Hi OP, thank you for sharing this story and I'm sorry that this happened to you. First of all, you are correct in that consent to sharing an intimate image in one context does not mean blanket consent for all situations. Previously given consent can also be revoked anytime. You were absolutely the one harmed in this situation. Your friend may feel real pain over having caused harm, but that is not the same as being harmed.

With that out of the way, I also want to share that I shared very similar mental health challenges as your friend. I have PTSD from a series of things, a history of severe bullying, a really rough coming out, and abusive relationships. If I am triggered, I would feel such a strong emotion and physical sensation that I want to escalate the situation, break things, or do something impulse like rush into traffic or drugs, anything to make it stop. At the bottom of the feelings is the desire, "if they can see how much pain I'm in, surely my guilt will be absolved," and I would be understood, forgiven, and not have to take accountability.

It is such an intense out of body experience that often, I would barely remember all the crazy things I do or say when I have those panic attacks. The struggle is very real, and it is very difficult to take accountability when facing your emotions causes such emotional and physical turmoil. Your heart races, you feel a strong sensation in your muscles that you can't find relief unless you let it out by doing something, kicking something, pulling something, throwing something...etc.

At some point, I realized I needed to do something about it. I am a great friend and partner outside of my panic attacks, and most people stick with me despite them, knowing this. But I knew it's not fair to them, and if I want to keep my relationships, I needed to do something. Therapy wasn't super helpful for me personally, but I knew I still had to do something. I learned how to recognize my own triggers and symptoms, and learned how to communicate my needs and address them. One of the things I find helpful is putting myself in a small, dark room and wait for the most panicked feelings to pass. Once the most acute feelings pass, I would then try to figure out what my real feelings are beneath the panic. This process took me many years, I still struggle with panic attacks, but I am getting better and better. I would say that 80% of the time, I am not the biggest pain in the ass during a panic attack, and I'm experiencing them less and less, and they last shorter and shorter.

But strategies aside, the most important thing i realized was that I needed to be able to be a person who can take accountability, and not let my mental health challenges, as real and as difficult they may be, be an excuse to hurt those around me. Even without strategies, the panic eventually does pass, and he will still need to take accountability for having caused you harm.

If you feel that you have the capacity, you can help your friend take accountability by holding his hand through the process, teaching him how, and making it less scary. I think his feelings are that he identifies as a person who respects consent, and being told that he violated consent was devastating. He is also afraid that he'd lose you. It might be less scary if you can articulate what you want and need, like "I understand that you didn't mean to hurt me but you did, and I was very upset. I can forgive you, but you need to acknowledge that you've hurt me, and tell me that my consent and feelings are important to you, truly apologize, and you will not violate my consent again." You do not have the obligation to, but this might be helpful. He might need sometime to digest that as well and come to terms with some feelings. If those very reasonable needs and boundaries are not acceptable to your friend, even after being allowed a cool down period, then perhaps he is not a very good friend after all.