Ear Piercing May Function as Covert Self-Injury in Bipolar Disorder

In a case report published in Frontiers in Psychiatry, researchers Liang Lv, Meng-Yun Guan, Xiao-Yu Zhang, and Yue Shen from the Third People’s Hospital of Huzhou documented an adolescent patient whose self-injurious behavior shifted into repeated self-inflicted ear piercings.

The authors observed that bipolar disorder is frequently associated with non-suicidal self-injury, with behavioral manifestations that can vary across the course of the psychiatric illness.

The clinical account focuses on an 18-year-old female diagnosed with treatment-resistant bipolar disorder whose self-injurious patterns evolved over time from wrist cutting to periungual skin picking.

This trajectory ultimately progressed to the patient performing 11 self-inflicted ear piercings within a 48-hour period, an action that resulted in localized infection.

Following the procedures, the patient reported experiencing transient relief from agitation, and clinicians noted that the acts were carried out with no suicidal intent.

The investigators concluded that repeated self-inflicted ear piercings over a short timeframe, combined with impaired behavioral control, disregard for infection risk, and use as an emotion-regulation strategy, may reflect a non-suicidal self-injury pattern. While noting that ear piercing may represent a covert substitute in some adolescents with bipolar disorder, the authors emphasized that the practice should not be automatically classified as self-injury, advising clinicians to carefully distinguish such behaviors from routine body adornment.

In this context, ear piercing may function as a covert alternative form of self-injury that serves an NSSI-like function. The authors point out that this specific behavior is commonly overlooked in daily clinical practice, which explains why documented scientific reports and case summaries detailing the phenomenon remain scarce.

Subject of Research: Non-suicidal self-injury manifestations in adolescent treatment-resistant bipolar disorder

Article Title: From cutting to ear piercing: evolution of self-injurious behavior in an adolescent with treatment-resistant bipolar disorder: a case report

Article References: Lv, L., Guan, M.-Y., Zhang, X.-Y., & Shen, Y. (2026). From cutting to ear piercing: evolution of self-injurious behavior in an adolescent with treatment-resistant bipolar disorder: a case report. Frontiers in Psychiatry, 17, Article 1921720. https://doi.org/10.3389/fpsyt.2026.1921720

Image Credits: AI Generated

DOI: 10.3389/fpsyt.2026.1921720

Keywords: bipolar disorder, treatment-resistant bipolar disorder, non-suicidal self-injury, NSSI, ear piercing, self-inflicted ear piercing, adolescent psychiatry, wrist cutting, periungual skin picking, emotion regulation, body modification, localized infection, behavioral control, clinical case report, agitation relief, body adornment differentiation, covert self-injury