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Bipolar Disorder and Self-Injury

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Can self-injury lead to suicide?

Suicide is a major risk for people with bipolar disorder. Between 25% and 50% of those with bipolar disorder attempt suicide, and 15% die by suicide. But people who engage in self-injury to get rid of bad feelings are not necessarily suicidal.

Though self-injury and suicide are different, self-injury should not be brushed aside as a small problem. The very nature of self-injury is physical damage to one's body. It's important for the self-injurer to seek help.

What are warning signs of suicide with bipolar disorder?

Warning signs of suicide may include:

  • Talking about suicide
  • Always talking or thinking about death
  • Making comments about being hopeless, helpless, or worthless
  • Saying things like "It would be better if I wasn't here" or "I want out"
  • Worsening depression
  • A sudden switch from being very sad to being very calm or appearing to be happy
  • Having a "death wish," tempting fate by taking risks that could lead to death, like driving through red lights
  • Losing interest in things one used to care about
  • Putting affairs in order, tying up loose ends, changing a will
  • Hoarding pills
  • Unusual interest in nationally publicized disasters or suicides

How does someone with bipolar disorder stop self-injury?

If you or a loved one has bipolar disorder, it's vital that you work with your doctor to jointly manage your illness. By keeping your moods in check, you can avoid overwhelming feelings of sadness or anxiety that may lead to destructive behaviors like self-injury. Self-injury in itself is not a symptom of bipolar disorder, but often may be the sign of another co-occurring disorder that requires its own treatment.  Psychotherapies that target self-injurious behavior, such as dialectical behavior therapy (DBT), remain the cornerstone of treatment for this problem.  While medicines sometimes can be helpful for trouble controlling angry or aggressive impulses, including impulses to hurt yourself, medication alone is often not as effective as psychotherapy for managing impulses to hurt yourself. 

Some ways to keep your bipolar disorder managed include:

  • Seeing your doctor regularly for mental health checkups
  • Taking your prescribed bipolar medications every day whether or not you have symptoms
  • Staying away from alcohol and illicit drugs that may trigger mood swings
  • Finding a therapist you trust and working with this professional on your coping skills. Some types of behavior therapy can help you learn to deal with emotional distress in healthy ways.
  • Following up with your doctor's recommendations on having lab tests
  • Joining a support group and strengthening your family and friend support network

Treatment for self-injuring behaviors typically focuses on learning skills to better tolerate distress and refrain from self-harm.  Structured psychotherapies such as DBT involve exercises to gain mastery of distress tolerance skills, and using a psychotherapist to provide coaching through the use of those skills when necessary.

If you feel your bipolar symptoms are worsening, contact your doctor immediately. Sometimes a change in medication or dosage is all that's needed to treat breakthrough symptoms of depression or mania/hypomania. 

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WebMD Medical Reference

Reviewed by Joseph Goldberg, MD on February 08, 2014
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