When is it time to go to an emergency room?

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I am in the middle of a massive relapse. I’m sorry. I suppressed the trauma and detached myself and it just came back. I screwed up. I needed to seek more help.

Also my brother’s manic episodes were not great.

I don’t have suicidal ideation or do any self harm. I just might end up passing boundaries with regards to stalking and harassment. I think going to the emergency room should be reserved for a physical threat. I can reach out to schedule various levels of care, but I feel like I am running out of time and help might not come soon enough to keep myself out of trouble. I have not been proactive or even active about taking care of my mental health.

What do I do?

It sounds like what might help is a structured "fire drill" plan, similar to the SAA (Sex Addicts Anonymous) Three Circles model, to manage behaviors before boundaries are crossed. Here's a simplified version/suggestion:

Outer Circle (Healthy Behaviors):
- Call or text a therapist, crisis line, or support group when feeling triggered.
- Practice grounding techniques like deep breathing or going for a walk.
- Engage in safe hobbies or activities (exercise, reading, etc.) to redirect energy.

Middle Circle (Warning Signs):
- Feeling urges to stalk, harass, or violate boundaries.
- Isolating or avoiding contact with support systems.
- Ruminating on obsessive thoughts or engaging in risky behaviors online or in person.

Inner Circle (Danger Zone):
- Reaching out to or following someone inappropriately.
- Entering environments that may trigger harmful behaviors.
- Ignoring clear boundaries set by others.

If This, Then That Checklist:
- If feeling overwhelmed or losing control, then immediately call a therapist or crisis hotline.
- If you think you're about to cross boundaries, remove yourself from the situation (go home, turn off your phone, etc.).
- If you're unsure of your control, consider going to the ER or urgent mental health care, even if no physical threat exists.

You can develop your own check list or your own three circles diagram alone, or (better yet) with your therapist, doctor, or trusted support people.

This structure can help you stay focused and manage boundaries before things escalate.

Also consider DBT skills.

You can google any of these for more information or ask more questions here.

Perhaps you should err on the side of caution and seek help if you feel you might need it?

https://www.auroramhr.org/blog/identify ... th-crisis/

It is good to build some options between “do nothing” and ER

https://communityfirsthealthplans.com/b ... 11-vs-988/

I was so detached when my anxiety reached a critical level I had a massive attack. I literally felt like I was a different place mentally from 12 years ago. It took weeks just to reorganize my thoughts.

I don’t have people I can reach out to, which is very unhealthy. Most coping methods I have only helped temporarily.

I'd suggest making an appointment or two with a therapist (or for other help) even if it's weeks or months away. That way, if you need help then (even if for a different issue) you have it coming. Not making an appointment or getting on a list will just set you further back next time (or at least you'll still be stuck in the same place again). Waitlists are long for many things. Getting on them asap is the only way to eventually getting in. The time will pass whether you're on a list or not, so might as well be on it.

Make sure to cancel with a few days notice if you won't use the appointment when it comes around.

If you are experiencing psychotic episodes or disconnecting from reality you really will need to find someone to help. I know trust is hard. You will have to do as much self care as you can when your mental health is good enough to make changes.

Sweet Pea hugs