• Alicia Paz

Self-Harm Can Be More Than Physical

Content Warning- brief discussion of physical self harm.


There are some topics that seem to come up often in DBT skills coaching group. One of them is self-harm. When most people talk about self harm it typically involves cutting or injuring oneself without the goal of suicide.

I have created my own definition of self-harm, as harming oneself in the mental health realm goes far beyond a physical way of harming. Self-harm is any behavior that is harmful to one's self. Once again this is my own definition, not a diagnosis code, just my own opinion on what I consider self-harm when working with clients and students. I have heard similar things referred to as Treatment Interfering Behaviors (TIB) in DBT or self-defeating behaviors. I prefer the latter myself, as TIB is a bit outdated and can feel blaming.

So what does my definition include that the original definition does not?

Self Sabotaging: This could include leaving a healthy relationship before the other person leaves you. It could be not allowing yourself to grow within a company you work for, getting to a point in a goal and then choosing not to move forward or doing something that gets in the way of your success. This is the one that comes up in skills coaching that people are like 'wow, yup that's me!'

Choosing Poor Self-Care: This isn't forgetting to take meds occasionally, or going through a depressive episode and not having the best hygiene. This is a choice to skip meds that help you, not eating enough to sabotage a mood or punish yourself for something. Many find they do this when things are going well or they're having the feeling of waiting for "the other shoe to drop" or that they don't deserve to be happy or healthy.