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    Bipolar Disorder and Self-Injury

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    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 and other psychiatric disorders 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 he or she feels overwhelmed by 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.

    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 stop self-injurious behavior if he also has bipolar disorder?

    If you or a loved one has both bipolar disorder and, in addition, self-injurious behavior, 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, such as borderline personality 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.

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