What Are Internalizing Behaviors?

When considering harmful behavior, people may imagine violent, aggressive, or otherwise damaging actions directed toward others. Some individuals do not realize that emotional disturbances and mental health conditions can cause those who experience them to internalize instead of externalize challenging emotions. 

Known as internalizing behaviors, these reactions to stress and certain emotions are often hidden. However, the hidden nature of these behaviors doesn't mean internalizing is less damaging. Continuing such behavior can cause serious damage to one's overall mental health, self-esteem, and relationships with others. 

The core of internalization

Some children, teens, and adults struggle with self-control, struggling to understand and control their emotions and impulsive urges. This behavior may be typical in young children, as toddlers often throw tantrums, scream, stomp their feet, and throw objects. Although few adults would find this behavior acceptable, it can often be expected in younger life. 

However, an older child, teen, or adult struggling with self-control may show similar behaviors, which can lead to abusive or explosive tendencies. In some cases, people who grow up struggling to self-soothe may turn these tendencies inward on themselves, acting unkindly to themselves when emotions arise. These behaviors are called internalizing behaviors. 

What are externalizing behaviors?

Actions like throwing objects or yelling are externalizing behaviors, meaning they are directed toward an individual's environment or people around them. Behavior can be directed at loved ones, parents, teachers, or items. Common examples of externalizing behavior include:

• Verbal aggression
• Physical aggression
• Destruction of property
• Stealing

Although "negative emotions" such as anger are normal stress responses, the outward reaction suggests a person has difficulty separating their behaviors from their emotional responses or thoughts. Some people with frequent and severe externalizing behaviors may be diagnosed with the following mental health conditions: 

• Attention-deficit hyperactivity disorder (ADHD) 
• Intermittent explosive disorder
• Oppositional defiant disorder
• Substance use disorders
• Conduct disorder
• Antisocial personality disorder (ASPD) 
• Narcissistic personality disorder (NPD) 
• Pyromania
• Kleptomania

Treatment for externalizing behaviors is often personal and complex. These disorders are not, however, the only way that difficulty with self-control presents itself.

What are internalizing behaviors?

Some children and adults who struggle to cope with stress and emotions exhibit internalizing behaviors. Instead of acting out toward others, they self-harm or treat themselves unkindly. People with these behaviors may be more likely to be diagnosed with the following mental illnesses: 

• Depressive disorders
• Anxiety disorders
• Post-traumatic stress disorder (PTSD)
• Complex PTSD (C-PTSD) 
• Borderline personality disorder (BPD) 

Emotions that may prompt internalizing behaviors include but are not limited to loneliness, isolation, abandonment, grief, suffering, rage, envy, jealousy, insecurity, self-doubt, and self-hatred.

In one study, researchers found that mental health professionals have become more aware of and concerned with internalizing behaviors over the past three decades. The results mark how information can lead to changes in levels of understanding of the prevalence of these symptoms in adolescents and adults of all gender identities and how peers can support each other through the internal conflict they are facing to navigate these thought patterns and isolation.

Types of internalizing behaviors

There are several ways people may take out emotions or symptoms on themselves, including the following: 

• Partaking in negative self-talk out loud or in the mind 
• Willingly participating in risky activities to harm oneself, even subconsciously, such as substance use, risky sex, etc. 
• Cutting, burning, tearing, or using other physical forms of self-harm 
• Insulting oneself 
• Crying and blaming oneself when relationship conflict occurs 
• "Punishing" oneself for perceived or actual failure
• Withholding joy or fun from oneself 
• Isolating from others 
• Controlling one's eating patterns 

If you are experiencing a crisis related to an eating disorder or would like further resources, contact the ANAD Eating Disorders Helpline at 1-888-375-7767 from Monday through Friday, 9 am to 9 pm CT. 

Risk factors for internalizing behaviors

Anyone may partake in internalizing behaviors. However, the following are common risk factors that could indicate someone might use these behaviors: 

• Sadness, loneliness, shame, guilt, and fear
• Believing one is unwanted or unloved
• Withdrawing from social activities 
• Becoming irritable or nervous, especially when stressed or emotional
• Difficulty concentrating or focusing on tasks
• Sleeping a lot more or less than usual
• Eating a lot more or less than usual
• Suicidal thoughts, attempts, or ideation

Internalizing behaviors may develop when individuals try to self-control inappropriately. Unlike those with externalizing behaviors, they might try to control their emotions from within. Internalizing behaviors often come from shame, an emotion often connected with trauma and maltreatment in childhood. 

Some people experiencing a condition that involves internalizing behaviors may hide their symptoms so well that their family and friends are unaware of their struggles. They may not ask for help, which could mean their behaviors aren't noticed until they escalate to severe self-harm. 

Mental illnesses and symptoms that cause internalizing behaviors 

Internalizing symptoms can present in many mental illnesses. Below are mental illnesses and symptoms that may be most associated with these behaviors. 

Depression

Depressive disorders, like major depressive disorder and dysthymia, are often associated with internalizing symptoms. Although depression can present itself in many ways, the Diagnostic and Statistical Manual of Mental Disorders (DSM) lists the following symptoms. Excluding the last symptom, these symptoms must present every day or nearly every day for at least two weeks:

• A prolonged low mood 
• Less interest in previously enjoyed activities
• Less interest in personal hygiene 
• Significant weight loss or gain
• A slowing down of thoughts paired with a reduction of physical movement
• Fatigue or extreme loss of energy
• Thoughts of worthlessness or hopelessness
• Guilt or shame 
• A diminished ability to concentrate
• Recurrent thoughts of death or suicide 

Anxiety

Because they occur together frequently, some people may think that depression and anxiety are the same illness. However, anxiety disorders present differently than depression. The DSM-5 lists the symptoms of generalized anxiety disorder as the following:

• Excessive anxiety
• Difficult controlling worry
• Restlessness
• Being on edge
• Becoming easily fatigued
• Difficulty concentrating
• Irritability
• Muscle tension
• Sleep disturbances

For someone with an anxiety disorder, internalizing behaviors can be a serious challenge, as one may fear opening up about their symptoms to others. However, left untreated, anxiety does not go away and can worsen over time. It can also lead to serious mental illnesses like depression and social anxiety disorder. 

Social withdrawal

Social withdrawal is a symptom of numerous mental health conditions, including anxiety and depression. It is also one of the main symptoms of avoidant personality disorder (APD), which is characterized by the following:

• Extreme social inhibition
• Thoughts of inadequacy
• Sensitivity to negative criticism and rejection

Social withdrawal is a common coping mechanism for those experiencing intense emotions and stress that prompt internalizing behavior. Instead of acting out, introverts and others who look inward may choose to be alone and harm themselves. Social withdrawal can also be due to severe anxiety about how others perceive you. 

Somatic symptom disorder

Another way internalizing behaviors may present is through somatic symptom disorder (SSD). SSD is not as well-known as anxiety and depression and is considered rare. SSD shows up as physical symptoms with no underlying cause. It is characterized by pain, neurologic challenges, stomach issues (gastrointestinal complaints), and sexual symptoms.

People living with SSD are often viewed as "faking symptoms" since there isn't an underlying cause that physicians can pinpoint. However, this is a misconception. The distress, frustration, and physical pain from SSD are real and can lead to internalizing behavior.

The effects, while often physical, also manifest in other ways. People living with this condition may struggle with academic performance, socializing with others, psychological adjustment, and employment. These challenges may go unnoticed.

How to find support for internalizing behaviors

The following analogy may explain why pinpointing internalizing behaviors can be difficult. Think of a stage with 25 dancers. Even if all 25 are equally talented, the ones in the first row, especially if they give more energy, may catch your attention first. Noticing these dancers does not take away from the abilities of those in the back but can make it challenging to give them support. 

If you, your child, student, or someone else you know is struggling with emotional control, anxiety, depression, or internalizing behavior, it may be beneficial to seek assistance from a professional. Try not to let fear, helplessness, guilt, or shame stop you from getting the help you need, even if it is difficult. Learning new habits and ending self-directed, harmful behaviors through therapy is possible.

If you struggle to reach out for help, you may not want to meet with a therapist in person. If that sounds like you, online therapy through a platform like BetterHelp could be a solution. An online therapy platform lets you meet with a provider from home and choose between phone, video, or live chat sessions. 

Research shows that online therapy can play a significant role in reducing depression and anxiety symptoms. For example, one study found that online therapy was even more effective than traditional in-person sessions, with 100% of participants in the online group showing continued symptom reduction three months after treatment. Individuals in the face-to-face group showed worsened depressive symptoms over the same period.