2.3 Factors Associated with Self Harm
2.3.3 Traditional Masculinity
Green and Jakupcak (2016) suggested that investigating the impact of traditional masculinity may hold a key in understanding adolescent male self-harm. They argued that the way self-harm presents in males can be complicated by a number of factors -
including the adoption of traditional western norms for masculine behaviour. In the sole paper to highlight this issue, they attempted to show how the true nature and identification of male self-harm can be shrouded by traditional masculine norms and expectations. They also highlighted potential difficulties in assessing male self- harm in relation to the current diagnostic criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Their research was based on a clinical case study of a 19 year old male.
Green & Jakupcak (2016) proposed that whilst some of the self-harm behaviours displayed by males are typical of the diagnostically relevant traits constituting self- harm as measured by the DSM-V, others are not. They challenged some of the assumptions about self-harming behaviour which may not be relevant for males e.g., the assumption that self-harm is necessarily carried out in private. They proposed that some male self-harm behaviours may be conducted in a social setting and cited examples from their case study of the precarious behaviours engaged in by a young male. These included jumping from heights, punching walls, going out with the
intention of getting into physical confrontations - all of which could potentially lead to harm. Whilst sustaining consistent and serious injuries as a result of his escapades, their participant reported his behaviour to be ‘just messing around’ with his friends, imitating risky acts seen on TV and social media sites. The motivation was to gain the reputation of being ‘the craziest guy’ and this crazy behaviour was reinforced by the applause and gratification he received from his peers. Notably, these reasons and functions did not concur with the formal diagnostic criteria or more common reasons given for self-harm. Looking into the young man’s background, researchers found a number of factors, such as a disrupted upbringing without security or consistency,
depression, rejection /unavailability of parents, abuse – all factors which have been found to correlate with self-harm in males.
In addition, Green & Jakupcak (2016) argued that sometimes males lack conscious awareness of their intentions and the reasons why they engage in dangerous or risky behaviours, and this may hide unconscious attempts to self-harm. Whilst self-harm behaviours such as cutting and scratching are seen as taboo in society, some of the behaviours that could constitute male self-harm e.g., excessive drinking, aggressive behaviour, risk taking, are tacitly sanctioned through western male gender role socialisation. Since these functions and behaviours fail to synchronize with the diagnostic criteria for self-harm, miscalculations are easily made about how and why many males self-harm. They conclude that self-harm as it occurs in males, can be a highly complex phenomenon which can be difficult to identify - for both clinicians and young males themselves, because of western male culture. They argue for the
magnification of the background, family and life context in assessment situations where males are repeatedly hurting themselves. All of the background factors
identified in their case study e.g., broken attachments, home life disruption are indeed factors that have been shown to correlate with self-harming behaviour (McMahon, 2010). Haavisto et al (2005) specifically identified an association between physical aggression and self-harm.
The authors conclude that socially defined masculine behaviours including aggressive externalised acts may have latent functions, including communicating distress,
‘Masculine gender socialisation impacts the form and functions of some men’s self-harm behaviours. Specifically …difficulties expressing intentionality, as well as the perceived normativeness of…some men’s self-harm behaviours, results in these behaviours either being dismissed as not self-injurious or simply as normative for men.’ (Green & Jakupcak, 2016, p 152)
Also they stress the importance of being
…alert to both the unique constellation of symptoms that
accompany self-harm for many men (appearing as aggression or violence, occurring in social settings)… the factors that likely influence this presentation (masculine norms)… for psychological distress that likely accompanies these behaviours as well as for other maladaptive strategies for emotional regulation.
(Green & Jakupcak, 2016, p 153)
Through the use of case study methodology, a rich and detailed narrative has been presented about male self-harm, although limited in terms of generalising the findings beyond the immediate context. Green & Jakupcak (2016) have shed light on a number of important issues regarding male self-harm, such as the alternative ways that self- harm may be expressed in males and the implications this has for assessment i.e., using diagnostic criteria which may not be relevant to some aspects of male self-harm. Another limitation of the research is the ethnocentric definition of western masculine
behaviour. Notions of masculinity have the capacity to vary not only globally, but amongst and within local communities.
Importantly, the study offers one explanation as to why prevalence figures for male self-harm may sometimes lag behind those of their female counterparts. It highlights how the extant diagnostic criteria for identifying self-harm can actually hinder the identification of male self-harm. The authors suggest that the criteria should be differentiated along gender lines.
2.4 Prevalence of Self Harm
Prevalence was addressed by six of the eight papers selected for review, and the literature demonstrated inconsistency in establishing a reliable picture of prevalence between males and females.
Haavisto et al (2005) found a self-harm rate of 2.2% and 4% rate of ideation using a single sex sample of 18 year old males. Including females in their sample, McMahon et al (2010) was able to provide a comparison and found marked differences based on gender. They found a ratio of at least 3:1 when comparing lifetime history rates of self- harm for females and males respectively. Sornberger et al (2012) also reported higher prevalence of self-harm amongst females compared to their male counterparts. They found a 32% prevalence rate in females and 17% in males. To investigate further, the researchers conducted additional analysis of the data to qualify frequency in terms of how often participants had engaged in the behaviour using the descriptors ‘only once’, ‘a few times’ or ‘did it frequently’. In doing this they found only a significant