According to the DSM-5, at least three out of twelve symptoms must be present for a diagnosis of catatonia. These symptoms include:
- Stupor (oblivious inability to move or respond to stimuli), catalepsy (rigid body posture)
- Mutism (little to no verbal communication)
- Waxy flexibility (body remains in whatever position it is placed by another)
- Negativism (lack of verbal response)
- Posturing (holding a posture or position that goes against gravity)
- Mannerisms (extreme or odd movements and mannerisms)
- Stereotypy (frequent repetitive movements for no reason)
- Agitation (for no reason), grimacing (distorted facial expressions)
- Echolalia (repeating others’ words)
- Echopraxia (repeating others’ movements)
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I was in IOP, until Friday. Tuesday night, I ended up in the emergency room for stitches around 3 am. When I told the therapist at IOP on Thursday, she was extremely concerned. We agreed at that point, however, that IOP was still working. Thursday night, I had a massive crying fit and was obsessing over suicide for hours before I was finally able to fall asleep. At the end of group on Friday, I told the IOP therapist that I thought it was time to step up to PHP… Don’t get me wrong, I don’t want to be in PHP. It makes my schedule extremely cramped and I had to take a break from physical therapy just to make it work. I already have to leave early two days a week for school.
Over the weekend, I ended up in the ER again for more stitches…
I started PHP again on Monday. That day went okay, nothing really out of the ordinary or strange. Yesterday, however, there were issues. During the last part of the morning, the discussion turned to suicide and I found myself unable to move or speak or respond with more than a movement of my head. And even that was difficult. I was aware, I wasn’t dissociated. I could hear everything that was being said, I just couldn’t participate in any way and was just staring off into space at nothing. The therapist asked if I was okay, and I was able to kind of snap out of it for a moment and nod yes. He asked if there was anything they could do to help, and I shook my head. At that point, I just wanted the attention off of me. He eventually went back to the discussion, and I went back to being catatonic. At some point, he asked me a question, trying to pull me into the discussion. I just kinda sat there and stared at him. He asked me if the topic of the discussion was causing me to go catatonic, and I shook my head no, even though it technically was the topic.
At the end of group every day, the therapist checks in with each of us about suicidality and homicidality. When he got to me, I struggled to give an answer… I just nodded at the question. He knows I never have homicidal thoughts, that my harmful thoughts are always aimed at myself. He asked me if the catatonia is often related to an increase in suicidal thoughts, and I nodded.
When I obsess over suicide or self harm, I am usually in a catatonic state of some degree. And when I was catatonic in group, I was obsessing… a lot. I didn’t want to tell him that, though. I didn’t want to admit that I was imagining being at the top of the cliff next to the Pennybacker Bridge, standing at the edge. Knowing that I had sent my goodbyes to my friends and that none of them knew where I was and none of them could figure out where I was in time. Imagining how the wind would feel up that high, and how the wind would feel as I started to fall. The image in my mind goes the entire way, all the way to the end. Even the graphic image of hitting the rocks… and what my body would look like when I was found and pulled back up to the road. What my friends and family would think and feel, and how they would react. I know it would hurt them, but there are times that even that is not enough to keep the images from coming forefront in my mind. Even that is not enough to keep me from counting pills and seeing if I have enough for the backup plan.
At this point, though, it is just obsessing. There is no intent to do anything. And that is the difference between being allowed to leave PHP for the day and not. The therapist would still let me leave if I had mild intent, but I could contract for safety and agree to be there the next day of group. He has in the past. He has always said that he will not force me to go to the hospital. He wants it to be my decision, not his. He doesn’t want to take that power from me. He knows my history of trauma and being controlled, and does not want to perpetuate that trauma by taking away my ability to control whether I go to the hospital or not.
I have been committed once, and trust me, it was not a pleasant experience. Being put on a 72-hour police order of emergency protection was humiliating. It was like being told I couldn’t take care of myself, that I wasn’t an adult with the free will to make choices, that I needed someone to make choices for me because I was literally incapable of knowing what was best for me. After the hold was over, and I was no longer angry about being forced to be in the hospital in the first place, I agreed to sign the paperwork to be there voluntarily. That didn’t take away that fact that I was forced to be there in the first place and had no choice about when I could leave. If I asked to leave, they would have just taken me to court. It wasn’t worth it.
So, since yesterday’s events in PHP and going catatonic while in group, I have been in and out of catatonia. In and out of obsessing. I haven’t slept. I had to go to the ER again, this time they gave me staples. So now I have two sets of stitches and one set of staples. I have been to the ER on the 4th, then the 8th, and the 11th. All in the early morning hours. The stitches I can take out on my own when their 10 days are up, but the staples I have to make an appointment with my primary care physician to get them out. I am not looking forward to that, at all. He worries… and he isn’t shy about letting me know he is concerned.
Another part of this whole situation that is bothering me is that the PHP therapist and I went over my treatment plan yesterday… one of the goals on it is to go two full weeks without going to the emergency room for self harm. He made sure to say that he didn’t want that to keep me from going if I needed to go, just because I wanted to complete the goal. But we just went over it yesterday, and I have already failed. The night after we talked about it, I ended up in the ER… again… I wish I could just stop. I wish I could just not do it. But it’s not that easy. It’s never been that easy.
It’s about 6 am now, and I’m planning on going to the morning AA meeting and then heading to PHP. I need to grab something to eat for breakfast. When I was leaving the ER, I had to decide between Waffle House or a 24-hour coffee shop in town. I went to the coffee shop, so I haven’t had food yet. So, I’m gonna call it, and go find food. Thanks for reading and I hope you come back again!