Externalizing

Externalizing refers to actions and behaviors that individuals direct outwardly toward their environment. These displays of emotion are often characterized by a lack of self-control and disregard for societal norms. Potential signs of externalizing include the following:  

• Aggression
• Delinquency
• Hyperactivity
• Lying
• Cheating
• Stealing
• Vandalism
• Arson
• Fighting
• Verbal abuse
• Breaking the law
• Substance use

These signs may indicate the presence of specific mental health conditions called disruptive behavior disorders (DBDs), particularly in childhood, including the following. 

For those struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.

Oppositional defiant disorder (ODD)

Oppositional defiant disorder or ODD is characterized by symptoms like irritability and anger. Individuals with ODD often have particular difficulties engaging with authority figures or following rules. They may lose their temper frequently or deliberately attempt to irritate others. They might blame others when becoming overwhelmed with challenging emotions like fear under stressful circumstances or to divert attention from their own problematic behavior. 

Conduct disorder (CD)

Conduct disorder is often associated with threatening, aggressive behavior. Individuals with CD may have difficulty following rules, get in trouble with the law, and resist conflict intervention. They may engage in deceitful behavior to avoid punishment.

Antisocial personality disorder (ASPD)

Like conduct disorder, people with antisocial personality disorder or ASPD often resist conforming to social norms and may eventually become involved in criminal behavior. They may have little to no regard for their own safety or that of others and may exploit others for personal gain. Teens with ASPD may have challenges maintaining employment and meeting financial obligations when they become adults, and they may have difficulties with interpersonal relationships.

Intermittent explosive disorder (IED)

Intermittent explosive disorder is characterized by impulsive, risky behaviors and difficulty controlling impulsions and aggression. Individuals with IED may not intend to harm others, as the outbursts may not be premeditated. Still, they may react violently enough to psychosocial stressors to do damage to individuals and property.

Other mental health conditions 

Disruptive behavior disorders (DBD) often occur in tandem with other mental health disorders, such as attention-deficit hyperactivity disorder (ADHD),⁵ anxiety, and depression. Symptoms of externalization are sometimes exacerbated when a child experiences frustration at school due to a learning disorder (a common comorbidity with DBD) or difficulties with socialization.

Research has suggested that adolescent behavioral challenges often occur due to intricate interactions between biological, family, and environmental factors. Possible causes of externalizing behavior include the following: 

Underlying psychiatric disorders

Individuals with externalizing behaviors may have psychiatric conditions, such as antisocial personality disorder, oppositional defiant disorder, conduct disorder, pyromania, and intermittent explosive disorder. These disorders can contribute to the development of behaviors that disregard rules, norms, and the rights of others.

Early onset of antisocial behavior

The onset of antisocial personality disorder is often associated with a history of conduct disorder. Early exposure to conduct-related challenges and a lack of intervention may contribute to the persistence of externalizing behaviors throughout adolescence and adulthood.

Environmental factors

A person's upbringing and environment can play a significant role in the development of externalizing behaviors. Exposure to violence, neglect, inconsistent discipline, and a lack of positive role models can contribute to the adoption of aggressive and rule-breaking behaviors.

Biological factors

Evidence suggests that genetic and neurobiological factors contribute to the development of externalizing behaviors. Genetic predisposition and alterations in brain structures responsible for impulse control, emotional regulation, and decision-making may increase the likelihood of engaging in externalizing behaviors.

Psychological factors

Individual psychological factors, such as poor emotion regulation, low frustration tolerance, and deficits in empathy, may contribute to externalizing behaviors. These factors may make it difficult for individuals to manage their emotions and react appropriately in various situations, leading to impulsive and aggressive behaviors. These factors are often believed to interact with and influence each other, leading to the complex nature of externalizing behaviors. 

For those experiencing abuse, contact the Domestic Violence Hotline at 1-800-799-SAFE (7233). Support is available 24/7. Please also see our Get Help Now page for more immediate resources.

Externalizing behaviors often manifest in various ways, reflecting a defiance of norms and authority. For instance, teenagers might display aggressive and confrontational behavior toward others, openly challenge authority figures, or rebel against societal boundaries. Examples of this behavior may include:

• Delinquent acts: Engaging in delinquency, such as shoplifting, vandalizing property, or skipping school, demonstrates a disregard for rules and societal expectations, often stemming from a desire for independence or attention.
  
• Aggression: Demonstrating aggressive behavior toward others through bullying, physical altercations, or cyberbullying can reflect a struggle to manage emotions and assert dominance among peers.
  
• Substance experimentation: Experimenting with drugs or alcohol can be a common externalizing behavior in adolescence. This risky behavior can be an attempt to rebel against restrictions and norms, often leading to negative consequences.

While a certain level of externalizing behavior may be expected during adolescence, the above examples could indicate a severe mental health condition and may lead to negative consequences for the individual and those around them. 

Research has shown that children who externalize negative behaviors may be at a higher risk of juvenile delinquency and violence​​. Additionally, externalizing behaviors can have a range of consequences that can significantly impact an individual's overall well-being, including but not limited to the following: 

• Social isolation and relationship strain: Externalizing behaviors can result in strained interpersonal relationships. Aggressive actions, defiance, and rule-breaking may alienate friends, family members, and peers, leading to isolation and a lack of social support.
• Academic and professional setbacks: Individuals displaying externalizing behaviors may experience academic difficulties due to causing disruptions in class, skipping school, or engaging in delinquent acts. These challenges can hinder educational attainment and future career prospects.
• Legal troubles: Engaging in delinquent acts and aggressive behavior may result in legal consequences, including arrests and legal charges. Such interactions with the criminal justice system can have long-lasting impacts on an individual's record and life trajectory.
• Emotional and mental health challenges: Externalizing behaviors often coexist with emotional and mental health challenges. Individuals may experience difficulty with anger management, impulsivity, and low frustration tolerance, which may lead to increased stress, anxiety, and symptoms of depression.