Depression and Recklessness: Can They Be Blood Brothers?

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It could be said that depression is a mood disorder, whereas recklessness is grounded in poor impulse control. Yet, strangely, they overlap—which can be seen as paradoxical, as both intuitive and counter-intuitive.

The feelings of depressives—such as sadness, hopelessness, and a kind of lethargy where activities formerly coveted pretty much cease to be of any interest—typify their deeply distraught reactions to outward stimuli.

How Depression Fuels Risky Behavior

It's hardly a coincidence that around 30 percent of those with major depression disorder end up taking their lives. And those who don't have usually contemplated suicide, though they've stopped short of it.

And this is where the propensity toward reckless behavior comes in, for it's understandable as a partial suicide: a curious phenomenon of non-suicidal suicide.

So if we explore the felt desperation of depressives, their suffering from a condition where they don't much care whether they live or die, it makes sense that they'd willingly undertake actions offering them only temporary emotional relief from an intolerable feeling state.

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Examples of Reckless Behavior

Often cited instances of unhealthy, risky activities include:

• Starting fights against stronger opponents.
• Unprotected sex or habitually hooking up with prostitutes.
• Speeding and unsafe driving generally.
• Alcohol and, too, drug abuse—whether prescribed or illicit.
• Compulsive behaviors, such as gambling and shopping.
• Non-suicidal self-injury (NSSI).

Because NSSI is possibly the most worrisome of these risky behaviors—as well as encapsulating the threats of all the negative activities listed above, I'll expand on its less familiar dynamics.

In a highly distressed state and needing to relieve their loathsome symptoms, depressed individuals not uncommonly resort to razor-cutting their flesh. But they may also resort to burning, carving, or scratching their skin with such fervor that their blood runs, and they may get infected or develop scars. Curiously, however, this horrendous act of self-mutilation can moderate their misery.

It's as though they have to engage in behavior so intense that—at least in the moment—it dulls the acuity of their so-burdensome emotional ache. And in that context, it's a release—virtually, a "gift," despite increasing the chances of accidentally dying.

In wrongheadedly taking charge of their pain—or transferring it to something more physically manageable—they succeed in numbing themselves against a far greater pain.

And that pain might involve grief, guilt, anxiety, shame, or excessive anger, personally experienced as more perilous than anything else. Additionally, there's what's been called secondary pain, which relates to a need to punish themselves for whatever they may be ashamed of.

Feeling non-deserving, not cared about, of no importance to anyone, they feel their self-inflicted pain is warranted: a retribution against their very self.

Such brutal self-judgment suggests another way that harming themselves can constitute a release for them. And, indeed, such self-abuse can (however unconsciously it's carried out) result from past trauma or been modeled by another family member—addicted, say, to aggressive outbursts, drinking, drugs, sex, shopping, and so on.

Moreover, it can even be a final cry for help in certain instances. And in any case, reckless acts have been linked to the secretion of dopamine, a key motivating factor.

Treatment for Depression-Induced Reckless Behavior

While the recklessness of some depressives momentarily distracts them from the negative thoughts and feelings plaguing them, its attendant costs usually exacerbate their problems.

At least three things must change if a person is to successfully terminate these ultimately self-defeating behaviors. They need to:

1. label the behaviors worsening their condition and acknowledge that they're not working.
2. find more adaptive ways to communicate or let out what's so troubling them.
3. confront underlying issues they haven't before appreciated or been neglecting.

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Theoretically, they can do this independently, particularly if they have a reliable support system. But realistically, to recover fully from their reckless habits, at the least, they'll require protracted group work (such as a 12-step program, like Alcoholics Anonymous).

Still, it should be added that since two prominent causes of depression are loneliness and feeling socially isolated, these individuals will also need to expand their likely deficient social skills.

Optimally, they'll get psychotherapy, and with a mental health professional expert in treating both depression and its accompanying reckless behaviors, for there's now a professional consensus that these two closely connected maladies ought to be dealt with simultaneously.

Short-term cognitive behavioral therapy (CBT) has been shown to be effective in reducing depression and reckless behavior. But with tougher, treatment-resistant depression, a deeper, more trauma-based approach (such as Eye Movement Desensitization and Reprocessing [EMDR] or Internal Family Systems Therapy [IFS] may be required.

Ideally, when therapy is complete, people, places, or things that triggered the depressive's reckless reactions will no longer be applicable. But in the meantime, therapists can employ stopgap measures to help them avoid the prompts that have precipitated their exaggerated, counterproductive responses.

Besides contriving to make the depressive's triggers less accessible, therapists can assist them in substituting activities (like meditating or taking long, brisk walks), which are not only healthier for them but can also positively alter their brain chemistry.

Dialectical Behavior Therapy (DBT) is a highly-respected offshoot of CBT. It mixes empathy with confrontation, and it's frequently employed in treating borderline personality disorders, being found especially effective in mitigating impulsive, reckless acts, such as self-injury and suicide attempts.

It's also been extended to and found efficacious with substance abuse, various eating disturbances, and poorly controlled anger.

The focus of DBT is paradoxical in that at the same time it unconditionally accepts the client as they presently are, it helps them beneficially change how they deal with emotional upsets. Plus, it teaches clients more socially approved methods of meeting their interpersonal needs—or, in select instances, to more calmly accept others' limitations in meeting those needs.

Often recommended as an adjunct to (vs. replacement for) therapy are psychiatric medications employed to help clients better manage over-the-top anxious or agitated depression. It's extremely difficult for depressives to absorb what's proposed to them if their emotions are so pronounced that their more adult executive functioning has been seriously compromised.

Lastly, anything that strengthens their support system can be pivotal for people suffering from depression and recklessness. So candid yet tactful, communication with friends and family can give them the emotional support and encouragement they need to recover from what's tenaciously taken hold of them.

Generally speaking, depression-causing recklessness is hard to overcome, so it necessitates a comprehensive treatment plan. Consequently, the literature briefly summarized should offer a roadmap to what elements in counseling will prove most therapeutic.

If you or someone you love is contemplating suicide, seek help immediately. For help 24/7, dial 988 for the National Suicide Prevention Lifeline, or reach out to the Crisis Text Line by texting TALK to 741741. To find a therapist near you, visit the Psychology Today Therapy Directory.

© 2023 Leon F. Seltzer, Ph.D. All Rights Reserved.