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Depression and Risky Behavior

Why self-destructive behavior may accompany depression and what to do about it.
WebMD Feature
Reviewed by Laura J. Martin, MD

Depression poses many dangers, burdening people with hopelessness and raising their risk of suicide. But in attempts to quell the pain, some turn to alcohol, drugs, and other harmful behaviors that endanger them even further, psychologists say.

“There is a strong relationship between depression and high-risk behaviors,” says Pamela Cantor, PhD, a psychologist and lecturer at Harvard Medical School.

“Excessive drinking, drug abuse, unsafe sex, and cutting are all self-injurious behaviors that individuals may use to provide temporary relief from intense emotional pain,” she says -- a pain that some experts have labeled “psychache.”

It’s a fairly common scenario in therapists’ offices across the country. Cara Gardenswartz, a clinical psychologist in private practice in Beverly Hills, Calif., and a lecturer at UCLA, estimates that roughly 30% of her depressed clients engage in some type of “self-injurious or harmful behavior,” she says.

Often, there’s more than one problem. “Someone with one self-injurious behavior is more likely to have two or three,” Gardenswartz says.

At Fordham University in New York, assistant psychology professor and researcher Peggy Andover, PhD, studies young people who engage in “nonsuicidal self-injury.” In other words, when they’re distressed, they cut, burn, carve, or scratch their skin in an attempt to make themselves feel better.

There’s not much data on how often depressed people will engage in nonsuicidal self-injury, Andover says. But researchers have studied those with self-injury for symptoms of depression. “What we know is that people who engage in nonsuicidal self-injury generally have higher levels of depressive [symptoms],” she says. Furthermore, newer research suggests that depression comes first and the self-injury follows, not vice versa, she says.

Reasons for Self-Destructive Behavior

Depression can unearth unbearable feelings that many people try to escape. For example, a depressed man who grew up in a violent and neglectful home may turn to drinking to bury the feelings of rage and poor self-esteem.

“For all of these high-risk behaviors, there’s a part of them that’s trying to numb themselves ... from really difficult and significant feelings of loss, anger, shame, or anxiety,” Gardenswartz says.

But there are secondary reasons, too: Self-destructive behaviors can communicate one’s misery, experts say.

“If they’re depressed and feel that nobody cares -- ‘Nobody loves me and I’m not important to anybody’ -- those behaviors can be a way of saying to themselves and others that ‘I deserve nothing. I don’t deserve to be healthy or happy or whole,’” says Mary Carole Curran, PhD, a psychologist in St. Louis. “Or sometimes, they say, ‘Pay attention to me.’ It’s a cry for help.”

Some turn to harmful coping methods because their families modeled such behavior, Gardenswartz says. For example, if one’s parents dealt with problems through drinking, an adult child might do the same.

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