning tools

Information on first-aid

Self-harm report card, “this report card can be used if seeking treatment for an injury – for example given to health professionals”

A list of things that you could do instead of self-harming

A list of reasons not to self-harm/take care of your wounds/practice harm reduction

A journal

A list of people you could talk to for support

Comfort items, like a small stuffie

Things to express yourself with, like art supplies

Infection Prevention

[Pt: Infection Prevention]

Infections can be life threatening and severe, even if they start out mild. Some ways that can reduce the risk of infection are...

Being up to date with vaccines (like the tetanus vaccine)

Never sharing tools

Not re-using tools if you self-harm in a way that breaks skin (i.e. cutting, burning)

If you do reuse tools, cleaning them before/after use by boiling them in water (~15 minutes) or soaking them in something with a high alcohol contents (i.e. isopropyl/rubbing alcohol, hard liquor, hand sanitiser), remember to dry well

Check your tools for rust, dirt, or cracking before use. Dispose if any found

Store tools in a clean, dry place; do not use something to self-harm if it was or could have been in an unclean place

Do not use the tools you use to self-harm for anything else

Clean your hands before self-harming, if you pick your skin/scabs, cleaning under your nails

Keep cuts, burns, and other open wounds covered with wound dressings. Changes dressings daily

Disinfect the area with an antiseptic (like isopropyl alcohol) before harming yourself

Having a healthy diet; malnourishment increases your risk of getting an infection and slows healing. This is especially important to remember if you have an eating disorder

Where/How You Self-Harm

[Pt: Where/How you Self-harm]

The location of where you hurt yourself can significantly reduce or increase the risk of long-term damage, regardless of how you self-harm. Avoid harming:

Joints or near them

Your face, head, or neck

Under side of your wrist

Hands

Your groin

On scars

Internally (e.g. overdosing/self poising or swallowing something), there is no way to see how severe internal damage is by yourself and you should always seek medical attention for internal damage.

Areas with veins, arteries, or major nerves (see below)

Areas with more fat are generally safer.

Nerves, Arteries, and Veins

[Pt: Nerves, Arteries, and Veins]

[Image description 1: a diagram of arteries and veins in the human body. Image description 2: a diagram of nerves in the human body /end ID]

Arteries and veins are the two largest types of blood vessels, they carry blood to and from the heart. Arteries and veins can be damaged from cutting, burning, hitting yourself, and other forms of self-harm. Damage to an artery causes serious bleeding that can be fatal in minutes and always need immediate emergency medical attention, venous bleeding is less serious but can also be fatal and usually needs medical attention. Bleeding can be internal and isn't always immediately obvious. The above diagram on the left shows the location of veins and arteries in the body so you can avoid them. You can find more detailed diagrams of specific body parts online by Googling "blood vessels in [body part]" and looking at images. You can learn more about different types of blood vessels and bleeding here.

Alcohol, some drugs/medications, and some medical conditions (like haemophilia) can make bleeding harder to stop and increases the risk of bruising and internal bleeding. It is important to avoid using drugs or alcohol when self-harming since increased bleeding can be a significant risk, if you take medications or have a medical condition that can increase bleeding, and are able to, talk to your doctor.

Nerves are what send signals through our bodies so that we can feel things and move. Some nerves also control things that you aren't aware of, like you're organs. Nerves can be damaged from cutting, burning, hitting yourself, or other forms of self-harm and damage to nerves can make it harder or impossible to move or feel things. The above diagram on the right shows the location of larger nerves in the body so you know how to avoid them. You can find more detailed diagrams of specific body parts online by Googling "nerves in [body part]" and looking at images. You can learn more about nerves and nerve damage here.

Nerves, veins, arteries, and tendons (what connects your muscles to your bones so you can move) usually all point in the same direction and, if you cut, cutting in the same direction makes you less likely to damage them. For example on your arms this would be vertically.

Severity of Injures

[Pt: Severity of Injures]

Larger, deeper, or more sever injuries carry more risk of severe bleeding, nerve damage, and tendon/ligament damage. If your able to, self-harming in a way that levels fewer, smaller, shallower, and less sever injuries is a good way to significantly reduce harm.

If you hit yourself to self-harm, using a pillow, folded clothes, a helmet, or something will reduce the severity of injures

Using drugs or alcohol when self-harming can make it harder to respond to emergencies or make them more likely to happen so avoiding drugs while self-harming is much safer.

Reducing Frequency and Avoiding Self-Harm

[Pt: Reducing Frequency and Avoiding Self-Harm]

Avoiding self-harm, even if you don't quit entirely, is a one of the best ways of reducing risks from self-harm. This is a short guide for where to start if you want to quit self-harm.

Finding the Why

[Pt: Finding the Why]

Understanding why you self-harm can be important when trying to find how to stop or reduce self-harming. The Hurt Yourself Less Workbook (edited to remove some fatphobic language + images of self-harm, original here) is a work book to help you explore and understand your self-harm.

Keeping a diary of what happened that made you want to self-harm, how you felt and what you were thinking before and after you self-harm can help you identify patterns to what causes you to self-harm and how, if at all, it might be helping you. From there you can find other, less harmful, ways to cope with what causes you to self-harm or things that can serve the same function.

As well as finding why you self-harm, coming up with reasons you want to stop or reduce the amount you self-harm can help. Keeping a list that you can add to and look back on when you want to self-harm can keep you motivated. You can also find lists online if you need ideas.

Breaking the Cycle

[Pt: Breaking the Cycle]

Self-harm can often become a cycle and something you do because you are used to it or because it has become addictive.

For some people, focusing to much on only stopping self-harm and not acknowledging why they self-harm can cause them to feel shame if they relapse, causing them to self-harm more, and creating a cycle. It's important to remember that self-harming is not a morally bad thing and that you are never a bad person for self-harming, even if other people try and make you promise not to. It takes time to find ways to not self-harm and relapsing when your trying to quit is common and normal.

When self-harm becomes the first thing you think of when your upset or bored, trying alternatives, distractions or delaying can help break that cycle. Here are some resources with ideas for alternatives, distractions or delaying:

Calm Harm, an app that helps you “ride the wave” of self-harm urges. Free in the UK and US, charges may apply elsewhere.

Delaying Self-harm

Helping yourself if you self-harm, both short- and long-term advice, there's also a version for people under 18

Distractions and Displacement

Distractions that can help…

Distraction Techniques and Alternative Coping Strategies

Caring For Injuries

[Pt: Caring For Injures]

Cutting/Scratching

[Pt: Cutting/Scratching]

Stop Bleeding; apply pressure with gauze or a clean non-fuzzy cloth (not toilet paper, cotton pads, tissues, kitchen paper, or anything else that may leave fibres in a cut). If the blood is spurting from the wound, apply pressure and immediately call for an ambulance you have hit an artery. If bleeding doesn't stop after ~10 minutes of applying pressure you need medical attention, head to the emergency room.

Asses damage;

You NEED an ambulance immediately if...

The injury is spurting bright red blood; you have hit an artery

You have symptoms of shock

The injury is internal, like if you've swallowed something

You lose sensation or movement in any area; this is a sign of nerve or tendon damage

You have a medical condition that means you need an ambulance

You are unsure if you need an ambulance

If you do not think you can take care of your injuries alone and cannot get yourself to A&E

You NEED to go to A&E/ER immediately if...

The bleeding does not stop after 10 minutes of applying even pressure

The injury is to a joint, palm, your face, or genitals

You can see muscle or bone. Muscle looks like meat

The tool you used to cut/scratch yourself was rusty

You have a medical condition that means you need emergency medical attention for your injury

You do not think you can take care of your injuries alone

You should get stitches (or if stitches aren't possible use wound closures, see below) if...

You can see fat (looks like yellow bubbles) or fascia (a thin white layer underneath fat)

The cut is 6 mm/0.25 in deep

The edges of the cut are jagged

Even if you do not fit any of the above criteria you can still go to A&E for self-harm, thoughts of self-harm or suicide. If you are unsure how serious an injury is, call your local A&E/ER's nurse line (if in the UK call 111 or use 111 online).

3. Cleaning; rinse out the wound with saline or clean water to remove any debris. Only use antiseptic if the tool you used to cut was dirty or the wound has become dirty.

4. Bandaging; for cuts that gape, wound closures like steri-strips, butterfly bandages, or zip-stitches can reduce risk of infection and speed up healing. You can make butterfly bandages with tape. Wound closures should be kept on until the cut has healed (~10-14 day usually) and covered with gauze. Change the gauze daily and check for signs of infection (see below). Keep the wound closures dry.

For cuts that do not gape or if you do not have any wound closures, put petroleum jelly/Vaseline on the cut(s) and cover with plasters/band-aids or gauze. If you are having problems with non-stick gauze sticking to cuts, I suggest using tefla. You can make tefla. If you have no gauze or plasters, clean, non-fuzzy cloth can work as a bandage. Change dressing daily or if it gets wet/dirty and check for signs of infection (see below) until the cut(s) are fully healed.

Burning (Thermal)

[Pt: Burning (Thermal)]

Remove clothing/jewellery; remove any clothing or jewellery from around the burn, if its stuck don't force it.

Stop burning; remove the source of heat and rinse with cool water for ~20 minutes, do not use ice or cold water

Assess damage; if the burn is larger then your hand you should seek immediate medical attention

You NEED an ambulance immediately if...

You have symptoms of shock

You lose sensation or movement in any area; this is a sign of nerve or tendon damage

No pain, this is a sign of nerve damage or a third degree burn

You have a medical condition that means you need an ambulance

You are unsure if you need an ambulance

If you do not think you can take care of your injuries alone and cannot get yourself to A&E

You NEED to go to A&E/ER immediately if...

The injury is to a joint, palm, your face, or genitals

The burn is white, black, or dark red and dry, this is a third degree burn

You have a medical condition that means you need emergency medical attention for your injury

You do not think you can take care of your injuries alone

4. Bandaging; do not use gauze or plasters/band-aids on burns. Cover the burn(s) with a hydrocolloid bandage or other burns bandage. Clean Plastic wrap or tefla can be used as a bandage with petroleum jelly/Vaseline. Do not wrap plastic wrap around yourself, use tape instead. You can make tefla. Change the dressing daily or if it gets wet or dirty and check for signs of infection (see below). Keep the wound covered till fully healed.

Chemical Burning

[Pt: Chemical Burning]

Remove chemical; remove any clothes soaked in the chemical, rinse all areas that have come into contact with the chemical thoroughly with warm water for 30+ minutes. Do NOT attempt to neutralise the chemical.

Go to hospital immediately; chemical burns are hard to asses the severity of and often require surgical intervention. If you have symptoms of shock or the burns are wide spread call an ambulance. Absence of pain is not a good sign.

Bruising/Hitting

[Pt: Bruising/Hitting]

Assess damage; if you have hit your head, be aware of the symptoms of concussions. Hitting yourself can cause bruising, sprains, strains, tears as well as more serious injuries (see below).

You NEED an ambulance immediately if you have...

An open fracture (bone has broken through the skin) or head, back, rib, or collar bone fracture

A misshapen limb

Symptoms of internal bleeding

Any symptoms of shock

You suspect a fracture or broken bone and don't have someone to take you to hospital

Bleeding from your head that doesn't stop after 15 minutes

Bleeding or clear fluid leakage of fluid from ears or nose

Weakness or inability to move part of your body

Different sized pupils (the black part of your eye)

A seizure

Problems with walking, balance, or communicating

Difficulty staying awake or keeping your eyes open

Changes in vision or hearing

You NEED to go to A&E/ER immediately if you have...

A closed fracture (no bone visible), not to your face, head, back, ribs, or collar bone and the limb is not misshapen

Blood in your pee or poo or that you cough up

Bleeding that doesn't stop after 15 minutes of pressure

Bulging/swelling muscle

Severe muscle pain or severe pain when stretching

Muscle tightness

A body part that has gone grey/blueish/cold or has a faint or no pulse

Confusion/restlessness/agitation/memory issues

A severe headache

Vomiting

If you have a head injury, do not drive yourself to A&E, get someone else to drive you or call an ambulance.

2. Treating; for non-head injures...

Protect; if a join is injured, a brace can be used to protect it

Rest; rest the injured area to allow it to heal, avoid putting weight on the injury. This also means avoiding harming in the same area.

Ice; use a cold compress on the injured area for about 20 minutes every ~3 hours to reduce swelling.

Compression; use an elastic bandage to on any swelling, make sure you don't wrap to tightly and cut or circulation.

Elevate; elevate the injured area to promote blood flow.

Repeat for three days or until swelling and pain goes away. Over the counter pain medications like acetaminophen/Tylenol can help with pain and so can muscle soreness creams like Deep Heat and Icy Hot. Gentle stretching can help with mild muscle tightness

If pain worsens or doesn't get better seek medical attention.

Head injures can be treated similarly to injures to the rest of the body. Use a cold compress periodically, rest as much as you can, and take acetaminophen/Paracetamol/Tylenol or another over the counter pain killer if needed. Rest as much as you can and avoid anything that could worsen the injury like contact sports or more head banging for as long as you can.

Drugs and alcohol can worsen head injuries and slow healing, avoid them as best you can. Driving or using other machinery can be dangerous after a head injury.

If symptoms worsen or persist for 2 weeks seek medical attention.

Self-Poisoning/Overdosing and Swallowing Foreign Objects

[Pt: Self-Poisoning/Overdosing and Swallowing Foreign Objects]

Internal self-harm always needs to be treated by a medical professional, call an ambulance. Do not attempt to make yourself throw up.

Infection

[Pt: Infection]

Assess damage;

If you have symptoms of a sever infection seek immediate emergency medical attention...

Confusion or disorientation

Feeling faint, dizzy, or fainting

Irregular heartbeat and/or breathing

Cold, clammy, pale skin

Fever (body temperature of 38c (100.4 f) or higher)

A red line coming from the wound

Severe muscle pain

Painful muscle spasms

This is not an exhaustive list of symptoms, more info here.

Symptoms of a mild infection include...

Spreading redness, heat, or swelling near the wound

Increased or new pain

Slow healing

Thick, smelly, or discoloured drainage leaking from wound. Normal drainage is watery, doesn't smell strong, and clear or yellowish

2. Treatment; if the infection is severe, seek intimidate emergency medical attention. If the infection is mild it is still good to see a doctor if you're able, but if you can't see a doctor...

Clean the the wound(s) with warm water and unscented anti-bacterial soap

Soak in warm water or apply a warm wet cloth for ten minutes

Apply antibiotic ointment to the infected wound(s)

Re-dress the wound(s). Do not reuse dressings.

Repeat this 3 times a day daily until infection subsides. If the infection worsens or does not go away seek medical attention.

Wound Care Myths

[Pt: Wound Care Myths]

Antiseptics (like hydrogen peroxide, alcohol, etc.); antiseptics damage cells and slow healing, they should not be used unless the tool used to self-harm was dirty or the wound is dirty. Many ointments advertised for wounds contain antiseptics, so it's important to check the ingredients before using them.

Antibiotic ointment (like Neosporin, Polysporin, etc.); use of antibiotics on wounds that are not infected can cause irritation, rashes, and contribute to antibiotic resistance. Antibiotics can also slow healing and there is no evidence that the use of antibiotics reduces the risk of infection. Do not use antibiotic ointment on wounds that are not infected. Many ointments advertised for wounds contain antibiotics, so it's important to check the ingredients before using them.

Letting wounds "breath"; wound dressings maintain an ideal healing environment, leaving them uncovered dries out the wound which slows healing and increases itchiness and pain. Uncovered wounds are also at an increased risk of infection

Butter/oil on burns; oils can trap heat on a burn that isn't cooled and bacteria in the oil can cause an infection. There is also no evidence it helps with healing.

Ice/cold water on burns; ice or cold water do more damage to burnt skin, use cool water

No pain is a good thing; no pain after an injury is a sign of nerve damage and is not a good thing. If you lose sensation in an area seek immediate emergency medical attention

Scabs are a good thing; scabs form when a wound is dry and tissues dies. Wounds that are left to dry out heal slower then wounds that are kept bandaged and moist.

Image credits (in order of appearance):

This Photo by Unknown Author is licensed under CC BY 3.0.

TE-Nervous system diagram by theEmirr is licensed under CC BY 3.0.