Being a teenager is tough, and dealing with mental health issues makes it even more challenging. Studies show that 75% of lifelong mental health conditions emerge in adolescence.¹ 13% of the global disease burden for 10- to 19-year-olds is from a mental health condition.² Suicide is the third leading cause of death in teens aged 15-19,³ and serious interventions in mental health care are often necessary.
Regardless of your circumstances, you don’t have to go through this alone. We’ve gathered the best mental health resources to help you, your teenager, or your friends, including facts about common mental illnesses, why they occur, and what to watch out for.
If you are currently experiencing thoughts of suicide, please reach out to a friend or loved one, a text or phone crisis line (text HOME to 741741, or call 988 or 1-800-273-8255), or your local emergency department.
As of 2019, the top three most common mental illnesses in teenagers are:⁴
We’ll talk about each of these — as well as eating disorders and psychotic disorders, which often begin in teenagers — in more detail below.
Depression is one of the most common mental illnesses. More than one in three teenagers report experiencing a low mood or persistent feelings of hopelessness, the two hallmark symptoms of depression.⁵ Teen girls suffer from depression at rates three times higher than teen boys: about 20% of teenage girls compared to 7% of teen boys.⁶ And that number’s only going up: rates of major depression increased by 66% in teen girls from 2005 to 2017.⁷
A depression diagnosis requires experiencing at least five of the following symptoms for at least two weeks:⁵⁵
Feeling sad isn’t the only way you can experience depression. It can also manifest as feeling “numb” or apathetic to everything, including your future or things you once liked. It might also come through as irritation, frustration, and rage in some people.
While we often think of depression when we hear “mood disorder,” there are actually several different types of mood disorders. About 28% of people with other mood disorders began experiencing symptoms in their teens.⁸ These disorders include bipolar I and II, cyclothymia, and dysthymia (also called persistent depressive disorder).
People with both types of bipolar disorder experience periods of feeling very high (mania or hypomania) and very low (depression). It might sound like fun, but mania can devastate your life. Symptoms of mania only last a few days (one to two weeks on average) and crash into depressive episodes. A manic episode might include:⁵⁶
Hypomanic episodes are similar but don’t last as long and have less severe symptoms. Hospitalization is sometimes necessary to help someone in a manic episode, particularly when putting themselves or others in danger.
Symptoms of bipolar disorder in teenagers overlap with many other common mental illnesses, so bipolar disorder can be hard to identify. If you’re worried that your mood swings are beyond normal for a teen, or if your teen’s acting recklessly in ways you’ve never experienced, don’t be afraid to reach out for help.
Anxiety disorders are a broad classification of disorders that affect how we think about the future. Excessive worry — or a strict avoidance of worry — is the hallmark symptom. One in three teenagers experience symptoms of an anxiety disorder, making this a prevalent set of mental illnesses.⁹ They occur more often in girls than boys and are more common in LGBTQ+ youth than cisgender and heterosexual youth.¹⁰ More than 80% of youth who took an anxiety screening questionnaire in 2020 reported feeling moderate to severe anxiety.¹¹
Some of the most common anxiety disorders include:⁵⁷
Generalized anxiety disorder (GAD) is what most of us think of when anxiety disorders come up. People may refer to it as just “anxiety.” The disorder is characterized by overwhelming, excessive worry over a wide range of subjects (hence calling it “generalized”). You might be worried about little things like whether or not you’ll be late or if you’ve failed a test or big things like your family’s health or the world's future. Specifically, symptoms include:⁵⁷
There are a lot of physical ways that GAD might manifest. At first, it might not be evident to an outsider that a teen is struggling with anxiety; it might look instead like they’re not getting enough sleep or are just “being a teen.” Others might become withdrawn or upset when they’re not in contact with friends. The number of ways an anxiety disorder can appear in teens is as extensive as their concerns.
Panic attacks are sudden, brief periods of severe anxiety lasting no more than thirty minutes or so. They can be triggered by something (like an upcoming presentation) or for no reason. Women are twice as likely to have panic attacks, and they tend to start in the teenage years (or earlier).¹² Some symptoms of panic attacks include:⁵⁷
Some people report that panic attacks feel like they’re having a heart attack or dying. Panic attacks and anxiety-related issues make up 1% of all trips to the emergency room.¹³ While they feel uncomfortable, panic attacks will pass. They won’t last forever, and most of the severe symptoms dissipate within about 5-10 minutes.
Anxiety works — and worsens — through cyclic avoidance. In teens, this might look like school avoidance. Skipping school or staying home because of physical anxiety symptoms can alleviate some anxiety, which makes the idea of returning to school more anxiety-provoking. Over time, anxiety builds on itself, making you feel more isolated and making it harder to return to school. As difficult as it may be, performing the activity that makes you anxious and breaking the cycle is often the only way to heal.
It’s extremely common to have both depression and GAD. Studies examining both illnesses estimate that up to 86% of adolescents who have one also experience the other.¹⁴ And if you have both, you’re more likely to have worse symptoms for an extended time with a higher risk of suicide attempts.¹⁴ It’s essential to take anxiety seriously before it gets ahead of you.
ADHD isn’t a mental illness as much as it’s a neurodevelopmental disorder, but it has a wide range of impacts on teens’ lives. It’s commonly diagnosed in early childhood around the start of school, but some people — particularly young women — still go undiagnosed until later in life. 3.3 million teenagers have been diagnosed, with boys almost three times as likely to have a diagnosis.¹⁵ About half of all childhood ADHD cases persist into adulthood,⁵⁸ and young women are particularly likely to have their ADHD worsen throughout their teenage years.¹⁶
ADHD affects executive functioning, the mental skills that help us manage everyday life. The “classic” symptoms of ADHD are external manifestations of the difficulties they experience. There are three clinical subtypes, which we’ll explore below.
Hyperactive ADHD looks more like stereotypical ADHD. People with hyperactive ADHD have high energy levels that they can’t get rid of, resulting in fidgeting, inability to stay in one place for a long time, excessive talking, or struggling with patience. Impulsivity goes hand-in-hand with hyperactivity, meaning you might act without thinking or be unable to stop yourself from doing something you want.
Once separately called attention deficit disorder (ADD), inattentive ADHD is a subtype that centers around problems paying attention. It might look like daydreaming, a short attention span, procrastination (or difficulty starting tasks), or simple forgetfulness. This type of ADHD is more common in girls.
When someone experiences both hyperactivity and inattention, it’s considered combined type ADHD. This is the most common manifestation of ADHD in youth.
Eating disorders are ruthless. They have the highest death rate out of any mental illness and aren’t something to be taken lightly. One in five people with anorexia will die because of it, and one in four will attempt suicide.¹⁷ Specifically, eating disorders revolve around an unhealthy relationship to food, body dissatisfaction, and a sense of control.
About 9% of all people experience an eating disorder at some point.¹⁸ Most eating disorders start in adolescence, with 75% of anorexia cases and 83% of bulimia cases beginning before 18.¹⁹ 81% of ten-year-old children are afraid of gaining weight,²⁰ and elementary school-aged girls are made fun of most often for being overweight.²¹ So it’s easy to see how eating disorders have become so prolific.
There are three major eating disorders:⁵⁹
Anorexia nervosa is what most people think of when they think about eating disorders; it’s also statistically the most fatal. People with anorexia will go to extreme lengths to lose weight or maintain being underweight, starving themselves because of what they perceive as flaws in their bodies. To be diagnosed with anorexia, you must exhibit all three of the following symptoms:
The rate of anorexia nervosa doubled from 2006 to 2016, with a median age of onset at 14.²² There are dozens of health consequences of malnutrition from anorexia, such as:
Bulimia nervosa, on the other hand, works cyclically between binges and purges. Binges involve eating large amounts of food uncontrollably within two hours, and purges include compensatory behavior for binging, like forced vomiting, laxative abuse, over-exercising, or using diet pills. This cycle must occur at least once a week for three months for a bulimia diagnosis. Like anorexia, bulimia has serious health consequences; tooth loss, ruptured stomachs, and esophagi aren’t uncommon outcomes of bulimia, while there is a slightly lower risk of death. The rate of bulimia tripled in adolescents and young adults from 1988 to 1993.²³
Binge eating disorder (BED) is like bulimia without purging or other compensatory behaviors. Binge eating is a compulsion, different from overeating around the holidays. The severity of the disorder depends on how often binges occur, and those with BED often experience a lot of shame, disgust, and guilt around their experiences.
Suppose you don’t meet the exact requirements for anorexia or bulimia. You may binge and purge less than three times a week or have the symptoms of anorexia but a BMI over 18, like 94% of people with eating disorders.¹⁷ If that’s the case, you may receive a diagnosis of Other Specified Feeding or Eating Disorder (OSFED). Not meeting the full criteria doesn’t make a case any less severe: teens with OSFED are just as likely to be hospitalized, have extreme thoughts and behaviors, and die as those with clinically diagnosable anorexia or bulimia.²⁴ Yet, people with OSFED are significantly less likely to receive treatment.
While uncommon in teens under 15, psychosis often develops in the late teen years and early 20s. 40% of male patients with psychosis have symptoms starting before they turn 19.²⁵ This development is almost always preceded by “prodromal symptoms” or slight changes in thinking and behavior over a long period, from several weeks to several years. Researchers notice that having trouble regulating your emotions is a common prodromal experience (but also related to other mental health concerns like borderline personality disorder, bipolar disorder, autism, and more).²⁶
Five major symptoms define an active psychotic state (two of which are necessary for a diagnosis).
Hallucinations are experiences of physical sensations (from the five senses) that are not based in reality. They are often more subtle than the “seeing a giant dragon breathing fire in the living room” stereotype of hallucinations. Instead, a hallucination might look like a shadow in the corner of your eye that you can’t look at straight-on, someone calling your name when you’re alone, or feeling like there’s something on your hands that isn’t there.
Delusions go hand-in-hand with paranoia and are strongly held beliefs about reality that are clearly false. There are many kinds of delusions, from believing that the CIA has bugged your house to thinking your favorite celebrity is sending subtle cues that they’re actually in love with you. These delusions often become consuming and can significantly distort how someone moves through life.
When someone has difficulty maintaining a steady stream of logic or keeping track of their thoughts, words can come out in a jumbled mess. This disorganized speech might look like responding to a question with unrelated answers, quickly shifting topics, or using an incomprehensible string of words (often called “word salad”).
Not to be confused with “doing bad things” or depression, negative symptoms in psychosis mean lacking a normal response. This symptom can present as flat affect (not responding to or expressing any emotions, good or bad), going mute, or a complete lack of motivation beyond typical teen experiences.
Severe impairments in your ability to care for yourself can be disorganized or catatonic behavior. Catatonic behavior is the complete removal of movement from daily life — often portrayed as sitting like a statue without moving or with very stilted, bizarre movements. In contrast, disorganized behavior is doing something inappropriate without acknowledging anything is wrong (like wearing shorts and a tank top in the middle of a blizzard or laughing after something terrible happened).
In teenagers, a psychotic disorder might look like a sudden, severe drop in grades, no longer caring about personal hygiene, and intense, inappropriate emotions (or a complete lack thereof). Studies have found that teens with psychotic disorders have more depressive symptoms and fewer psychotic symptoms.²⁷
There are a few different psychotic disorders, differentiated mainly by how long you experience symptoms.⁶⁰
Psychotic disorders still have a lot of social stigmas. Despite the misconceptions, people with psychosis aren’t more likely to be violent; a 2015 study found that only 12% of violent behavior nationally is associated with people experiencing psychotic symptoms.²⁸
It might be scary to think someone you love could be going through this. There are antipsychotic medications that help people keep psychotic symptoms at bay and are safe for adolescents to take; people on the right antipsychotic medication can feel total relief from symptoms. Most people who have one episode of psychosis don’t go on to develop schizophrenia, and the earlier you intervene, the better likelihood of a positive outcome.
While these issues aren’t cut-and-dry mental illnesses, they often occur alongside the top five above and are just as dangerous.
Trying various substances can be part of teen experimentation. Alcohol, nicotine, and marijuana are the three most common. By the time they’re 18:²⁹
While it’s illegal for people under 21 to drink alcohol, about 10% of all alcohol consumed in the United States is by teenagers.³⁰ In a 2019 report by the National Survey on Drug Use and Health, 16% of teens reported drinking alcohol in the last 30 days, ranging from 7% of eighth-graders to 26% of high school seniors.³¹ And while teens drink less often than adults, they drink more when they have the opportunity.
Binge drinking encompasses 90% of teen drinking. Consuming five or more drinks in one sitting can lead to more reckless behavior like drunk driving, more health risks, and a greater likelihood of developing alcohol addiction. Adults who started drinking before they were 15 are more than five times more likely to experience alcohol use disorder than people who waited to start drinking at age 21 or later.³²
Nicotine use in teens fell consistently in the early 2000s but came back with a vengeance in the late 2010s due to vapes and flavored pods. Many of these flavored pods (particularly the JUUL brand) were discontinued in 2018 because of their direct marketing to children. The market peaked right before the discontinuation at 27% of teens having vaped in the 30 days before taking a national survey.²⁹ Still, cigarette use, chewing tobacco, and other forms of nicotine consumption are rapidly decreasing in youth.
Nicotine is an incredibly addictive substance with dozens of adverse health outcomes. It’s one of the most challenging substances to quit, and nearly nine out of ten adults who smoke started as teenagers.³³ Since nicotine has so many devastating health impacts, 1 in 13 people who smoke now will die of a smoking-related illness.³⁴
Interestingly, illicit drug use by teenagers dropped sharply in 2021, even in the wake of increasing numbers in adults, thanks to the COVID-19 pandemic.³⁵ But it’s still important to stay aware of the lifelong health consequences that substance abuse can have.
With the onset of puberty, some teens may develop (or have worsening) gender dysphoria. Gender dysphoria is a deep sense of discomfort, distress, and misalignment between your gender and implicit self. It shouldn’t be confused with body dysmorphia, which is a disconnect between what you feel like your body looks like and what it is. Gender dysphoria is not a phase nor something you can learn from a friend. Some people describe gender dysphoria as feeling like they were “born in the wrong body,” exacerbated by the development of secondary sex characteristics during puberty.⁶¹
Dysphoric teens are more likely to have many other mental health crises.
Transitioning to your correct gender can almost entirely reverse these adverse outcomes. For teens, this almost exclusively looks like puberty blockers, which delay or stop natal puberty without harm. Transitioning decreased the odds of depression by 60% and suicidality by 73% compared to teens who don’t in a recent study.⁴⁰ And starting that care earlier — in teenage years rather than later in life — overwhelmingly leads to better mental health outcomes.⁴¹
Those who experience gender dysphoria are overwhelmingly transgender, though having gender dysphoria isn’t a prerequisite for being transgender. While the DSM-V still considers dysphoria a mental health condition, being transgender is not a mental illness.
While not a mental illness, self-harm is a common method of outwardly expressing one’s internalized feelings. Up to 25% of all teens are currently or have self-harmed.⁴² Since young women are most likely to experience depression, it makes sense that they’re more likely to end up in the hospital for self-harm or a suicide attempt. That number increased by almost 20% from 1999 to 2014.⁴³
Self-harm is not about “seeking attention.” It’s a coping mechanism that some use when negative feelings get too bad to handle on their own. Self-harm isn’t always a sign that someone is suicidal, though it correlates with higher levels of suicidality and more frequent suicide attempts.⁴⁴ It is, however, a sign that they are in extreme emotional distress.
People often hide self-harm from others out of embarrassment, shame, or fear of getting caught. For example, a teen might wear long sleeve shirts and full-length pants in the middle of summer. Self-harm can become a compulsive behavior that mimics patterns of addiction.
There are several different ways one might self-harm. The most common types include:⁴⁵
Suicide isn’t something to be taken lightly. In 2019, it was reported that 18.8% of high school students have seriously considered taking their own life, and 9% have attempted before. This number has increased by 57.4% since 2007 and appears only to be trending upward.⁴⁶ Attempting suicide once is the most likely risk factor that someone will try again. It’s the second leading cause of death in people under 18, and 90% of people who die by suicide have a clinically diagnosable mental illness at their time of death.⁴⁷
Non-heterosexual youth are at a high risk of suicide death, as one-quarter of 12- to 14-year-olds who die by suicide are LGBT+, despite only making up 8% of the population.⁴⁸ Their attempts are almost five times more likely to need medical treatment from poisoning, injury, or overdose.⁴⁹
Other risk factors that can increase suicidality include:
If you’re feeling suicidal, please know you are not alone. You can reach out to someone through a crisis line (text HOME to 741741 or call 1-800-273-8255) or call a friend or trusted loved one. If things feel too intense, go to your nearest emergency room.
Needing a hand with suicidal thoughts and feelings isn’t anything to be ashamed of. We’ve put together a guide with suicide prevention resources you can use to help yourself in this vulnerable moment.
There isn’t only one reason that mental illnesses happen. Instead, it comes down to a combination of things like:
Many psychiatrists and researchers are moving away from the biochemical model of mental illness. Our brain’s serotonin, dopamine, and norepinephrine levels are important parts of how we understand mental illness, but they don’t cover everything.
Teenagers have been experiencing mental illnesses at higher rates than the rest of the population for as long as we’ve recognized mental illnesses.⁵¹ Specifically, teenagers are at an increased risk of developing mental health concerns because of their unique biological makeup. Fluctuating hormones from puberty and neurodevelopmental changes make them particularly vulnerable to mental illness.
While the brain develops, new neurons connect and are disconnected, while some old, unnecessary neurons are pruned. This development helps to bring your brain to full maturation. But the brain doesn’t age at the same rate: parts of the brain that control emotions and rewards mature faster than the prefrontal cortex (which monitors decision-making, social activity, and personality). Emotional regulation, a common symptom of many mental illnesses, is also particularly slow to develop when you’re a teenager.
When your brain is great at feeling big emotions but can’t understand or make decisions about them, it’s easy to see how mental health problems begin more readily during puberty.
Nationwide, over 60% of teens struggling with a mental illness don’t receive the treatment they need, including more than two-thirds of those with severe depression.⁵² The COVID-19 pandemic only made things harder: a study revealed that 83% of teenagers with pre-existing mental health conditions said the pandemic worsened their mental health.⁵³
While individual mental health struggles have their own symptoms and precursors, there’s also a lot of overlap in behaviors. It might sometimes be challenging to tell the difference between everyday stress and a sign of poor mental health. Some things that might cue you to an underlying mental health issue include more systemic difficulties with coping, such as the following:
If things seem abnormal — especially if a teen’s behavior has changed suddenly — don’t be afraid to sit down with them and ask what’s going on.
It’s hard to hear that someone you care about is struggling. So is seeking help. Understanding both parts of this is crucial for the best possible outcome if a teen comes to you with concerns about their mental health.
If you’re helping a teen, aim to be calm when speaking to them. Remember that talking about mental health can feel sensitive and vulnerable. If the teenager suspects you might judge them, they will likely withdraw or downplay their struggles in the future.
Also, don’t be afraid to seek help for yourself throughout this process. Take a few extra moments of self-care (such as a mindfulness activity, meditation, a short walk, or hugging your pet) every day, or seek counseling or therapy alongside the teen if you feel overwhelmed. Therapists and counselors are professionals who are trained to help and will be able to help you come up with ways to support your teen while keeping yourself safe.
If you are a teen or want to help a teenage friend, identify who is safe to talk to about your concerns. Sadly, not every adult in your life is qualified or emotionally mature enough to discuss mental health issues. The last thing you want is to be shamed, belittled, or ignored after bringing up your mental health concerns. A trusted adult should be respectful of you and your experiences, non-judgemental, and considerate of your needs.
If you aren’t sure who to turn to, take an inventory of the adults you trust to support you in your life, including people such as:
Parents, guardians, step-parents, aunts, uncles, grandparents, older cousins, older siblings
Teachers, vice principals, principals, school nurses, school counselors, administrative staff
Coaches, directors, Scout leaders, religious leaders, mentors, social workers
Once you’ve determined your trusted adults, see if you can set aside some time to share your feelings or help your friend figure out how to approach them (if they ask for help). If your friend is resistant to reaching out to someone and you’re worried about their health, you can always turn to a trusted adult in your life for help.
Several common barriers to care can keep teens from getting the mental health support they need.⁵⁴
Being willing to both learn about mental health care and share that information openly is critical to fighting these barriers. Things like financial burdens aren’t something you can out-learn, but resources are available to help you get therapy at a low cost.
There are always multiple ways to pursue treatment. Depending on the presenting problems, you may benefit from therapy, medication, lifestyle changes, or a combination of these approaches. More severe mental illnesses may require psychiatric hospitalization to get things under control. If you’re looking to help a peer or friend, you can point them toward local resources or trusted adults who can help.
Parents and guardians can take a more direct charge with seeking treatment, helping your teen determine the best plan of attack, and making an appointment. Discuss this with them, no matter what plan you think will be best. Unfortunately, if they aren’t willing to seek treatment, it’s considerably less likely that the treatment will work. However, that doesn’t mean you should give up. A teenager who presents as resistant to help is often just afraid of the process or concerned that nothing will help.
If things seem unmanageable or you’re worried about acting on suicidal thoughts and feelings, don’t be afraid to go to the emergency room. Professionals will be able to help you decide on the next steps for care.
No matter what, it’s essential to remind a struggling teen of your support. You’re there to help them and listen through this challenging time. Letting them know that you’re there to listen — and doing so when they come to you — is one of the best ways for them to feel heard. If they aren’t the talking type, showing other displays of connection to remind them that you’re there will help.
Be sure to avoid judgemental language; in some cases, they may not want to receive advice (as much as you’d like to give it). Modeling open, curious, and accepting communication is the best way to foster their willingness to share their feelings with you. For example, using “I’ve noticed” statements as a way to lead into a topic rather than directly asking (“I’ve noticed you’re sleeping in lately” as opposed to “Why are you sleeping so much lately?”) is often more effective.
If you’re having trouble with your mental health, there are people around you willing and eager to listen and help you out. You aren’t a burden for reaching out. No matter what, there is always someone on your side.
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