Adolescence has been described as a period of “storm and stress” with an assumption that most adolescents have emotional turmoil and mental health disturbances during this period of rapid growth and emotional changes. In fact, this is not true. Although adolescence is a time when disorders including depression, substance abuse, eating issues, bipolar illness and schizophrenia may first appear, the majority of adolescents, thought to be about eighty percent, do not manifest psychiatric disturbances. Needless to say, their moods and behaviors are often changeable and unpredictable. The difference between teens is remarkable; fortunately, most of these behaviors still remain within the normal range.
Sections in this book review psychiatric disorders including depression, anorexia nervosa, bulimia, personality disorders, posttraumatic stress disorder and substance abuse. In this chapter, background material and information about more subtle mental illness, screening and genetics is presented.
Psychiatrists and other specialists who work in the mental health field use a description approach to the classification of mental illness. Called the Diagnostic and Statistical Manual of Mental Disorders-IV, this manual was first published in 1952 and has undergone periodic revisions and updates. DSM-IV is a compendium of information and diagnostic criteria that incorporates objective and descriptive elements that allows for increasing reliability in diagnosis among practitioners in the field.
Despite DSM-IV, the diagnosis of mental illness in adolescents may be difficult. Recurrent bodily symptoms such as abdominal pain or headache are exceedingly common in teens. In one study, around fifty-three percent of younger adolescents reported frequent headaches and forty-seven percent reported frequent abdominal pain. On the other hand, there are a group of psychiatric disorders characterized by the presence of symptoms suggestive of physical disease. Termed the somatoform disorders, teens with this illness have no medical explanation for the symptoms. Although hypochondriasis is rare in adolescents, somatization disorder, body dysmorphic disorder and factitious disorder are more common.
Somatization disorder is characterized by multiple somatic complaints over a long period of time for which no medical condition can be found. Although not frequently seen in adolescents, more than half of adults with this disorder report that their symptoms began before the age of fifteen. More common in adolescents is the body dysmorphic disorder where the teen is preoccupied with an imagined defect in his or her appearance. Because of a widespread unhappiness with their body image, these teens may show social isolation and avoidance. Teens with factitious disorder have signs and symptoms of illness that they produce consciously in contrast to those with somatization disorder where the symptoms are developed unconsciously.
These types of disorders may begin quite subtly. Depression may begin with changes in appetite or sleep. Substance abuse, such as chronic smoking of marijuana, may manifest by moodiness and changes in academic performance. Anorexic girls may have slow and insidious weight loss.
As a result, some clinicians who work with adolescents use psychosocial screening questions in order to detect the early symptoms and signs of mental illness. Parents may be asked what types of activities their teens like to do. Most emotionally healthy teens engage in a number of different age relevant activities and enjoy them. Questions about academic performance can be utilized. For example, poor academic performance may be a signal of depression, substance abuse or attention deficit disorder.
When the adolescent is alone with the clinician, he or she may be asked if there is a history of drug use in their peer group. It is well known that a teen whose peers are abusing substances will probably abuse them. It is far more likely that a teen will answer a sensitive question truthfully about his peers than when directed at his activities. Since nine to fifteen percent of high school students report having made a suicide attempt, a question about suicidal thoughts is appropriate.
While certain types of mental illness seem to have a higher familial basis including manic-depressive illness, substance abuse and depression, many teens with a family history of mental illness do not develop mental disorders. Yet others, who have no family history, do develop mental health problems. The literature speaks of resilience or risk and protective factors; these factors might either increase or decrease the effects of stress on an adolescent’s emotional health.
Authorities in the field cite such factors as good health, normal IQ, good peer relations, parental competence, adequate economic resources, good intrafamily communications, high access to community resources and connectiveness as some factors that are protective and decrease the impact of stress. Conversely, ill health or chronic disease, low IQ, poor peer relations, incompetent parenting, poverty, intrafamily conflicts, low access to community resources and disconnectiveness are risk factors that increase the impact of stress.
While DMS-IV will list many of the symptoms and signs of mental illness, subtler psychosocial dysfunction that is not necessarily well outlined is the leading cause of disability in the adolescent population. Early discovery of emotional issues moreover, may lead to early treatment and prevention of more serious mental illness.
As the Twenty-First Century begins, there are increasing efforts leading to a better understanding of the genetics associated with some mental illnesses that begin in childhood or adolescence. For example, a genetic basis for attention deficit disorder has been suggested by studies of twins and families. In fact recent findings suggest that functional variants of genes that are involved in dopamine neurotransmission confer a familial risk for ADD. Authorities feel however that this contribution is small. In dyslexia, which is a disability with respect to language function that is not related to academic disadvantage or developmental delay, researchers note a familial clustering of cases. This would imply that the condition is hereditary. Early studies have suggested a linkage between measures of phonological awareness and a locus on chromosome 6P.
Further research into the genetics of mental illness may reveal problems with genes that lead to a susceptibility rather than a cause of mental disorders. Adolescents may have “vulnerability genes” that under certain environmental influences may lead to serious developmental disorders and mental illness. The challenge is to discover these influences and provide effective preventions and treatments.
Related topics:
Anorexia nervosa and bulimia nervosa, autism, depression, genetic disease, manic-depressive disorder, obsessive-compulsive disorder, personality disorders, psychosomatic disorders, stress
