How bipolar disorder and self-harm are connected

While there are different types of bipolar disorder, all involve dramatic shifts in mood, energy, and behavior. People with bipolar disorder have a higher risk of self-harm, with up to 60% engaging in self-harm at least once in their life. Self-harm — also called nonsuicidal self-injury — is often a way for people to cope with distressing emotions or situations, though the relief is usually temporary. 

Self-harm is not a diagnostic symptom of bipolar disorder but it’s more common among those with the condition. While most people who self-harm are not attempting suicide,* engaging in self-harm may increase the risk of suicidal behavior, making professional support especially important.

If you or a loved one is struggling with bipolar disorder and self-harm, help is available. A therapist can provide emotional support, teach you coping skills when you feel the urge to self-harm, and how to manage the symptoms of bipolar disorder. 

*A note on safety: The 988 Suicide and Crisis Lifeline offers 24/7 confidential support through trained crisis counselors. If you or someone you care about is experiencing emotional distress, self-harm, or a suicidal crisis, please call or text 988. For life-threatening emergencies or immediate assistance, call 911.

Signs of self-harm in people with bipolar disorder

Self-harm behavior can vary. But for someone with bipolar disorder, it’s usually done as a way to cope with the extreme ups and downs that often come along with this mental health condition.

Self-harm with bipolar disorder might look like: 

• Cutting, scratching, or stabbing your skin with a sharp object 
• Hitting or banging your head or other body parts  
• Burning your skin with matches or lighters 
• Engaging in other forms of self-inflicted pain without suicidal intent

People self-harm in different ways. If you or a loved one self-harms in any way, it’s important to get help as soon as possible. 

Research suggests you might be at a higher risk of self-harm depending on your bipolar disorder type. For example, one study showed that almost half of people with bipolar I enrolled in the study had self-harmed.

Another study found people with bipolar disorder who experience more depressive episodes and severe mania tend to engage in higher-risk self-harm behaviors. The people in this study were also receiving specialized medical care, including inpatient treatment.

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Why do people with bipolar disorder self-harm?

Self-harm can be a difficult behavior pattern to break. It’s often a way to feel temporary relief from distressing emotions. 

Some people who self-harm can also feel temporarily good afterward, as people’s brains can release beta-endorphins after pain. But these emotions usually come back after someone self-harms.  

Certain traits, like impulsivity or difficulty regulating emotions, may increase the risk of self-harm in people with bipolar disorder. Research suggests that people with bipolar disorder who struggle with emotional regulation or experience more depressive episodes are at greater risk of self-harming compared to those with fewer depressive symptoms.

Additionally, trouble with emotional regulation is associated with self-harm. Evidence shows that emotional regulation can be harder for people with bipolar disorder.  

Because self-harm is often linked to difficulty managing emotions, it can also co-occur with other mental health conditions including:: 

• Depression
• Anxiety disorders
• Complex post-traumatic stress disorder (C-PTSD)
• Borderline personality disorder
• Dissociative disorders
• Eating disorders
• Sleep disorders
• Substance use disorders 

Understanding why self-harm happens is an important step toward breaking the cycle. With the right support and coping skills, people can find healthier ways to manage emotions and work toward long-term stability.

Dealing with bipolar disorder and self-harm together

Sadly, around 20% of people with untreated bipolar disorder die by suicide. And those with bipolar I are more likely to attempt or die by suicide. However, early treatment can make a big difference.

Some effective treatment options for self-harm behaviors in those with bipolar disorder include:

• Cognitive behavioral therapy (CBT): CBT can help you identify and change thought patterns that contribute to self-harm. This could include negative thoughts that often repeat in your head, impacting your self-esteem. 
• Dialectical behavioral therapy (DBT): DBT teaches you skills for emotional regulation, distress tolerance, and coping with self-harm urges connected to your symptoms of bipolar disorder. 
• Mindfulness-based cognitive behavioral therapy: MBCT integrates mindfulness techniques to help you manage depressive symptoms and respond to distressing emotions more effectively. 

Though not a replacement for professional support, there are other ways to manage the urge to self-harm, including: 

• Distracting yourself: Distractions that require your full attention are best. Engaging in activities that require focus, like puzzles or creative tasks, can help shift attention away from self-harm urges. 
• Calling a trusted friend or family member: Reaching out to someone you trust can provide support and help you manage the urge to self-harm.
• Playing or snuggling with a pet: Spending time with pets can provide comfort and reduce distressing emotions.
• Leaving the room or building you’re in: Changing your environment can create distance from self-harm urges and help you refocus. 

With the right combination of self-care strategies and professional support, you can effectively manage your urges to self-harm and work toward healing.

Find care with Rula

Self-harm is common in people who have bipolar disorder, but help is available. Self-harm usually isn’t an attempt at suicide but it can make managing bipolar disorder more challenging. The good news is that with the right treatment and support, many people learn healthier ways to cope and regain a sense of control.

At Rula, we’re committed to delivering a comprehensive behavioral health experience that helps people feel seen and understood so they can get back to feeling their best. 

Rula makes it easier to find a licensed therapist or psychiatric provider who accepts your insurance so you don’t have to choose between affordable care and excellent care. With a diverse network of more than 15,000 providers, 24/7 crisis support, and appointments available as soon as tomorrow, we’re here to help you make progress — wherever you are on your mental health journey.

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