What about the boys?

Svein Øverlandclinical psychologist

Child and Adolescent/forensic psychology

Superego ASSuperego.as

Gender inequality

Gender stereotypes and men

The fear of low testosteron level

Even heroes fall down

The breakdown in meaning

Pornofication

• Pornography in it self doesnt seem to increase risk for sexual violence,

• with the exception of men with misogynic attitudesand severe personality disorders (Nøttestad, Hald & Øverland, 2010)

• Girls report feeling physically inferior to the womenthey view in pornographic material, while boys fearthey may not be as virile or able to perform as themale characters (Owens et. al 2012)

• For both gender, pornography use is associated withhigher incidence of depressive symptoms and decreased emotional bonding with caregivers

Harming others – harming himself

• Aggression can be directed both inwards and outwards

From grafitti to vandalism and arson

From risky driving to deliberate self harm

From rape and partner violence to murder

• Or both

murder-suicide

Partner violence

Only partner type

Low frequency

At home

Stress related

•Borderlinepreget typeModerate/serious violence

Seldom outside home

History of relational problem

unsecure attachment/jealous

Unhappy/impulsive

• Antisocial type Moderate to serious violence

Antisocial, angry, drug problems and general

psychopathology

Low level og empathy and regret

From shame to violence

…and to self harm and suicide

Last chance: Eldar Rønning has one last chance of winning the Gold

Medal in the Olympics

Thats why Eldar hits himself before starting the run.

Uses the pain to motivate himself

Suicide per age and gender in Norway

Gender differences in suicide versus suicide attemps

Suicide

Men

All ages

Dangerous methods

Shooting/hanging

> 50 % die at first attempt

Suicide attempt

Women

young

Less dangerousmethods

poison

repetetive

Definition of self-harm

• A class of actions with the common features of self inflicted intense bodily or psychological pain with the intent of changing a negative emotion, cognition or difficult relationship

(Øverland 2008)

Gender perceptions

• But why isnt hitting the wall as hard as you can, regarded as deliberate self harm?

It hurts

It is deliberate

But it is social acceptable

Gender differences in deliberate self-harm

% DSH Suicide attempt

Girls Boys Girls Boys

Depression 59 40 26 17

Poor self esteem 64 52 28 24

Negative body image 53 42 21 25

Without problems 14 8 3 3

N= 4066

Gender differences in risk for Deliberate Self-harm

(McMahon et. al. 2010)

• Drug use and having a friend with deliberate self-harm enhance risk for self-harm in both sexes

• Poor self esteem, trauma, self-harm in family, and problems with friends and family enhances risk for self-harm in girls

• Being bullied, problems at school, impulsivity and anger, enhances self-harm in boys

Positive and negative masculinity and femininity (Straiton, Roen & Hjelmedal, 2012)

• Negative femininity positively predicted self-harm and recent suicidal ideation status

• Positive masculinity was negatively related to suicidal ideation and self-harming while negative masculinitywas negatively related to self-harming

• The findings suggest that it is not the conventionalfeminine gender role per se that is associated with

suicidality, but specific negatively evaluated aspects.

Homosexuality og trans-sexuality

• Increased risk of DSH in homosexual boys (Skegg m.fl 2003)

• Increased risk of DSH in trans-sexual boys (Anderssen m.fl 2013)

• Classroom intervention reduces risk for health problems in general for adolescents (Rosa kompetanse/Pink competence)

Warning signals

Haavisto et.al. 2005: Less than 16 percent of boys with severe DSH had

received any form of mental health services a year before

DSH was associated with anxiety and aggression

Self reported symptoms of depression was predictive of DSH in adolescence

TIME

CONTROL

1

2

3

No sleepSurpriseparty

Meeting thefamily

Bus back to institution

I have to pretend..

I am a looser

Nothinggonna help

Suicide attemt

Loosing control

Improving health services for boys

• More than 50 % of the youth in Norway uses the”youth health station” – a free drop-in service

• But far less boys than girls

• And even less boys from low socio-economic status (Jensen/SSB, 2009)

• Organizing special weekdays as ”boys days”, specifictopics increase use of service

• Anonymity seems more important for boys

• Boys prefer meeting same gender nurse and doctor

It doesnt have to be complicated

How to approach the boys?

• Start by finding an ”open arena”

• Target his and your own nonverbal and paraverbalcommunication

• Normalize having problems

• and stress the importance of acknowledging problems as strength of character

And as always…

• More research is needed

• And the willingness to have an interest in the healthand well being of boys, even though they dont ”cryfor help” to often and dont always cooperate to well