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Unintentional Injury and Bipolar Disorder

Well, there goes that New Years resolution.  Injured again, just as I started to exercise.

People with bipolar disorder get hurt a lot. Those with BP suffer from 6 times more unintentional injuries than the general population.

It seems to happen to me just as I begin a new exercise routine.  I’ve had stress fractures, broken toes, etc.  This time I fell while walking the dogs.  I bruised my ribs terrible and it hurts to breathe and to move.  Exercise, right now, is out of the question.  It’s not hypochondria, because I really do get injured.  Maybe something in my sub-conscience…

It seems you can look up anything and find it’s co-morbid with bipolar disorder, and self-injury is certainly common in people with severe BP.  But the numbers on unintentional injury are compelling.

Poor impulse control in mania and hypomania drives some of us into riskier behavior, and depression can be disorienting and numbing.  Substance abuse, so common in people with BP, certainly raises one’s risk of injury by affecting decision-making capabilities and motor-control.  Also, focused attention is not a strong suit in people with BP.

Because of these factors and more, the propensity to end up injured seems to run across the spectrum of BP.

Unintentional injuries are most common in episodes of hypomania rather than depression, so researchers point to impulsivity, especially aggressive impulsivity, as a possible causal factor of these injuries.

The best numbers on unintentional injury come from studies on mood stabilizers, as unintentional injury is usually noted in research subject surveys.  It appears this common co-morbidity, while striking, has not been specifically studied.

Research on unintentional injury is derived from a survey of drug trials from 1995 – 2013, and may be incomplete as subjects with present suicidal ideation and active mania are often selected out of studies on mood stabilizers.  We’re left with more detailed research on subjects with hypomania and depression.

The studies reported on lithium, anticonvulsants and, to a lesser extent, antipsychotics.  They found that subjects taking lithium had the lowest levels of unintentional injuries.  This may be because people taking lithium have better motor-control, but it is more likely that those taking lithium are older and less likely to engage in risky behavior.

As it stands, we know people with bipolar disorder get injured at a much higher rate than the general population, but we don’t entirely know why.  At some point in the timeline of causation all accidents can be prevented.  Perhaps with a little more information we will know how to prevent more accidents, and injuries, in those of us with bipolar disorder.

But for now, I put off strenuous physical activity until I heal.  I’m not old, but I’m getting older, so the prospect of falling is ominous.  Plus, I have osteoporosis, which could be the result of BP or the medicines used to treat it.

Maybe these injuries are the bipolar disorder, or maybe I’m just clumsy.  All I know is that right now I hurt, and I can’t wait to move around confidently and be active again.  It’s an important part of managing BP.



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Unintentional Injury and Bipolar Disorder

George Hofmann

George is the author of Resilience: Handling Anxiety in a Time of Crisis, from Changemakers Books. Visit George's site or join the Facebook group Practicing Mental Illness

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APA Reference
Hofmann, G. (2020). Unintentional Injury and Bipolar Disorder. Psych Central. Retrieved on September 22, 2020, from


Last updated: 17 Jan 2020
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