Understanding Bipolar Disorder and Self-Injury Connection

Understanding the Connection Between Bipolar Disorder and Self-Injury

Self-injury, also known as self-harm, is the act of deliberately and intentionally hurting oneself as a coping mechanism for emotional distress. Forms of self-injury include cutting, burning, bruising, scratching, hair pulling, and interfering with wound healing. While self-injury can occur in individuals without mental illness, it often presents as a symptom in certain psychiatric disorders like borderline personality disorder and bipolar disorder.

Bipolar disorder is a mental health condition characterized by extreme shifts in mood and energy levels. Individuals with bipolar disorder experience periods of mania or hypomania (elevated moods and energy) and periods of depression. Rates of self-injury tend to be higher in those with bipolar disorder compared to the general population.

Prevalence of Self-Injury in Bipolar Disorder

Various studies have found high rates of self-injury in people with bipolar disorder:

• A 2007 study found that around 35% of individuals with bipolar I disorder had a history of self-harm, compared to only 4% of healthy controls.
• A 2014 study reported that 21% of participants with bipolar disorder had engaged in self-injury at some point in their lives.
• Another 2014 study found lifetime rates of non-suicidal self-injury at 21% in bipolar I disorder and 13% in bipolar II disorder.

Overall, research consistently shows that anywhere from 13-35% of individuals with bipolar disorder engage in self-harm behaviors. This is significantly higher than the estimated 4% lifetime prevalence of self-injury in the general population.

Reasons for Self-Injury in Bipolar Disorder

There are several theories as to why those with bipolar disorder may be more prone to self-injury:

Emotional Dysregulation

Problems regulating emotions are common in bipolar disorder. Self-injury may provide temporary relief from intense emotions that feel unmanageable, such as anger, sadness, emptiness, anxiety, and self-loathing.

Impulsivity

Many individuals with bipolar disorder struggle with impulsivity, or difficulty controlling urges and behaviors. The impulsive nature of self-injury may make it more likely to occur during a mood episode.

Distraction from Internal States

Self-injury can serve as a distraction from painful thoughts and feelings. The physical pain of self-harm shifts attention away from emotional suffering.

Self-Punishment

Feelings of low self-worth, guilt, and self-hatred are common in bipolar depression. An individual may feel they deserve to be injured as a form of self-punishment.

Gaining Control

The lack of control experienced during mood episodes may motivate self-injury as a way to regain a sense of control over one's body and environment.

Communicating Distress

Self-injury can serve as a non-verbal signal for help to others when an individual feels unable to express their distress verbally.

Self-Injury Triggers in Bipolar Disorder

Certain bipolar mood states and symptoms tend to increase the risk of self-injury:

Depressive Episodes

The despair, emptiness, and suicidal thoughts during bipolar depression can precipitate self-injury. This behavior may occur with or without suicidal intent.

Mixed Episodes

Mixed episodes involve symptoms of mania and depression simultaneously, often leading to significant agitation, anxiety, and racing thoughts. Self-injury may provide a sense of relief or control during this volatile state.

Psychosis

Loss of touch with reality during manic or depressive psychosis can lead an individual to engage in self-harm for non-logical reasons that feel valid in the moment.

Interpersonal Problems

Relationship conflicts, social isolation, and feelings of abandonment during bipolar episodes can trigger someone to self-injure.

Substance Abuse

Alcohol and drug use, common in bipolar disorder, reduce inhibitions and impair judgment - making self-destructive behaviors like self-injury more likely.

Impulsivity and Risk-Taking

The increased impulsivity of manic states may lead to risky, self-damaging behaviors with little forethought of consequences.

Warning Signs of Self-Injury Risk in Bipolar Disorder

Some signs that an individual with bipolar disorder may be at imminent risk of self-injury include:

• Talking, writing, or posting on social media about self-harm
• Isolation from friends, family, and social activities
• Looking up information online about self-injury methods
• Severe insomnia or sleeping too much
• Intense and uncontrollable mood states
• Feelings of hopelessness about the future
• Increasing alcohol or drug use
• Hoarding objects that could be used to self-injure
• Re-opening partially healed wounds or interfering with wound healing

Paying attention to these warning signs and taking them seriously is crucial for getting timely professional help to prevent self-harm.

Treatments to Reduce Self-Injury in Bipolar Disorder

A comprehensive treatment plan can help minimize self-injury behaviors in bipolar disorder. Treatment strategies include:

Medications

Mood stabilizers, antidepressants, and atypical antipsychotics help regulate mood and impulsivity. Medication reduces bipolar symptoms that may otherwise trigger self-injury.

Psychotherapy

Talk therapy like cognitive-behavioral therapy (CBT) and dialectical behavior therapy (DBT) provide coping skills training, emotion regulation, and cognitive restructuring of negative thought patterns.

Self-Monitoring

Using mobile apps or journaling to track moods, identify triggers, log self-injury urges, and substitute healthier coping skills can prevent harmful behaviors.

Limiting Access

Restricting access to objects that may be used for self-injury when an individual is actively suicidal or self-harm urges are strong.

Support Groups

Peer support provides understanding and reduces isolation. Sharing alternatives to self-injury learned by others can be very helpful.

Hospitalization

Inpatient hospitalization may be necessary during acute bipolar mood episodes accompanied by self-harm behavior to manage dangerous symptoms.

Creating a Self-Injury Prevention Plan

Individuals with bipolar disorder can collaborate with their treatment team to create a self-injury prevention plan:

• Identify personal warning signs of self-harm urges
• Make a list of healthy distractions that provide temporary relief from the urge to self-injure
• Remove access to means of self-injury during high-risk periods
• Create a list of trusted friends and family members to contact for support when urges arise
• Make an appointment with a therapist and psychiatrist at the earliest sign of worsening mood symptoms

Having a plan in place helps counter the tendency towards impulsivity and regain control during a self-injury crisis.

The Role of Family and Friends in Prevention

For loved ones of an individual with bipolar disorder prone to self-harm, it is important to:

• Learn the person's self-injury warning signs and triggers
• Check in regularly via text, phone, or in person
• Provide consistent emotional support and encouragement
• Avoid shaming, lecturing or criticizing
• Notify the treatment team if self-injury warning signs appear

While ultimately it is up to the person to avoid self-harming, a strong social support system makes resistance easier during vulnerable mood states.

The Outlook for Self-Injury Recovery in Bipolar Disorder

With professional treatment and a personalized management approach, many individuals with bipolar disorder can reduce self-injury urges and stop self-harming altogether. However, it often requires time, diligence, and daily commitment to replace the self-soothing function self-injury provided with healthier coping skills. There may be setbacks during periods of high bipolar symptom severity. Patience, self-compassion, and continuing to adjust treatment based on current needs improves self-injury recovery prospects in bipolar disorder.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.