Introduction: Reported rates of non-suicidal self-injury (NSSI) differ by gender but may be under-reported and under-recognised in men. People engaging in NSSI rarely seek professional help without encouragement, so others play a key role in its identification and potential intervention. The current research investigated others’ interpretations of NSSI, examining whether gender affects the likelihood of NSSI identification and views of how common and acceptable NSSI is. Method: Participants (N = 429; 74.1% female, 23.3% male; please see below for further demographic information) responded to two vignettes describing a person self-injuring by punching a wall or by cutting themselves. The person’s gender in each vignette was manipulated. Following each vignette, the participants rated the level to which they agreed the behaviour was common for the gender of the person described, as well as the level to which they agreed the behaviour was acceptable for the gender of the person described, on a 5-point Likert scale. Following both vignettes, participants were presented with a definition of NSSI and rated the level to which they agreed cutting and wall-punching were forms of NSSI on 5-point Likert scales. Independent-samples t tests and goodness of fit χ2 tests were conducted as appropriate. Results: Participants were more likely to identify wall-punching as common for men and cutting as common for women. However, there was no significant difference in whether wall-punching was identified as NSSI or considered to be an acceptable behaviour, regardless of the gender of the person engaging in it. That is, although research suggests that men are far more likely to engage in wall-punching as a form of NSSI than women, participants did not recognise this. Overall, the results indicated a gender-dependent difference in how acceptable and common NSSI is thought to be, but no noticeable difference in identification of a behaviour as NSSI. Wall-punching, typically a form of NSSI engaged in by males, tended not to be identified as such. Conclusion: There is an effect of gender on how NSSI is interpreted, and it seems that men’s NSSI is, and will continue to be, under-recognised. This has important implications for the treatment of men’s NSSI, which is more likely to be seen as aggression and therefore deserving of punishment than an attempt at emotion regulation.

Garisch JA, Wilson MS. Prevalence, correlates, and prospective predictors of non-suicidal self-injury among New Zealand adolescents: cross-sectional and longitudinal survey data. Child Adolesc Psychiatry Ment Health. 2015 Jul 8;9:28.
Wester K, Trepal H, King K. Nonsuicidal self-injury: increased prevalence in engagement. Suicide Life Threat Behav. 2018;48(6):690–8.
Klonsky ED. The functions of deliberate self-injury: a review of the evidence. Clin Psychol Rev. 2007;27(2):226–39.
Andover MS, Primack JM, Gibb BE, Pepper CM. An examination of non-suicidal self-injury in men: do men differ from women in basic NSSI characteristics?Arch Suicide Res. 2010;14(1):79–88.
Bresin K, Schoenleber M. Gender differences in the prevalence of nonsuicidal self-injury: a meta-analysis. Clin Psychol Rev. 2015;38:55–64.
Kimbrel NA, Thomas SP, Hicks TA, Hertzberg MA, Clancy CP, Elbogen EB, et al. Wall/object punching: an important but under-recognized form of nonsuicidal self-injury. Suicide Life Threat Behav. 2018;48(5):501–11.
Patel TA, Dillon KH, Cassiello-Robbins C, Calhoun PS, Beckham JC, Kimbrel NA. Anger, impulsivity and wall/object punching in a sample of US. veterans with psychiatric disorders. J Psychiatr Res. 2022;147:269–73.
Fitzgerald J, Curtis C. Non-suicidal self-injury in a New Zealand student population: demographic and self-harm characteristics. NZ J Psychol. 2017;46(3):156–63.
Whitlock J, Muehlenkamp J, Purington A, Eckenrode J, Barreira P, Baral Abrams G, et al. Nonsuicidal self-injury in a college population: general trends and sex differences. J Am Coll Health. 2011;59(8):691–8.
Curtis C. Young women’s experiences of self-harm. Young. 2016;24(1):17–35.
Gratz KL, Roemer L. Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the difficulties in emotion regulation scale. J Psychopathol Behav Assess. 2004;26(1):41–54.
Chapman AL, Gratz KL, Brown MZ. Solving the puzzle of deliberate self-harm: the experiential avoidance model. Behav Res Ther. 2006;44(3):371–94.
Nock MK. Why do people hurt themselves?: new insights into the nature and functions of self-injury. Curr Dir Psychol Sci. 2009;18(2):78–83.
Swannell SV, Martin GE, Page A, Hasking P, St John NJ. Prevalence of nonsuicidal self-injury in nonclinical samples: systematic review, meta-analysis and meta-regression. Suicide Life Threat Behav. 2014;44(3):273–303.
Lucena NL, Rossi TA, Azevedo LMG, Pereira M. Self-injury prevalence in adolescents: a global systematic review and meta-analysis. Child Youth Serv Rev. 2022;142:106634.
Robinson K, Wilson MS. Open to interpretation? Inconsistent reporting of lifetime nonsuicidal self-injury across two common assessments. Psychol Assess. 2020;32(8):726–38.
Barrett LF, Bliss-Moreau E. She’s emotional. He’s having a bad day: attributional explanations for emotion stereotypes. Emotion. 2009;9(5):649–58.
Hayes SC, Strosahl K, Wilson KG, Bissett RT, Pistorello J, Toarmino D, et al. Measuring experiential avoidance: a preliminary test of a working model. Psychol Rec. 2004;54(4):553–78.
Nolen-Hoeksema S. Emotion regulation and psychopathology: the role of gender. Annu Rev Clin Psychol. 2012;8:161–87.
Tamres LK, Janicki D, Helgeson VS. Sex differences in coping behavior: a meta-analytic review and an examination of relative coping. Pers Soc Psychol Rev. 2002;6(1):2–30.
Victor SE, Muehlenkamp JJ, Hayes NA, Lengel GJ, Styer DM, Washburn JJ. Characterizing gender differences in nonsuicidal self-injury: evidence from a large clinical sample of adolescents and adults. Compr Psychiatry. 2018 Apr;82:53–60.
Lloyd-Richardson EE, Perrine N, Dierker L, Kelley ML. Characteristics and functions of non-suicidal self-injury in a community sample of adolescents. Psychol Med. 2007 Aug;37(8):1183–92.
Green JD, Kearns JC, Ledoux AM, Addis ME, Marx BP. Masculinity and men’s self-harm behaviors: implications for non-suicidal self-injury disorder. Am J Men’s Health. 2018 Jan;12(1):30–40.
Inckle K. Strong and silent. Men Masc. 2014;17(1):3–21.
Bresin K, Sand E, Gordon KH. Non-suicidal self-injury from the observer’s perspective: a vignette study. Arch Suicide Res. 2013;17(3):185–95.
Levant RF, Wimer DJ, Williams CM. An evaluation of the Health Behavior Inventory-20 (HBI-20) and its relationships to masculinity and attitudes towards seeking psychological help among college men. Psychol Men Masc. 2011;12(1):26–41.
Seidler ZE, Dawes AJ, Rice SM, Oliffe JL, Dhillon HM. The role of masculinity in men’s help-seeking for depression: a systematic review. Clin Psychol Rev. 2016 Nov;49:106–18.
Collins NL, Miller LC. Self-disclosure and liking: a meta-analytic review. Psychol Bull. 1994 Nov;116(3):457–75.
Eagly AH, Crowley M. Gender and helping behavior: a meta-analytic review of the social psychological literature. Psychol Bull. 1986;100(3):283–308.
Ellemers N. Gender stereotypes. Annu Rev Psychol. 2018 Jan 4;69(1):275–98.
Plant EA, Hyde JS, Keltner D, Devine PG. The gender stereotyping of emotions. Psychol Women Q. 2000;24(1):81–92.
Shields SA. Gender and emotion. Psychol Women Q. 2013;37(4):423–35.
Simon RW, Nath LE. Gender and emotion in the United States: do men and women differ in self-reports of feelings and expressive behavior?Am J Sociol. 2004;109(5):1137–76.
Brescoll VL, Uhlmann EL. Can an angry woman get ahead? status conferral, gender, and expression of emotion in the workplace. Psychol Sci. 2008;19(3):268–75.
Rosenfield S. Gender and dimensions of the self: implications for internalizing and externalizing behavior. In: Frank E, editor. Gender and its effects on psychopathology. Washington, DC: American Psychiatric Press; 2000. p. 23–36.
Lui LMW, Lee Y, Lipsitz O, Rodrigues NB, Gill H, Ma J, et al. The influence of prescriber and patient gender on the prescription of benzodiazepines: results from the Florida Medicaid Dataset. CNS Spectr. 2022 Jun;27(3):378–82.
Ussher JM. Women’s madness: misogyny or mental illness?Amherst, Mass: University of Massachusetts Press; 1992.
McIntyre RS, Chen VC, Lee Y, Lui LMW, Majeed A, Subramaniapillai M, et al. The influence of prescriber and patient gender on the prescription of benzodiazepines: evidence for stereotypes and biases?Soc Psychiatry Psychiatr Epidemiol. 2021;56(6):1083–1089.
Rosenfield S, Vertefuille J, Mcalpine DD. Gender stratification and mental health: an exploration of dimensions of the self. Soc Psychol Q. 2000;63(3):208–23.
Goodwin MH. The hidden life of girls: games of stance, status, and exclusion. Oxford: John Wiley and Sons; 2007.
Lightdale JR, Prentice DA. Rethinking sex differences in aggression: aggressive behavior in the absence of social roles. Pers Soc Psychol Bull. 1994;20(1):34–44.
Aguirre Velasco A, Cruz ISS, Billings J, Jimenez M, Rowe S. What are the barriers, facilitators and interventions targeting help-seeking behaviours for common mental health problems in adolescents? A systematic review. BMC Psychiatry. 2020 Jun 11;20(1):293.
Eagly AH, Steffen VJ. Gender and aggressive behavior: a meta-analytic review of the social psychological literature. Psychol Bull. 1986;100(3):309–30.
Labouliere C, Kleinman M, Gould M. When self-reliance is not safe: associations between reduced help-seeking and subsequent mental health symptoms in suicidal adolescents. Int J Environ Res Public Health. 2015 Apr 1;12(4):3741–55.
Doyle L, Treacy MP, Sheridan A. Self-harm in young people: prevalence, associated factors, and help-seeking in school-going adolescents. Int J Ment Health Nurs. 2015 Dec;24(6):485–94.
Han J, Batterham PJ, Calear AL, Randall R. Factors influencing professional help-seeking for suicidality. Crisis. 2018 May;39(3):175–96.
Rowe SL, French RS, Henderson C, Ougrin D, Slade M, Moran P. Help-seeking behaviour and adolescent self-harm: a systematic review. Aust N Z J Psychiatry. 2014 Dec;48(12):1083–95.
Michelmore L, Hindley P. Help-seeking for suicidal thoughts and self-harm in young people: a systematic review. Suicide Life Threat Behav. 2012 Oct;42(5):507–24.
Hasking P, Rees CS, Martin G, Quigley J. What happens when you tell someone you self-injure? The effects of disclosing NSSI to adults and peers. BMC Public Health. 2015;15(1):1039.
Bancroft L. Why does he do that? Inside the minds of angry and controlling men. New York, NY: Berkley Books; 2002.
Nielsen E, Townsend E. Public perceptions of self-harm — a test of an attribution model of public discrimination. Stigma Health. 2018;3(3):204–18.
Robinson K, Garisch JA, Kingi T, Brocklesby M, O’Connell A, Langlands RL, et al. Reciprocal risk: the longitudinal relationship between emotion regulation and non-suicidal self-injury in adolescents. J Abnorm Child Psychol. 2019;47(2):325–32.
You do not currently have access to this content.