Q. What are the most significant mental health issues facing adolescents today? What are the main causes for these issues? Genetics? Or societal issues?

A. In my practice, about half of the patients I see are adolescents, ages 12 to 18 years old. The mental health issues they deal with are broad and diverse. An interesting problem is sorting out what may be “normal” adolescent behavior from “abnormal.”  In general, adolescents may be moody, irritable, isolative and insecure.  It is a time of development in which they are working on “separation and individuation.”  In other words, this is a time when teens are starting to develop their own identity and are working toward becoming independent from their parents.  This can cause deep feelings of fear and discomfort that the teen may not even be conscious of.  The feelings may therefore manifest in the moodiness or anger that is so commonly seen.

contemplative teenMany things can cause the process of separation and individuation to be delayed or impaired.  Untreated psychiatric disorders such as depression, anxiety and ADD commonly interfere with the developmental process.  Some studies show that up to 25 percent of American teens will experience an anxiety or depressive episode by the age of 18.  These disorders are considered to be related to genetics but also environmental factors (nature plus nurture).  It seems that more and more, teenagers are struggling with psychiatric problems.

Along with genetics contributing to mood, attention or anxiety problems, environmental associations have been made.  These include various toxins, processed foods, media exposure (texting, internet, television, etc.), bullying, school and social stress, sleep deprivation, and substance use.

It seems there is more and more pressure on teens to perform well in school and to engage in extra-curricular activities. When a teenager is feeling bad, one of the first things that may be affected is motivation for social activity or school work.  Grades drop and the teen seems apathetic.  Additionally, the teen will be less social and may start drinking or using drugs to start to feel better.

It is common for parents in this situation to become angry and punish their child, when, in fact, what the child needs is support and encouragement.  The teen may respond to punishment by becoming more angry and oppositional. This can quickly become a very complex picture in which it is almost impossible to sort out behavioral problems from the psychiatric problems without professional help.

The teen who is suffering from these problems will often avoid talking about how he or she feels.  A common reason for this is that teens do not want to feel different from their peers. They want to be accepted. The stigma of mental health problems will contribute to the teen repressing his or her bad feelings. This unfortunate pattern tends to worsen the existing symptoms and drive the teenager to find alternative and often counter-productive or harmful coping mechanisms.

It is therefore the job of the psychiatrist to sort out the genetic history that may be affecting the teen and to establish a bond and a trusting relationship with the teen and parents.  Once good rapport is established, the work of sorting out the home, social and school issues can be most efficiently accomplished.

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