ADOLESCENT MENTAL

HEALTH CONCERNS
MARIEGELLA CHRISTE S. CIOCSON,MD,MMHoA,FPPS
PPS BICOL
Adolescence is a new birth, for the
higher and more completely human
traits are now born.
G. Stanley Hall
ADOLESCENCE

10–19 years is a unique and

formative time

multiple physical, emotional

and social changes, including
exposure to poverty, abuse, or
violence, can make
adolescents vulnerable to
mental health problems
ADOLESCENCE

crucial period for developing and maintaining social and

emotional habits important for mental well-being

habits include: adopting healthy sleep patterns; taking

regular exercise; developing coping, problem-solving, and
interpersonal skills; and learning to manage emotions

Supportive environments in the family, at school, and in the

wider community are also important
FACTORS AFFECTING
MENTAL HEALTH
desire for greater autonomy

pressure to conform with peers

exploration of sexual identity

increased access to and use of

technology

quality of their home life and their

relationships with their peers

Violence (including harsh parenting

and bullying) and socio-economic
problems are recognized risks to
mental health
GREATER RISK FOR MENTAL
HEALTH CONDITIONS

living conditions

stigma

discrimination or exclusion

lack of access to quality support and services

MENTAL HEALTH IN
ADOLESCENTS
Worldwide, 10–20% of
adolescents experience mental
health conditions

remain underdiagnosed and

underrated

Signs of poor mental health can

be overlooked for a number of
reasons, such as a lack of
knowledge or awareness about
mental health among health
workers, or stigma preventing
them from seeking help.
MENTAL HEALTH CONDITION

10–20% of adolescents experience mental health

conditions

Signs of poor mental health can be overlooked for a

number of reasons: lack of knowledge or awareness about
mental health among health workers, or stigma preventing
them from seeking help.
MENTAL HEALTH
CONDITIONS
Emotional disorders

Childhood behavioral
disorders

Eating disorders

Psychosis

Suicide and self harm

Risk taking behaviors

EMOTIONAL DISORDERS
Depression or anxiety

Excessive irritability

Frustration, or anger

Rapid and unexpected changes in

mood and emotional outbursts

Younger adolescents may

additionally develop emotion-
related physical symptoms such
as stomach ache, headache, or
nausea.
DEPRESSION

Globally, depression is the

ninth leading cause of
illness and disability
among all adolescents

anxiety is the eighth

leading cause.
DEPRESSION

Depression can be profoundly disabling to an adolescent’s

functioning, affecting schoolwork and attendance.

Withdrawal or avoidance of family, peers or the community

can exacerbate isolation and loneliness

At its worse, depression can lead to suicide.

DEPRESSION

Well-meaning friends or family members may try to tell

someone with depression to “snap out of it,” “just be
positive,” or “you can be happier if you just try harder.”

But depression is not a sign of weakness or a character

flaw.

Most people with depression need treatment to get better.

SIGNS AND SYMPTOMS OF
DEPRESSION?
• Do you constantly feel sad, anxious, or even “empty,” like you feel
nothing?

• Do you feel hopeless or like everything is going wrong?

• Do you feel like you’re worthless or helpless? Do you feel guilty about
things?

• Do you feel irritable much of the time?

• Do you find yourself spending more time alone and withdrawing from
friends and family?

• Are your grades dropping?

SIGNS AND SYMPTOMS OF
DEPRESSION?
• Have you lost interest or pleasure in activities and hobbies that you used to enjoy?

• Have your eating or sleeping habits changed (eating or sleeping more than usual or
less than usual)?

• Do you always feel tired? Like you have less energy than normal or no energy at all?

• Do you feel restless or have trouble sitting still?

• Do you feel like you have trouble concentrating, remembering information, or making
decisions?

• Do you have aches or pains, headaches, cramps, or stomach problems without a

clear cause?

• Do you ever think about dying or suicide? Have you ever tried to harm yourself?
SEEK IMMEDIATE
ASSISTANCE
• Suicidal thought

• Hearing voices or seeing things that no one else can hear or see

• Experiencing unexplainable changes in thinking, speech, or writing

• Being overly suspicious or fearful

• Showing a drastic and sudden decline in school performance

• Having sudden personality changes that are bizarre or out of

character
CHILDHOOD BEHAVIORAL
DISORDER

Oppositional defiant disorder

Conduct disorder

Attention deficit hyperactivity disorder

OPPOSITIONAL DEFIANT
DISORDER

one in ten children under the age of 12 years are thought to

have oppositional defiant disorder (ODD)

boys outnumbering girls by two to one

OPPOSITIONAL DEFIANT
DISORDER
• Easily angered, annoyed or irritated

• Frequent temper tantrums

• Argues frequently with adults, particularly the most familiar adults in their lives, such
as parents

• Refuses to obey rules

• Seems to deliberately try to annoy or aggravate others

• Low self-esteem

• Low frustration threshold

• Seeks to blame others for any misfortunes or misdeeds.

CONDUCT DISORDER

Children with conduct disorder (CD) are often judged as

‘bad kids’ because of their delinquent behaviour and refusal
to accept rules.

Around five per cent of 10 year olds are thought to have

CD, with boys outnumbering girls by four to one

Around one-third of children with CD also have attention

deficit hyperactivity disorder (ADHD).
CONDUCT DISORDER: TYPICAL
BEHAVIOR
• Frequent refusal to obey parents or other authority
figures

• Repeated truancy

• Tendency to use drugs, including cigarettes and

alcohol, at a very early age

• Lack of empathy for others

• Being aggressive to animals and other people or

showing sadistic behaviours including bullying and physical or
sexual abuse
CONDUCT DISORDER: TYPICAL
BEHAVIOR

• Keenness to start physical fights

• Using weapons in physical fights

• Frequent lying

• Criminal behaviour such as stealing, deliberately lighting fires,

breaking into houses and vandalism

• A tendency to run away from home

• Suicidal tendencies – although these are more rare.

ATTENTION-DEFICIT
DISORDER

Around two to five per cent of children are thought to have

attention deficit hyperactivity disorder (ADHD), with boys
outnumbering girls by three to one
ATTENTION-DEFICIT
DISORDER

• Inattention – difficulty concentrating, forgetting

instructions, moving from one task to another without
completing anything.

• Impulsivity – talking over the top of others, having a

‘short fuse’, being accident-prone.

• Overactivity – constant restlessness and fidgeting.

RISK FACTORS

• Gender – boys are much more likely than girls to suffer from
behavioural disorders. It is unclear if the cause is genetic or linked to
socialisation experiences.

• Gestation and birth – difficult pregnancies, premature birth and low

birth weight may contribute in some cases to the child’s problem behaviour
later in life.

• Temperament – children who are difficult to manage, temperamental

or aggressive from an early age are more likely to develop behavioural
disorders later in life.
RISK FACTORS
• Family life – behavioural disorders are more likely in dysfunctional
families. For example, a child is at increased risk in families where
domestic violence, poverty, poor parenting skills or substance abuse are
a problem.

• Learning difficulties –problems with reading and writing are often

associated with behaviour problems.

• Intellectual disabilities – children with intellectual disabilities are

twice as likely to have behavioural disorders.

• Brain development – studies have shown that areas of the brain

that control attention appear to be less active in children with ADHD.
EATING DISORDERS

Anorexia nervosa: People with anorexia nervosa may see

themselves as overweight, even when they are dangerously
underweight
EATING DISORDERS

Bulimia nervosa:

: People with bulimia nervosa have recurrent and frequent

episodes of eating unusually large amounts of food and
feeling a lack of control over these episodes

: This binge-eating is followed by behavior that compensates

for the overeating such as forced vomiting, excessive use of
laxatives or diuretics, fasting, excessive exercise, or a
combination of these behaviors.
EATING DISORDERS
Binge eating

: People with binge-eating disorder lose control over his or her

eating

: Unlike bulimia nervosa, periods of binge-eating are not followed by

purging, excessive exercise, or fasting

: As a result, people with binge-eating disorder often are overweight

or obese

: Binge-eating disorder is the most common eating disorder in the

U.S.
PSYCHOSIS

■ Hallucinatory experiences and delusions are more common in our

patients than we may realize and occur frequently in the pediatric
population. While not a benign occurrence, psychotic symptoms do not
necessarily portend the future development of schizophrenia.

■ Psychotic symptoms in children and adolescents can occur in the

context of a bevy of psychiatric disorders other than schizophrenia (eg,
depression, anxiety, attention-deficit/hyperactivity disorder, posttraumatic
states, and autism spectrum disorders) or can be secondary to a wide
variety of medical conditions.

■ The onset of psychosis is usually preceded by a period of

nonpsychotic symptoms known as prodromal symptoms.
RISK TAKING BEHAVIORS

Risk taking = curiosity + challenge + excitement + denial

That’s one formula for adolescent growth

RED FLAGS OF RSIK TAKING
BEHAVIOR

SUBSTANCE USE

BOREDOM

EXCITEMENT

RULING EMOTIONS
SUBSTANCE USE

Increases the likelihood of unwise risk taking

As sober caring about self and what is happening is lost, so

is degree of carefulness that is taken until choices become
more careless

In the in the extreme, the young person stops caring about

consequences at all and acts carefree in the moment
BOREDOM

To escape the protracted pain of not knowing what to do

with ones self, young people will sometimes risk anything to
relieve the discontent of feeling disconnected, aimless, and
at loose ends.

For example, to escape their sense of emptiness and lack

of purpose and inactivity and restlessness, one friend may
join another and turn to vandalism to engage their interest
on a hot summer night
EXCITEMENT

For some young people, excitement is their experience of

choice.

Risk-taking serves this end by creating a state of high

intensity, of feeling totally alive – stimulated and challenged.

For example, some young people, even starting in

childhood, seem drawn to living on the edge for the
excitement it provides and the competence from daring it
can inspire
RULING EMOTIONS

Adolescence is an emotionally intense and vulnerable time

when it’s easy to let the big three negative emotions –
despondency, anger, and fear – become so powerful that
they are allowed to do the adolescent’s thinking for her or
him.

Under the ruling orders of these feelings, a young person

can be lead to self-defeating and self-destructive acts
WHEN TEENS ARE STRUGGLING, SPEAKING
UP CAN BE HARD, BUT REACHING OUT IS
THE FIRST STEP TO FEELING BETTER
STIGMA AND SILENCE

half of adolescents affected are struggling in silence

hard to speak up

once you start reaching out you’ll realize that “You’re a

member of a community, and there’s real help out there.”
GETTING STARTED

Write down what you’re feeling: organize thoughts and get a

clearer idea of what you want to say

Find a symptom checker online: help you make sense of

how you’re feeling and give you a place to start when
talking to your parents or a therapist

Give a head’s up: let them know that you’d like to have a
serious conversation and ask them to set some time aside
WHO TO TALK TO?

There’s no ‘right’ first person to talk to

What’s important is finding someone you feel comfortable

opening up with, and who you know will listen
SOURCES
Adolescent Mental Health, WHO

Rae Jacobson, How to Talk About Mental Health Issues, Child

Mind Institute

https://www.nimh.nih.gov/index.shtml

J. Stevens, Psychotic Disorders in Children and Adolescents: A

Primer on Contemporary Evaluation and Management,
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4116281/

Pickhardt,C,Adolescence and Risk-Taking, Psychology

Today,2014 July
“Being a teen can be tough. Just try to surround yourself
with really good friends that really have your back, and
also be a really good friend to those who really care
about you. If you're not sure about certain things, talk to
your friends that you trust and your family.”

VICTORIA JUSTICE