I don't know what to do

[Seth91]

Hi... i've been having some trouble with my mental health. Little bit of background first. I'm 25, i had agorophobia for about 5 years where i couldn't leave the house by myself due to extreme anxiety.. in this time i also had bad mood swings, very easily depressed and very insecure about my relationship at the time. Uh, a lot has happened and in this past year I came out as gay, broke up with my financé who i'd been with 7 years (and known since i was 5 years old and who supported me all that time), moved out and lived by myself and did very well in my job (once i was able to leave the house and started in a job) and got promotions etc. It's been noticed by my ex that i have extreme mood swings; very depressed/suicidal one minute and very high and 'on one' the next where I get loads of work done, really enthusiastic and happy and confident etc etc . It looked like bi-polar (with hypomania as no psychosis stuff?).

I went to a GP and I told him that I self harm, can have suicidal thoughts, have no motivation sometimes/no hope for the future etc and then other times I'm super creative and passionate and motivated. I told him I'd been treated for anxiety in the past with CBT (never been on any medication) and that I'd had depression before around this time (but declined medication) but that more recently it wasn't manageable and I had been self harming more etc... He basically told me I was fine and it could be 'Bi-polar lite' and to keep a mood diary for 5/6 weeks, score myself 1 for low and 10 for high and then average it out? I tried to say again that I felt really depressed and self harmed more but he didn't seem interested, I'd booked a double appointment for time to explain things but I was out of the room in 15 minutes. I don't understand how averaging out my moods is going to be helpful as.. if i'm high 50% of the time and suicidal the other 50% that then averages as... 5, a normal mood. This morning I hurt myself quite a lot, first time for a while, although i always want to and find other ways of self harming, such as not eating sometimes, i didn't show up to work and scared everyone there as I never do a no-show, i'm always very reliable and never have any sickness. I don't know what to do, is the GP right? Am I not bad enough yet for help and need to wait longer?

[tomhealy]

Hello,

I am currently writing a report on self harm at the moment and if you take a read let me know if you identify with any of what I say; if we can get to the root of the reasons why you self harm we can work towards solving it. We can explore possibilities of bipolar and other symptoms, I can talk through a lot with you if you wish?

The experiential avoidance model of deliberate self-harm dictates the following; The person (who we will refer to as P) is presented with a stimulus which evokes an emotional response such as anger, shame, sadness or frustration. This emotion is a of a high intensity which the person has difficulty regulating when aroused, P will usually have a skill defect of regulating emotion and therefore have poor distress tolerance. The person then goes into an avoidance state (be that avoidance of the problem or of the correct emotions they should be regulating). The avoidance state then leads them onto deliberate self- harm that provides them with a temporary relief. The DSH is negatively reinforced by reduction in the intensity of or escape from unwanted emotional arousal. The negative reinforcement, habituation to the negative effects and rule-governed behaviour exacerbate the vicious cycle and over time DHS becomes a more automatic conditioned response to emotional arousal of the same feelings mentioned previously.

The self-punishment hypothesis is formulated that mixes cognitive and behavioural aspects of a person’s nature. It posits that DSH produces reductions in emotional arousal through a process called self-verification. Self-punishment is a broad category of this behaviour, including self-criticism and over self-injury, self- deprivation and other “deserved” negative consequences to perceived transgressions (an act that goes against a law or rule, this can be self-prophesised or be a social rule etc). Self-verification theory states that peoples behaviour and ways that are consistent with their basic believes about themselves, or self-concepts. When these basic beliefs are disconfirmed, people experience an aversive state of tension known as disintegration anxiety (when a person feels as though their personality is being affected by extreme states and feelings of anxiety), this usually occurs by a high emotional state of arousal and feelings of being out of control. Similarly, cognitive dissonance theory postulates that inconsistencies between important cognitions (e.g. “I deserve to be punished” and “I have not been punished) create aversive effect of dissonance. As a result, individuals may engage in various behaviour to restore both their sense of control and their experience of the world as predictable. It is when their basic beliefs about themselves are confirmed such as after their deserved punishment that their emotional arousal diminishes. When individuals who engage in deliberant self-harm hold the belief that they are bad or have committed some serous transgression DHS may reduce emotional arousal by confirming negative self-concepts. In support of this hypothesis, self-punishment is a common reason for engaging in DSH offered the first explanation of anxiety relief following self-punishment, suggesting that self-punishment and self-destructive behaviours are maintained by their capacity to (a) alleviate distress associated with negative thoughts about oneself and (b) lessen external punishment.

Similarly, DHS as a self-punishment may relieve distress by adverting or reducing interpersonal conflict or external punishment following perceived transgressions (i.e. escape conditioning). That is, DSH may be followed by (temporary) changes in the social environment, such as reduced demands or the termination or others unpleasant behaviours. For instance, abusive family members may be less likely to deprecate or punish a child who already has pre-emptively engaged in self-deprecation or self-punishment. Studies previously have shown that people tend to reduce aversive behaviour to those who exhibit shame or self-deprecation.

There are many other models proposed that explain that behaviour of self-mutilation. (1) The environmental model suggest that self-mutilation creates environmental responses that are reinforcing to the individual whilst simultaneously serving the needs of the environment by sublimating and expressing inexpressible and threatening conflicts and taking responsibility for them. (2) The drive model suggest that self-mutilation is a replacement, a compromise between life and death drives. (3) The affect regulation model proposes that self-mutilation stems from the need to express or control anger, anxiety, or pain that cannot be expressed verbally or through other means. (4) The Dissociation model offers the explanation that self-mutilation is a way to end or cope with the effect of dissociation that results from the intensity of the affect and finally (5) the interpersonal boundaries model implies that self-mutilation is an attempt to create a distinction between self and others. It is a way to create boundaries and protect against feelings of being engulfed or of loss identity.

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Hi I would go and see another doctor to be honest and ask for meds and/or to be referred to counselling. Some doctors don't get mental health. Get a second opinion.