Mental Health Month: Normal Teen Angst or Adolescent Mental Illness?

May is Mental Health Month. Mental illness is not an adults-only issue. Almost half of all chronic mental illness begins by age 14; three-quarters by age 24. Yet the stigma associated with mental illness prevents many teens from seeking help. The normal drama, moodiness and withdrawal from family of the teen years can blind parents to a teen’s very real distress. To complicate things further, there are sometimes medical or lifestyle issues at the root of emotional and behavioral change.

We should never ignore talk of self-harm or suicide. We should never minimize a teen’s very real emotional pain. But it’s important that we take care not to jump to the conclusion that there is an emerging mental illness when changes in mood or behavior may be due to something else. The issue may be as simple as too many hours on video games or as complicated as drug addiction. Careful observation and perhaps assessment by a doctor or mental health provider are needed to make an accurate diagnosis and to determine the best treatment.

Let’s look at a list of some of the common causes of concern. If your child is showing significant negative changes in a number of these issues or if there are changes in intensity, frequency and duration of any one or two of them, a mental health evaluation might be in order. However, before you panic about the possibility of mental illness, do consider whether what you are seeing are normal (though sometimes alarming) adolescent issues or an undiagnosed medical problem that will respond to medical treatment.

Common causes of concern include the following:

• Mood swings. 
  A teen’s rollercoaster of emotions may be due to hormonal shifts, vitamin deficiencies or an inadequate diet. Before concluding there is a mental health diagnosis, confer with the primary care physician. If the problems persist despite reassurance from the doctor that it will run its course or in spite of treatment for a medical problem, do seek an evaluation by a mental health counselor. It is possible that the mood swings are due to emergence of bipolar disorder. It’s also possible the teen needs only to learn some self-calming techniques or needs someone to talk to about how to handle new social or academic stresses.
• Feeling tired and low energy. 
  If your teen is getting plenty of sleep but is still tired much of the time, confer with your primary care doctor. If medically fine but still tired, it is possible that your teen is depressed.

  One study reported that teens who went to bed before 10 p.m. are 24 percent less likely to become depressed and 20 percent less likely to have suicidal thoughts than those who went to bed later. It is true that there are other variables to consider but sleep deprivation does probably have a lot to do with a depressed mood.

  If your teen isn’t regularly getting 7 – 9 hours of shuteye every night, try to engage the teen in an experiment. Get the TV, computer and phone out of the bedroom and declare “lights out” by 10 p.m. for two weeks and see if the teen’s mood improves. If not, follow up with an appointment to a mental health provider for an assessment for depression.

• Confused thinking or problems with concentration. 
  This is a serious concern, especially if it is not related to already-diagnosed ADHD. Sleep deprivation, drug use, vitamin deficiencies or other medical conditions can be the culprit. Consult with the primary care doctor. If the teen is medically healthy, see a mental health specialist for an evaluation.
• Heightened anxiety. 
  Many teens are stressed now and then. However, if anxiety regularly gets in the way of functioning, it’s time to provide some extra support. Some teens are open to learning how to use meditation, yoga, exercise or other calming techniques. If not, a counselor can help your teen learn new ways to cope with the unexpected and the stressful. If anxiety is constant and upsetting, medication may be needed so the teen can take full advantage of talk therapy or calming techniques. Make an appointment with a counselor for an assessment.
• Changes in eating habits. 
  If your teen goes on a questionable diet, starts to severely limit food, overexercises or binge eats, talk about whether there is excessive concern about weight or appearance. If the answer is yes, make an appointment for your teen to see a physician or a nutritionist for advice about sensible diet and exercise. If they refuse help and continue to worry obsessively about weight or to dangerously curtail calories, see a counselor who specializes in eating disorders.
• Substance abuse. 
  Use of alcohol and street drugs can be a way to be accepted, to party or to avoid problems. It also can be a way a teen instinctively self-medicates an emerging mental illness. If your teen is using substances, the first intervention is a frank talk to determine what it is about. If the teen can’t or won’t stop, then it’s time to seek professional help.
• Avoiding friends. 
  The shifts in social status and group membership during the teen years can be brutal. Your teen may need your support or intervention if there is bullying going on or may need some guidance about how to find and maintain friends. If your teen isolates from local peers, limits social contact to online “friends” he or she has never met or has a generally negative or dismissive attitude about relationships, make an appointment with a counselor. Sometimes it is easier for teens to talk to a supportive therapist than to admit to their parents the extent of their discouragement about their ability to find and hold onto relationships.
• Being irritable with family. 
  It is normal for teens to separate from family members while carving out their own identity. Sometimes teens have to be find a reason to be angry with parents in order to take that step away. Reevaluate whether you are encouraging enough independence. If anger or irritability is chronic or way out of proportion during normal family conflict, then it may be a sign of depression. See a mental health provider for input about the need for medication and therapy.
• Changes in school performance. 
  Sometimes teens need help with balancing their responsibilities in school with their passion for an activity or their involvement with friends or a romance. Offer practical help with prioritizing and scheduling. If they have stopped caring about school, are frequently absent or can’t seem to manage their schoolwork regardless of support, delve deeper. It could be a sign that they are abusing substances or are in emotional trouble.
• Reports of hearing or seeing things others don’t, reports of feeling unreal or separate from others or emergence of new ritualistic behaviors. 
  Seek a mental health evaluation. Although there are sometimes medical causes, such symptoms are often an indication of the onset of mental illness.
• Self-harm or talk of suicide. 
  Always, always take it seriously. The idea that people who talk about it don’t do it just isn’t true. Yes, it’s possible that self-harm or threats to “end it all” is a way to get attention or a way to manipulate others, in which case it’s important to ask why such extreme behavior is necessary to achieve those goals. Sadly, it’s also possible that cutting or consideration of suicide is the only way a teen sees to stop emotional pain. It’s not safe to sort this out on your own. Get expert advice.

If you have been concerned about negative changes in your teen, take this month as an opportunity to do a thoughtful run-through of the above list. Teasing out mental illness from normal teen distress isn’t easy. But you do know your child. Trust your instincts. If you can’t account for changes that concern you, confer with a professional. You may learn that your teen is a normally abnormal adolescent. If treatment is needed, though, early assessment and intervention is the way to get your teen back on track to be all he or she can be.

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