The co-occurrence between internalizing and externalizing behaviors: A general population twin study

Paola Pesenti-Gritti, C. A M Spatola, Corrado Fagnani, Anna Ogliari, Valeria Patriarca, Maria Antonietta Stazi, Marco Battaglia

Research output: Contribution to journalArticlepeer-review


Although Internalized and Externalized problem behaviors are described as separate phenomena at the psychometric and clinical levels, they frequently co-occur. Only few studies, however, have investigated the causes of such covariation. In a sample of 398 twin pairs aged 8-17 drawn from the general population-based Italian Twin Registry, we applied bivariate genetic analyses to parent-rated CBCL/6-18 Internalization and Externalization scores. Covariation of Internalizing and Externalizing problem behaviors was best explained by genetic and common environmental factors, while the influence of unique environmental factors upon covariance appeared negligible. Odds ratio values showed that a borderline/clinical level of Externalization is a robust predictor of co-existing Internalizing problems in the same child, or within a sibship. Our findings help to approximate individual risks (e.g., in clinical practice, predicting the presence of Internalization in an externalizing child, and vice-versa), and to recognize that several shared environmental and genetic factors can simultaneously affect a child's proneness to suffer from both types of problem behaviors.

Original languageEnglish
Pages (from-to)82-92
Number of pages11
JournalEuropean Child and Adolescent Psychiatry
Issue number2
Publication statusPublished - Mar 2008


  • Bivariate twin studies
  • CBCL/6-18
  • Comorbidity
  • Internalization externalization

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Developmental and Educational Psychology


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