[LonesomeTonight]

Tried posting this on the SI board last night, no response of any kind, so thought I'd try here.

Brief background, which some of you know: I have generalized anxiety, panic disorder, social anxiety, some OCD (mostly contamination fears), plus depression off and on. Been on Effexor XR for about 2 months, was on Paxil before that, Zoloft before that.

Possible trigger:

I did a bit of SI about, oh, 20 years ago in senior year of high school. Also SUI attempt my freshman year of college

The past few years, when I'm feeling especially anxious, I'll sometimes scratch my skin really hard or press my fingernail into my finger, like to take my mind off the anxiety. Not sure if that really "counts" as SI but thought I'd mention it since it does involve self-inflicted pain.

Now for the reason I'm posting here. A few times in the past two months, I've had a fairly intense urge to SI, something beyond just scratching my skin. Each time was triggered by something--one time, fear of abandonment by someone that triggered past fears of abandonment. Another, feelings of worthlessness and self-hatred brought about from a fight with my husband in which he was very critical of me (there was some other stuff going on, too). And yesterday, when I was feeling very incompetent as a mother, plus some other stuff. I didn't give in beyond just scratching/pressing my fingernails into my skin on my stomach, but I felt the urge to.

I think maybe some of this has come about because some recent work in therapy (plus some transference, but won't go into that here) has dealt with some of the stuff going back to high school and younger, so I'm dealing with some of those feelings. But I'm also wondering if it could partly be the Effexor, since I started that 2 months ago and have only felt this since then? Has anyone here experienced more SI urges with certain medications?

And how do you go about bringing this up to your T (and p-doc, in case it's the Effexor)? I've been seeing her for a few years, so she knows me well, but I'm still afraid of freaking her out. I don't want her to worry I'll do something serious. But I still feel like I need to bring it up. Suggestions on how to do that?

Thanks. And if I should have trigger-warned anything else, my apologies--please fix as needed, mods, or let me know.

[stopdog]

I don't have any input to give but good luck with it.

[anilam]

I highly doubt any good enough T would freak out if the client mentions SI. I hope they would see it for what it is, the first step on a way to overcoming it.
As for the med influence- how about posting it in the PC's med section? It seems pretty lively

[SoupDragon]

I used to SI about 30 years ago. Then it stopped, although looking back I was using other unhealthy strategies to manage my feelings.

SI kicked off again after starting T. Not sure if it was the T or just because I was not in a good place at the time.

T was aware, think they probably asked about it at sometime as a general question
But they did 't over react.

I think it might be helpful for you to share so your T has knowledge of how you are coping with stuff. Then it might be that you explore triggers and other ways of managing your feelings.

Take care. Soup

[Partless]

LonesomeTonight, I'm sorry for what you're going through. I don't think pressing your fingernails into your skin or scratching hard or things like that would count as clear self-harm, I think lots of people do stuff like that as way to distract themselves (or in some ways "ground" themselves) when they're real upset or dissociated.

But they're not nothing either. I mean you are dealing with a pain here and I can understand you also worried about SI and also freaking out your therapist by talking about those things.

How much do you trust your T to be a good T? Has something you said so far has freaked her out? If not, then don't worry about it so much, you might be surprised that your T is more accepting and understanding of those urges than you might imagine. If you like, you can start talking about self harm in general or even mention these things like scratching and so on, and watch her reaction and keep going till you get to point you cover all SI stuff and telling your T everything. Remember, you can stop at any time. Say only as much as you're comfortable.

[pbutton]

I recently had to bring up that I was massively carving into my fingers, and suddenly pulling out my eyebrows. I just blurted it out awkwardly, but that worked out just fine. T handled like a champ, and pdoc told me that yes, it was very highly likely the med change that was creating an issue.

[Lauliza]

I told my Pdoc a few years ago and I also just kind of blurted it out. I had an entry because I see him once a month but this time I made and appointment 2 weeks in a row. So he asked me why the extra appointment and I just told him - I also showed him - I had a hard time articulating it and he was caught off guard. Once it was out he handled it very well and I felt much better. I too think it may have been influenced by my meds as it had been over 25 years since I had done anything like this. At the time I didn't make the connection immediately so I didn't say anything to my doctor about my suspicion. Had I told him I think he would have taken my concerns seriously, however. We did switch the meds eventually for other reasons and the urges did subside. If you have any thoughts your meds could contribute definitely tell your pdoc as it is a very reasonable concern. Your T should not be freaked out - they deal with this all the time. Just do what's best for you so they know.

[stopchewinggum]

It may just be that effexor doesn't work that well for you. (Unless, there was some other even that took place.) I've had to bring up this issue before. I just brought it up plainly, and I did right when I started the session. That made it easier for me. It's kind of a scarey thing to mention at first, but it didn't turn out badly. It was much better getting it out of the way. I just straight out said, "I'm having SI urges, lately."

[LonesomeTonight]

Thanks so much for all the comments. Will respond more later tonight.

[LonesomeTonight]

So, you all were right, well, at least about my marriage counselor (MC), who I talked to about it today. I'd shared with my husband over the weekend, and he reacted as well as could be expected, though a little freaked out. He suggested we mention it to MC, since we were seeing him today and I don't see my individual T till Wed. (I am going to talk about it with her, too, of course). Plus MC and I have a good rapport, though I also have some erotic and paternal transference for him (which both he and H know about).

So after starting the session with some lighter stuff, H suggested I talk about the other thing. I gave this whole long preface saying I was kind of afraid to talk about it, because I didn't want him to freak out or be too worried. MC said this thing about how he has a certain impression of both H and I (having seen us for probably a couple years now) and that, for the most part, anything we do or say now probably wouldn't change that impression much, unless like we'd murdered someone. (Part of me would love to know what that impression is--part of me is afraid to!) He said how everyone makes mistakes, and that doesn't change who they are. I was like, "Well, this wasn't so much a mistake thing." Then he was talking about something else (I forget what), and I was like, "No, not that either." So he said, "Well, I could spend all day guessing, or you could just tell me!"

Took me a minute or so, but I got it out. Clearly wasn't what he was expecting. He first confirmed that I didn't want to end my life. Then he said how common my thoughts were and why some people do it, and also how it can become an addiction. He said he didn't want to act like it was no big deal, because it is something, but it's also not this horrible thing. He seemed to strike a good balance between taking me seriously and being concerned, while not being like "Oh my God, time to check you into the hospital!" There was a little joking in there (it's how he generally is), and he said if it was a big, serious, awful thing, then he wouldn't be joking around.

One interesting thing was that he always wears glasses, and he took them off shortly after I opened up to him about it, and then kept them off until it was time to schedule the next appointment. It struck me, because he doesn't normally do that. It made him seem extra caring and attentive--so maybe that was his intent. (Though with the transference, there was also an element of, "Oh, he has such nice eyes...no, must focus on what we're talking about!")

We talked some more (he was asking H's impressions, too) and was saying he was glad I told him and that it's better to talk about things like that. MC said we could talk about it more in there if I wanted (like in future sessions--I said it was partly up to H, but H said it was something that could affect the marriage, so we could). And that I should definitely bring it up with T and p-doc, which I was planning to (T Wed., p-doc Friday). And that he doesn't think p-doc (or T) will be freaked out either.

He didn't seem to have an opinion on whether it was a result of the Effexor, stopping Paxil, or just other emotional stuff that came up in therapy/stress in my life. I was saying how a lot had come out in therapy with him and T in the past couple months, like childhood stuff, and how that had been painful. He compared therapy to lifting weights, saying that it hurts right after you do it, but ultimately makes you stronger. Which makes sense.

So I'm really glad I brought it up and am satisfied with his reaction. I did say he could tell T if he wanted (I signed stuff before that they could share info), but he said he thought it would be better if I was the one to tell her, which does make sense. I can report back after I tell her.

Thanks for the support.

[LonesomeTonight]

Super quick update because I'm about to head out the door:
Met with my individual T yesterday. She was also very understanding and not freaked out about what I told her. Even when I mentioned

Possible trigger:

fleeting suicidal ideation

from one day last week, which I had not talked about to H and didn't bring up in front of MC since H was there. She said the feelings could be a result of one or more of the following: OCD (which I have) with psychotic features (which I don't know that I've had before--she said not to be freaked out by the word "psychotic" in there), anxiety (got it), depression (have had it lately), and/or the Effexor. Or possibly stopping the Paxil, but I was down to like 8 mg for a week or two before stopping it, or "crumbs," as she said, so that's less likely. Also possible that I'm reacting to stuff coming up in therapy--all the childhood stuff that came up as a result of the transference--or the fact that I'm a mom and identifying with my 4-year-old, who's rather emotional--and who her developmental pediatrician thinks may have anxiety (along with a bit of a speech delay and possibly something else going on).

She did say she hadn't really seen me be like this before--as in having such extreme reactions to things as I have the past couple months. Like breaking down sobbing and getting upset with myself over seemingly minor things.

The good news is I see my p-doc tomorrow for the first time in a month. So we'll see what she says. Of course, when I saw her a month ago, I was like, "Yeah, Effexor seems to be working good, just went up in dose, a bit of stress/anxiety, but mostly doing OK!" She's fairly new, so I tend to tell her bits and pieces of the story, because there's only so much I can fit in during a 25-min med check. I mean, I try to be honest about my mood (for the most part) and symptoms, but might not be like, "So the reason I was really upset that one day last month was related to transference for your colleague in the office next to yours, and there was a misunderstanding, and it made me go back to childhood fears of abandonment." I would probably just say, "Something in therapy triggered childhood fears of abandonment."

I've also had a bit of what I think is derealization (or maybe depersonalization) lately, but didn't get a chance to bring that up with T (or MC). I had some of that as a kid, too, but not so much in the past 20 years. Maybe I'm just reverting to childhood/teen/college-age methods of coping? I do snuggle with a stuffed elephant of my daughter's sometimes lately, too...

OK, that wasn't so short, but compared to my usual postings...Any advice on how to approach this with p-doc? Thanks!

[LonesomeTonight]

Adding on to this (now that I'm back home). T said one way to bring it up with p-doc would be to say that when I was younger, I sometimes resorted to SH to deal with emotions. It's been a long time since I've done that, but I'm having urges to do that again. And that maybe I could also say it's a sort of escapist fantasy (those were T's words, not mine). Does that sound OK? I'm just trying to figure out what to say that will express that I'm concerned about this and don't want to have these feelings and am a bit scared by them, while not setting off serious alarm bells.

Wish I could somehow meet with her and T at the same time, but that's of course not possible (partly because T only works M-W). MC should be in tomorrow, if p-doc is concerned, so she could theoretically check with him. Again, much of my concern is that p-doc and I don't know each other particularly well (only seeing her since Nov., and for the last few months only once a month or so), compared to 3.5 and 2 years, respectively, with T and MC.

And I had like 25 min to do this in, since it's a med check appt. (She's kept me longer before though, so I imagine she will in this case too, if needed.)

[LonesomeTonight]

OK, talked to p-doc today. Was only supposed to be a 25-min med check, but it ended up being a full 50 minutes (luckily she didn't have anyone right after me)--and then I had to pay the difference, since I usually pay before the appt. I was afraid I'd find it hard to talk to her since I haven't known her too long, but I think talking about it with MC and T earlier this week really helped and made me figure out what I had to tell her.

She was concerned and very understanding (but also not "freaked out"). She thinks I'm clearly in the middle of a major depressive episode. My feelings are probably caused by a combination of factors. It could be that Effexor is contributing to them. Or it might be that it's just not being effective in treating the depression (feeling pretty anxious now, too). She's trying me on Cymbalta, which makes me a bit nervous, because I'm nervous any time I start a new drug, fearful of reactions. And now that I've had a possible depressive reaction to Effexor, which is an SNRI like Cymbalta, I'm nervous about that, too. (Doesn't help that I have emetophobia, and nausea is a potential side effect of like every psych drug practically.)

I'm seeing her again in a week, plus I'm to call if I have major side effects

Possible trigger:

or go to ER if it's suicidal ideation

. Which I promised to do. Plus I see MC Monday and T Tuesday, so I have support set up if it turns out I have a negative psychological reaction.

Still nervous...

[Rive.]

Hi LonesomeTonight, sorry I just caught your posts today. Just wanted to say thank you for the update & I am glad you were able to talk to her about the urges etc. That was a brave thing to do. I am also glad she didn't freak out! You never know with some p-docs!

I am no expert in drugs (and totally understand the apprehension in taking any (new) stuff) but I don't think all drugs (even if they are SSRIs) are bound to have similar effects.. At any rate, it is good news that she is trying to work out what had been causing these reactions.

I know it's easier said than done but at least she provided you with the safety net to contact her + see her sooner. You also have this forum to unload if it helps at all.. Take care.

[LonesomeTonight]

Originally Posted by Rive.

Hi LonesomeTonight, sorry I just caught your posts today. Just wanted to say thank you for the update & I am glad you were able to talk to her about the urges etc. That was a brave thing to do. I am also glad she didn't freak out! You never know with some p-docs!

I am no expert in drugs (and totally understand the apprehension in taking any (new) stuff) but I don't think all drugs (even if they are SSRIs) are bound to have similar effects.. At any rate, it is good news that she is trying to work out what had been causing these reactions.

I know it's easier said than done but at least she provided you with the safety net to contact her + see her sooner. You also have this forum to unload if it helps at all.. Take care.

Thanks for your response! I do appreciate how much she's trying to work with me on this. You're right about different drugs having different effects--I've tried a few different SSRIs, and they've generally affected me differently. (The worst for me was Prozac, which made my anxiety more severe.)

It definitely helps to talk about stuff on this forum. Everyone on here seems so supportive of each other--it's really a great community! And even if I type stuff out and no one responds, it still helps to figure out what I'm thinking and get it out of my head.

You take care, too!