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Self-injury is fairly common among younger women with bipolar disorder, especially during particular phases of the illness.
Many people with bipolar disorder deliberately injure themselves. Self-injury is often referred to as “cutting,” but other tactics such as burning, punching, and pulling out hair are also used.
Women are much more likely than men to cut themselves, but people of all races and all backgrounds engage in the behavior. Usually cutting begins in adolescenceor early adulthood, but once started it is more likely to recur even as the person gets older, especially during certain phases of bipolar disorder.
If you have a loved one with bipolar disorder who engages in self-injury, it’s important to learn why she does it, what mood episodes may contribute to the behavior, and what you can do to help her.
Bipolar Disorder and Cutting: Why?
You may be surprised to learn why people living with bipolar disorder cut themselves. Self-injury is actually not suicidal behavior. It usually has a different motivation entirely. “With cutting, it’s a [tension] release phenomenon,” says Suresh Sureddi, MD, assistant professor of psychiatry at the University of Texas Southwestern Medical Center in Dallas and director of Lifepath Systems, a community mental health clinic in Plano, Texas. Tension has built up within the patient and cutting helps get it out. “They’ll tell you, ‘I never wanted to hurt myself. I felt depressed, but I was so tense I just cut myself — [and now] I don’t feel bad anymore.’ ”
Dr. Sureddi says that in people living with bipolar disorder, cutting is more common during what is known as a “mixed phase,” during which the patient is experiencing manic and depressive symptoms at the same time. However, Sureddi notes he does see it during severe depressive phases of the illness as well. During mixed phases, patients often feel very depressed and sad, but also can’t sleep, are agitated, and have impulsive behaviors, so they tend to be in distress — and this phase tends to be the most destructive one of bipolar disorder.
Sureddi adds that any phase of bipolar disorder can lead to use of alcohol and drugs: “When you mix drugs and when you already have depression or any of the major mood episodes, you are also much more prone to cause self-injury.”
Bipolar Disorder and Cutting: How Can Parents and Caregivers Help?
Cutting is such a serious, dangerous, and frightening behavior that you may feel helpless. You may fear that there isn’t anything you can do to help your loved one. But there are some very positive steps you can take to help her control her bipolar disorder, which in turn may help control her cutting behaviors as well:
- Be calm and supportive. Although living with a loved one with bipolar disorder can be very frustrating, it is very important not to show that frustration to her or to be critical. She is also likely to be frustrated by her illness and needs your support. Sureddi says that in order for your loved one with bipolar disorder to do well, family members “have to remain calm, stay supportive, and educate the patient to stay on the medication, encourage the patient to finish either school or maintain jobs, [and] maintain a healthy lifestyle.” He emphasizes that regular sleep patterns are very important in terms of controlling moods and staying well. You may also be able to help your child find alternative ways of relieving stress, which is a common trigger of mood episodes.
- Help identify mood changes. Another important role you can take is to go to doctor’s appointments with your loved one and learn how to recognize signals that she is starting a mood episode. Sureddi says he discusses with his patients the importance of letting family members help them identify when their moods are changing and they are beginning a bipolar phase. He says the phases can come on so suddenly that the person living with bipolar disorder may not even realize it, but family members will notice the signals — such as being cranky or irritable, or not sleeping — sooner. “You can catch it very early and adjust medication or start another medication that actually prevents hospitalization or any other negative outcomes,” Sureddi says.
If you see any of the signs that a loved one with bipolar disorder is cutting or otherwise injuring herself — such as scars, wearing long sleeves in warm weather, or giving excuses for how injuries occurred that just don’t make sense to you — tell her doctor immediately. Together you can figure out the best way to help.