Scar

September 8, 2007 11:03 PM

Why do Bipolar sufferers cut themselves?

A friend of mine, who has the disease, used to cut his arms regularly. I always wanted to ask him why, but was unsure how to broach the subject. I happen to have a minor form of the illness myself, but have never felt compelled to do this, although I have read on a few sites that Bipolar patients usually cut themselves. Is this true? Is there a reason for it?

posted by hadjiboy to health & fitness (28 comments total)

I think it's more tied to depression than to bipolar specifically.
posted by MadamM at 11:10 PM on September 8, 2007

I don't think self-cutting is exclusive to Bipolar patients... I have a close family member who was a cutter in her mid-teens. She has said, and things I've read have said so as well, that the cutting is a form of "release"... A release of pain, or of overwhelming emotion, that the cutter feels unable to express... There's more information on the Wikipedia page for Self-Injury/Self-Harm.
posted by amyms at 11:11 PM on September 8, 2007

According to selfharm.org, "Self-injury is a coping mechanism. An individual harms their physical self to deal with emotional pain, or to break feelings of numbness by arousing sensation."
posted by miss lynnster at 11:34 PM on September 8, 2007

Not sure why, but depressed horses do it too. I think Temple Grandin opines it's a desire to feel something, to reassure themselves they're capable of feeling.
posted by orthogonality at 12:49 AM on September 9, 2007

I actually read an article about this today that was published in one of those weird print-only New-York-City-based literary things. It was about smoking, but the logic is the same. It's a way to bring control into a life that feels like it's out of control. As to why they would choose something that's not only unpleasurable (unlike smoking) but also self-destructive, I would guess it is because they are mentally ill and do things that don't make very much logical sense.
posted by Electrius at 12:54 AM on September 9, 2007 [1 favorite has favorites]

Because the pain of physical harm is simpler than emotional pain, and more immediate. When you're in pain, the answer is simple: stop it, and the pain goes away in the end. Compared to psychological pain, it makes much more sense, and is much easier to control - and when you're dealing with it, it occupies your attention enough to make those petty mental problems sink into the background...
posted by ubersturm at 1:02 AM on September 9, 2007 [1 favorite has favorites]

What ubersturm said. Also, people who are depressed or cutting may feel guilty about things they know they can't change. Two cutters I've been close to have done it because there was a lot going on that they felt they should have been able to control or help even though there was nothing more they could have done about those circumstances. They were punishing themselves for what they saw as their failures to bend the world to the way they felt it should be.
posted by Cricket at 1:07 AM on September 9, 2007

Many animals will intentionally harm themselves when distressed. Its not a phenomena unique to bipolar sufferers or even to human beings.

Many people cause harm to themselves for various reasons - often unknown reasons and in many different ways. Often self harming behaviour isn't considered to be 'self harm'. Many people smoke, drink or eat junk foods to cope with stress/depression and this isn't considered to be self harm, these are considered to be 'normal' and socially acceptable responses to stress. In the long-term these activities can be far more damaging to your body but they don't carry with them the shame and guilt of cutting yourself - which inevitably worsens the problem.

The short lived release is followed by a lot of shame, guilt and hiding what you've done.

I have seen it suggested (though I'm not sure I believe it) that self-harm and depression is caused by hypoglycaemia.

Just because your bipolar friend does it, doesn't mean you should feel compelled to do it.

Electrius - smoking is way more self destructive than cutting on a long-term basis and cutting isn't unpleasant to those that do it. They do it because it is pleasurable.
posted by missmagenta at 1:32 AM on September 9, 2007 [2 favorites has favorites]

missmagenta, it is incorrect that cutters "do it because it is pleasurable" -- of course, some do derive physical or emotional pleasure from the act, but the motivation (we all agree there is a motivation) in many other cases comes from a different source -- as mentioned above, a desire to assuage guilt or to be reassured of feeling are two examples -- that are completing unrelated to pleasure.

Also, I think the animal self-injury phenomena are rather different from what cutters experience and that the usefulness of this comparison is limited.

All this just to say that cutting is not simply perverse nor explicable as animal; as part of ongoing psychiatric illness, it is a complex, multiform, very human phenomenon.
posted by bluenausea at 4:57 AM on September 9, 2007

Cutting is more common in Borderline Personality sufferers than Bipolar. There is overlap between the two diagnoses: they are on different axes in the DSM, and Borderline is very frequently comorbid with Axis I diagnoses like Bipolar or Major Depression, Recurrent, etc. I know mental health workers who use cutting as the major marker for Borderline Personality disorder.

I think it is at least partly an addiction to the endorphins released by the pain.
posted by RussHy at 6:15 AM on September 9, 2007 [1 favorite has favorites]

Reformed cutter with her two cents on her plate:

Cutting isn't just about the sensation of the cut itself. There's a lot of different sensations involved, both immediately and over the weeks after. While a lot do it primarily for the release, some of us are doing it because it feels good to bleed. It seems magnificently messed up, but as someone mentioned up thread, it's about as destructive as smoking or drinking litres of coke a day, just more immediate. It's a special, demented sort of pleasure, but it's a pleasure nonetheless- that frission as the edge sits on the skin, the feeling of penetration, the cold moment of clarity before the blood starts to flow. There's an intimacy to seeing the inside of your own body, a secret little niche that no-one else will ever see, a part of yourself that is ephemeral and exists only for you, only at that moment. It can be a deeply reflective action.

But a lot of cutting was for me at least about the healing afterwards. I loved watching my scabs form, each with its own unique texture and sensation, and I loved how my skin would knit and my scars would fade. They changed the way the creases in my skin sat and the way it felt moving over my flesh. It reminded me of my own vitality, taking me back to the moments when I could see my own muscle tissue, bare and raw. My own strength, naked. So much is made of the alleged guild and that desire for sensation that comes from the cut itself - we heal after. We always heal after, and nothing proves the ability to fix yourself like a clean white scar. It's a affirmation that you're alive, and that you can still heal.

I've stopped, and haven't cut in at least six years. I was worrying a lot of people, including my kid sister who was way too young to be confronted with my more abberant desires. But I'd be lying if I said I never got the urge to go back to it.
posted by Jilder at 6:41 AM on September 9, 2007 [8 favorites has favorites]

Think about all the different relationships a person can have with, say, food, or alcohol.

Like lots of things, cutting means different things to different people.
posted by mjao at 7:34 AM on September 9, 2007

Reformed self-injurer, and speaker on this subject to HS and college classes, med students and nurses. (I use the term "self-injurer" since many people who cut themselves also do other things to injure themselves. It does mean different things to different people, but in a great many cases, it's to try to control overwhelming feelings. Personally, the primary reason I did it was because I felt like I was a balloon that was going to explode, and cutting took some air out of the balloon. This is a very good article on the reasons why, by a psychologist who works exclusively with self-injurers.

It's also important to note that just because one self-injures, they do not automatically have borderline personality disorder. It is just one of the possible indicators of BPD, and a person needs to meet several others for that diagnosis. Unfortunately, as soon as a self-injurer presents to a doctor or other medical person, the cutting itself automatically triggers that diagnosis because of a misunderstanding of the variety of reasons someone might self-injure. This is where I come in in an attempt to dispel this and other misconceptions.
posted by la petite marie at 8:07 AM on September 9, 2007 [3 favorites has favorites]

Sorry - hit "post comment" too early by mistake.

To finish my thought on misunderstandings in the medical community in particular, many think that if self-injurers want to feel pain, they will give them pain, and I have experienced (as have many I spoken with), doctors who will give stitches without anesthesia, etc.

OK - I'll get off my soapbox now!
posted by la petite marie at 8:14 AM on September 9, 2007 [1 favorite has favorites]

I have absolutely no idea if it's accurate, but there is a science-fiction trilogy written by Scott Westerfield, which is in many ways a parable for adolescents. The third and final book in the series, Specials, is written from a cutter's viewpoint, and might be of use to you with regards to your question.
posted by WCityMike at 8:41 AM on September 9, 2007

Reformed cutter here, too.

Bottom line is that anyone who feels like they're out of control of their life may do this. Hell, I doubt I was ever depressed or bipolar or anything, but I definitely don't like feeling out-of-control. That self-harm would give me a focus, would kind of bring me back to reality.

From a more "science!" standpoint, pain releases endorphins, which are like the brain's happy pills. The pain brings on a sort of rush, kind of like a milder form of adrenaline rush. It's an instant sort of pick-me-up. See: masochists.

Anyway, I haven't cut myself in years, but, like Jilder, there are certainly times that I think about going back to it. Then I look at my arms and see the scars there, and it kind of shakes me back to reality.
posted by Verdandi at 9:07 AM on September 9, 2007

la petite marie:
I didn't mean to imply the cutting = Borderline; my point was that it's much more common for Borderline than for Bipolar, so much so that many professionals do equate the two. They shouldn't, but they do.
posted by RussHy at 9:14 AM on September 9, 2007

One of the most frightening symptoms of depression, for me, was literal apathy — "lack of feeling," the sense that I just couldn't have any emotional reactions to anything, good or bad. The this is good/this sucks judgments that are constantly playing in most people's heads would go missing from mine for hours or days at a stretch. It would just be ehh... this is.... okay, I guess over and over. It was scary the way sudden blindness or deafness might be scary — I was losing a whole dimension from my experience of the world.

So I would injure myself sometimes to make sure that I still could have those feelings at all.* Even a strong aversive reaction — "Ow! That was a terrible idea!" — was reassuring. It meant that some things still felt better than others, that I hadn't lost that realm of experience altogether. (To keep running with the analogy: suppose you wake up one morning and you can't hear normal sounds at all. But then the construction crew outside your window starts in with a jackhammer, and you can hear that just fine. You'd probably be happy to hear it, no matter how obnoxious the noise was, because it meant you could hear.)

I'm familiar with the idea that cutting is about guilt, or punishment, but even with the benefit of a lot of years of hindsight those don't ring true for me. YM, I guess, MV.

*You have no idea how hard it was to explain this without quoting Nine Inch Nails.
posted by nebulawindphone at 9:21 AM on September 9, 2007 [3 favorites has favorites]

I never cut as a method to relieve apathy, though I do understand why someone would. My cutting was always linked to overwhelming psychological pain and often occurred after a specific event that made me feel stupid, shamed and out-of-control. For instance, I came onto a younger man at a party, and he rejected me as politely as he could. I was drunk at the time. When I got home and thought about what I'd done, I imagined him telling his friends. I imagined them laughing about it. I cut my arms in several places that night.

Other times it was a way to cope with severe depression that wasn't necessarily situational. As others have said, dealing with physical pain is much easier than dealing with emotional pain.

And bizarrely, it was also occasionally a method of dealing with a particularly irritating situation. I remember one time my aunt and uncle from out of town were visiting. My boyfriend had just dumped me, and I wanted them to LEAVE. I was pacing the floors. Finally, I went to my room and cut myself, then screamed for my parents. Well, that did the trick. By the time I left my room they were gone. I could be an awfully manipulative crazy little thing.

I also think it is related to my general tendency to pick. I pick at zits, scabs - anything in or on my body that shouldn't be there. I feel compelled to get it out of me, and it's extremely gratifying when I do. So it may be that the sight of blood was proof I was dealing with all the bad stuff - purging myself. Of course it never lasted.

I don't cut anymore, but it's still sometimes a temptation. I think in that way it is similar to drug addiction.
posted by Evangeline at 9:47 AM on September 9, 2007

RussHy:
Sorry - didn't mean to imply I was targeting you with the borderline comment. It's a touchy subject for me, since I speak to so many professionals that believe cutting=borderline every time. That's why I'm trying to clear up some of the misconceptions.

They are probably the ones stitching people up without anesthetic, too. Assholes.

Exactly.
posted by la petite marie at 10:01 AM on September 9, 2007

I cut. I cut when I was also badly injuring my body with bulimia. I got better, then when I was badly depressed again I would "cut" by bruising myself very badly.

I guess it was about control. I could "control" the amount of pain I was going through. You think that was bad? that was nothing. I could do worse to myself.
posted by arha at 10:16 AM on September 9, 2007 [1 favorite has favorites]

Physical pain and emotional pain use some of the same nerve pathways. Cutting is like jamming the frequencies. Flood your system with some physical pain and it can drown out or release the emotional agony that was there before. Usually the emotional agony is extreme, and compared to the very manageable physcial injury of a small cut, there really is no comparison. It does actually make sense.
posted by scarabic at 10:53 AM on September 9, 2007

Control thing.
posted by devilsbrigade at 10:54 AM on September 9, 2007

For me it was the ultimate release of tension. Perhaps the endorphins bit others have referred to. I would be upset about something, usually depressed, and it just felt like my body was one giant coiled mass of tension. Sometimes I wanted to hit people, smash things, etc etc, but a) you can't do that and not have anyone notice and b) it was never satisfying enough.

Cutting was like the ultimate bodily sigh. Everything relaxed after that. My body was calmer, I was calmer. I had to be to wash up and make sure everything was as it should be. Plus I could lose it and no one would necessarily know. Mentally much neater.

Anyway, like the others it's been years since I've cut. But never quite long enough, I find.
posted by aclevername at 1:26 PM on September 9, 2007 [1 favorite has favorites]

They don't, as a matter of statistical course.
posted by OmieWise at 4:25 PM on September 9, 2007

I agree that it has to do with control, and I would bet it specifically has to do with assuming control of one's own fate. That was my experience, at least. But for me, it had nothing to do with feeling real or alive, and was not really associated with pain or euphoria. The main issue was the feeling of belonging to myself, and to no one else.

And, I am also a big fan of Jilder's response.
posted by Coatlicue at 8:00 PM on September 9, 2007

Would you classify repeatedly pulling off scabs (from accidental wounds, such as scrapes, shaving legs) with cutting?
posted by bad grammar at 8:17 PM on September 9, 2007

Thanks for the insight everyone--I really appreciate it. This has really opened my eyes.
posted by hadjiboy at 8:43 PM on September 9, 2007