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Externalizing Behavior: Despair plus Rage


Dr. Coplan traces the pathway from internalizing to externalizing behavior. Despair and rage are intertwined, leading to tragic final outcome.


Last time  we were talking about internalizing behavior – all the emotional stuff we deal with on the inside. Someone who feels miserable and hopeless will seek a way out of their pain. Too often, the way out is suicide. But there is another, even more horrific end point: All of that despair can suddenly flip over to rage. Now we are talking about the items 7-9 in Lorna Wing’s list:

1. Assumption that the person’s own needs supersede all other considerations
2. Lack of awareness of wrongdoing
3. Intellectual interest (what Asperger himself called “Autistic acts of malice”)
4. Pursuit of “special” interests (objects, people)
5. Vulnerability
6. Cry for help
7. Hostility towards family
8. Hyperarousal
9. Revenge
Take a look at the diagram. I’ve added a big arrow leading from Internalizing Behavior to Externalizing behavior. In this scenario, despair and rage are inextricably intertwined. Newtown, Virginia Tech, Isla Vista, Red Wing, and Columbine were not just “mass shootings.” They were suicides. That fact tends to get ignored, or, if someone raises it, the person who does so gets shouted down as being too sympathetic to the shooter. This is misguided. The only way to reduce the recurrence risk of “the next Newtown” is to take an unbiased view of the shooter’s behavior. (It drives me nuts to hear people characterize Adam Lanza as “evil.” I have blogged at length on that subject, here.) Internalizing behavior often goes through a long gestation period before it finally bursts out as externalizing. The real tragedy is that internalizing behavior is often overlooked until it’s too late.
I’ve also added a smaller, dashed line from social rejection directly to externalizing, but people who externalize right away may be letting off pressure – like a volcano with a vent on the side of the mountain. They sometimes commit violence, but it doesn’t seem to be to the same scale as someone who has been internalizing for a long time. The mass shooters we read about in the headlines are almost always described as quiet, unobtrusive people who had never hurt anyone before their one and only cataclysm.

proposed pathways


Click on graph to view full size.

Finally, I’ve added a pathway coming in from the right, labeled “Obsessive Thinking.” This is the same trait we encountered earlier, when discussing “innocent offending”. The person who is obsessed with computers may become a hacker; the person who is obsessed with a particular movie star may become a stalker. If, instead, the person is obsessed with thoughts of having been wronged, then the obsessive thought pattern fuels anger. We’ve all been there: We get irked at someone. Usually we are able to “let it go” (although it may take a while). What if you could never let it go? What if all of the wrongs and hurts you experienced (whether real or imagined) were indelibly added to a mental list, and you dwelled on that list endlessly? Not by choice, but because your brain was wired that way?

Newtown and Isla Vista also exemplify Wing’s item #7: “Revenge against family.” The first person Adam Lanza killed was his mother. Framing Adam Lanza’s behavior as revenge, rather than dismissing him as someone who was “just crazy,” or “evil,” makes us stop and think: Revenge for what? And why did he feel that he had no recourse but to shoot his way out? (Vulnerability, on Wing’s list.) Persons with ASD often manifest black and white thinking. They often catastrophize (i.e. blow something up out of proportion). Did these cognitive traits play a role in shaping Adam Lanza’s behavior? In an eerily similar way, Elliot Rodger (we still don’t know if he had AS) spoke of killing his stepmother and his younger brother. He seems to have resented his stepmother because of perceived rejection, and his younger brother simply for being normal. As it happened, Elliot was not living at home, so his luckless housemates rather than his family were his first victims.

Of course, none of these pathways are unique to persons with ASD. What we don’t know is the relative risk stemming from these pathways in persons with ASD compared to persons with neurotypical development, what tips the balance from potential behavior to actual behavior, or what to do about it. More next time.


Join the conversation on Facebook and find out my answer to this question from a Facebook viewer …. “You disagreed with Peter Lanza’s assessment of Adam’s actions as evil. How can you not classify killing 26 complete stangers (20 of them children) as evil?”

Dr. Coplan traces the pathway from internalizing to externalizing behavior. Despair and rage are intertwined, leading to tragic final outcome.

Posted by James Coplan, MD – Developmental Pediatrician / Autistic Spectrum Disorders on Sunday, April 26, 2015

James Coplan, MD is an Internationally recognized clinician, author, and public speaker in the fields of early child development, early language development and autistic spectrum disorders. Join Dr. Coplan on Facebook and Twitter. Have a question for Dr. Coplan? Ask the doctor.









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