Topic: depression

Question: If I am trying to stop self-harming and I seek help, will I need to be put in an inpatient setting?
I have bipolar disorder, paranoid personality disorder, posttraumatic stress disorder, anxiety and obsessive-compulsive disorder. I last self-harmed a week ago. When I am stressed, overwhelmed, hurt, or angry, the urge to self-harm is all I can think of. I am trying to seek help.

Answer (from Kaileen McMickle, MS, LPCLicensed Professional Counselor):
Glad you are reaching out here!There are two types of self-harm: suicidal and non-suicidal.  A lot of people I see and have seen engage in self-harm just to manage emotional dysregulation, but not to end their lives.  Self-injury actually does a great job at helping us to manage really intense emotional states--even from a chemical level in the body.  When you self-harm, it's triggers your body's endorphin production, which is a chemical that makes us feel good.  I'm not saying you should do it, but I understand why you would choose that option because it is pretty powerful.To answer your question, I've never heard of anyone being admitted into inpatient for trying to stop non-suicidal self-injuring.  Even some people I've worked with that are suicidal and self-harming have remained outpatient given we have an extensive safety plan, including how to reach out for help and coping skill development.  Unless you are at high risk of suicide, you would most likely be outpatient.  I also work from a harm reduction model, meaning that if you have to self-harm it might as well be as safe as possible.  When people are trying to stop, sometimes the pressure gets in the way and they relapse (very normal and actually expected).  So we prepare for that by discussing measures to take to make sure the method you use is very safe.  Things here include making sure anything piercing the skin is properly disinfected, areas on the body to avoid cutting, and self-harm alternatives that still cause pain but are much safer.  For example, some people hold ice in the palm of their hands, or snap rubber bands on their wrists.  There are many websites that have safer alternatives as well if you just do a quick google search.  Have patience with yourself here, too.  You've found a way to manage a whole lot of emotions--and it's worked for you--you did that by yourself!  You also want better for yourself and have made the first steps for change and that's really spectacular.  It'll be similar to quitting any habit, so stick in there.  And if you find a counselor that fits for you, even better!  I wish you so much luck!

Answer (from Nicole StoneAnxiety, relationship crisis, and the separation/divorce experience.):
Seeking professional help does not mean that you will necessarily be admitted into an inpatient setting - though  to be honest, that can become an option if you feel unsafe or if you are unable to plan for safety. However, many clients who struggle with self-harm can find help in outpatient settings - particularly those which offer a treatment called Dialectical Behavioral Therapy (DBT). Looking for a DBT professional or group therapy setting may be particularly helpful, but a skilled professional can help you to figure out how to identify other options even when you are experiencing overwhelming emotions. Without knowing your location, I also recommend searching to find your local helpline or suicide prevention hotline. The volunteers on the other end of the line can be very helpful even if your intention is not suicide and they are likely also to be able to connect you with resources in your area. Calling into the helpline may also be a first step alternative to self-harming when you're feeling overwhelmed.

Answer (from Sherry Katz, LCSWCouples and Family Therapist, LCSW):
I wonder if you really are the long list of descriptions you wrote here.Usually people with personality disorder and people who have bi polar disorder, are not self-aware and do not anticipate their actions the way you write.One possibility is to find a second opinion as to whether you have been overdiagnosed or misdiagnosed.  This happens a lot, especially in clinics which make money from prescription drugs and creating dependencies on these prescription drugs.Yes, follow your intuition and ask for help.  Just try to find a place which may see you in a different light than someone with a long list of diagnoses.