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Depression and Risky Behavior

Why self-destructive behavior may accompany depression and what to do about it.

The Costs

When depressed people resort to self-destructive behaviors, the physical damage is obvious: liver damage from alcoholism, sexually transmitted diseases or HIV from unprotected sex, or infections and scarring from cutting one’s skin.

Psychologically, the attempts to avoid or soothe painful emotions with self-destructive behaviors usually backfire, experts say.

“Drinking numbs the brain, drugs obliterate pain for a while by altering perception, sex provides distraction and a temporary feeling of connection which, however, almost always results in greater feelings of isolation and aloneness,” Cantor says. “These behaviors are all maladaptive coping mechanisms.”

Gardenswartz says she once treated a woman who became drunk repeatedly, sometimes on as many as four bottles of wine per night. The woman said that after men had sexually assaulted her, she would wake up feeling ashamed. But beyond the woman's understanding, the vicious cycle continued.

Powerful, unconscious forces and past traumas often drive such self-destructive behavior, according to Gardenswartz. For example, some women who engage in high-risk sex may have been molested as children and learned unconsciously to disrespect themselves and their bodies, she says. “Unfortunately, that was the message put into them.”

“The person has a void inside. They just feel so much pain from the past,” Gardenswartz adds. “They end up harming themselves instead of helping themselves.”

Besides the physical and emotional costs, high-risk behaviors also make suicide or accidental death more likely.

“These behaviors are usually a means of avoiding suicide and relieving pain, yet individuals who self-harm have a greater risk of suicide and suicidal behaviors than individuals who do not,” Cantor says. “Thus, these symptoms of distress, if left untreated, may lead to suicidal gestures, attempts, or plans to commit suicide.”

Or, as Gardenswartz notes, a person might not have suicidal intentions but may die accidentally from a drug overdose or car crash.

Treating Harmful Behaviors

Treatment for self-destructive behaviors should focus on the underlying causes, experts say.

“You have to find out, where is that coming from?” Curran says. “A lot of those behaviors come from having experienced trauma, either witnessing it or experiencing it personally. There’s all this pent-up energy, and it comes out in the anxiety, depression, and risky behaviors. Dealing directly with the trauma helps.”

Besides supportive psychotherapy, antidepressant medications can be useful, says Cantor.

Therapists can also teach avoidance techniques, she says. “If you can avoid a trigger, you can avert the behavior. One has to take oneself away from situations that prompt self-destructive behaviors.” For example, a person who clears alcohol or blades from his or her surroundings will find it harder to drink or to cut.

Depressed people can also learn to substitute activities that don’t cause damage. For instance, relaxation techniques or meditation can help them to manage their feelings, rather than resorting to harmful behaviors, Curran says.

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