Intimate Disclosure among Best Friends of Youth: An Opportunity for Prevention of Internalizing Disorders
Buskirk-Cohen, Allison, Forum on Public Policy: A Journal of the Oxford Round Table
A Public Mental Health Problem
One of the more significant mental health concerns facing youth as they transition from childhood to adolescence is the threat of internalizing disorders. Risks for developing internalizing symptoms and disorders, namely anxiety and depression, increase during this developmental period (e.g., Avenevoli, Knight, Kessler, and Merikangas 2008; Hankin et al. 1998; Rutter 1991; Sorenson, Rutter, and Aneshensel, 1991). Additionally, in early and middle adolescence, girls begin to manifest higher rates of internalizing symptoms that do boys (e.g., Hankin et al., 1998; Hussong 2000; Mariano and Harton 2005; Rudolph 2002; Rudolph and Conley 2005). Internalizing symptoms are related to serious adjustment outcomes for youth, including significant social impairment (Canino et al. 2004; Gotlib and Hammen 1992; Hammen and Rudolph 1996) along with impairment in occupational performance, interpersonal functioning, quality of life, and physical health in young adulthood (Lewinsohn, Rhode, Seeley, Klein, and Gotlib 2003). Furthermore, emotional distress during adolescence is associated with an increased risk of suicide (Harrington et al. 1994; Weissman et al. 1999).
Interestingly, another developmental change is taking place that ought to provide youth with protection against this mental health threat. The nature of friendships and the functions they serve change as children develop into adolescents. In childhood, friends serve as playmates; in adolescence, they are viewed as confidants who provide emotional closeness (Buhrmester 1990; 1996; Furman and Buhrmester 1992). Gender differences in friendship also emerge during the developmental transition from childhood to adolescence. Adolescent girls tend to place more importance on affirmation of connectedness in their friendships, whereas boys favor verification of status or agency (Buhrmester 1996). Adolescent girls report more intimacy and support within their friendships than do boys (Burda, Vaux, and Schill 1984; Dindia and Allen 1992; Rose and Rudolph 2006). In sum, adolescent friendships ought to offer more support than childhood friendships, with the friendships of girls being more supportive than those of boys. However, these findings run contrary to the expectation that supportive friendships would offer protection against emotional distress.
Because intimate disclosure is an important hallmark of the difference between children and adolescents' friendships and ought to serve as a buffer against internalizing symptoms, this paper focuses on youths' responses to disclosure and the impact of these responses on their emotional adjustment. Thus, the main purpose of this paper is to explore the role of intimate disclosure as a process contributing to the increase in internalizing symptoms experienced by youth as they enter adolescence, with special attention to gender differences and perspectives from different areas of research. In reviewing the literature, this paper is organized around two main areas of conflict in the research: 1) defining and measuring distress, and 2) over-lapping constructs regarding the disclosure processes. A critical examination of how different branches of psychology and related disciplines approach the study of disclosure may lead to a better understanding with potential to addressing this public mental health problem.
Issues with Definitions and Measurement
Defining Internalizing Problems. Anxiety and depression are often referred to as "internalizing disorders," which have been defined as "conditions whose central feature is disordered mood or emotion" (Kovacs and Devlin 1998, p.47). The symptoms of internalizing disorders include withdrawal, fearfulness, inhibition, and/or anxiety (Hogue and Steinberg 1995; Kovacs 1998). Despite being recognized as separate disorders by the DSM-IV (American Psychiatric Association 1994), empirical studies tend to find that depressive and anxious symptoms overlap considerably, particularly in children and adolescents (Achenbach and Edelbrock 1978; Reynolds 1992). …