Judgments of impairment and distress associated with symptoms of internalizing and externalizing disorders

Abstract

The pattern of dysfunction (i.e. impairment vs. distress) judged to be associated with disorders empirically identified by Krueger, Caspi, Moffitt and Silva (1998) as internalizing (e.g. major depressive episode; agoraphobia) was compared to the pattern characterizing disorders classified as externalizing (e.g. antisocial personality disorder; alcohol dependence). In Study 1, lay raters (N=270) judged the social impairment, occupational impairment, and personal distress associated with symptoms of seven internalizing and four externalizing disorders. As predicted, symptoms composing internalizing disorders were perceived as involving a greater degree of distress, and a lesser degree of impairment, relative to symptoms composing externalizing disorders. In Study 2, conducted with a small sample of clinician judges (N=21), symptoms composing internalizing disorders were again judged as involving a greater degree of distress (but, in this case, not a lesser degree of impairment) relative to symptoms composing externalizing disorders. This research provides a novel means of validating the distinction between internalizing and externalizing groups of disorders.

Keywords:

• impairment
• distress
• internalizing
• externalizing

Acknowledgements

This research was supported by a grant from the Faculty of Arts and Science Research Fund, Grant MacEwan College.

Notes

1. By coin toss, we deleted symptoms of social phobia from the internalizing disorder group, and symptoms of alcohol dependence from the externalizing disorder group. We then reanalyzed the lay judgments from Study 1 for differences between symptoms composing the internalizing and externalizing groups on personal distress and impairment. These omissions had no impact on the pattern of findings reported.