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Overview of Psychosocial Problems in Adolescents

By Sharon Levy, MD, MPH, Assistant Professor of Pediatrics; Director, Adolescent Substance Abuse Program, Harvard Medical School; Boston Children's Hospital

Psychologic and social problems, particularly involving behavior and school issues, are more common during adolescence than at any other time during childhood. Adolescents are much more independent and mobile and are often out of the direct control of adults. When misbehavior becomes severe and frequent, adolescents should be evaluated for a psychosocial disorder by a mental health professional. In particular, depression, anxiety, and eating disorders are common during adolescence. Adolescents who have anxiety or mood disorders may have physical symptoms such as fatigue or chronic fatigue, dizziness, headache, and abdominal or chest pain.

Depression is common among adolescents, and doctors actively screen for it during examinations.

Suicide is rare, but thoughts about suicide (called suicidal ideation) are more common. Suicidal ideation requires an immediate mental health evaluation; parents should not be expected to determine how "serious" the problem is on their own.

Anxiety often manifests during adolescence, as do mood disorders and disruptive behavioral disorders such as oppositional defiant disorder and conduct disorder.

Thought disorders, in which an individual has difficulty distinguishing between fantasy and reality (also called psychotic disorders), most commonly begin during adolescence or early adulthood. The first episode of psychosis is called a psychotic break. Schizophrenia and schizoaffective disorder are examples of thought disorders. Periods of psychosis may be related to drug use. In these cases, psychosis may resolve after a period of time. Psychotic episodes may occur with marijuana, particularly edible products.

Eating disorders, especially in girls, are common and can be life threatening. Some adolescents go to extraordinary lengths to hide symptoms of an eating disorder, which may include substantial reductions in food intake, purging after eating, use of laxatives or extensive, vigorous exercise.

Doctors can often identify these problems. They can offer adolescents practical advice and, when appropriate, encourage adolescents to accept treatment provided by specialists.