The Link Between Self-Harm and 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 warning of persons who may likely attempt suicide at a later date.

Non-suicidal self-injury can take many different forms including cutting, burning, scratching, abrasion, punching, and headbanging. 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.

Demographics of Self-Injury

Self-injury is seen more frequently in younger people with as many as 17 percent of teens and about 15 percent of college students engaging in self-injurious behavior. Seventeen percent is also the lifetime prevalence of self-injury. In one analysis of self-injury report data sets from 1990 to 2015, rates increased through 2015.

The first episode commonly occurred about age 13, with almost one-half (47 percent) reporting only one or two episodes. Cutting was the self-injury behavior most frequently reported (45 percent), and girls in this analysis were more likely to self-harm. The most frequent reason for self harm was to have relief from disturbing thoughts or feelings. Although slightly more than half sought help, most looked for help from a friend, not a professional, pointing to one avenue for intervention.

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.

It's also important to note that teens, particularly girls, may go through a period of self-injury with a diagnosis of any major mental illness/personality disorder.

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)

Borderline Personality Disorder 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 the Impulse for Self-Harm

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).

If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see our National Helpline Database.

Treatment of Self-Injury Associated With Psychiatric Disorders

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.

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  2. Gillies D, Christou MA, Dixon AC, et al. Prevalence and Characteristics of Self-Harm in Adolescents: Meta-Analyses of Community-Based Studies 1990-2015. J Am Acad Child Adolesc Psychiatry. 2018;57(10):733-741. doi:10.1016/j.jaac.2018.06.018

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