18 Mar Childhood Mental Health: Internalizing Versus Externalizing Disorders
Behavioral health conditions in childhood and adolescence can be either externalizing or internalizing in nature. The type of disorder influences the rate of linkage to treatment, the level of involvement in parental involvement in treatment, and treatment outcomes. Additional research into internalizing and externalizing concepts and data is needed to support advancements in clinical applications in child mental health services.
Internalizing Disorders
Internalizing symptoms are directed inwardly toward oneself. These include sadness, guilt, fear, worry, depression, and anxiety. These symptoms often result in behaviors that are destructive towards oneself. These symptoms are related to behavioral health disorders such as anxiety, depressive, borderline personality disorder, and eating disorders.
Research in 2013 from the American Psychological Association reports gender differences in the prevalence of internalizing disorders, with internalizing disorders occurring more frequently in girls than boys. Risk factors contributing to internalizing disorders include family conflict, harsh parenting, lack of parental warmth, neglect, bullying, and sexual abuse.
The Centers for Disease Control and Prevention (CDC) reports suicide as the second leading cause of death for youth aged 15 to 19. Internalizing and externalizing symptomatology is related to an increased risk for suicide at these ages. A 2019 study in the International Journal of Environmental Research and Public Health found that internalizing symptoms, including depression over time, had a higher correlation to suicide in adolescents.
Externalizing Disorders
Externalizing symptoms are directed outwardly toward others and the environment in which the youth interacts. Symptoms stem from emotions such as anger, aggression, and hostility. Rule-breaking behaviors or violations of social norms, such as physical fights, property destruction, and defiance, are examples of externalizing behavior.
Externalizing problems in young children can lead to behavior disorders such as oppositional defiant disorder, conduct disorder, antisocial personality disorder, and intermittent explosive disorder. Attention-deficit hyperactivity disorder (ADHD) is also categorized by externalizing symptoms.
Research suggests that externalizing disorders occur more frequently in boys than girls. The nature of externalizing symptoms is more evident in adults who interact with youth experiencing these behaviors than those with internalizing symptoms. Disruptive behaviors in the classroom and community tend to draw attention. Research published in the journal for School Mental Health in 2019 reported that teachers perceived externalizing problems as more severe and were more likely to make mental health referrals for these youth.
Characteristics of youth displaying externalizing symptoms include personality traits such as oppositional nature, impulsivity, and a lack of empathy. Family influences, including unresponsive parenting, controlling or hostile parenting, or bullying, correlate with increased diagnoses of externalizing disorders.
Research promoting a greater understanding of the nature of externalizing and internalizing disorders, the etiology, and symptoms will aid in improving treatment interventions and outcomes geared toward the nature of the youth’s symptoms.