Today is Self-harm and Self-Injury Awareness Day. To mark this important day, we spoke with Malinder Bhullar, Lead Psychologist at Elysium’s Spring Wood Lodge, about the complex subject.
She said: “For many people, self‑harm and suicide is linked to overwhelming emotions, impulsivity or visible distress. But for others, the path is quieter, more concealed, and far less recognised. Some people are not driven by emotional volatility, but by an almost relentless self‑control – a style of coping that can keep their distress unseen, even from those closest to them.”
Malinder specialises in Radically Open Dialectical Behaviour Therapy (RO‑DBT), an evidence‑based approach designed not for people who feel “too much”, but for those who have learned to show far too little. She explains that traditional DBT helps individuals who experience rapid emotional shifts or impulsivity. RO‑DBT, however, is “for the opposite kind of problem,” grounded in years of research, it can benefit people who maintain such tight behavioural control that their true emotions and intentions rarely reach the surface or show up in ways that are missed or misunderstood.
What looks like calmness, compliance or high functioning can mask what Malinder calls “emotional loneliness” – a profound disconnection that occurs when someone is unable to signal their feelings in ways others can recognise and respond to. These patterns can make it hard to form authentic relationships, seek help when it’s needed or even recognise internal distress until it becomes unmanageable.
Crucially, people with this over‑controlled presentation can be more at risk of highly planned and severe self‑harm and completed suicide. Their struggles are less visible, their emotional signals more subtle, and their internal pressures more contained. At other times, the patterns can seem “out of control” but are driven by compulsions or “rules” that if ‘broken’, can trigger overwhelming distress. “It’s often not talked about,” Malinder says, “because unlike people who are emotionally unstable, this tends to be very hidden – but much more likely to be successful.”
RO‑DBT shifts the clinical lens away from symptoms like anxiety or depression and instead looks at how people communicate, or socially signal, emotions. Malinder describes individuals who smile while they are furious, or who seem flat and unresponsive even when something wonderful happens. These are not affectations; they are deeply learned survival strategies, often reinforced since childhood, interacting with someone’s natural biotemperament.
Children who are naturally cautious, rule‑bound or risk averse may grow into adults who remain on the fringes of social groups, who excel at delaying gratification, or who feel safer observing than participating. For some, particularly those who are neurodivergent or misdiagnosed earlier in life, this pattern becomes a rigid framework that keeps true emotions and intentions tightly locked away.
Inside, however, anger, fear and sadness may sit unexpressed for years.
RO‑DBT aims to help kindly but assertively open those emotional channels, by targeting social signalling patterns that usually unintentionally, are keeping people emotionally lonely. Unlike standard DBT, it places much of the responsibility on the individual, encouraging them to step towards vulnerability and connection in small, deliberate ways. One of the key strategies is self-enquiry practice. Therapists like Malinder provide structure and presence, but step back enough that the person must take the lead.
“It’s one of those curious models where the therapist can seem quite hands‑off but is actually very active” she says. “It invites the individual not to avoid things – they have to step forward in the dance, critically without losing face in the process. This factor is critical working with overcontrolled individual.”
The therapy is demanding – not just because of the emotional work, but because few clinicians are trained to deliver it. Fewer than 20 are registered across the UK, and the sessions are resource‑intensive. Outcomes can be powerful.
Some people arrive in services with years of repeated self‑harm or suicide attempts, and a history of being treated as emotionally unstable, when in fact their behaviours stem from compulsive, rule‑driven patterns rather than impulsive ones. Recognising this difference can change everything.
She describes one woman who initially dismissed RO‑DBT outright because it contained “DBT” in the title – she had tried DBT before, but without success. Only later, after careful exploration and growing trust with staff who neither pandered nor withdrew, did she reach the “tipping point” where she was ready to try something new. That readiness – when the cost of coping outweighs the comfort of staying the same – marks a key moment in recovery.
What often makes the greatest difference, Malinder notes, is the environment. When people feel genuinely met where they are, without fear, appeasement or over‑accommodation, old patterns can begin to loosen. She recalls service users who had spent years in highly restrictive settings that unintentionally hardened their defences further. At Spring Wood Lodge, consistency, clarity and respectful boundaries have allowed some individuals to reconnect with themselves and others in ways they had never experienced before.
Malinder believes its potential is clear: “I’ve seen it get to places that other therapies never could – not because those therapies were wrong, but because they weren’t the right fit.”
By better understanding over‑control, by listening closely to subtle forms of distress, and by offering connection instead of assumptions, we take one more step toward ensuring that no one has to struggle unseen.