Network analysis of the association between alexithymia and cognitive-emotional regulation strategies in nursing students with non-suicidal self-injury: a gender difference perspective

Background Non-suicidal self-injury (NSSI) is prevalent among nursing students and closely linked to alexithymia and emotional dysregulation. However, conventional total-score analyses treat alexithymia and cognitive emotion regulation strategies (CERS) as unitary constructs, obscuring dimensional associations across multiple strategies. Network analysis overcomes this limitation by modeling dimensions as interconnected nodes, identifying central and bridge dimensions, and enabling comparisons of network structure across groups. This study therefore applied network analysis to the alexithymia-CERS associations in nursing students with NSSI, focusing on gender differences. Methods This study surveyed 1,072 nursing students with NSSI using four instruments: a Sociodemographic Questionnaire, Diagnostic and Statistical Manual of Mental Disorders (5th edition), Toronto Alexithymia Scale, and Cognitive Emotion Regulation Questionnaire. Results In the overall network, “difficulty identifying feelings” emerged as the most central node, exhibiting the highest strength centrality and serving as the primary bridge linking alexithymia to CERS. The network comparison test revealed significant gender differences in network structure. Strength centrality was highest for “refocusing on planning” in males but for “difficulty identifying feelings” in females, whereas bridge centrality was highest for “difficulty identifying feelings” in males but for “externally oriented thinking” in females. Conclusions This study delineates the associative network between alexithymia and CERS in nursing students with NSSI. The identified network patterns exhibit significant gender differences, suggesting distinct psychological mechanisms between males and females. Given the cross-sectional design, causal inferences cannot be drawn, and longitudinal studies are warranted to verify these pathways. Nonetheless, gender-specific profiles may inform future interventions targeting emotion regulation deficits in this population.