At a high level, there are two ways an individual processes feelings of frustration and discord.  We have internalizers who force their feelings inward.  These individuals can fall into the diagnostic category of anxious, depressed, PTSD, and often have social issues.  This is where your gaming addictions fall under typically, as internalizers prefer to be alone (or with internet “friends”) as opposed to socializing with others.

Then we have the externalizers – people who press their frustration and discord outward.  Oppositional defiant disorder, conduct disorder, impulsivity and other disruptive behaviors fall into this category.  Bullying is common here, while the internalizers tend to get bullied.  You can find stealing, truancy, and various legal problems in this category which may involve violating the rights of others.

Generally speaking, drug use is more prevalent in the externalizers group, but can be found among the internalizers.  For the externalizers the appeal of drug use tends to be more about rule breaking and the allure of “hustling” or making money- even if the child’s resources are already abundant- and the “rush” of the high.  For the internalizers we can also see drug use, but the appeal is more about self-medicating or simply following the crowd.

Please see the graphic below for an illustration of these two common groupings:

These two categories are often grouped apart in treatment programs.  It will be necessary to have this information so the best referral can be made, as often the therapist assigned will be determined off this single criteria.

Some programs go as far as to focus on one behavioral or diagnosis type.  There are specialty focus programs for students with anxiety related issues; or trauma, loss, attachment disorders which fall under the internalizing category.  Other programs may focus exclusively on disruptive behaviors such as oppositional defiant disorder.

If a program that treats both ends of the continuum is chosen, it’s critical to ensure the student is not housed with someone where victimization could occur.  For example we would not want to have a oppositional defiant child with a history of bullying room with a socially awkward child with a PTSD diagnosis who has been the victim of bullying.

References for this page:

Drabick, Deborah, A.G.; Steinberg, Elizabeth; Hampton Shields, Ashley (2015). “Overview of DSM Disruptive Behavior Disorders”. In Beauchaine, Theodore P.; Hinshaw, Stephen P. The Oxford Handbook of Externalizing Spectrum Disorders. New York, New York: Oxford University Press. p. 9. ISBN 978-0-19-932467-5.

Levy, Florence; Hawes, David J.; Johns, Adam (2015). “Externalizing and Internalizing Comorbidity”. In Beauchaine, Theodore P.; Hinshaw, Stephen P. The Oxford Handbook of Externalizing Spectrum Disorders. New York, New York: Oxford University Press. ISBN 978-0-19-932467-5.

Click on a Factor below to explore the topic:

I. Severity of Issues

II. Etiology (how the issue was formed)

III. Diagnostic Cluster

IV. How the Child Handles Frustration and Discord

V. Child’s Belief System and Prevalent Issues

VI. Cost and Length of Stay, VII. Academics

VIII. The Child’s Interests, IX. Program Location, and X. Everything Else