Externalizing disorders

Externalizing disorders (or externalising disorders) are mental disorders characterized by externalizing behaviors, maladaptive behaviors directed toward an individual's environment, which cause impairment or interference in life functioning. In contrast to individuals with internalizing disorders who internalize (keep inside) their maladaptive emotions and cognitions, such feelings and thoughts are externalized (manifested outside) in behavior in individuals with externalizing disorders. Externalizing disorders are often specifically referred to as disruptive behavior disorders (attention-deficit/hyperactivity disorder, oppositional defiant disorder, and conduct disorder) or conduct problems which occur in childhood. Externalizing disorders, however, are also manifested in adulthood. For example, alcohol- and substance-related disorders and antisocial personality disorder are adult externalizing disorders. Externalizing psychopathology is associated with antisocial behavior, which is different from and often confused for asociality. Externalizing disorders (or externalising disorders) are mental disorders characterized by externalizing behaviors, maladaptive behaviors directed toward an individual's environment, which cause impairment or interference in life functioning. In contrast to individuals with internalizing disorders who internalize (keep inside) their maladaptive emotions and cognitions, such feelings and thoughts are externalized (manifested outside) in behavior in individuals with externalizing disorders. Externalizing disorders are often specifically referred to as disruptive behavior disorders (attention-deficit/hyperactivity disorder, oppositional defiant disorder, and conduct disorder) or conduct problems which occur in childhood. Externalizing disorders, however, are also manifested in adulthood. For example, alcohol- and substance-related disorders and antisocial personality disorder are adult externalizing disorders. Externalizing psychopathology is associated with antisocial behavior, which is different from and often confused for asociality. Externalizing disorders often involve emotion dysregulation problems and impulsivity that are manifested as antisocial behavior and aggression in opposition to authority, societal norms, and often violate the rights of others. Some examples of externalizing disorder symptoms include, often losing one's temper, excessive verbal aggression, physical aggression to people and animals, destruction of property, theft, and deliberate fire setting. As with all DSM-5 mental disorders, an individual must have functional impairment in at least one domain (e.g., academic, occupational, social relationships, or family functioning) in order to meet diagnostic criteria for an externalizing disorder. Moreover, an individual's symptoms should be atypical for their cultural and environmental context and physical medical conditions should be ruled out before an externalizing disorder diagnosis is considered. Diagnoses must be made by qualified mental health professionals. DSM-5 classifications of externalizing disorders are listed herein, however, ICD-10 can also be used to classify externalizing disorders. More specific criteria and examples of symptoms for various externalizing disorders can be found in the DSM-5. There are no specific criteria for 'externalizing behavior' or 'externalizing disorders'. Thus, there is no clear classification of what constitutes an externalizing disorder in the DSM-5. Attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), conduct disorder (CD), antisocial personality disorder (ASPD), pyromania, kleptomania, intermittent explosive disorder (IED), and substance-related disorders are frequently referred to as externalizing disorders. Disruptive mood dysregulation disorder has also been posited as an externalizing disorder, but little research has examined and validated it to date given its recent addition to the DSM-5, and thus, it is not included further herein. Inattention ADHD symptoms include: 'often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities,' 'often has difficulty sustaining attention in tasks or play activities,' 'often does not seem to listen when spoken to directly,' 'often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace,' 'often has difficulty organizing tasks and activities,' 'often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort,' 'often loses things necessary for tasks or activities,' 'is often easily distracted by extraneous stimuli (for older adolescents and adults, may include unrelated thoughts),' and 'is often forgetful in daily activities.' Hyperactivity and impulsivity ADHD symptoms include: 'often fidgets with or taps hands or feet or squirms in seat,' 'often leaves seat in situations when remaining seated is expected,' 'often runs about or climbs in situations where it is inappropriate,' 'is often unable to play or engage in leisure activities quietly,' 'is often 'on the go,' acting as if 'driven by a motor,' 'often talks excessively,' 'often blurts out an answer before a question has been completed,' 'often has difficulty waiting his or her turn,' and 'often interrupts or intrudes on others.' In order to meet criteria for an ADHD diagnosis, an individual must have at least six symptoms of inattention and/or hyperactivity/impulsivity, have an onset of several symptoms prior to age 12 years, have symptoms present in at least two settings, have functional impairment, and have symptoms that are not better explained by another mental disorder. ODD symptoms include: 'often loses temper,' 'is often touchy or easily annoyed,' 'is often angry and resentful,' 'often argues with authority figures, or for children and adolescents, with adults,' 'often actively defies or refuses to comply with requests from authority figures or with rules,' 'often deliberately annoys others,' and 'often blames others for his or her mistakes or misbehavior.' In order to receive an ODD diagnosis, individuals must have at least four symptoms from above for at least six months (most days for youth younger than five years) with at least one individual who is not a sibling, which causes impairment in at least one setting. Rule outs for a diagnosis include symptoms occurring concurrently during an episode of another disorder. CD symptoms include 'often bullies, threatens, or intimidates others,' 'often initiates physical fights,' 'has used a weapon that can cause serious physical harm to others,' 'has been physically cruel to people,' 'has been physically cruel to animals,' 'has stolen while confronting a victim,' 'has forced someone into sexual activity,' 'has deliberately engaged in fire setting with the intention of causing serious damage,' 'has deliberately destroyed others' property (other than by fire setting),' 'has broken into someone else's house, building, or car,' 'often lies to obtain goods or favors or to avoid obligations,' 'has stolen items of nontrivial value without confronting a victim,' 'often stays out at night despite parental prohibitions, beginning before age 13 years,' 'has run away from home overnight at least twice while living in the parental or parental surrogate home, or once without returning for a lengthy period,' and 'is often truant from school, beginning before age 13 years.' In order to receive a CD diagnosis, individuals must have three of these symptoms for at least one year, at least two symptoms for at least six months, be impaired in at least one setting, and not have an antisocial personality disorder diagnosis if 18 years or older. ASPD symptoms include: 'failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest,' 'deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure,' 'impulsivity or failure to plan ahead,' 'irritability and aggressiveness, as indicated by repeated physical fights or assaults,' 'reckless disregard for safety of self or others,' 'consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations,' and 'lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.' In order to meet diagnostic criteria for ASPD, an individual must have 'a pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years,' three or more of the above symptoms, be at least age 18 years, have a conduct disorder onset before age 15 years, and not have antisocial behavior exclusively during schizophrenia or bipolar disorder.