Teens and mental health

Adolescence is a time of dramatic shifts and transitions. Not a child, but not quite adult, it's a time of continually trying to figure out where to fit in.

And more information on this webpage from American Academy of Adolescent Psychiatry

Self-esteem and identity

This time of your life comes along and says "forget everything you ever thought you knew." Your body is changing. You wake up a half inch taller then when you went to bed. A few new elements have been added to your self-care routine. You start putting distance between yourself and family. Whereas before you thought Mom knew everything, now you wonder why she doesn't understand anything. You have disagreements you didn't used to have and you don't like going on family outings like you used to. You just FEEL different.

Friends become all-important but also sometimes harder to keep, and sometimes they bring up things you might not be prepared to deal with. There's an unwritten "don't tell your parents" code that sometimes can put you in a tough spot. You might be pressured into doing things you don't want to in order to keep a friend. This is a time of life where you start making adult decisions and deciding what kind of peson you want to be. Habits formed at this age tend to be the ones you stay with. If you are conscientious about money or exercise at 16, it's a fair bet you'll be that way at age 40.

I don't know if it's actually harder to be a teen now than when I was a teen (like way back in the 70's). Every generation likes to say, "It's not as good as it used to be." But there are different challenges now. Some things that have always been, like sexual abuse and domestic violence also exist now and maybe more with the advent of internet porn and sexual slavery. But unlike a generation ago, when such things were considered a private family matter and the victim was often blamed, at least now we have resources organized and people can get help. Divorce has become much more common, though perhaps that's better than living in an abusive and chaotic household. We are more accepting of variations of lifestyle and sexuality, but we have also lost some social constraints that make for family stability. There have been a lot of changes in the last 40 years, especially with the explosion of electronic communication.

This page is for teens who want to learn more about mental health. Perhaps because you want to be a counselor or social worker some day, or because you're concerned about a friend or relative, or even yourself. I included what I think are some of the most common challenges of the teen years. I also include some suggestions as to how to deal with these issues. No one suggestion will work for everybody, and I also strongly recommend adult involvement with any of these situations.

My hope is that there are enough caring and observant adults to go around. If you can't count on a parent or relative, you might seek support from a teacher or friend's parent. There are also opportunities to get support through churches, YMCA and other organizations.

If you want to read more, here is a site to go to that has a lot of helpful information.

Dealing with parents/guardians

Whether you're with the parent(s) you were born to, or in another arrangement such as with a step parent or foster care, you probably live under an Authority Figure. Authority FIgures aren't perfect and part of maturing is coming to that realization. Hopefully you have a good relationship with your Personal Authority Figure(s), even if you don't see eye to eye on everything. Whether you're lucky enough to have parent(s) that you're close to, or if the relationship is toxic or even abusive, there are certain things you have a right to.

Your rights as a minor to expect from an Authority Figure are:

Food, clothing and shelter

Education

Guidance and affection

To be free from physical, sexual and emotional abuse

If you're lucky enough to have Authority Figures you get along with, your biggest problem might be embarrassment when Mom comes to pick you up and is wearing her Pajama Jeans.

You have a right to be free from abuse.

Sexual abuse includes any sexual behavior toward a minor by an adult, including exposure to adult nudity and sexual conversation for the goal of getting you or them sexually aroused.

Physical abuse is generally defined as physical contact that inflicts pain, causes injury, creates a climate of fear and intimidation.

Emotional abuse involves using words that demean or demoralize the individual. It's different than just an angry parent yelling, although that can certainly be abusive. Emotional abuse is about destroying self-esteem.

If you feel you're being abused and/or neglected, and you can't escape the situation, or or there are other children in the home you feel are being abused, it's absolutely necessary to bring your concerns to a trusted adult. Be prepared for Children's Services to be contacted, and if there is suspected abuse or neglect, it should be reported.

In between excellent parents and caregivers that are consistent, reliable and nurturing and the abusive ones, there are Authority FIgures that just practice Bad Parenting. Interactions can be toxic and at times rise to the level of abuse, but most actions aren't substantial enough for Children's Services to get involved. Toxic relationships can take their toll, causing emotional and relationship problems that extend into adulthood.

If you find yourself in an uhnhappy home life here are some suggestions for knowing how to deal:

Even if you despise the adult in question, try your best to follow the rules and be respectful, even they're being disrespectul or unreasonable. Taking the proverbial High Road is going to increase your credibility if you seek help from another adult. It might also improve the relationship at home, or at least keep them off your back.

If trying to get along on your end or getting help from another adult doesn't improve things and you're really worried about your physical or mental health, the next step would be to try to find another place to stay, or at least get a break for a short time. If you have a relationship with a trusted adult, take advantage of their availability to restore your self-esteem and faith in humanity.

Preparation for adulthood; The Wonderful World of Work

You can't control time moving forward but you can control how you move with it. This may be the first time you have a paying job and have to deal with adults that aren't necessarily going to care about your wellbeing or give you second chances. Everything you've learned so far about getting along with others will come into play. Your parents won't be able to intervene. But the benefits of getting and keeping a job are obvious and sometimes not so obvious. Besides money of your own, every job has the potential for promotion and learning skills that can be transferred to another job.

Some brief advice about entering the Wonderful World of Work:

Be prepared to go along to get along. Your employer's job is to keep the company profiting. It may or may not be better somewhere else, but one of the "transferrable skills" hidden in any job is being able to cooperate even when you don't like or agree with others. Try your best to stick it out if it's simply hard work or you don't like the manager.

On the other hand, you don't owe anyone your future, so you might consider quitting if:

Your employer is violating labor laws for minors.
Work is interfering with school or another important activity.
The job is causing you to feel stressed even when not on the job.
You have an illness or injury that's made worse by the job.

These points aren't meant to be all-inclusive. If you're having problems with your job and haven't been able to resolve them on your own, seek out a trusted adult to discuss your concerns and help you make a decision.

depression

Depression is often first noticed in the teen years and there are many contributing factors. There are the physical changes that can make you compare yourself to everybody else, negatively, of course. Friendships can change and become more difficult. You might find that your best friend since second grade now is in a relationship and never has time for you.

Depression is a result of a combination of genetic and environmental factors. If depression runs in your family, you're at higher risk of developing depression. You can reduce your risk by healthy behaviors such as healthy diet and regular exercise, and by getting in the habit of making wise choices so that you prevent unnecessary stress. For example, good study habits can prevent a mid-semester crisis when you realize you're failing.

Because of a teen's relative lack of experience with life, teens with depression are at increased risk for suicide attempts The teen years involve many stressors and heartbreaks. It may be for some the first time experiencing what feels like a life-altering crisis. A first love might fail and you believe you'll never be happy again. You get fired from a job and you worry if you'll ever be able to manage as an adult.

Signs of depression include:

persistent sadness, anger or irritability

physically slowing down or feeling agitated

sleeping too much or too little

feeling exhausted

losing interest in friends, hobbies and activities

feelings of worthlessness or excessive guilt

negative views of others, pessimism about the future

thoughts of death or suicide

If you experience one or several of these symptoms or know someone who is, it's important to get treatment and support. A doctor should be seen to rule out medical causes such as thyroid problems or an underlying illness. Counseling is also important to understand how you fell into depression and to help address any circumstances that are triggering or contributing to the depression. Medication may be an option, especially if the depression is extreme. Often, however, proper diet and exercise can be more effective than medication.

Some unhealthy behaviors that contribute to depression: too many caffeinated sugary beverages (nothing against Mountain Dew, just sayin')

too much junk food and not enough good foods (especially those with high sugar content)

smoking

substance abuse including alcohol

irregular sleep hours (staying up late when there's school in the morning)

dwelling on the negative without productive problem solving

not attending to relationships, letting problems build up with friends

falling behind on school work

Being around people who are depressed or complaining

Self-injury

Self-injury and suicide are two different things but self-harm can indicate suicide risk or lead to accidental death. Self-injury includes cutting, burning, even breaking bones. Sometimes it's easy to notice such as cuts on the forearms. Sometimes it's done on parts of the body that are more easily hidden, like thighs and torso. Self-injury is a signal of deep emotional pain. Indivuals say they self-injure to relieve emotional pain, indirectly let others know they're hurting, act on negative feelings toward onesself. It can also be an indirect call for help and support.

Problems with self-injury include:

risk of infection or other complications from self-injury

tendency for self-injury behaviors to escalate over time

embarrassment at having to explain scars if others notice

If you are self-injuring, it's an indication you should seek professional counseling. Medication may or may not be recommended, at least for a short term to decrease intense emotions. Therapy, however, is what gets at the roots of self-injuring.

Dating and relationships

Sexuality, sexual orientation, friends with benefits.... It might seem like traditional dating has gone the way of the land line, but most people eventually want to partner up with someone for the long term. There's no shortage of pressure to have sex before you feel ready, to move quickly into relationshiips or to compromise your values in other ways. Choices you make now can affect you for decades to come. What are you supposed to do?

The short anwer is that you have every right to make decisions that fit your values and ensure your long-term happiness and sucess. The long answer is that you have to figure out what your values and priorities are. See my Values Page for a discussion on values.

Some things to consider about entering into a relationship:

How do I feel about myself when I'm with this person?

What kind of relationship do I want?

How do we spend our time together? And is that how I want to be spending my time?

How does this person treat me and others?

Visit my Relationships Page for more disucssion on the nature of healthy and not-so-healthy relationships.

Career and College Decisions

Looming on the horizon is the Wonderful World of Work. You're being asked to decide how, for the next 40 years or so, how you want to spend the better part of your waking hours. And "How should I know how I want to spend the rest of my life?!?" you ask.

FIrst of all, realize that you won't be locked into a fixed path necessarily. You can change directions or build on what you have at any point. In fact, most caeers evolve over time, and often look nothing like the initial starting point.

The important thing is to stay in school, as that is the biggest factor in how much you can earn. As far as how to choose a major or first job after high school, take advantage of opportunities to sample different kinds of work that might appeal to you. You can often job shadow and get a feel for what the work is really like.

If college right after high school isn't in the plans there are still great opportunities to gain experience or maybe even start a business. You'll need to be open and alert for new opportunities and ready to volunteer to lay the ground work for that perfect job coming your way.

To Party or Not To Party

It's not uncommon to encounter drugs and alcohol starting in 6th or 7th grade. You know there are laws and rules and (hopefully) your parents would "kill" you if they caught you using something, but ultimately it will be your decision, with all the potential consequences as a package deal.

Why is it okay for adults and not for teens to use alcohol, and in some states, marijuana?

The assumption here is that by a certain age, a person has completed their education, learned a trade and established lifestyle habits that maintain a certain level of order and predictability. The other assumption is that the brain has reached a certain level of development and is no longer as vulnerable to harm from intoxicating substances.

As a minor, it's unlikely that you've achieved that level of self-sufficiency. On the off-chance that you are on your own, all the more, because you're having to meet demands that youu're probably not neurologically ready for. Your mind and body are in the middle of a significant stage of growth, and much of that growth will be affected by what you do now.

It is presumed that by the early 20's this process has been completed and the brain is no longer vulnerable to threats to its development. Habits formed during the teen years are likely to become more entrenched as an adult, such as smoking. Teens that started younger, such as before age 14, tend to be by age 18 a much heavier smoker and more likely to have difficulty quitting.

Also, you're probably still learning how to manage emotions and your life (a task many adults still haven't mastered) and using substances can interfere with this learning process, leaving you less able to cope with the stressors you face now or will soon as an adult.

Even for young adults, it might be wise to hold off engaging in any substance use if there are problems with getting or keeping a job or completing your education. Your responsibility at this age is the process of becoming economically independent from your parents and if you're not there or on track, you could be setting yourself up for a lifetime of frustrations.

Some ways to avoid the pressure to party:

Get involved in organized sports or activities. You'll be more likely to be busy when the party kids invite you, and it makes it harder to argue if it's the middle of soccer season.

Tell them your parents would "kill" you if you did that.

If you find yourself wiht a group thats drinking, or if you're a young adult out with friends and don't want to drink, have a coke, eat something, make an excuse to leave early.

Simply be assertive and say you're not into that.

Bullying

Bullying can be physical or social. It's when a pattern of aggressive or hostile behavior is established toward a particular person or group. Physical bullying can include hitting, tripping, cornering, blocking, throwing things, to name a few. Social bullying includes spreading rumors, excluding, humiliating, ridiculing. Bullying can be done publicly or privately, such as doing things when nobody's around then pleading innocence.

If you're being bullied:

Whlie there's no rule that any one person has to be your friend, you have every right to be treated with respect and consideration.

If you find yourself being bullied, the worst thing to do is retaliate, the exception being if you need to physically defend yourself. On the contrary, you might try first to try appealing to the bully from person to person. try to find a time when things are not heated and they aren't around others so there's no audience. Approach them in an easy calm manner and ask, in a non-confrontational way, " Can we talk about this?" Calmly tell them that you don't want to be enemies. Ask them if there is something they think you did to them to make them not like you. Then listen. It might be hard to hear criticism or you might not agree wth them, but if they start giving you an answer about somethng specific (and not just "because you're a geek") . There might be a misunderstanding, or something you weren't aware of. As hard as it may be to do, liistening at this point could be the most important thing you can do to end the bullying, maybe even tun this in to a friendship.

If you can't appeal to reason, or get support from friends, then this is not something to try to "tough out," or handle on your own. It's not fair for anyone to expect you to deal with this alone, so if anyone criticizes you for getting help from adult, they're wrong.

If you know of someone being bullied:

Peers often avoid for fear of getting bullied or ridiculed

group-think also takes hold. Onlookers end up blaming the victim. Will you be one of them? You could take actions to neutralize the bullying. You can offer support by sticking up for the victim, challenging the bully's behavior. You can make efforts to insulate the victim by inviting them to join you for lunch or after school or weekends. If possible, recruit your friends to help support. If there's a big enough group involved, the bully(s) can suddenly find themselves on the unpopular side and this neutralizes much of their power.

Schools need to be proactive about bullying, and have policies in place to address reports of bullying. For more information on bullying, here is an excellent webpage.

eating and body image disorders

body image weighs heavily during adolescence and there is no shortage of pressures to have the ideal physique. Your body is changing and it's easy to become insecure about your looks at a time when looks seem even more important. Combined with life changes that come with adolescence, you can feel out of control and be tempted to seek a sense of control in what and how much you eat. There is a fine line between being "disciplined" and having an eating disorder.

Eating disorders can lead to long term health problems or even death. In most eating disorders, the individual loses sight of what's healthy or even realistic. This can lead to setting of ever-increasing standards of control or restriction where the scale is never low enough, the body never thin enough or musclar enough. The individual becomes more and more preoccupied with their ever-changing goal to the exlusion of a normal life. Long term health consequences can result from malnutrition or chemical imbalance, and either of these can lead to death.

If you are finding yourself in this spot, go with the side of you that is getting tired of the rigors of your disorder and get help. It will be difficult and uncomfortable, but isn't what you're doing now diffiuclt and uncomfortable?

If it's a friend, keep encouraging them to get help and don't support them in playing games with their body. Talk to a trusted adult about your concerns.

How to help a friend that you're worried about if they're:

anorexic

cutting

suicidal*

being abused

just not themselves not in a good way

You might find yourself with a friend or a classmate some day and encounter something scary. Maybe they share that they've been depressed and have been thinking of overdosing, or they have been on a crash diet and becoming obsessed with weight loss. You don't want to overreact, and worry that they might be upset if you tell an adult, but you worry that if they keep doing what they're doing it will turn out badly. . Or maybe you worry about you or them getting into trouble. What should you do?

This kind of situation can catch you off guard. First because you probably have never been in this situation and it might take some time for it to sink in what is happening.

If your friend is expressing hopelessness, had a major breakup or other loss, or you know life seems to be crumbling around them in some way, or they hint at suicide but you're not sure, it's OKAY and actually a good idea to ask if they're thinking about suicide. I promise you it won't suddenly make them start thinking about suicide then try it. It's not like nobody's ever heard of suicide before. It's an important question that therapists need to ask their clients sometimes. Regardless of their answer, if you're so concerned that you're asking, then it's beyond what you can do as a friend. Even counselors will, in most situations where suicide is a concern, call and consult with another counselor or the local crisis hotline. The only time I don't consult is where the intent is pretty clear cut and then I'm calling 911.

This is call for immediate help from a reliable adult. If nobody you know is immediately available, call 911.

What happens if someone is suicidal and you get help?

The police and /or ambulance may come to the scene or you might be advised to go to the nearest emergency room. There, the person will be admitted to the ER, interviewed, and most likely a mental health professional will be called in to evaluate. You may be asked what hapened and what your concerns are. A decision will be made whether to hospitalize the person or not.

What do I do if the person refuses help or gets upset and threatens to leave?

This is not a time to worry about your friend being mad at you. If it turns out your friend isn't at imminent risk and isn't hospitalized, that decision should be made by a qualified professional. They still probably need help and adults involved need to know that there is a concern.

If a person is talking about suicide, their judgment could be impaired by strong emotions or a persistent depressed mood. They can't be counted on to make a good decision and may be intent on attempting suicide. In this case, call 911.

They very well might be mad at you but look at it this way: They had no right to drop that kind of bombshell on you and expect you to carry the burden of their safety singlehandedly and to be left worrrying.

Also, as long as they're alive there's always an opportunity to reconcile and get past this. Whatever your friend might think of you for telling, remind yourself that you were right not to keep these concerns a secret.

What if it's not about suicide but about one of the other concerns?

If your friend seems to be not themselves lately and they seem unhappy, it's okay to check in with them and ask. Tell them that you've noticed a change in them and want to know if they're okay. Then listen. It's okay to ask questions to understand the situation better, but be careful not to be too quick to give advice. Unless directly asked, advice isn't alwasy what's wanted or needed. Sometimes just having someone listen to you makes things seem bearable.

Be prepared, however, for what they share with you. If you learn that your friend is at serious risk of harm, even if it's not imminent, insist that they get help. You can offer to go with them to talk to a parent, a teacher, or a guidance counselor.

These might not be an immediate emergency, but still things that pose a long term risk. Your friend is at risk for physical illnesses and problems in

the future. These situations can also eventually lead to risk of serious injury or illness, death or suicide.

In any of these situations, if your friend is not seeking help, then they are for one reason or another not able to act on their own behalf and need someone to intervene.

If you don't feel that your parents or theirs will be able to deal effectively with the situation, seek out a trusted adult, such as a teacher or guidance counselor for help.

And take care of yourself after this. Talk to someone about your thoughts and feelings. Get counseling for yourself if you continue to be affected by this.