19 Mar Gender Patterns in Internalizing vs. Externalizing Psychiatric Disorders
Emotional expression is a monumental developmental task in childhood and adolescence, and considerable research has shown gender differences. These differences influence the expression of mental health symptoms. To successfully ameliorate symptoms afflicting youth, diagnostic practices, and treatment interventions need to address the influence gender has on symptom expression.
Gender Differences in Symptom Expression
A 2012 study published in the Journal of Abnormal Psychology found that adolescent females are two times more likely to develop internalizing disorders than adolescent males. These disorders constitute psychiatric illnesses, such as anxiety, somatic disorders, and depression. Additional research has shown that girls diagnosed with a more externalizing disorder, such as ADHD, still tend to have a more internalized expression of these symptoms. The researchers in this 2021 study reported in the Child and Adolescent Psychiatry and Mental Health journal concluded that gender remained a significant predictor of externalizing symptoms.
Gender differences in psychopathology may play a role in the frequency of diagnosing specific diagnoses, meaning the presence of a psychiatric illness may be overlooked. Research in the Journal of the American Academy of Child and Adolescent Psychiatry identified gender differences in the symptom expression of ADHD. Girls diagnosed with ADHD displayed more significant intellectual impairment, lower levels of hyperactivity, and lower rates of other externalizing behaviors. So while boys are more frequently diagnosed with ADHD, as many as four boys to every one girl identified, this may be related to gender differences in which symptoms gain the most attention. Referral bias for treatment may occur more frequently in boys. Externalizing symptoms such as hyperactivity, aggression, and classroom disruption may garner more attention from teachers and parents, resulting in a higher referral rate to a mental health professional.
The gender differences in the trajectory of internalized symptoms for girls compared to boys were reported in the Journal of Abnormal Psychology in February 2020. Girls were noted to manifest risk related to internalized depression and anxiety symptoms at a higher level than boys. While both girls and boys with a higher trajectory of symptom development reported risk factors of high BMI, self-harm, low mental well-being, depressive symptoms, and low educational motivation, females were more likely to engage in other high-risk behavior such as cigarette and cannabis use and sexual activity at a young age.
Gender differences in social and peer relationships also influence internalized vs. externalization of symptoms. A study in Developmental Psychology found that girls’ internalizing symptoms were related to interpersonal vulnerabilities in social and peer connections. Social norms imposed on male children and adolescents may result in a greater tendency to respond to stressors with externalized expressions. Research shows that patterns of symptom expression are related to gender differences in socialization and traditional gender roles in seeking help and how to cope with symptoms.
The gender differences in how children and adolescents’ mental health symptoms manifest present implications for educators, psychologists, and parents. Symptom expression may play a role in under-identifying certain mental health disorders. In addition, treatment interventions can be directed at the symptoms that are the most disruptive and noticeable. However, this may result in inadequacies in treatment outcomes if an underlying, internalized issue is unrecognized. Comprehensive screening is one means of better identification of symptoms that may lie beneath the surface of the manifested symptoms.