People with bipolar disorder, depression, and other mood disorders often have episodes when they feel extremely sad, hopeless, anxious, or confused. When these emotions get too intense, the person may struggle with how to cope with overwhelming emotions, and for some people, efforts at coping with distress may take the form of acts of self-injury.
Self-injury, often including cutting, self-mutilation, or self-harm, is an injurious attempt to cope with overpowering negative emotions, such as extreme anger, anxiety, and frustration. It is usually repetitive, not a one-time act. Often, people who deliberately injure themselves are survivors of traumatic events during childhood or early developmental periods in life. Self-injuring behaviors that occur because of difficulty coping with stress are not a symptom of bipolar disorder itself, but may happen when someone's emotional coping strategies are not well-developed.
The bipolar spectrum is a term used to refer to conditions of many people with depression, substance abuse, and a wide range of other psychiatric conditions who also have some symptoms of bipolar disorder. Although they have these similar symptoms, they are not diagnosed with bipolar disorder as it is commonly defined. Some psychiatrists find the concept useful. But since it has not been rigorously studied it hasn't been widely adopted.
Self-injurious behavior is most widely recognized as a key feature of another condition called borderline personality disorder. Borderline personality disorder is a disturbance involving longstanding problems in regulating moment-to-moment emotional reactions to stressful events, especially those involving strong emotional reactions with high sensitivity to interactions with other people. Self-injuring behaviors also sometimes happen in people whose behavior becomes disorganized because of a primary psychotic disorder (that is, an inability to literally differentiate reality from fantasy), head traumas, or developmental disabilities.
What are some forms of self-injury?
Cutting the skin with a sharp object is one form of self-injury. Other forms of self-injury may include burning, scratching, hitting or bruising, biting, head-banging, or picking at skin. Sometimes pulling out hair is a form of self-injury.
Some people who engage in self-injury may do so methodically or regularly, almost as if self-injury were a ritual. Other people may use self-injury impulsively -- at the spur of the moment -- as a way to get immediate release for built-up tension. They may use self-injury either as a way to regulate intense emotions or as a distraction technique.
No matter how self-injury is used, it is an unhealthy and dangerous act and can leave deep scars, both physically and emotionally.
Why do people engage in self-injury?
Just as there are healthy ways to relieve stress, such as exercise, there are also unhealthy ways to cope with negative feelings. For some people, self-injury is a coping mechanism.
Along with self-injury, some people with bipolar or another psychiatric disorder may be more apt to abuse drugs or alcohol than people without mood disorders. Some experts believe that risky behaviors are related to the patient trying to self-soothe unpleasant mood states, particularly if they feel overwhelmed in their ability to cope with distressing emotions.
Like drugs and alcohol, self-injury tends not to be an effective way to try to relieve emotional discomfort. That's why it's important that people with mood disorders -- especially when traumatic events or abuse have occurred in childhood -- talk with their doctors about effective strategies to help manage emotional distress.