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Background: Little is currently known about prevalence and clinical correlates of non-suicidal self-harm (NSSH) among adult bipolar spectrum disorder patients.Repeated NSSH is a sign of serious dysfunction and distress in patients and often presents clinicians with difficult challenges.Studies from adolescent samples indicate that NSSH is prevalent and associated with suicidal behaviour in early onset bipolar disorder.Aims: To investigate the prevalence of lifetime episodes of NSSH in a catchment area based sample of bipolar spectrum disorder patients and to study whether NSSH is associated with exposure to childhood trauma, earlier age at onset of the disorder and more symptoms of emotion dysregulation.Furthermore, to test the hypothesis that a pattern of repeated episodes of NSSH would be associated with a suicide attempt (SA) history compared with patients without repeated NSSH.Methods: As part of the Thematic area psychoses research study (TOP), a consecutively included sample of 199 in-and outpatients (18-65 yo, 65 % women) with bipolar Ⅰ disorder (69 %), bipolar Ⅱ disorder (24 %) and bipolar NOS disorder (7 %) treated at university hospitals in Oslo, Norway, were interviewed for history of self-harm (NSSH, SA or no self-harm history) and a range of clinical characteristics using the TOP protocol.Results: A history of NSSH was present in 25% (n=49) of the sample, whereof 55 % had repeated episodes (>=3 episodes, n=27).The NSSH episodes had low lethality, but two out of three participants with repeated NSSH also had a suicide attempt history (67% vs.25%, p<0.001).Higher exposure to childhood trauma, young age at onset of disorder, increased number of depressive and hypomanic episodes and current depressive symptoms and emotion dysregulation were divaricately associated with a history of repeated NSSH.In the multivariate analysis suicide attempt history, current emotional dysregulation, multiple hypomanic episodes, younger age and female gender were associated with a pattern of repeated NSSH.Conclusion: Non-suicidal self-harm was prevalent in this clinical sample of patients with bipolar spectrum disorders, primarily among women.A pattern of repeated non-suicidal self-harm was associated with suicide attempt history and clinical features such as earlier onset and more emotional dysregulation, which all may indicate an increased suicide risk.Possible implications for assessment and treatment will be discussed.