You bring up a lot of interesting and I believe valid points. In a nutshell you sound a lot like me, although I haven't wanted to harm myself in a very long time and don't feel like I will.

Your observation on feeling the 'rush' after an intense session is a revelation for me. I also have issues using opiates, to tamp down intense emotional reactions due to PTSD triggers, and I suspect the relational issues are similar for a lot of other people.

Unfortunately I don't have any insight beyond what you bring up; I just wanted to let you know that it feels pretty accurate. Hang in there and please try not to harm yourself right now. I think you know that until you allow yourself to 'feel' and tackle the PTSD, you're not going to make any progress.

I had to find a T that I absolutely knew was 'safe' for me, and once they convinced me that 're-telling' the trauma was not the same as being re-victimized, I was able to start to face it and integrate it into my life safely.
Everyone gets to that stage in their own way. I hope you are able to do it for yourself.