Internalizing disorders

Internalizing disorders or non personality mental health disorders make up the bulk of all psychiatric disorders. These are the disorders that therapists will encounter most often in their practices. They include the most commonly diagnosed ailments, such as depression and anxiety. Let’s take a closer look at how these illnesses are classified and what tools we use to diagnose and treat them. 

How do we classify mental health disorders? 

The ICD-11 is used all over the world to diagnose psychiatric and medical disorders but American therapists still tend to use the DSM-5-TR.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR)

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) has been called the bible of American mental health diagnosis. It is widely accepted as the way to standardize the diagnosis of disorders in the American mental health community. It includes groupings of all the known psychiatric disorders with applicable diagnostic codes and criteria needed to fulfill the diagnoses.

Until the DSM-5 premiered in 2013, mental health disorders were categorized according to an Axial system. That system was eliminated, however, to make it more uniform with the International Classification of Diseases (ICD-11), the preeminent classification system in the world. Now, the diagnostic codes found in the DSM-5-TR match the codes in the ICD-11. 

What diagnoses are considered internalizing mental health disorders? 

The largest classification of mental health disorders is what used to be called Axis I disorders. These are all psychiatric disorders that are not personality disorders, intellectual development disorders, or mental-health-related medical conditions.

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The following diagnoses are all part of this group: 

• Anxiety disorders
• Mood disorders
• Eating disorders
• Schizophrenia (may also be associated with external behaviors)
• Post-traumatic stress disorder (may also be associated with external behaviors)
• Obsessive-compulsive disorder
• Substance-related disorders

How common are internalizing mental health disorders? 

These are the most commonly found mental health disorders in the world. Close to half of all people will experience one of these disorders during their lifetime. Anxiety disorders alone will affect almost a third of all people.

Can these disorders be treated?

These types of mental disorders are highly treatable. And while some of the most serious (e.g., schizophrenia) may not be considered totally “curable”, many times they can be treated to the point where people live functional lives. 

Does insurance cover treatment for internalizing mental health disorders? 

Insurance companies typically cover treatment for these types of disorders. They consider them treatable and would rather reimburse outpatient therapy than have the situation worsen to the point where they may require in-patient services. That doesn’t mean, however, that they will reimburse therapy forever. As with any disorder, a comprehensive treatment plan is necessary to show the expedient manner in which you plan to address the client’s issues. 

How do we diagnose internalizing mental health disorders? 

Clinicians have several resources available for diagnosing these types of disorders: 

Clinical interviews 

Clinical Interviews are the primary way most therapists assess clients. The most common is the unstructured interview, where the client asks the client a series of questions in the quest to find out as much information as possible. This is often done as part of the intake session. While the therapist may have some set questions, they also are likely to ask spontaneous questions as they arise in the natural course of the interview. 

Clinicians can also administer a more structured clinical interview. These tools provide standardized questions that tend to mirror the criteria for diagnosis. The gold standard of structured interviews is the Structured Clinical Interview for DSM-5 (SCID-5). The questions in this tool are designed to assess whether the client meets the criteria for specific DSM diagnoses.  

Quick screening measures

A clinical interview often yields exactly what you need to know, but sometimes more specific screening tools are helpful. Screening measures are something you can give if you have a hunch about a client but want a little more information. They are usually self-report measures that can be completed in only minutes. For example, you might give someone the Beck Depression Inventory (BDI) or the Generalized Anxiety Disorder Scale (GAD-7) to further assess depression and anxiety. 

Psychological testing 

If a client’s diagnostic picture is more complicated, then psychological testing might be in order. This involves a battery of assessment measures that—when put together—give you a more complete diagnostic picture. A standard battery of testing will likely include an IQ scale (e.g., The Wechsler Adult Intelligence Test), a personality test (e.g., the Minnesota Multiphasic Personality Inventory (MMPI), and a projective measure or two (e.g., the Thematic Apperception Test (TAT), the Rorschach Inkblot Test). It should be noted that a full battery will take hours to administer and can cost thousands of dollars if not covered by insurance. 

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Clinical observations

Maybe the most informative type of assessment is done by a therapist during the therapeutic process. The longer a client is in therapy, the more information a therapist will accumulate about them. Maybe most importantly, this includes the actual behavior of the client week after week. It is not uncommon for a therapist to form or alter a client’s diagnosis as they get to know their client on a deeper level. As they say, actions speak louder than words. 

How do we treat internalizing mental health disorders? 

Clinicians have a variety of treatment options when addressing internalizing mental health disorders:

Psychotherapy

Of course, therapy is going to be the first intervention in a therapist’s toolbox. While many types of therapy will lay claim to the successful treatment of these disorders, cognitive-behavioral treatment (CBT) dominates the landscape. It possesses an overwhelming amount of evidence to support its efficacy in addressing the former Axis I disorders. This is not to say that other forms of therapy, such as interpersonal or psychodynamic therapy are not effective. They do work, but these types of therapy simply don’t have the same breadth of research support. 

Although most people will seek individual therapy for help with internalizing disorders, group therapy is also a popular modality. This is particularly true of substance abuse disorders and trauma. 

Medication

Most psychotropic medication is designed to treat internalizing mental health disorders. Antidepressants, anti-anxiety, and antipsychotic medications flood the market. While medication has some advantages, it has generally not been found to be more effective than psychotherapy. However, there are certain disorders (e.g., schizophrenia, bipolar disorder) where medication is often the first line of intervention. And, other disorders, such as depression, seem best treated by a combination of therapy and medication.