Teen Emotional Problems Go Unnoticed

Clinical Depression, Anxiety Disorders, PTSD Found in Many Adolescents

From the WebMD Archives

Aug. 4, 2003 -- Nearly one-fifth of the nation's teens are suffering from emotional disorders.

Some have faced violence and abuse in their lives and have enormous difficulty dealing with it. The result: clinical depression, even posttraumatic stress disorder (PTSD). For others, the trouble is internal -- they battle an inherited anxiety disorder, triggered by troubling life experiences.

Unfortunately, few adolescents are getting the psychological help they need.

Two studies, appearing this week in two of the country's top psychology journals, address these issues.

The studies should be a wake-up call for parents, school counselors, teachers, and psychologists, says Alan Delamater, PhD, director of clinical psychology in pediatrics at the University of Miami School of Medicine.

"Don't ever underestimate the emotional difficulties kids may be having," he tells WebMD. "Many people minimize these things, think they're a phase, think the kids are weak. These problems are real."

Kids React to Violence

Dean Kilpatrick, PhD, director of the National Crime Victims Research and Treatment Center at the Medical University of South Carolina in Charleston, has studied the issue extensively.

"Shocking numbers" of adult women have been victimized, his studies show. "We found that most traumatic events occurred when they were children and adolescents -- not when they were adults," he tells WebMD.

In their current study, Kilpatrick and colleagues conducted telephone surveys of 4,023 boys and girls, ages 12 through 17, asking them carefully worded questions about the major traumatic experiences in their lives to uncover incidents of sexual assault and physical assault, as well as witnessing violence in person (not in the movies or on TV).

Researchers also asked questions intended to gauge the symptoms of PTSD, clinical depression, and substance abuse or dependency in the teens.

The findings: "A high percentage of teens -- nearly one-half -- had experienced some traumatic event in their adolescent years," he reports. Some 40% had witnessed violence in person.

Other statistics:

  • Those who witnessed violence were three times more likely to be involved in substance abuse.
  • Those who had a physical assault were twice as likely to have clinical depression.
  • Sexual assault victims were 80% more likely to suffer from PTSD than other teens.

In fact, teens very often suffered from more than one emotional disorder, as other studies have discovered. "It seems to be more the norm than the exception," says Kilpatrick.

"Violence is a problem, and violence-related mental health disorders are also a problem," he tells WebMD. Also, the disorders do not go away with time, he reports. "This indicates they were not getting effective treatment."

Kilpatrick's study appears in the Journal of Consulting and Clinical Psychology.


Enemy Within: Social Anxiety Disorder

For many kids, social anxiety disorder (SAD) -- it used to be known as shyness -- creates emotional turmoil that can lead to all sorts of adjustment problems in adulthood.

In fact, upwards of 15% of adolescents face SAD, which has a strong genetic link, reports James D. Herbert, PhD, director of the Anxiety Treatment and Research Program at Drexel University in Philadelphia.

His paper, which appears in the Clinical Child and Family Psychology Review, outlines the research thus far on how this disorder affects teens.

Among his findings:

  • Although onset of SAD typically is age 15, shyness may be evident as early as 21 months. Children are inhibited, fearful, and uneasy around novel situations and people.
  • Only 34% of adolescents classified as behaviorally inhibited toddlers go on to develop SAD.

"These results suggest that other factors may lead to the expression of the disorder in otherwise predisposed individuals," writes Herbert. "Specific life experiences are often theorized to represent just such triggers."

Some of those triggers: Overly critical and controlling parents, peer rejection, victimization, and trauma in a social situation. "Each of these experiences has the potential to set in motion negative feedback loops involving anxiety, avoidance behaviors, and potential deficits in social competence," Herbert says.

It's a vicious cycle that can seriously hinder dating, employment, and independent living in adulthood, he says.

Get Treatment: It Works

"Many adults just don't realize that kids are suffering," says Delamater.

Bottom-line message: Parents need to talk to their kids, and not just about superficial things, and not just when trouble's afoot. "It sounds trite, but it's not," he tells WebMD. Tune in to your kids, be open, and listen without judgment.

Start when they're young. You'll form the basis for a good relationship when they're teenagers.

Signs of trouble:

  • Sudden changes in behavior or mood
  • Sudden disinterest in favorite hobbies or people
  • Drastic change in appearance
  • Becoming withdrawn
  • Obvious changes in grades

Parents, ask your kids what's wrong, Delamater says. "It's unlikely that kid will just open up about using drugs. They're not likely to give that up right away. But families that provide lots of support to kids -- not money for a therapist, I'm talking emotional resources like acceptance, letting them talk -- those kids learn to cope better.


"There are effective treatments out there," he tells WebMD. "It's a shame that we can't get more people to treatment, but there are lots of barriers -- insurance, plus some people don't want to admit their kids have emotional problems."

With the help of a good therapist, effective treatments can really make a difference in helping kids get past PTSD, clinical depression, and social anxiety disorder, he says.

WebMD Health News


SOURCES: Journal of Consulting and Clinical Psychology, August 2003. Clinical Child and Family Psychology Review, August 2003. Dean Kilpatrick, PhD, director, National Crime Victims Research and Treatment Center, Medical University of South Carolina, Charleston. James D. Herbert, PhD, director, Anxiety Treatment and Research Program, Drexel University, Philadelphia. Alan Delamater, PhD, director, clinical psychology in pediatrics, University of Miami School of Medicine.
© 2003 WebMD, Inc. All rights reserved.


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