[PBCMom]

I have a history of SI but haven't done any for a pretty long time. There are times when things get really difficult for me and the urge returns...sometimes the urge is stronger than others. Most of the time I am able to resist the urge. When I do SI, I find relief in the moment when I cut, but I feel really horrible and disgusting later. And if I do allow myself to SI, inevitably it leads to a cycle of needing it again and again to get that relief and it can take some time to break the cycle and stop the SI again.

I've been having a really tough time the past week or so fighting the need to SI. I'm having such a hard time and everything feels so overwhelming and unbearable. None of my usual coping strategies are bringing any relief and as I run out of things to try the need for the sense of relief I get when I SI gets stronger and stronger.

There is part of me that feels like maybe I should just go ahead and allow myself the release/relief and SI. Right now it feels like I am just prolonging the inevitable and the longer I hold out the stronger the need is...it feels like the longer I wait the harder it will be to keep the SI under control and I'm afraid of doing more harm than I really intend.

So my stupid question is really one about caring for myself afterward if I'm not able to continue to resist this need. I'm afraid of hurting myself so badly that I'll need more medical attention than just the first aid I've been able to take care of myself in the past. While I'm trying to fight the urge to SI, I also feel like I need to have a plan in place and know what to do just in case I fail.

If I do cut too deep and think it needs stitches, where is the best place to go and will I have to worry about someone trying to force me to be hospitalized? Can I just go to an urgent care center instead of a hospital ER to get stitches if I need to? Would that just freak them out and would I be better off going to an ER? If I go to an ER will they understand that I wasn't suicidal but it was just SI gone too far and be willing to just stitch me up and go back on my way as long as I promise I will follow up with my therapist or psychiatrist?

I don't want to SI. I'm trying really hard not to. But I'm just trying to make sure I know how to handle things because right now the urge is strong and I feel like if I do lose the battle and start to SI I will also lose the self control that keeps me from doing too much harm. Maybe if I know that I know what to do just in case it will eliminate a little bit of that anxiety and allow me to direct that strength to continue to fight the urge.

I'm sorry...I know this is rambling and a stupid question. Just trying to be as strong as I can be right now.

[ThisWayOut]

I'm sorry you are struggling so badly right now. I can definitely relate.
I'm not advocating the si, but I want to answer your questions to the best of my ability.
I have found that the response to si differs by person and by setting. In my experience, ER staff have seen it more than urgent care centers, and can be a bit more understanding of it being a coping mechanism rather than a suicide attempt. The ER can be scarier, but also a bit gentler depending on the particular staff treating you. I have found that most times, even for only si, they will have you talk to a crisis counselor or have a psychiatric eval. Again, depending on the severity of the cut, the placement, and the staff working, this can go quickly and they discharge you with instructions to follow-up with your treatment providers, or you could get stuck there.
In my experience, urgent care staff don't see as much of it, and will either mistaken it for a botched attempt, or still insist on you getting an eval. The few times I had gone to my doctor's office instead of the ER, she always sent me to the ER for an eval (this had to do with the placement, and my frequently "going a bit too far" by accident because I had been getting less and less relief). A few times, the ER staff sent me home with a crisis plan and a follow-up with my therapist. There were also some times that I was admitted for a few days. It totally depended on the staff and the hospital I went to/was sent to.
There was a time I was seeing an nurse practitioner that knew my therapist and worked closely with her. I was able to go to her for "a quick check" on an emergency basis and she would fix me up, then call my therapist while I was with her. She only ever sent me to the ER once out of about 2 dozen times, and that was only because she misunderstood what I had said.

all that being said, is there any way you can ensure minimizing damage? I know sometimes I have deliberately used a very dull blade. It gave the over-all feeling of cutting (the pressure, the scrape, very little blood), and I was able to refrain from doing too much damage. It also allowed me to be more "violent" in my si (especially if I was angry at myself, or feeling really out of control) without doing much damage. I would only do this at times when I felt I would do too much damage either from having held off for too long and the urges built up too much, or from being too emotionally out of control.

I have also been known to place a phone book or large stack of magazines in front of me and cut them instead. It was also helpful when I felt more out of control. If I got the emotional energy out on the unassuming paper, I would either be ok not cutting, or I would do it much less on myself.

Lastly (or should this be first actually?), can you call you T or a crisis line to talk about what's going on? I know I tend to act first, then talk later, but figured I would throw that out there also. It can be really tough sometimes, and any help you can get re-directing your energies or resisting the urges can come as a blessing. I would hate to see you have to get sutures for a slip up. I would much rather read that you were able to reach out and use alternative coping skills. I know it's difficult though...

Good luck, hope you can find relief without self injury.

[PBCMom]

Originally Posted by MdngtRain

I'm not advocating the si, but I want to answer your questions to the best of my ability.

Thank you. I know you're not advocating it. I don't want to do it. But I very much appreciate your thoughtful, detailed and helpful response.

Originally Posted by MdngtRain

I would only do this at times when I felt I would do too much damage either from having held off for too long and the urges built up too much, or from being too emotionally out of control.

This is exactly where I'm at. I do feel emotionally out of control and I think that is what is triggering all of this and making me struggle with feeling like I need to si. Because I'm trying to fight it, the need and the urge is building up and it feels like if I allow myself to si that it will just come bursting out of me and cause too much damage. It feels really scary.

Originally Posted by MdngtRain

I have also been known to place a phone book or large stack of magazines in front of me and cut them instead. It was also helpful when I felt more out of control. If I got the emotional energy out on the unassuming paper, I would either be ok not cutting, or I would do it much less on myself.

I've never heard this suggestion (and I've heard MANY) but this actually sounds/feels like it could be helpful. Thank you. I may try the phone book thing...if I can find one.

Originally Posted by MdngtRain

Lastly (or should this be first actually?), can you call you T or a crisis line to talk about what's going on?

Crisis lines freak me out. I know I should be calling my T. I don't know if I'm just too scared, or if it's because I think I should be able to hold it all together until my next appointment (my appointments are kind of spread out and out of whack because of the holidays) but I just can't make myself call. I want to do this on my own.

Thank you so much for your response and suggestions.