Understanding Self-Injury in Bipolar Disorder

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Self-injury can happen for many reasons, and it's more common than many people think. Who are these people, and why are they doing self-harm by cutting, burning or otherwise hurting themselves?

  • And you can't fight the tears that ain't coming
    Or the moment of truth in your lies
    When everything feels like the movies
    Yeah you bleed just to know you're alive

    ~Goo Goo Dolls

Perhaps it is inconceivable to you that someone would deliberately cut her wrists -- not to take her own life, but specifically to inflict an injury.

You find it horrifying to even consider that an individual would burn his own skin with cigarettes, matches or a lighter.

Maybe you've seen the scars which run the length of a friend's or loved one's arm, but you have pretended not to notice ... or perhaps you understand perfectly. Perhaps you have personal experience with hurting yourself.

From whichever side of experience you view this picture, the truth remains that self-injury is a very real and painful issue. It is a serious problem for an estimated 1 percent of the population in the United States alone or 1,000 people in every 100,000. (Demographics of Who Self-Injures)

What Is Self-Injury?

This question is not as easy to answer as it may seem. There is an incredible spectrum of self-injurious behavior along with a great many diversified opinions on what should be classified as pathological. However, the author of Secret Shame (a very well-researched and organized Web site) believes that the best definition of self-injury comes from Winchel and Stanley - "the commission of deliberate harm to one's own body.

The injury is done to oneself, without the aid of another person, and the injury is severe enough for tissue damage (such as scarring) to result. Acts that are committed with conscious suicidal intent or are associated with sexual arousal are excluded."

This definition may be a bit too all-encompassing.

Kharre, the author of another Internet resource on self-injury, points out that it could include socially accepted practices such as piercing and tattooing.

Finally, there is this definition: "Self-Injury (SI) is the act of physically hurting yourself on purpose without the intent of committing suicide. It is a method of coping during an emotionally difficult time that helps some people temporarily feel better because they have a way to physically express and release the tension and the pain they hold inside. In other people hurting themselves produces chemical changes in their bodies that make them feel happier and more relaxed."

Why Do People Self-Injure?

There are many opinions and theories, but research does seem to indicate that some mechanisms such as an imbalance in serotonin and alterations in physiological arousal may play a role. However, I believe the best answers to this question come from those who have firsthand experience. In When the Urge to Hurt Yourself Wins, members share their personal experiences with the need to injure themselves. These offer a rather poignant picture of the intense emotional and even physiological drive to find solace, to find a calm if even for a brief moment, or in some cases, to use pain as relief from numbness.

  • Know you have died
    And your pain is the sign
    You're alive, you're alive, you're alive, you're alive
    You can still bleed
    You can cry, you can need
    You can shred your soul
    You can rise when you fall


Who Self-Injures?

By far the majority of people who self-injure are female, usually in their teens to thirties. Typically those who self-injure are intelligent and well-educated. They come from the middle- to upper-middle-class, and sometimes they have been raised by an alcoholic parent and sometimes have been subjected to physical and/or sexual abuse (Secret Shame). It should be noted, however, that some reports now indicate that the percentage of men is quite a bit higher than initially thought (Kharre).

Secret Shame has compiled a psychological profile of those who tend toward this type of behavior. Some of the included characteristics are:

  • strongly dislike/invalidate themselves
  • are hypersensitive to rejection
  • are chronically angry, usually at themselves
  • suppress or direct inward
  • tend to act in accordance with their mood of the moment
  • are depressed and suicidal/self-destructive
  • suffer chronic anxiety
  • tend toward irritability
  • do not think they have much control over how/whether they cope with life
  • do not see themselves as empowered

I did it when I felt my most depressed -- when I felt so removed from this world that I didn't even feel real anymore. I think I cut myself because I wanted to feel pain - because feeling anything, even pain would mean that I was alive and real and living in this world, and not fading into the background.


Why Do So Many With Bipolar Disorder Self-Injure?

Within the ranks of those who have bipolar disorder, this seems to be a common phenomenon. Why? To date, I have not been able to find any specific research dedicated to finding a common cause. However, in my opinion, the duality of self-injury and a diagnosis of bipolar disorder should hardly come as a surprise.

Consider again the list of common psychological characteristics. This could almost read as a list of symptoms of bipolar disorder (see our Red Flags series) most especially as it relates to those who struggle with dysphoria - that very difficult emotional state which combines the worst features of both mania and depression.

In addition, self-injury can be associated with many other disorders that frequently co-occur with bipolar disorder, including borderline personality disorder, post-traumatic stress disorder and others.

  • I do dissociate when I cut but not always.
    I cut to focus my mind when my thoughts are racing.
    I cut to make physical what I feel emotionally.
    I cut to see blood because I really like it.
    I don't like to cut and yet I'm not sure I can give it up.

    ~Alysynn, on our Bipolar Disorder Forum

Regardless of the roots of this problem, regardless of the cause, this is a serious concern for those with this disorder. It is a very painful, very scary, very real situation. For those who fight this overwhelming condition, please take a minute to read the beautiful Words of Encouragement from a member of our forum.

For Further Study:

Kharre's Home - offers suggestions for avoiding self-injury behavior and includes a worksheet for when the need arises to go to the hospital.
Secret Shame - top-notch site crammed with information and resources.
Resources - offers info specific to the UK and some in the USA.

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