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Three Signs Your Teen Needs Therapy

How to tell the difference between teen angst and more serious conditions.

Some kids pass through adolescence swiftly, with little turmoil. For others, puberty detonates like a time bomb; once it goes off, nothing is the same.

As a psychotherapist, I’ve sat with many brokenhearted parents as they agonize over their teen’s behavior, mystified by the metamorphose.

“She was such a happy child.”

“He was so easy.”

“She used to be so kind-hearted.”

Desperate for answers, parents often get a bad case of the "shoulds."

“I should have been stricter.”

“I should have spent more time at home.”

“I should have seen this coming.”

Or fault DNA:

“He’s just like his father.”

“The men in my family are all alcoholics.”

Depression runs in the family.”

Unfortunately, blame is a soothing balm with a short shelf life. Any relief it offers fades and discomfort returns. Blaming your kids for their behavior is another faulty solution that is guaranteed to make conflicts go from bad to worse (see How to Fight with Teenagers Without Pushing Them Away).

What’s normal teenage angst? How can you tell if your kid needs professional help?

Developmental vs. Atypical Depression in Adolescence

In “The Handbook of Child and Adolescent Group Therapy,” I identified two different kinds of adolescent depression: a developmental depression vs. atypical depression:

Developmental Depression in Adolescence

Adolescence is frequently accompanied by a grieving period triggered by a sudden awareness of the fragilities of life. As teens enter into developmental depression, they engage in disquieting meditations about death, symbolic of their loss of innocence and childhood identity. The realization of mortality, that loved ones and they themselves are vulnerable, begins to darken their outlook.

Though developmental depression causes internal unrest, it also signals a fresh chapter in a teenager’s life in which a new sense of self begins to emerge. This unrest is normal and necessary; teenagers cannot forge a cohesive sense of self without sifting through these insecurities and uncertainties. The two key issues of developmental depression—identity and separation-individuation—must be wrestled with. If not, teenagers remain mired in outdated, early childhood behaviors such as temper tantrums or bullying.

The following features of adolescent developmental depression are suggested:

  • Mood instability
  • Feelings of sadness and melancholy
  • Loss of interest in some but not all pleasurable activities
  • Social anxiety
  • Occasional fatigue, insomnia or hypersomnia
  • Infrequent suicidal or homicidal ideation without intent

Atypical Depression in Adolescence

Conditions that exacerbate developmental depression and create more serious emotional instabilities result in atypical adolescent depression. Generated by increased levels of emotional distress, atypical depression is often triggered by disruptive forces such as:

  • Undiagnosed learning disabilities
  • Illness and injury
  • Trauma
  • Social rejection
  • Parental conflicts
  • Death of a loved one
  • Financial hardship
  • Changing homes or schools

Unlike a developmental depression, in which teenagers experience tolerable levels of melancholy and mourning, atypical depression overwhelms teens with crushing despair and overpowering psychic tension. Unwelcomed feelings of rage, frustration, hopelessness, or powerlessness flare up and frequently give birth to mercurial moods, negativity, or destructive obsessions.

Adolescents experiencing atypical depression are engrossed in a psychic battle to ward off unwanted insecurities, and engage in defenses such as denial, projection, or dissociation. While these defenses are helpful and necessary, they require much psychic energy to maintain. For this reason, during atypical depression, teenagers may appear persistently fatigued, hypervigilant or exhausted.

Features of atypical adolescent depression may include:

  • Predominantly depressed or irritated mood
  • Loss of interest in activities that were once enjoyable
  • Social isolation and panic attacks
  • Persistent fatigue, insomnia or hypersomnia
  • Prolonged feelings of hopelessness and indecisiveness
  • Severe mood swings
  • Persistent suicidal or homicidal ideation

Three Signs That Your Teenager Needs Help

Sometimes it can be difficult to know whether your teenager is suffering from a developmental or atypical depression. Here are three red flags that demand attention:

1. Self-harm

If your teenager is cutting, hitting or hurting him or herself, this is a sign of unbearable emotional turmoil and psychic imbalance. Self-harming behaviors can become habit-forming and escalate over time.

2. Chronic substance abuse

Experimentation with drugs of alcohol may be all too common in adolescence, but if your kid is regularly coming home drunk or high, a serious problem is taking root. Act immediately, particularly if your family has a history of substance abuse. Teens suffering from atypical depression are far more likely to develop substance abuse problems. (See "Teen Prescription Med Abuse Skyrockets, Parents Clueless.")

3. Suicide ideation or attempts

I’m always shocked when parent don’t take threats of suicide or actual attempts seriously. They believe they can manage the situation themselves or their kid is “just being dramatic.” With teen suicide rates on the rise, particularly among girls, all attempts or threats demand professional attention.

What to do if your teen suffers from Atypical Depression

When something goes wrong with their kids, asking for help can trigger feelings of failure or shame in parents. But getting help for your child is an act of compassion, not a sign of weakness. More importantly, atypical depression, left untreated, can negatively alter the entire course of your child’s life.

In Chapter Eight of When Kids Call The Shots, I outline seven parenting crises that parents face and actions they can take to resolve them. Parents often tell me that they were surprised to discover how much support is available.

For starters, the internet offers endless opportunities to consult with professionals, such as crisis hotlines, support groups, parenting coaches, parenting classes, parenting blogs, books, and articles. Speaking with your kid’s guidance counselor is also a great way to reach out and ask for help.

Click to hear an audio sample of WHEN KIDS CALL THE SHOTS: How to Seize Control from Your Darling Bully—and Enjoy Being a Parent Again.

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