Dr. Angela Hanford
Did you know that, according to Kessler et al. (2005), an estimated 20% of adolescents in the United States have a diagnosable mental health condition? According to the Center for Disease Control (CDC) (2017), suicide is the 3rd leading cause of death for teenagers between the ages 15 to 19.It has also been estimated that 3.1 million teenagers in the United States between that ages of 12 to 17 have experienced a major depressive episode (National Institute of Mental Health, 2017). With these statistics in mind, let us take a brief look at the lives of three (fictional) teenagers.
Caleb is a captain on the football team, is in the Honor Society, and is well liked by his classmates. His teachers and church staff see him as a leader, someone who they can count on to encourage others and to “get the job done” when given a responsibility.
What people do not see are Caleb’s constant anxiety and self-doubt. He believes that he has to be perfect in order to be liked, so he has built an identity around achievement. He has strong emotions that he does not know how to express. In fact, sometimes when he is upset he punches himself or objects. At night he lays awake with swirling thoughts. He longs for freedom but does not see anywhere to turn.
Sarah is often late for school or misses school completely. She is constantly complaining of a headache or stomach ache. Her parents are tired of her irresponsible behavior and see these physical complaints as excuses. Her grades have dropped and she is seen as “lazy.” People see her smiling face as she interacts with her friends, so it must not be depression, right?
Sarah just needs to focus and “get her priorities straight.” However, as with Caleb, people do not see her internal world. People do not see the constant sadness and anxiety that she endures. Although these feelings lessen when around friends, they are always in the background. Sarah dreads school, not because she does not want to learn, but because the pressure she feels is enormous. She feels trapped with nowhere to turn. Sarah is fearful of telling anyone, lest they become even more angry with her.
Cassie is fifteen and is known for her attitude and tendency to fight with her peers. In class, she talks back to the teacher and often skips class entirely. It is hard for people to see beneath that tough and angry exterior.
However, beneath that initial layer are intense feelings of inadequacy, depression, and fear. Rather than withdrawing, she feels threatened and copes with this by fighting back. It is the only way that she knows to protect herself. She needs help but pushes away the very people that could point her in the right direction. She longs to be loved, but cannot show softness.
The similar theme in these examples is that the internal world of each teen does not match what others are perceiving. Since the struggles are not necessarily obvious, it would be easy to overlook the fact that each teen is in significant distress. In fact, many “common teenage problems” may actually signal that something deeper is occurring.
Common Teen Problems That May Be Overlooked
Here are several areas where it is easy to miss that your teenager is struggling with deeper emotional pain. This list is not exhaustive and teens that manifest these emotions and behaviors do not necessarily have a diagnosable condition.
1. MoodinessPeople often label teenagers as “moody”. However, it is not actually the norm for a teenager to have prolonged periods of irritability. In fact, moodiness can actually be a sign of something deeper, such as anxiety or depression. Did you know that the criteria for depression (American Psychiatric Association, 2013) actually includes irritability (as opposed to depressed mood) as a criterion for children and teenagers?
It is also important to note that even if a teenager appears happy around his or her friends, this does not necessarily rule out the presence of depression. A high level of stress or anxiety may also manifest as irritability. This is why it is important not to dismiss a teenager who is angry or irritable but, instead, to look for something below the surface.
Apparent laziness may look like a drop in grades, failure to turn in assignments, increased time sleeping, or a lack of motivation to engage in activities. It is important to remember that part of depression is a lack of motivation.
Furthermore, as a clinician, I have worked with many teenagers who have experienced a drop in grades due to depression. By treating the depression, grades eventually improve. Anxiety is another area that can affect motivation and grades since someone who is anxious can become so overwhelmed that they cannot finish work or may even give up.
Undiagnosed attention-deficit/hyperactivity disorder (often inattentive presentation) could also be associated with “lazy” behaviors (e.g., not turning in homework). Fortunately, all of these conditions are treatable if correctly diagnosed.
3. Attitude Problems
As with “moodiness”, simply labeling a teenager as having an “attitude” is likely not seeing the complete picture. Again, irritability is associated with depression. It is also possible that the teen has pent up anger that he or she does not know how to express in a healthy manner. There are many explanations for why a teenager may express prolonged periods of anger and disrespect. It is important to determine what is contributing to the disrespectful attitude.
4. Obsessive Technology Use
There are many reasons for why a teenager is glued to his or her phone or computer screen, many of which are beyond the scope of this article. However, one possible explanation is that your teenager is using technology to cope with emotions that he or she is unable to manage by healthier means.
For example, I have worked with teens who experience a constant barrage of anxious thoughts at night. The only way they have found to quiet their anxious thoughts is to numb out on YouTube or Netflix until they are so tired that they fall asleep. In this case, it is important to teach them healthier ways of coping with anxiety.
5. DramaSometimes when teens experience relational problems at school, it is written off as typical teenage drama. If your teenager is experiencing frequent relational troubles, it is important to dig a little deeper. Maybe your teen needs to learn skills for navigating relationships or there is bullying present. As previously mentioned, depression can manifest as irritability, which may result in relational troubles.
6. Frequent Physical Complaints
It is possible for emotional struggles to be expressed by the body. For example, it is not uncommon for someone who is anxious to experience stomach aches or headaches. Depression is another diagnosis that often has physiological manifestations.
Other Signs to Notice
Besides the above problem areas, there can be other signs that may signify your teenager is struggling, such as:
- A change in grades
- Any significant change in behavior or emotions
- Significant weight gain or weight loss
- Secretive behaviors
- A sudden change in friend groups
- Change in hygiene
- Frequent lying
- Getting into trouble at school
The bottom line is to look for significant changes in emotion and/or behavior.
Tips For Helping Your Teen
1. The first step is to educate yourself and your teenager about emotional and physical health. Daniel Siegel’s Brainstorm (2013) is geared toward teaching parents and teenagers about brain development.
2. Talk about it! Ask questions! If you suspect that your teen may be struggling, it is important to open up a dialogue where they can share.
3. Create an environment where it is safe for your teenager to express his or her emotions. This may mean taking a step back and listening before reacting. Also, it is important to avoid shaming. Validate your teen’s emotions, as these are real emotions regardless of how illogical they may appear.
This is where Daniel Siegel’s “connect and redirect” and “name it to tame it” (Siegel, 2013) comes into play. If someone is in an emotionally heightened state, it only increases the emotion when presented with logic. Therefore, first, empathize and connect. Once the emotion has been calmed, the brain is in a state where logic is more easily received.
4. Teach your teenager how to manage emotions in a healthy way. There are many books out there that can help you and your teen talk about emotions and coping.
One book that I have seen some teenagers find helpful is Don’t Let Your Emotions Run Your Life for Teens: Dialectical Behavior Therapy Skills for Helping You Manage Mood Swings, Control Angry Outbursts, and Get Along With Others (2011).
5. Model and teach your teenager how to set and maintain healthy boundaries in relationships, regarding activities and time, and with technology (e.g., social media use).
6. Mindfulness exercises can help an individual learn how to gain control over his or her thoughts and to focus on the moment.
7. Make sure that you set realistic expectations of your teenager. Also, make sure that you have set clear expectations.
When and Where To Seek Help for Teen Problems
If you notice a teen who is struggling, there is help! It is normal for anyone to experience a variety of emotions, such as times of sadness or stress. However, if emotional distress persists this can signal a problem. It is especially important to seek a professional evaluation anytime suicidal thinking, violence and/or extreme aggression, or self-injurious behavior are present.During an initial evaluation, the counselor will make an assessment and point you and your teenager to the appropriate treatment. For example, a counselor can help your teen learn how to express and cope with difficult emotions in a healthy manner. Other times, the counselor may educate them on how to set healthy boundaries and navigate difficult relationships.
Dialectical behavioral therapy (DBT) is often recommended for someone who has difficulty managing emotions, has suicidal thinking, or engages in self-harm behaviors. DBT includes both individual therapy and group therapy. The skills group therapy component for teenagers typically consists of five modules: mindfulness, emotional regulation skills, distress tolerance skills, interpersonal effectiveness skills, and walking the middle path.
There are a variety of treatments available. If you suspect your teenager is struggling, talk to them and take the first step toward healing. We are here to help individuals and families to navigate through the difficulties of life as they move toward health and freedom.
National Institute of Mental Health: https://www.nimh.nih.gov/index.shtml
Siegel, D. J. (2013). Brainstorm: The power and purpose of the teenage brain.
Teen Link (teenage crisis line): https://866teenlink.org
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Center for Disease Control (2017). Adolescent Health. https://www.cdc.gov/nchs/fastats/adolescent-health.htm. Retrieved on 9/28/18.
Kessler, R. C.; Berglund, P.; Demler, O.; Jin, R.; Walters, E. E. 2005. Life-time Prevalence and Age-of-onset Distribution of DSM-IV Disorders in the National Co-morbidity Survey Replication. Archives of General Psychiatry 62: 593-602.
National Institute of Mental Health. (2017) Major Depression. https://www.nimh.nih.gov/health/statistics/major-depression.shtml. Retrieved on 9/28/18.
Siegel, D. J., & Bryson, T. P. (2014). No-drama discipline: The whole-brain way to calm the chaos and nurture your child’s developing mind (First edition). New York: Bantam.
Van Dijk, S. (2011). Dialectical behavior therapy skills for helping you mange mood swings, control angry outbursts and get along with others. Okland, CA: New Harbinger Publications.
“Angst”, Courtesy of Graham Wizardo, Pexels.com, CC0 License; “Downcast”, Courtesy of It’s Me Neosiam, Pexels.com, CC0 License; “Drop of Water”, Courtesy of Pixabay, Pexels.com, CC0 License; “Pink Flower”, Courtesy of Pixabay, Pexels.com, CC0 License