Often misunderstood and overlooked, especially until about the 1980s, internalizing disorders comprise of a specific type of emotional and behavioural problem in children and adolescents (Merrell, 2013). It consists of issues that are based on ‘over controlled symptoms’ (Merrell, 2008). It refers to the fact that these problems are manifested when children have a maladaptive control of their own internal cognitive and emotional states. Thus, it can be said that these problems are developed and also maintained within the individual, making them difficult to diagnose or detect through external observation and measurement.
Depression
Children and adolescents or even adults when face setbacks or disappointments in life, feel sad. However, it eventually fades or lessens over a period of time as they cope with it. Depression is not having a bad mood or an occasional feeling of being down or sad. Parents need to be concerned and contact professionals when sadness and other related symptoms (to be discussed further) last for weeks, months or longer than that, hampering the child’s ability to function in their daily lives. Thus, depression exists on a continuum of severity from mild and transient state of low mood to severe symptoms impacting the quality of life of an individual (as depicted in Table 5.2). It is primarily characterized by the following symptoms: depressed moods, loss of interest in activities, sleep related problems (hypersomnia or insomnia, that is, too much or too little sleep respectively), weight loss or gain, psycho motor retardation (slow physical movement) or agitation, loss of energy or fatigue, difficulty in concentrating, thinking or making decisions, feeling of guilt, worthlessness, and recurrent thoughts of death. It has been studied that the preoccupation with death and related thoughts is more often seen in older children and adults and might not be manifested in the younger ones as their concept of death is vague and not well-built. Irritability and certain physical complaints such as headaches, stomach aches, etc. are two additional physical complaints that are often seen in children and teenagers with depression (Merrell, 2013). It is important to note here that all these symptoms might not be present in one individual to diagnose him/her with depression. Presence of at least five of these symptoms (and at least one of the symptoms should be depressed mood or loss of interest in pleasurable activities) for a period of two weeks is necessary for the diagnosis. Also, if the child is young, it is more likely that loss of interest would be displayed more than the depressed mood.
Anxiety
Some of us often feel distressed and worried in our day-to-day life situations, such as, before appearing in a test or exam, before a competition, when stuck in traffic, especially when already running late etc. The worry and anxiousness, decreases as we come out of these situations. But, if the individual (adult or child) remains anxious irrespective of the situation and is not able to cope with it, it could be an anxiety disorder and would require attention from a psychologist. Before we proceed with this, it is important to understand the difference between three terms that are often used synonymously – anxiety and fear.
Social
Withdrawal Social withdrawal has always been associated with constructs such as shyness, isolation, rejection, inhibition, passivity, social reticence, and peer neglect. It is now understood as an umbrella term describing a behavioral prototype derived from various underlying causes (Rubin & Coplan, 2004). Thus, behavioural inhibition has been understood as a biologically based wariness because of exposure to novel people and situations (Kagan et al., 2007). Shyness is the selfconscious behavior in situations of perceived social evaluation (Crozier, 1995). When an individual is watching others from far or is remaining unoccupied when in social company, it is called as social reticence (Coplan et al., 1994). Social withdrawal thus, is linked to psychological maladaptation as it represents behavioral expression of internalized thoughts and affect pertaining to social anxiety and depression (Vasa & Pine, 2006).
Body Image Issues and Eating Disorders
We live in an image conscious culture where messages regarding “the right look” are set and shared by media. Concerns about how we look in the mirror, how we eat, are we fat or overweight are very common, especially in adolescents. It has got an adaptive value also as it helps in maintaining a normal weight, reducing the risk of diabetes, hypertension and other such chronic ailments. But, when this concern goes overboard and people have extreme weight concerns and body dissatisfaction, it may qualify for eating disorders.
Weight concerns include feeling overweight most of the time, even when it is not the case. The individual may have a thin physique yet may talk about exercise vigorously due to a drive for thinness. It is possible that they may focus on certain areas of the body that they have to tone down or decrease in size. Body dissatisfaction is the distress with one’s appearance and subsequent avoidance of certain situations because they elicit body related concerns (Grabe & Hyde, 2006). Some of the feeding and eating disorders that would be discussed in this section are- anorexia nervosa, bulimia nervosa, binge eating disorder, pica, and avoidant/restrictive food intake disorder.
Somatic Problems
Somatic problems are complaints related to body or the physical discomfort, pain, or illness. It is presumed that they do not have a known organic or medical basis, rather are caused by emotional distress and are psychological in origin. But, not having a physical origin does not mean that they are unreal or fake. It is important to consider here that the word “known” has been used while saying that a somatic symptom has no known medical basis. Thus, it is possible that the physical discomfort could be due to an injury or physical problem that is currently not within the limits of medical understanding and assessment technology. Very much like social withdrawal, somatic symptoms are a part of various internalizing problems such as anxiety and depression. It is also widely understood that somatic complaints and problems are very common in children and youth (Merrell, 2013). Some of the common complaints are: headache, stomachache, pain in the eyes, nausea, pain in the limbs or joints, breathing problems, skin rashes, and itching. They may also report feeling dizzy or faint. Some individuals with significant and long-lasting somatic complaints may develop an oversensitivity to physiological cues, thus, becoming too alert for any physiological change or sensation in the body which others may not be able to notice. In certain cases, these complaints might just be inconvenient and uncomfortable and not debilitating in nature, but, in some other cases, they may hamper daily adaptive functioning in life.
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