Dialectical Behavior Therapy for Treating Deliberate Self-Harm Behaviors

DBT Self HarmThere is a significant distinction between suicidality and deliberate self-harm (DSH) behaviors such as cutting. Unlike those who take (or attempt to take) their own lives, individuals who engage in self-harming behaviors do so to regulate their emotions, to relieve themselves from emotional pain, or to stimulate a pain relief response within the body. While self-injurious acts are a deliberate means to inflict physical damage that is sometimes quite severe, the desire to end life is rarely the goal or intention of DSH.

Self-harming behaviors often elicit a brief sense of calm and tension release. However, the intended effects are short lived and are subsequently followed with feelings of shame, guilt, and more painful emotions. DSH behaviors can extend beyond cutting, and can include distressing actions such as burning, hitting, pinching, breaking bones, ingesting toxic substances, interfering with healing of wounds, and banging or punching walls and other objects to induce pain.

The presence of psychopathology significantly elevates the probability of self-injurious behaviors and thoughts. One group that is especially susceptible to self-injury are those individuals diagnosed with Borderline Personality Disorder (BPD). Approximately 70% to 75% of individuals with BPD exhibit some type of self-harming behavior. Research findings strongly indicate that engaging in self-injurious behaviors helps to regulate emotions in individuals with BPD; up to 96% of patients with BPD who use self-harm as a coping mechanism report relief from unpleasant emotions after self-injury. 

Other disorders where self-injury is highly prevalent include dissociation disorders (69%), eating disorders (26% to 55% for Bulimia Nervosa, and 27% to 61% for anorexia nervosa, binge-purge subtype), and 41% for those meeting the criteria for major depressive disorders. 

To address the trend toward increasing occurrences of self-harm, clinicians continue to seek the most effective treatment options for DSH. While identifying the best approach for treating self-harming behaviors can be complicated and challenging, encouraging treatments do exist and are being implemented with increasing success. 

One treatment shown to be particularly effective among those who self-harm is Dialectical Behavioral Therapy (DBT). Because those engaging in DSH can often have difficulty recognizing the temporary nature of emotional pain, finding relief can seem overwhelming and even impossible. Using a DBT approach has proved highly effective in offering self-harming individuals a skill set that allows them to explore their emotions and learn how to regulate and respond to them. Armed with these skills, they’re better equipped to deal with challenging emotions when they arise. Over the past few years, several clinical trials and studies have more closely scrutinized DBT’s ability to treat individuals who exhibit DSH behaviors.

One study examined the effectiveness of DBT in self-harming women in an institutional setting. Here, the female patients also met criteria for borderline personality disorder (BPD). After participating in the full one-year treatment package of DBT, study results indicated a significant reduction in DSH during the course of therapy as well as at the 6-month follow-up. Participants demonstrated a reduction in dissociative experiences and an increase in survival and coping beliefs; improvements in depression, suicidal ideation, and impulsivity were also noted.

In an attempt to evaluate the effectiveness of a shorter course of DBT (6-months as opposed to one-year) in reducing self-harm urges in patients with BPD, another study’s findings were also highly encouraging. Using this condensed version of DBT, research outcomes underlined significant reductions in deliberate self-harm urges, suicidal ideation, subjective distress, and depression.

To mitigate self-injurious behaviors, individuals must develop specific skills to manage these troublesome, destructive actions. Encouraging statistics from studies using DBT to address self-harming activity makes room for the possibility of helping individuals to move away from maladaptive and often devastating coping mechanisms.