Adolescence is a challenging life stage even for the most well-adjusted individuals. Between the hormonal upheaval of puberty, increasing social and academic pressures, and the hunger for independence — plus the friction it can cause with parents — the teenage years are rarely easy.
The turmoil inherent to this life stage can create a double bind: Teens are both more vulnerable to certain mental illnesses and more likely to hear parents and practitioners dismiss their symptoms as “just part of being a teenager.” It’s certainly important to avoid pathologizing run-of-the-mill adolescent challenges, but spotting and treating true mental-health disorders early can help an individual get their life on track before symptoms escalate.
Depression, social anxiety, and substance abuse represent three of the most common adolescent mental-health disorders. Here’s how to differentiate between these conditions and normal “teen angst” — and how parents, teachers and other adults can offer support.
Moodiness or Mood Disorder?
Roughly one in four children will meet the criteria for a mood disorder sometime during adolescence. These conditions include major depression, which involves persistent, debilitating low moods, and bipolar disorder, in which moods swing between extreme highs and lows. Menstruating adolescents may also experience premenstrual dysphoric disorder, a cycle of mood disturbances concurrent with menstruation.
As any parent of a teen can attest, moodiness and puberty go hand in hand. So how to determine whether mood issues are a cause for concern? First, know that depression manifests in many ways. When depressed, teens are especially prone to irritability and hyper-sensitivity — think erupting in response to the slightest criticism.
Next, consider intensity and duration. It’s perfectly normal for adolescents to become tearful from time to time; more concerning is if they refuse to get out of bed for several days in a row.
Also think of the impact on daily functioning. Mood changes that interfere with a teen’s school performance, extracurricular activities, or social life all signify red flags.
Finally, consider the context. Stressors, losses, and even a falling out with a friend can trigger a shift in mood, but most teens will return to baseline in a few days or weeks.
How to Help: Start by listening without offering advice. Let the individual know their feelings are valid and help them identify healthy ways to channel their emotions, such as painting or writing. Remember, talking isn’t the only way to process feelings.
Also encourage exercise, sleep, and social connection — the building blocks of good mental health (see “How Exercise Can Alleviate Depression, Anxiety, and Stress” to learn more about the positive affects exercise can have on mental health). Sometimes simply re-engaging with the things that make us feel good does the trick.
However, if the individual expresses thoughts of suicide — and especially if they have devised a specific plan and the means to carry it out — seek professional help. As the second-leading cause of death among American adolescents, suicide should always be taken seriously. (Learn more at “The Warning Signs of Depression — and When to Seek Help“.)
Self-Consciousness or Social-Anxiety Disorder?
Social-anxiety disorder represents a specific class of anxiety disorders especially common among teenagers: About one in 10 adolescents will meet the criteria for the disorder by age 18, and the majority of adults who struggle with this condition began experiencing symptoms as a teen.
Socially anxious individuals dread social situations due to an intense fear that others will find them stupid, boring, or awkward. But many, if not most, teens feel self-conscious in social situations — and overestimate how much others notice it. It’s another disorder in which the line between typical and troubling often blurs.
To differentiate between social anxiety and ordinary teenage self-consciousness, consider a few factors.
First and foremost, how does the anxiety impact their social or academic functioning? Those exhibiting social-anxiety disorder avoid or, at best, painfully endure social gatherings, which can lead to missing school or even refusing to go to public places like restaurants.
As with mood disorders, consider the context. Could the anxiety be tied to a recent situation, such as changes in a friend group, or has it persisted for months no matter what’s going on in the individual’s life?
Finally, recognize the difference between social anxiety and introversion. Introverts are easily overwhelmed by social situations, but don’t necessarily assume others are judging or mocking them.
How to Help: It can be tempting to steer adolescents away from anxiety-inducing situations — after all, no parent likes to see their kid struggle. But there’s truth to the adage “face your fears”: Only by pushing through discomfort do we learn how to tolerate it. Start with low-hanging fruit, such as gatherings with cousins or neighborhood friends; then build up to more anxiety-inducing situations.
Another helpful adage: “Don’t compare your insides to other people’s outsides.” It’s easy to forget — especially when we’re young — that everyone struggles with self-consciousness from time to time, even if it isn’t obvious.
Experimentation or Substance Abuse?
In theory, there is no such thing as healthy substance use during adolescence. Because of their nascent impulse-control capacities, adolescents run the risk of engaging in dangerous behaviors like unprotected sex or reckless driving when using drugs or alcohol. Moreover, studies show that those who begin using illicit substances in adolescence are more likely to develop a dependency than those who do not use them until adulthood.
Yet it’s no secret that many young people do use drugs and alcohol: Before graduating high school, roughly two-thirds of Americans will try alcohol a least once and about half will try marijuana. So it’s important to differentiate between experimentation and potential addiction.
Substance-use disorders are distinguished from non-disordered use by several criteria, including frequency of use, impact on functioning, and inability to stop despite negative consequences. When assessing an adolescent’s use, other factors should also be considered.
When, where, and with whom does the person use? Compared to a teenager who uses drugs or alcohol only at weekend parties, for example, one who regularly uses alone after school will likely be at greater risk of developing an addiction.
Also consider whether the individual is motivated by experimentation or escape. The desire for new experiences — including risky ones — is inherent to adolescence. More concerning is when substances become a default for coping with loneliness, anxiety, or other difficult emotions.
How to Help: First, resist the urge to shame and blame: No one wants to hear they’re a screw-up, and few teens respond well to disparaging comments about their friends. Focus instead on education. This includes information not only about the general hazards of use but also about individual risk factors such as a family history of addiction.
While parents are well within their rights to instigate an abstinence-only approach to drugs and alcohol, it’s easy to overlook the perils of peer pressure — or to inadvertently fan the flames of rebellion by coming down too hard. The harm-reduction model of treatment emphasizes safety over strict abstinence and involves developing a realistic plan for how to handle situations in which drugs or alcohol are present. How can they respond to pressure from peers? Who can they call if they don’t have a sober ride home? And who can they feel safe confiding in if they do decide to use?