Summary: A meta-analysis and narrative review finds that bisexual people are substantially more likely to engage in non-suicidal self-injury (NSSI) than people of other sexual orientations. Symptoms of anxiety and depression, plus negative experiences such as bullying and physical assault, appear to contribute to this elevated risk.
Source: University of Manchester
New research from the University of Manchester indicates that bisexual people face a markedly higher likelihood of non-suicidal self-injury compared with heterosexual and gay or lesbian populations.
This review and meta-analysis examined data pooled from 24 independent studies and appears in the Journal of Affective Disorders. It focused on non-suicidal self-injury (NSSI), which typically includes behaviours such as cutting, hitting, burning, or scratching oneself without suicidal intent.
Key quantitative findings show that bisexual people had significantly higher odds of engaging in NSSI:
- 6.07 times greater odds of NSSI in the previous 12 months compared with heterosexual people.
- 4.57 times greater lifetime odds of NSSI compared with heterosexual people.
- 4.37 times greater lifetime odds of NSSI compared with gay men.
- 2.13 times greater lifetime odds of NSSI compared with gay men and lesbian women combined.
Across the reviewed studies, symptoms of anxiety and depression were the most consistently reported correlates of NSSI among bisexual people. Other contextual factors—including experiences of physical assault, bullying, and feelings of not belonging—were also identified, though relatively few studies examined these links in depth and more research is needed to clarify their roles.
Led by trainee clinical psychologist Brendan Dunlop, the research team is also conducting an online longitudinal study called Self-Injury in Young Bisexual People: a Longitudinal investigation (SIBL). This study invites bisexual young people aged 16–25 to report their experiences weekly over six weeks, with the goal of exploring whether biphobia, social exclusion, and psychological processes like emotion regulation and cognitive patterns are associated with self-injury.
Dunlop commented that self-injury occurs across all sections of society—across cultures, genders, ages and sexual orientations—but that mental health outcomes for bisexual people appear consistently worse than for other sexual orientation groups.
He noted: “Self-injury often signals intense distress or difficulty managing overwhelming emotions. It can also lead to physical harm such as infection or scarring and is associated with increased risk of other dangerous behaviours, including suicide. It is therefore important to understand why this behaviour occurs so we can better support people who struggle with self-injury.”
“It’s important we understand why this behaviour occurs, so we can identify ways of better supporting those who struggle with self-injury.”
The review highlights the need for early identification and prevention of NSSI among bisexual people. The authors acknowledge that bisexual people may be less likely to access group-based or community services due to biphobia or a reduced sense of belonging within some LGBTQ+ spaces. As a result, alternative outreach and support methods may be necessary.
Potential approaches suggested by the researchers include targeted online mental health resources, posters and information aimed specifically at bisexual people in community venues, and direct engagement between support services and bisexual communities. Educational and voluntary organisations could also play a role in providing accessible support for bisexual people presenting with emotional distress or self-injury.
About this psychology research article
Source:
University of Manchester
Contacts:
Haley Bridger – University of Manchester
Image Source:
Image credited to University of Manchester.
Original Research: Closed access
“Bisexuality and Non-Suicidal Self-Injury (NSSI): A narrative synthesis of associated variables and a meta-analysis of risk” by Brendan J. Dunlop, Samantha Hartley, Olayinka Oladokun, Peter J. Taylor. Journal of Affective Disorders.
Abstract
Bisexuality and Non-Suicidal Self-Injury (NSSI): A narrative synthesis of associated variables and a meta-analysis of risk
Background
Previous work has identified bisexual people as being at elevated risk for non-suicidal self-injury compared with heterosexual and gay or lesbian groups. This review aimed to update estimates of that risk and to synthesise variables associated with NSSI in bisexual populations.
Methods
The study protocol was pre-registered (CRD42019145299). Researchers searched major databases from earliest records through October 2019 and identified 24 eligible papers. Meta-analyses with moderator tests were conducted to quantify NSSI risk, and a narrative synthesis described predictors and correlates. Each study was assessed for risk of bias.
Results
Across included studies, bisexual people had up to six times the odds of engaging in NSSI relative to other sexualities. Anxiety and depression symptoms were the most commonly reported mental health variables associated with NSSI in bisexual samples. Many studies showed a moderate risk of bias. The review suggests that higher rates of anxiety, depression, and exposure to negative life events may help explain the increased prevalence of NSSI in bisexual people.
Limitations
Most studies were cross-sectional and focused on Western populations, limiting causal inference and generalisability. Only English-language studies were included in the review.
Conclusions
Findings are clinically relevant: they point to the importance of early detection and prevention of NSSI among bisexual people. The authors recommend that future research examine bisexual people as a distinct group rather than subsuming them within broader sexual minority categories.