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The relationship between self-harming behavior, suicide attempt history and defense mechanisms in patients with opioid-use disorder Objective: The aim of this study was to investigate the relationship between defense mechanisms and a history of self-harming behaviors (SHB) and suicide attempts (SA) in patients with opioid-use disorder (OUD). Method: The study group consisted of 100 inpatients diagnosed with OUD. A Sociodemographic and Clinical Data Form, Defense Style Questionnarie-40 (DSQ-40), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) were applied to all participants. Results: Subscale scores for passive aggression (p=0.001), somatization (p<0.001), and immature factor (p=0.004) were higher in OUD patients with a SHB history than in those without. The anticipation subscale score was higher in patients with SHB and no relationship was found between other mature defense mechanisms and SHB (p=0.013). There was no significant relationship between SHB and BAI and BDI scores. Passive aggression (p=0.048), somatization (p=0.001), and immature factor (p=0.044) defense mechanism subscale scores were higher in patients with a history of SA. There was no relationship between SA history and mature defense mechanisms in OUD patients. BDI (p=0.05) and BAI (p=0.05) scores were higher in the presence of a SA history. In logistic regression analysis, passive aggression subscale scores and younger age determined the history of SHB in OUD patients. A history of SA was determined by lower age and suppression, dissociation, somatization, BAI, low idealization, projection, devaluation, splitting, and rationalization scores. Conclusion: This study showed that immature defense styles were used more frequently by patients with a history of SHB and SA, and a history of SA was associated with higher anxiety and depression scores; SHB history was used as a kind of coping mechanism and was not associated with anxiety and depression scores in OUD. Association of a history of SHB or SA with the use of immature defense mechanisms may require consideration of the application of therapeutic programs that include a more effective use of mature defenses in addition to specific pharmacotherapies for patients with OUD. Therapeutic success rates could be increased if it is considered during planning pharmacotherapy that a history of SA is related with high anxiety and depression scores.