It’s not that uncommon for teens and young adults to self-harm. While this can be very upsetting for parents, and highly distressing for a young adult, punitive approaches often backfire. One well-established therapeutic approach that can be helpful with young adults is Dialectical Behavioral Therapy or DBT.
In this Insight, I explain what self-harm behavior is, why young adults do it, and how DBT techniques can help young people manage the intense feelings they experience.
What Is Self-Harm Behavior?
Self-harm refers to when a person hurts their own body on purpose. It is thought to be more common amongst women than men, but they are actually about equal.
One of the key differences is that women are more likely to use cutting, whereas men are more likely to use hitting or burning. It also appears to be more common among people who report nonheterosexual orientations and among Caucasians than non-Caucasians [1].
A person who self-harms usually does not mean to kill themselves, but they are at higher risk of attempting suicide and dying by suicide if they do not get help [2].
Self-harm is sometimes referred to as non-suicidal self-injury (NSSI). It involves intentionally inflicting damage on one’s body without suicidal intent and for purposes not socially sanctioned [2] [3].
Self-harm encompasses a wide range of behaviors, including:
- Cutting one’s skin with a sharp object
- Piercing the skin with sharp objects
- Embedding objects under the skin
- Burning oneself with cigarettes, matches, or candles
- Breaking bones or bruising oneself
- Hitting or punching oneself or punching things (like a wall)
- Poisoning through an intentional overdose or ingesting non-consumable substances
Symptoms and warning signs of self-harm:
There are numerous signs that someone is self-harming, including [2]:
- Scars
- Wearing long sleeves or pants, even in hot weather
- Talking about feeling worthless or helpless
- Fresh cuts, bruises, bite marks, or burns
- Keeping sharp objects on hand
- Frequent reports of accidental injury
- Emotional and behavioral instability and unpredictability
Why Do Young Adults Self-Harm?
Young adults who engage in self-harm don’t intend to end their own life. In fact, it is most often performed in the absence of suicidal ideation. But there are several main reasons why young adults do self-harm, including [1]:
- By a wide margin, it is to (temporarily) alleviate overwhelming negative emotion. Intense negative emotions precede self-harm, and the performance of self-harm results in reduced negative emotions as well as feelings of calm and relief.
- Slightly more than one-half of people report that they self-injure as a form of self-directed anger or self-punishment.
- Third, NSSI can serve multiple other functions, such as a desire to influence others or to produce a physical sign of emotional distress, but each of these functions is relevant only to a minority of people who self-injure.
Three misconceptions exist about self-harm behaviors. One is that it is due to childhood sexual abuse. Another is that it is only an element of Borderline Personality Disorder. A third is that it is attention-seeking. Instead, self-harm is most often performed in private as a way to quickly alleviate intense negative emotions [1].
Dialectical Behavioral Therapy: Recommended Treatment for Self-Harm
DBT is an evidence-based therapy approach created for treating elements of Borderline Personality Disorder (BPD). It has found broader application in recent years, beyond BPD
Self-harm and self-injury are understood in DBT as behaviors that temporarily reduce overwhelming emotional pain but also reinforce a cycle of dysregulation.
The Basics of DBT
DBT focuses on teaching four core skills that empower young adults to manage difficult emotions, improve relationships, and navigate life’s challenges more effectively.
- Mindfulness
- Distress tolerance
- Emotional regulation
- Interpersonal effectiveness
The “dialectical” element of DBT emphasizes balancing acceptance with change. These are two opposing ideas that work together to foster growth and resilience. I’ll focus here on the distress tolerance and interpersonal effectiveness elements.
Distress Tolerance vs. Stopping Self-harm
Distress tolerance in DBT is about surviving crises “without making things worse”. This includes not engaging in self-harm, substance use, or other high‑risk behaviors during emotional peaks. These skills do not try to solve the long‑term problem in the moment; instead, they aim to [4]:
- Decrease physiological arousal and emotional intensity.
- Increase acceptance and willingness (e.g., radical acceptance).
- Create a time gap between urge and action so alternative behaviors become possible.
The Self-Harm Urge, Distress Tolerance, and The TIPP Set
Distress tolerance skills, including the TIPP set, are specifically designed to “ride out” urges without acting on them and to get through the crisis safely. TIPP works by rapidly shifting the body’s physiological arousal so that the urge becomes more manageable and other skills (like problem-solving or emotion regulation) can be used instead.
The specific crisis skill set often taught as TIPP or TIPS targets the body’s acute fight‑flight response that usually accompanies strong urges to self‑injure. It consists of:
- Temperature: Using cold water on the face or holding an ice pack activates the dive reflex and can quickly slow heart rate and reduce the “I have to do something now” feeling that often precedes self-harm.
- Intense exercise: Short bursts of vigorous movement (running in place, fast stair climbing, jumping jacks) burn off adrenaline and muscular tension associated with urges to cut, hit, or otherwise injure the body.
- Paced breathing: Slow, controlled exhalation, such as ~5–6 breaths/minute, lowers sympathetic arousal and can shift the person from “emotion mind” toward “wise mind,” making it easier to choose not to self‑harm.
- Paired muscle relaxation: Systematically tensing and then relaxing muscle groups while pairing the relaxation with a cue word helps counter the physical rigidity and agitation that accompany crisis states and urges.
TIPP: A Replacement for Self-harm
In practice, TIPP is a replacement for the acute, body-based effects that self-harm often provides (rapid down‑shift in arousal, sense of control, grounding). Young adults are coached to:
- Anticipate high‑risk contexts through chain analysis, then “cope ahead” by planning TIPP and other distress tolerance skills (e.g., ACCEPTS, self‑soothing) as first-line responses to urges.
- Combine TIPP with commitment strategies (e.g., short-term agreements not to self-harm, using skills cards, contacting supports) so that once physiological arousal drops, they can move to emotion regulation or interpersonal effectiveness work instead of returning to self‑injury.
In practice this might look like this: “When the urge to cut shows up and your body feels like it’s going to explode, we first use TIPP to bring your arousal down, then shift to skills like opposite action, contacting support, or problem-solving once you are out of the red zone.”
Interpersonal Effectiveness and Self-harm
Self-harm often arises from communication difficulties. Many young adults struggle to express their needs. This may lead them to use self-injury instead of reaching out for help. Interpersonal effectiveness is a core skill taught in DBT. It focuses on developing strong communication skills to express needs and feelings effectively [3] [5].
DBT involves a warm but structured approach to helping young adults. It is based on accepting them as they are but equipping them with more adaptive strategies to deal with their despair.
How Engage Young Adult Transitions Can Help
Engage Young Adult Transitions is a transitional living program and therapeutic community that assists young adults on their path to independence. Using attachment theory, we provide a foundation for forming connections, getting involved with the community, managing mental health, and building life skills for long-term success.
Engage offers structured autonomy and high support, without creating dependence. Our therapists and life coaches are here to honor the young adults’ need to gain independence and freely move to a more secure sense of self and their relationships.
Located just steps from Southern Utah University in Cedar City, we offer access to services seven days a week, including academic support, vocational training, career guidance, life skill coaching, mental health therapies, and recreational activities.
Our community offers high levels of therapeutic support that honor autonomy and independence while guiding young adults to a life of freedom, emotional wellness, and success.
Get involved with the Engage Transitions community today!
Sources
[1] Klonsky, E., et al (2014).Nonsuicidal self-injury: what we know, and what we need to know. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 59(11), 565–568.
[2] SAMHSA. 2023. Self-Harm.
[3] Life Skills Behavioral Health. The Power of DBT: 4 Core Skills to Overcome Self-Harm.
[4] Prada, P., et al. (2018). Strategies to Deal With Suicide and Non-suicidal Self-Injury in Borderline Personality Disorder, the Case of DBT. Frontiers in psychology, 9, 2595.
[5] DBT Center. How DBT Helps with Self-Harm and Suicidal Thoughts.