The worrying link between self-harm and ADHD

“He walked into A&E, stood in the middle of the waiting area and slashed his wrists.” It’s a story that’s all too common for Dr Phil Anderton, the director of ADHD 360, a private clinic which offers treatment and support for adults and children with ADHD in the UK. He was speaking about one of his patients who was in desperate need of help. “We were the only agency that was helping him and it wasn’t good enough or quick enough for him,” he said. “Social services wouldn’t help him, his GP wouldn’t help him.” The hospital staff treated his physical wounds and discharged him, but at no point was he offered any psychiatric care.

An estimated 3-5% of adults in the UK have ADHD, but the vast majority are undiagnosed. According to statistics from the charity ADHD Action, this means that up to 1.5 million adults in the UK may have the condition but as of 2018 only 120,000 cases were diagnosed.

This lack of support is particularly worrying considering the struggles associated with ADHD. People with ADHD often feel frustration about not being able to fit in, deliver things on time, hold down a relationship or a job and not understanding why. It leads to anxiety and depression – “which isn’t clinical depression or clinical anxiety,” Dr Anderton added.

Having worked in ADHD care for over 15 years, Dr Anderton is very aware of the difficulties his patients face. “I think there is a prolific link between self-harm and ADHD,” he said.

This is of particular concern at the moment with social distancing measures and lockdown changing the way people live. People with ADHD are not able to produce as much dopamine in their brains, and as such require stimulation through activities or medication to replace this. He is worried about what is happening now many of those activities are removed. “Some people don’t have a focus, they’re staying in because they can’t do stuff. Their mental health is starting to deteriorate, they are harming themselves,” he said. “It’s linked back to their ADHD.”

He believes that there are two main reasons which people may self-harm, either as a cry for help when they have exhausted all other means available to them, or due to feelings of anxiety and low self-esteem. Both are common in people with ADHD.

Charlie Latham is 35 and was diagnosed with ADHD in October 2018. They had been self-harming on and off since they were 15 and spoke about what led them to harming themselves. “I think it was a control thing. Like I had all of this frustration and didn't really know what to do with it. I've never suffered from depression as such. I wasn’t a depressed teen, but I was a bored and frustrated one.” At the time they didn’t seek support. “I don't think I felt the need to tell anyone because it was something I did for me,” they said. It was nearly 18 years from when they started self-harming till they received an ADHD diagnosis. “I wish something had been spotted earlier. I would have found everything so much easier - school, social skills. I probably wouldn’t have developed so many maladaptive coping strategies.”

Following their diagnosis and starting treatment, Charlie has stopped self-harming, is in their final year of university, training to be a mental health nurse and has developed more helpful coping strategies: “it’s amazing, the difference,” they said.

When they were growing up, their symptoms were more subtle compared to boys with ADHD, they said, and so weren’t recognised by their teachers or doctors. There is a lot more knowledge nowadays about the way ADHD presents in different genders, but at the time the lack of knowledge meant that many children, especially girls, didn’t receive the support they needed. “Had I had that,” Charlie said. “I may have understood [ADHD] more and been less frustrated and bored overall so may not have needed to self-harm.”