"Acting out" and "acting in" as behavioral responses to stress: a qualitative and quantitative study

In a sample of 270 depressed patients, we describe some behaviors in response to stress. One third acknowledged "acting out" behaviors--angry, destructive acts and "out of control" behaviors. Four fifths acknowledged "acting in" behaviors--most commonly withdrawal. As a percentage of subjects acknowledged both response styles (with alternate expression influenced by situation), we developed a dimensional self-report measure within a subsample of 177 who attended a follow-up reassessment. Assignment to four groups with contrasting expressions of "acting out" and "acting in" scores demonstrated differences in age, diagnostic status, age of onset of depression, and self-injurious behaviors.