Understanding Self-Injury in Bipolar Disorder and Other Mental Illnesses

Self-harm is seen in many psychiatric disorders, including bipolar disorder

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Self-injury is the act of hurting one's body without the intention of suicide. While self-injury is an entirely distinct behavior from suicide, it is often seen as a red flag in persons may likely attempt suicide at a later date.

Non-suicidal self-injury can take many different forms including cutting, burning, scratching, abrasion, punching, and head banging. More severe cases have involved bone breaking, self-amputation, and permanent eye damage.

Self-injury is a symptom associated with different forms of psychiatric illness, including major depressive cycles of bipolar disorder. Other causes include borderline personality disorder, eating disorders, and dissociative disorders.

Self-injury is seen more frequently in younger people with as many as 15 percent of teens and 17 to 35 percent of college students engaging in self-injurious behavior. The rate of self-injury is pretty much split down the center between women and men. However, the types of behavior differ considerably between sexes with women more likely to cut and men more likely to punch or hit themselves.

Adolescent psychiatric inpatients have the highest rate of self-harm, ranging from as low as 40 percent to as high as 80 percent, depending on the study. Among older psychiatric patients, the rate hovers between two to 20 percent.

Psychiatric Disorders Linked to Self-Injury

While rates of self-injury are higher in persons undergoing psychiatric care, the form and severity of the behavior can vary significantly.

Four specific psychiatric disorders are strongly linked to self-injury:

Major depressive disorder (MDD): MDD is linked to self-injury in 42 percent of adolescents undergoing psychiatric care. MDD is a characteristic feature of bipolar I disorder and one that is more likely to persist if left untreated.

In those diagnosed with persistent depression (dysthymia), one in eight will inflict self-injury as a "suicide gesture" wherein there is no actual intent to die.

Borderline personality disorder (BPD): BPD is the one condition most associated with self-injury, occurring in up to 75 percent of cases. Self-injury is seen as a means of mood regulation, with 96 percent saying that their negative moods were relieved immediately following an act of self-harm.

Dissociative disorders: Dissociative disorders are those characterized by feelings of being mentally and sometimes physically disengaged from reality. Most are related to extreme emotional trauma and can manifest with acts of self-punishment for an event the person feels "responsible" for. Around 69 percent of those diagnosed with dissociative disorder engage in self-injury. 

Eating disorders: Bulimia and anorexia nervosa, are also linked to self-injury in 26 to 61 percent of cases. Self-punishment is seen as the rationale behind many of these behaviors.

Causes of Self-Injury

Because there are many different mental disorders associated with self-injury, it's difficult to explain why you may experience an impulse to harm yourself. With that being said, in most cases, self-harm is related to negative feelings before the act, leading to a desire to relieve anxiety or tension.

Self-harm has also been linked self-punishment, sensation-seeking (often expressed as the desire to "feel something" when emotionally numb), or suicide avoidance (using pain as a relief valve for an otherwise self-destructive emotion).

Treating Self-Injury Related to Bipolar Disorder

Treating self-injury as a manifestation of a deeper disorder is complex. On the one hand, you want to minimize the physical harm while understanding that you can't do so without treating the underlying condition.

The process involves the structured assessment of the person's attitudes and beliefs, essentially to understand self-injury from his or her perspective.

Treatment involves counseling and the use of medications to treat the underlying disorder, whether it be bipolar depression, BPD, or a combination of disorders.

In some cases, the anti-seizure drug Topamax (topiramate) can reduce the incidence of self-injury when prescribed alongside a mood stabilizer. Positive results have been achieved in persons diagnosed with both BPD and bipolar I disorder as well as those with BPD and bipolar II disorder.

Source:

Kerr, P.; Muehlenkamp, J.; and Turner, J. "Nonsuicidal Self-Injury: A Review of Current Research for Family Medicine and Primary Care Physicians." Journal of the American Board of Family Practice. 2010; 23(2):240-259. 

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