What Are Internalizing Behaviors?

By: Mary Elizabeth Dean

Updated October 14, 2021

Medically Reviewed By: Aaron Dutil

Are you or someone you know struggling with internalizing behaviors? If so, you are in the right place to get help. When we think about harmful behavior, we usually imagine violent, aggressive, or otherwise damaging actions directed toward others. Many people do not realize that emotional disturbances and mental health disorders can cause those who experience them to attack themselves.

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Known as internalizing behaviors, these reactions to stress and negative emotions are often hidden. Because of the tendency to remain out of view, internalizing behaviors are not as well-known as externalizing forms that involve acting out. This does not mean internalizing behaviors are any less damaging. In fact, studies show that continuing such behavior can cause serious damage to one's overall mental health, self-esteem, and relationships with others.

Struggling with Self-Regulation

Many children, teens, and adults struggle with self-regulation. This means that they have trouble controlling their emotions and impulsive reactions.

A common example that most of us have witnessed is a toddler throwing a fit in a store because their mom or dad refuses to give them what they want. When throwing a tantrum, toddlers might scream, stomp their feet, and even throw things. Although few adults would find it acceptable, this behavior is somewhat expected for a child under three. So, though we wouldn't want to reward the behavior, we wouldn't find it alarming.

However, what would you think about the same situation but involving a 12-year-old? You might feel differently since you would expect a child of that age to have more control over their emotions. Although not the norm, many children (who grow into adults) struggle with self-regulation, even as they age, resulting in negative behaviors.

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Externalizing Vs. Internalizing Behaviors: The Difference

Some of these actions, such as those mentioned above, are externalizing behaviors, meaning they are directed toward an individual's environment. 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 with self-regulation. Many people who display externalizing behaviors frequently end up being diagnosed with one (or more) of the following mental disorders:

• Attention Deficit Hyperactivity Disorder (ADHD)
• Intermittent Explosive Disorder
• Oppositional Defiant Disorder
• Substance Use Disorder
• Conduct Disorder
• Antisocial Personality Disorder
• Pyromania
• Kleptomania

Treatment for externalizing behaviors is both personal and complex. These disorders are not, however, the only way that self-regulation presents itself.

Some children and adults who have trouble coping with stress and emotions exhibit internalizing behaviors. This is to say that instead of acting out toward others, they self-harm.

Depression and anxiety are two mental disorders that people who practice internalizing behavior often develop. According to scientific research, mental health professionals have become even more aware (and concerned with) of internalizing disorders over the past three decades.

Internalizing Behaviors and Symptoms May Include:

• Feeling sad, lonely, afraid, unwanted, or unloved
• Being withdrawn and not wanting to socialize
• Becoming irritable or nervous, especially when stressed or emotional
• Not wanting to talk or communicate with anyone
• Having difficulty concentrating or focusing on important tasks
• Sleeping a lot more or less than usual
• Eating a lot more or less than usual
• Negative self-talk
• Substance use
• Suicidal thoughts, attempts, or ideation

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Internalizing disorders develop when individuals try to self-regulate inappropriately. Unlike those with externalizing disorders, they might try "too hard" to control emotions and do so from within.

Also known as "secret illnesses," many people experiencing internalizing disorders hide their symptoms so well that even their family and friends are unaware of their struggles. Many people who experience internalizing behaviors never get help, which means their internalizing behaviors may progress into bodily self-harm (cutting) or suicidal thoughts and attempts.

If you or a loved one are experiencing suicidal thoughts, reach out for help immediately. The National Suicide Prevention Lifeline can be reached at 1-800-273-8255 or suicidepreventionlifeline.org/chat/ and is available 24/7.

Internalizing Disorders and Presentation

Internalizing disorders usually present themselves in these four primary ways:

• Depression
• Anxiety
• Social Withdrawal
• Somatic (Physical) Symptom Disorder

Depression

A common yet extremely serious mood disorder, depression is also known as major depressive disorder or clinical depression. Although depression can present itself in many different ways, the book Diagnostic and Statistical Manual of Mental Disorders (DSM-5), followed by mental health professions during diagnosis, lists the following symptoms. Excluding the last, these symptoms must present every day or nearly every day.

• Depressed mood
• Less interest in all, or almost all, activities
• Significant weight loss or gain
• A slowing down of thought along with a reduction of physical movement
• Fatigue or extreme loss of energy
• Feelings of worthlessness or inappropriate guilt
• Diminished ability to think or concentrate
• Recurrent thoughts of death, suicidal ideation with or without a specific plan, or a suicide attempt

Anxiety

Because they occur together so frequently, many people think that depression and anxiety are the same illness when they are different. All anxiety disorders present differently. DSM-5 lists the symptoms of Generalized Anxiety Disorder as:

• Excessive anxiety
• Difficult to control worry
• Restlessness
• Feeling on edge
• Becoming easily fatigued
• Difficulty concentrating
• Irritability
• Muscle tension
• Sleep disturbance

For a person living with an anxiety disorder, internalizing behaviors can be a serious issue. Unfortunately, left untreated, the anxiety does not go away and can also worsen over time. It can also lead to serious mental illnesses such as depression (listed above) and social withdrawal (discussed below).

Social Withdrawal

Social withdrawal can be a symptom of numerous mental health issues, including anxiety and depression. It is also one of the main signs of Avoidant Personality Disorder, which is characterized by the following:

• Extreme social inhibition
• Feelings of inadequacy
• Sensitivity to negative criticism as well as rejection

Social withdrawal is worth mentioning separately because it is a common coping mechanism for those experiencing strong emotions and stress through internalizing behavior. Instead of acting out, introverts and others who look inward choose to be alone rather than interacting with others who could help.

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Somatic Symptom Disorder

One final way that internalizing behaviors often presents is through Somatic Symptom Disorder (SSD). SSD is not as well-known as anxiety and depression. Many people first hear of this disorder at diagnosis.

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. Children living with an internalizing disorder tend to have trouble with academic performance, socializing with others, psychological adjustment, and employment. Again, these things tend to go unnoticed.

Next Steps

When asked why pinpointing internalizing behaviors is so difficult, especially in the classroom, one teacher described it this way:

Think of a stage where you have 25 dancers. Even if they are all equally talented, the ones in the first row, especially if they are giving more energy, will catch your attention. It does not take away from the abilities of those in the back; it just makes them a lot harder to spot.

If you, your child, student, or someone else you know is struggling with emotional regulation, anxiety, depression, internalizing behavior, please seek assistance from a professional today. Don't let fear, helplessness, feelings of guilt, or shame stop you from getting the help you need, even if it feels difficult.  It is possible to learn new habits and end self-directed, harmful behaviors through therapy.

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 percent of participants in the online group showing continued symptom reduction three months after treatment. On the other hand, individuals in the face-to-face group showed "significantly worsened depressive symptoms" over the same period. This study explores how internet-based treatment compares to regular face-to-face therapy.

If you struggle with any of these challenges, the last thing you might want to do is drive to a therapist's office for a session. If that sounds like you, online therapy with BetterHelp could be a powerful solution. BetterHelp's online therapy platform allows you access to trained professionals right from the comfort of your home. Plus, you can contact them on a more regular basis, which can be a great comfort during the tough times when you need to speak with a trusted professional. Consider the following reviews of BetterHelp therapists below from people experiencing similar issues.

"Robin is a wonderfully attentive, compassionate, patient, and insightful counselor. We got right to the kernel of what was coming up for me internally, identifying patterns of my own and others that may contribute to my experience. I walked away with a much deeper understanding and greater perspective on my life. Robin listened closely and became a trusted confidante with the psychological expertise to guide me that I needed. I felt safe to share anything with her, and she became a friend. I highly recommend Robin as a counselor. She made my first impression of BetterHelp excellent."

"I was in a bad headspace before connecting with Amanda. She has been so helpful! I have started my journey into mindfulness with her and have gained a variety of CBT tools with her help. I am now better able to regulate my emotions of anxiety and stress, cope with my past traumas, and start to live my life with peace. I feel like she helped me get back not only to my old self but help me start to grow into the best version of myself. She is there for you with tools if you need them or listens if you tell her that's what you need. In these times of chaos, it's wonderful to feel like you have someone in your corner and on your side. If you suffer from anxiety, trauma, or self-esteem issues, I highly recommend her!"