If you know (or are) a cutter who has been in treatment for self-injury, there is a pretty good chance that the treatment offered was some version of Dialectical Behavior Therapy (DBT for short). There is also a pretty good chance this treatment didn’t work.
DBT was designed for Borderline Personality Disorder, and has since been applied to a number of other problems, including substance abuse, binge eating, and suicidality. It focuses on reducing impulsive behavior and improving emotional regulation.
For some self-injurers, this is a good match for their needs, and DBT can work well. For many, though, impulsivity is not their problem, nor is emotional regulation – at least, no more so than for the ordinary teenager.
For these folks, their self-injury is methodical and calculated. They try to keep it hidden. Simply put, it is not evidence of Borderline Personality Disorder. It is better labeled as simply what it is – non-suicidal self injury, in the language of the new DSM-5. And to treat it with a form of therapy built for a drastically different kind of problem is not sensible.
Just to be clear, we’re fans of DBT here at KISI. It can work extremely well for Borderline and other disorders marked largely by impulsivity. It’s just that most of the self-injury cases we work with aren’t that, and they call for a different kind of treatment.
In future posts and articles, we will talk in more detail about the science behind various self-injury treatments. For now, it suffices to say that existing studies of DBT for self-injury often combine populations, putting non-suicidal self-injurers in with Borderline patients and suicidal teens, and produce the kinds of mixed results that we would then logically expect. We believe that as research in this area improves, DBT will fall out of favor for non-Borderline, non-suicidal self-injury cases. And we expect family therapy to become the treatment of choice, given how well we see it working.
– Ben Caldwell is a Fellow at the Kahn Institute for Self-Injury.