Internalizing problems of childhood are broadly defined as problems that occur within the child. Children with internalized problems often appear withdrawn, fearful, and shy. Internalized problems are managed within the child rather than being acted out externally in the environment. Beyond differing in their diagnostic criteria, externalizing problems differ from internalizing problems primarily in their expression. However, there is significant evidence that externalizing problems and internalizing problems occur comorbidly. Broadly speaking, the class of internalizing problems in childhood includes depression and anxiety. Subcategories of childhood anxiety disorders are also internalized disorders and include separation anxiety disorder, panic disorder, social phobia, simple phobia, obsessive-compulsive disorder, posttraumatic stress disorder, and generalized anxiety disorder. Similarly, subcategories of depressive disorders have been identified and include major depressive disorder, dysthymia, cyclothymia, and bipolar disorder.
定义内部化问题
尽管下一部分并不全面,但其目的是在诊断和统计手册的诊断标准的指导下,概述童年的某些内在化问题,第四版,文本修订版(DSM-IV-tr)。只有抑郁症和焦虑症的广泛类别才能进行审查。
儿童抑郁症
作为最普遍的疾病之一,抑郁症(通常称为情绪障碍)对孩子的能量,情绪和情绪表达产生了巨大影响。遭受任何形式的抑郁症的儿童经历了同伴关系,家庭关系,学术成就和整体社会心理发展的挑战。尽管成人抑郁症与儿童抑郁症之间存在许多相似之处,但存在一些明显的差异。具体而言,儿童表现出烦躁的心情,有时甚至无法静止不动,包括烦躁或节奏。
Depression has a profound impact on a child’s well-being similar to its effect on adults. Children with depression experience profound sadness, frequent periods of crying, feelings of helplessness and/or hopelessness, and a decrease or increase in appetite. Along with these symptoms often come feelings of discouragement or worthlessness and a loss of interest in pleasure and subsequent disinterest in previously interesting activities. Children with depression may be fearful and anxious and often experience a significant drop in school performance. Finally, these children may experience significant changes in their sleeping habits, specifically an increase or decrease, and they often complain of physical aches and pains that have no medical explanation.
儿童焦虑症
Children experiencing significant anxiety often experience intense fear, irritability, worry, and overall uneasiness. Anxiety can have a profound impact on a child’s well-being and can influence or profoundly affect the child’s school success, relationships with peers, self-esteem, and ongoing anxiety into adulthood. The specific symptoms of anxiety disorders differ according to diagnosis; therefore, below is a general overview of the broad diagnostic category of childhood anxiety.
When children experience a general sense of anxiety, they worry about things that occur in their everyday lives, such as school activities, peer relationships, and extracurricular activities. These fears often result in lower self-esteem, physical complaints without a medical explanation, and a strong need for reassurance. Other anxiety problems may be a result of unrealistic fear of a particular situation or object (phobias). Examples of such phobias may include fear of storms, snakes, spiders, height, water, or social situations. Children with phobias may attempt to avoid situations that may expose them to the environment or object that produces their fears, thus restricting their activity and social interaction. Other types of anxiety may manifest in a child through an intense fear of leaving his or her parents (separation anxiety), through patterns of repetitive thoughts or behaviors (obsessive-compulsive disorder), or a constant replaying of a stressful event (posttraumatic stress). Anxiety overall limits children’s willingness and at times capacity to freely experience the world and subsequently impacts their overall psychosocial development.
There is a high degree of comorbidity between anxiety and depression in children, meaning that children with symptoms of one, either anxiety or depression, often eventually exhibit symptoms of the other. It is important to note that to be considered significant, all symptoms associated with any of these internalizing problems must be present beyond what is to be expected with normal development and to a significant degree must cause problems with psychosocial and educational development. Any single symptom cannot lead to a diagnosis of one of the above internalizing disorders.
References:
- American Psychological Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., Text rev.). Washington, DC: Author.
- Gilliom,M。和Shaw,D。S.(2004)。幼儿期外在化和内在化问题的代码开发。发展与心理病理学,16(2),313-333。
- Ollendick, T. H., & King, N. J. (1994). Diagnosis, assessment, and treatment of internalizing problems in children: The role of longitudinal data. Journal of Consulting & Clinical Psychology, 62(5), 918-927.
- Sourander,A。和Helstela,L。(2006)。青少年外在化和内在化问题的儿童期预测指标。欧洲儿童和青少年精神病学,14,415-123。
- Zahn-Waxler,C.,Klimes-Dougan,B。,&Slattery,M。J.(2000)。童年和青春期的内部化问题:在理解焦虑和抑郁的发展方面的前景,陷阱和进步。发展与心理病理学,12(3),443-466。