Self Harm... Where to draw the line?

[lostandunsure]

I posted yesterday that things have been pretty bad lately, both of us sick, appliances broken due to old age, etc. She had a minor blow up the other day and things seemed to calm down.

I was wrong. She has simply turned her anger inward and has started scratching herself again. She now has several square inches on her arm that are raw, swollen and irritated due to scratching. I'm glad she doesn't cut, but this is pretty bad. She actually manages to peal the top layer off her skin in patches that leaves them raw and exposed, it looks quite painful.

When I notice it, if she hasn't hidden it from me, which she can be good at, I always ask her about it. If I don't then she tells me that I "must not care" since I didn't say anything. She constantly says that no one cares, because no one says anything, according to her, even her therapist didn't say anything. I was there, they were concerned and were closely monitoring things for escalating behaviors.

I know she does it to externalize her pain, to "feel something real"... . But where do I draw the line? If I catch her picking at her cuticles (how it starts) I try to make it obvious that I'm redirecting her by holding her hands. But, if I'm not around and it escalates to where she scratches herself raw, and we start needing to use antibiotic creams and large bandages, I get very, very scared.

How much is too much? How much to I "allow" before insisting that she go get more help? She was in a Partial Hospitalization the last time it happened because she couldn't stop her self and I was spending all night holding her hands and I just couldn't do it anymore. I don't think it will get that bad this time and maybe I just need to write about it, but it really does worry me because it is a sign of escalating behavior.

She's supposed to see a new psychiatrist in a couple of weeks and I'm hopeful that they will agree with what I've found on BPD, since she's never been officially diagnosed with anything but anxiety and depression... . Unless things get too bad I guess I'll hold on until we can talk to them.

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[maxsterling]

I wonder about this, too.  Mine was a cutter about 10 years ago before I knew her, and if I see her do that I know things have gotten bad and will definitely seek help.  I would do the same if she started using drugs or alcohol again.  That's a sure sign she has completely lost control.

She still self harms by scratching or hitting herself, even though she may not admit to it, and it completely scares me.  The first time it happened, we were in the car and she got upset with me for stating that she was too negative (this was the first time I experienced any serious emotional issues with her).  She started punching her leg and tried to open the car door while I was driving.  The next day, I told her things weren't working and I broke up with her and told her she needs to move out, and she became dysregulated again, this time scratching her forearm raw and hitting herself.  I was so scared I called the police, and then she tried to hit the policemen.  The police basically told her she had serious issues, told me to leave, and then they left. After they left, she threatened suicide.  The latest time she has self harmed, she freaked out because I was assembling bookshelves, and she went into the bathroom and I could hear her hitting herself, and then vomiting.  That time I tried to stay calm and in the next room, and decided that I will giver her 30 minutes to calm herself down before I called anyone.  And she managed to regain control in about 20 minutes. 

I think that is the way I will approach it going forward - If she is only hitting herself or scratching, I will give her time to regain control and know this is part of her process.  If she seriously threatens suicide, picks up a dangerous instrument, or starts smashing or breaking things, I call for help immediately.  But she knows she has BPD, knows what it means, and has gone through therapy, and is seeking therapy again.  That's why I give her the chance to regain control on her own.