Teen Mental Health: Professional Advice

With the issues and challenges of teenage life making frequent headlines, we thought it timely to speak with both schools and mental health professionals to understand how adults an support the mental wellbeing of young people. 

For this article, we spoke with Clinical Psychologist Jessica Rosslee of the Thrive Wellbeing Centre in Jumeirah Lake Towers. Jessica talks us through the signs and symptoms of common teenage mental health issues, including depression, anxiety, self-harm and eating disorders. Click here to find out how UAE schools in general approach mental health support.

Jessica, what are the first things parents should consider if they feel their child might be suffering with a mental health disorder?

I would say that the first thing to understand is that reaching a specific diagnosis will take into account the nature, duration and impact of the symptoms of that disorder. For example, for a diagnosis of depression, the symptoms should be present for at least two weeks consecutively. Many of us might feel down or depressed for a couple of days, but that is not the same as being clinically depressed.

Adolescence is not easy for parents or for teenagers. Our children move through various transitions; in their bodies, their hormones, emotionally and socially. The pressures can be overwhelming and as adults it is vital that we de-stigmatise mental health concerns. I hope one day we are able to treat mental health problems just as we would diabetes or high blood pressure: as an illness.

Can you tell our readers a little about depression in teenagers? What causes it and what are the signs that parents should be alert to?

Depression is the most prevelant mental health issue that we see. It can be caused by many things including developmental issues and difficult life events.

Again, we look for symptoms that have been present consistently for two weeks or more and which impair a teenager’s level of functioning. I tell parents to look at their child’s baseline behaviour. What were they like before and what has changed? These symptoms should be present in all areas of their life. For example, you can’t be classed as clinically depressed if you are able to function at school but not at home.

To be diagnosed with a clinical depression, a teenager would present firstly with one of the following symptoms:

• A feeling of being persistently sad, down, blue, hopeless or pessimistic. With teenagers, they can also present as being very irritable or moody
• Or, a lack of interest in life and the things they used to enjoy

In addition, we would also see one or more of the following symptoms, depending on whether the depression was mild, moderate or severe:

• Sleep. Your teen may struggle to sleep, sleep more than usual or complain of tiredness and a lack of energy
• Eating. They may eat more or less than usual. You might see impulsive or restrictive eating or lack of appetite
• Concentration and memory problems. Parents might notice academic complaints for example not handing work in on time, a lack of drive and interest
• Guilty feelings. Depression can manifest excessive guilt, where young people constantly find themselves wanting or at fault
• Psychosomatic retardation or agitation. Essentially, this means changes to in the way their body feels to them. They might feel heavy and slow or agitated and restless
• Suicidal thoughts or plans. Here, we always say to parents that we that we don’t question the seriousness of the threats or intentions. Always, always respond to suicidal thoughts or threats seriously, because if a child is communicating thoughts of dying, then that means that the depression is severe

Depression is often referred to alongside anxiety. What is anxiety and how do the two conditions inter-relate?

It’s true that these two conditions might often be found together. However not everyone who is depressed will have anxiety, or vice versa. That said, untreated anxiety can certainly develop into a depression. With treatment and their anxiety managed, many patients will feel their mood lift.

There are many different anxiety disorders, and we could talk for many hours on each one! However, to simplify things for parents, I tend to break things down into three areas. For a diagnosis of anxiety, we look for some of the following signs;

Physical Signs

Teens may complain of physical ailments such as headaches, stomach aches, eye problems, dry mouth, heart palpitations, sore muscles, spasms, neck pain, back pain, excessive sweating, trembling or shaking. They might refuse to eat and become restless, fidgety and distracted. When it comes to sleep, children with anxiety can often overthink which causes them to have poor sleep and difficulty relaxing.

Emotional Signs

There may be panic attacks or a fear of panic attacks. Teenagers might develop intense worries about the future, nightmares and obsessive thoughts. Outwardly, this can be seen as anger or tearfulness.

Behavioural Signs

Anxious teens can avoid different situations and events. In particular parents might see them refusing school or becoming overwhelmed in crowded places. You may also notice your teen constantly seeking the approval of others or the anxiety might manifest itself in compulsive behaviours such as frequent handwashing or arranging things.

Again, when it comes to anxiety, these changes need to be persistent over a period of time. Again, I say to parents that they need to know their child’s “baseline” and look for changes that are lasting and impair their functioning.

What about self-harm? What should parents look for?

Self-harm is a physically harmful way of coping with emotional pain. My teenage patients will tell me that self-harm brings about a sense of calm and a release of tension. Of course, this just doesn’t seem to make sense to many of us…why would harming themselves make a child feel calmer? I explain to parents that there is a biological component to self-harm. When someone deliberately harms themselves, they don’t feel the pain, they just experience the neuro-chemicals that bring about positive feelings. This can be addictive, much like an addiction to opiates.

Teenagers use self-harm because they don’t know how to regulate their moods. Often parents will expect that I will tell them to stop self-harming right from the first session. But that cannot be our initial goal. In therapy, we focus on giving them emotional techniques to regulate their emotions. We talk about the pain, and we give them techniques to manage their moods. In that way, the self-harm will begin to subside.

In terms of signs parents should look out for, again, it is about being alert to changes in behaviour. Look out for unexplained cuts and bruises. Ask yourself if a child who would have previously enjoyed wearing T-shirts and shorts has suddenly opted for long clothing, even in the UAE heat. Teenagers do need privacy, of course, but is there an excessive or new hiding of their body from family members?

What are Eating Disorders and how do we recognise them?

Eating disorders fall in to one of three conditions; anorexia nervosa, bulimia nervosa and binge eating. Parents might notice their child suddenly become preoccupied with calorie counting, diet apps or achieving a goal weight that goes beyond ‘normal’. Equally, they might gain weight or become secretive about the foods they consume. When it comes to bulimia, or forced vomiting, spending time in the bathroom immediately after meals is a key sign.

I would say that in most of the teenagers I have seen with eating disorders, they have a distorted body image. They often think they are much heavier than they in fact are. Again, these problems are often caused by teenagers not being able to manage stress in other areas of their life. By treating those issues, we can begin to addressed the disordered eating.

What advice do you have for parents who suspect their child has a mental health disorder?

I would advise parents to speak to their teenager first and foremost. Whilst you might be tempted to approach a professional first, that can create feelings of mistrust when you are dealing with young adults. The teenagers I work with often tell me that they wish their parents would just talk to them about the problems. I tell parents to reflect on their teen, to think about how they were before and how they are now. Go in to the conversation armed with the evidence of any changes, and take an empathetic, blame free, non-judgemental tone.

Once that first conversation has been had you and your teen can plan to access professional help, whether that is first via your family doctor or with someone like myself.