dr phelps, do you find that a lot of bipolar's engage in self mutilitation.  i have struggled with this all my life. i am now 50yrs of age. i am well educated and enjoy a professional carrer. however, as soon as things get stressful, i revert back to my old ways. never anything life threatining, but i have many scars. lately i have started carving up my face. this helps a lot. the questions i get are annoying, but since people don't want to think i cut myself in the first place, they are easily duped. i wish i were dead almost all the time, but i will not kill myself as i am too afraid. is there any light you can shread on this. thank you.

sincerely,
kathleen
 

Dear Kathleen -- 
There's an excellent web-resource on self-harm, entitled "Self-injury: You are NOT the only one" which you might find useful, although the main emphasis there is on pretty serious behaviors.. Yes, I've seen quite a few people with bipolar disorder who have discovered cutting and other self-injury--enough to convince myself that cutting is not always equivalent to "borderline personality disorder", which is a common belief (here's more on borderline versus bipolar if you need that).  They've found that somehow these activities change their experience-of-the-moment in a way that reinforces that way of coping; but worry about the effects and extent and implications of it, as well as the effect on others (if it's not entirely private). They also generally want to stop; and if they get a good response to treatment, they usually are able to do so (in my experience, I think it's everyone who has been able to stop, in fact in some cases we've used that behavior as a marker for whether treatment was sufficiently effective. On the other hand, I've had several patients who were able to stop with some relatively minimal psychotherapy, so sometimes it doesn't take much.).

Dr. Phelps
 

May, 2005