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, but may happen when someone's emotional coping strategies are not well-developed, or when certain other mental health problems co-exist with bipolar disorder.
People with bipolar disorder often have cycles of elevated and depressed mood that fit the description of "manic depression." When a person's illness follows this classic pattern, diagnosing bipolar disorder is relatively easy.
But bipolar disorder can be sneaky. Symptoms can defy the expected manic-depressive sequence. Infrequent episodes of mild mania or hypomania can go undetected. Depression can overshadow other aspects of the illness. And substance abuse can cloud the picture.
Self-injurious behavior is most widely recognized as a key feature of a 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.