Country Parent blog has teamed up with Teen Mental Health, an organization led by the IWK and Dalhousie University, to bring you a series of blog posts regarding the most common mental illnesses in adolescence. The posts are authored by Vanessa Bruce Little, the Knowledge Translation Lead at TeenMentalHealth.org.
by Vanessa Bruce Little
Bipolar Disorder is often misunderstood. Although most people have the basic understanding that someone with Bipolar Disorder has sudden and intense mood swings, they often miss the more detailed nuances of the disorder or confuse the fairly typical mood swings of adolescence with something more clinical.
Here’s how to know when it might be something more than just typical adolescent emotions:
First of all, there are two types of Bipolar Disorder: Bipolar I and Bipolar II.
Bipolar I Disorder is when the person experiences periods of Mania (called Manic Episodes). Manic episodes are periods of at least one week where the person has a really elevated and potentially irritable mood, and they behave in very busy and goal-directed ways, even if they don’t seem to be accomplishing much. Someone in a Manic Episode will often:
♦ Have really high self-esteem (to the point of being conceited)
♦ Feel less need for sleep
♦ Talk more than usual
♦ Feel like their thoughts are racing OR have a train of thought that’s hard for someone else to follow
♦ Be easily distracted by irrelevant or unimportant details
♦ Be very focused on accomplishing various tasks – even if they seem to serve no purpose
♦ Engage in risky activities with serious consequences (e.g., unprotected sex, excessive shopping sprees, drug use, bad financial investments)
In Bipolar I Disorder, when the person isn’t experiencing a Manic Episode, they are either experiencing periods of Depression (called Major Depressive Episodes, which look just like the clinical disorder, Depression), periods of Hypomania (called Hypomanic Episodes, which are basically shorter (approximately 4 days) and less severe versions of Manic Episodes), or periods of completely normal mood. How often the person switches between these different episodes depends on the individual, the situation, and how effectively they’re being treated. In Bipolar II Disorder, the person experiences both Hypomanic and Major Depressive Episodes but has not experienced any Manic Episodes.
Bipolar Disorder is highly heritable, which means that biological family members of someone with Bipolar Disorder (I or II) are at increased risk for developing the disorder themselves. It typically develops in the late teens (Bipolar I Disorder) or mid-twenties (Bipolar II Disorder), and affects about 0.6 to 0.8% of the population over the course of a year. Medication can be very effective for someone with Bipolar Disorder, but they will likely need to remain on the medication indefinitely in order to manage their symptoms.
As you can see, the mood changes associated with Bipolar Disorder cause significantly more impairment than your typical adolescent mood swings. The moods/episodes themselves are much more intense and cycling between the two can be quite dramatic. If you’re concerned that your teenager may have Bipolar Disorder (especially if someone in your family has been diagnosed with Bipolar Disorder or Schizophrenia), talk to your family doctor.
Other helpful resources:
Vanessa Bruce Little is the Knowledge Translation Lead at TeenMentalHealth.org (IWK Health Centre/Dalhousie University), a role for which she relies heavily on her background in Clinical Psychology, clinical training, and experience working with youth and families with behavioural, emotional, and social issues. In addition to developing the content of many of Teen Mental Health’s resources, Vanessa also coordinates large-scale projects and supervises students from a variety of disciplines. She strongly believes that you have to communicate in a way people will “hear” and that the quality of the content is irrelevant if your audience can’t understand it.
Read the entire blog series:
by Vanessa Bruce Little
By this point, you likely know how I intend to start this post. You’ve heard it before, but the words we use matter. OCD – or Obsessive-Compulsive Disorder – is one of those terms we often hear casually thrown around to explain someone’s preference for order or cleanliness. Off-the-cuff remarks like, “Oh, I can never leave my dishes in the sink; I’m too OCD” or “I had to remake the bed – it’s just my OCD” serve to further confuse the issue by minimizing the impact of actual OCD and pathologizing completely normal behaviour. OCD is not about keeping things tidy or perfectly in order. OCD is a serious mental illness in which someone experiences obsessions that cause intense feelings of anxiety and consequently, performs rituals or behaviours (called compulsions) to help reduce that anxiety. Although sometimes these obsessions and compulsions are related to cleanliness or order –often, they are not.
So what exactly is an obsession? Obsessions are persistent, intrusive and unwanted thoughts or urges that the person feels unable to control. Someone with OCD usually knows that that their obsessions may not make sense but is not able to control them, which can cause considerable anxiety.
And what about a compulsion? Compulsions are repeated behaviours that the person performs in order to decrease the anxiety caused by the obsession. These activities vary from person to person. Some common compulsions include: counting, touching, washing, and checking. Although compulsions might make the person feel better temporarily, they can actually make their anxiety worse over time. But even if the person knows that the compulsions don’t really help, it’s very difficult to resist performing them.
In order to be considered OCD, these obsessions and compulsions need to significantly interfere with the person’s ability to live their life normally – at school, at home, at work, and in their relationships.
So why does someone develop OCD? It’s complicated and the truth is that we often don’t know – but both genetics and the environment likely play a role. In rare cases, OCD can be caused by a bacterial infection.
The good news is that OCD is treatable. Most often, a combination of medication and psychotherapy (Cognitive Behavior Therapy with Exposure and Response Prevention) will be recommended. If you’re worried that you or your teenager may have OCD, talk to your family doctor. And remember – language matters, so the next time you’re complaining about your need for a clean house, skip the OCD label and remember that liking things to be clean is totally normal.
Other helpful resources:
Vanessa Bruce Little is the Knowledge Translation Lead at TeenMentalHealth.org (IWK Health Centre/Dalhousie University), a role for which she relies heavily on her background in Clinical Psychology, clinical training, and experience working with youth and families with behavioural, emotional, and social issues. In addition to developing the content of many of Teen Mental Health’s resources, Vanessa also coordinates large-scale projects and supervises students from a variety of disciplines. She strongly believes that you have to communicate in a way people will “hear” and that the quality of the content is irrelevant if your audience can’t understand it.
Read the entire blog series:
by Vanessa Bruce Little
Although Anxiety Disorders are the most common mental illnesses experienced by Canadians, they still only affect about 12% of the population over the course of a year. With the recent upsurge of anxiety talk in the media (see HERE or HERE), however, it’s no surprise that people think we’re facing an anxiety epidemic. Contributing to this proliferation is society’s recent tendency to pathologize anything negative, equating health with happiness instead of understanding that negative emotions are an essential and important part of the human experience.
We’ve gotten in the habit of using the word anxiety whenever we want to describe normal negative emotion. It’s a stand-in for stress, for worry, for nerves, for shyness, for any number of feelings that are completely and totally normal. And by using the word anxiety in their place, we not only make these emotions feel much scarier than they need to be, but also do a disservice to people who actually have an Anxiety Disorder by trivializing their experience.
Anxiety – real anxiety – is debilitating. It’s not just discomfort. It’s a sensation of fear that is excessive, overwhelming, can be all-consuming, often runs counter to rational thought, and pervades almost every aspect of someone’s life. So how can you tell when the fear your teen is experiencing is normal and when it might be something more? Here are a few guidelines:
- Is the fear persistent over time (usually months)?
- Is the fear always present in certain situations? (e.g., Every time they encounter a particular situation and not only occasionally)
- Is the fear debilitating? Does it prevent them from functioning at school, at work, or in their relationships?
- Is the fear out of proportion to the actual threat posed by the situation? (e.g., Looking out the window from the 10th floor of a building evokes the same fear as standing on the roof ledge of a 10-storey building)
There are several types of Anxiety Disorders that we tend to see in teenagers – Social Anxiety Disorder, Panic Disorder, and Generalized Anxiety Disorder.
Separation Anxiety Disorder is more common in children. Obsessive-Compulsive Disorder and Post-traumatic Stress Disorder are no longer considered Anxiety Disorders. Keeping in mind the guidelines above, here’s what you should know:
Social Anxiety Disorder:
Intense fear or anxiety in social situations where the person could be evaluated negatively by other people (e.g., social interactions, performances, or being observed).
Panic Disorder:
Experiencing recurrent unexpected panic attacks with no obvious cause. (Note that having panic attacks does not mean you have a panic disorder). The person will fear having another panic attack and/or avoid situations from which it is hard to escape in case they have another attack. This avoidance is called Agoraphobia.
Generalized Anxiety Disorder:
Excessive fear or anxiety about a number of events or activities that is difficult to control and occurs more days than not.
Remember, just because something causes stress or fear does not mean it’s an Anxiety Disorder. Many fearful reactions are completely normal versions of the stress response. If your teenager exhibits fear that is persistent, consistent, debilitating, and out of proportion; however, talk to your family doctor about what might be going on.
Other helpful resources:
Vanessa Bruce Little
Vanessa Bruce Little is the Knowledge Translation Lead at TeenMentalHealth.org (IWK Health Centre/Dalhousie University), a role for which she relies heavily on her background in Clinical Psychology, clinical training, and experience working with youth and families with behavioural, emotional, and social issues. In addition to developing the content of many of Teen Mental Health’s resources, Vanessa also coordinates large-scale projects and supervises students from a variety of disciplines. She strongly believes that you have to communicate in a way people will “hear” and that the quality of the content is irrelevant if your audience can’t understand it.
Read the entire blog series:
by Vanessa Bruce Little
A recent UK study asked people to report on their experience of mental illness and found something quite shocking: More than 40% of people who completed the survey said they had experienced Depression – almost triple the lifetime prevalence reported by previous studies.
But does this actually mean that 40% of people in the UK have Depression? No, it doesn’t. What it does suggest is that a significant number of people are confusing normal and expected negative emotion with the mental illness of Depression (see last month’s post for more information on this). We certainly don’t doubt that the people who make up this 40% have had experiences that felt negative, demoralizing, sad, and frustrating. But were they episodes of Depression? For most people, likely not. But to know when it might be Depression, you first need to understand what Depression is.
Depression is more than just having a bad day
For someone with Depression, these feelings of sadness are pervasive. They’re not usually a reaction to a specific event (e.g., the loss of a loved one), but if they are preceded by an event, the person’s reaction is often out of proportion to what actually happened (e.g., feeling devastated and worthless after a minor disagreement with a friend). These sad and low feelings are not time-limited (e.g., feeling sad and low for just a few hours) or situation-specific (e.g., only experienced during math class). Depression is intense, persistent, and can be all consuming. It’s not something you can just “snap out of”. And Depression is not caused by “being stressed out” (see last month’s post for why feeling stress is actually a good thing!).
Symptoms of Depression can include:
- Feeling persistently depressed, sad, unhappy or something similar (sometimes this can feel like not being able to feel anything)
- Losing pleasure or interest in all or almost all activities
- Feeling worthless, hopeless, or excessively and inappropriately guilty
- Difficulty thinking, concentrating, or making decisions
- Thinking about suicide, death, or dying
- Excessive fatigue or loss of energy
- Sleeping too much or too little
- Physical slowness or, in some cases, restlessness
- Significant changes in appetite or weight
Because each person is different, Depression will look a little different in each person. However, a teenager with Depression will have a number of these symptoms at the same time (usually within a two week window) and these symptoms will be sufficiently intense and pervasive to cause problems in many different areas of their life – from family and friends to school and work to general hygiene.
If you’re worried that your teenager may be experiencing Depression, talk to them. Ask them how they’ve been feeling. Let them know that you’ve noticed that something is wrong and that you’re here to help. Don’t downplay their thoughts and emotions, but don’t dramatize them either. Do your best to listen to what they’re telling you and think before you respond. If you’re worried that it is Depression, bring your teenager to your family doctor to be assessed. In many cases, your doctor can provide initial treatment or if necessary, they can refer you to appropriate evidence-based treatment. Depression is unlikely to resolve on its own without effective treatment so the earlier you seek help, the better.
For more information on Depression, including what is known about its causes and evidence-based treatments, check out http://teenmentalhealth.org/learn/mental-disorders/depression/
NOTE: The Netflix series, “13 Reasons Why” has received considerable attention from both teenagers and the media lately. There is concern that this series may increase the risk of self-harm and suicide for vulnerable adolescents due to the way suicide is portrayed. If your children are watching this series, it’s important to have a discussion with them about how they perceive it. For information on why the series may be problematic and how to proceed, Dr. Stan Kutcher and Dr. Alexa Bagnell from the IWK Health Centre have prepared these considerations for educators that may also be helpful for you: http://teenmentalhealth.org/news-posts/responding-13-reasons-considerations-schools/
Other helpful resources:
Vanessa Bruce Little
Vanessa Bruce Little is the Knowledge Translation Lead at TeenMentalHealth.org (IWK Health Centre/Dalhousie University), a role for which she relies heavily on her background in Clinical Psychology, clinical training, and experience working with youth and families with behavioural, emotional, and social issues. In addition to developing the content of many of Teen Mental Health’s resources, Vanessa also coordinates large-scale projects and supervises students from a variety of disciplines. She strongly believes that you have to communicate in a way people will “hear” and that the quality of the content is irrelevant if your audience can’t understand it.
Previous post:
Not Everything Is A Mental Illness
by Vanessa Bruce Little
Youth today – and parents too – know far more about mental health and mental illness than past generations. Awareness campaigns, among other initiatives, have raised the profile of mental illness both in Canada and worldwide.
As a society, we often assume that awareness is a good thing – that it increases identification of people with mental illness, and consequently, allows them to access treatment and improve. Unfortunately, this is often not the case. These public service announcements (PSAs) actually seem to confuse the issue further. Rather than the people who need help seeking treatment, we’re seeing that the people seeking help are those who don’t actually need professional treatment – and that those who do need the help are actually seeking help less. In other words, the exact opposite of what these PSAs are hoping to accomplish.
Part of this issue stems from the fact that awareness without understanding can be just as harmful as no awareness at all. People know that mental illness is a problem, but not what mental illness actually is. Many of us have a very superficial understanding of Anxiety or Depression (and all mental illnesses) – and consequently, start to label any negative emotion as a potential sign of a mental illness – which is certainly not the case. As a result, kids are being labeled as having an Anxiety Disorder or Depression, when in reality, their negative emotions are not only normal but expected (e.g. a reaction to an upcoming test or the death of a family pet). A first step to understanding mental illness is understanding that not everything is a mental illness; in fact, very little is.
Negative emotions are not only normal but healthy for kids and youth to experience. We don’t want to shield kids from experiencing negative emotions because it deprives them of the opportunity to grow and develop healthy coping strategies for later life. No one lives a life without low patches – there will always be emotional ups and downs – and now is the perfect time for someone to learn how to cope with these emotions in healthy and productive ways. If a child has had every problem pushed out of their way for fear of them feeling sad or anxious, they will enter adulthood without having practiced any of the coping skills necessary to successfully navigate independent life. Allow your child experience highs and lows. Your job is to help your child learn to navigate those stressors, not to remove the stressors completely from their life or to label a normal reaction as something much more problematic and concerning.
Over the next few months, we will be sharing overviews of the most common mental illnesses in adolescence. These will be short snapshots of the illness, but more information on each disorder can be found at teenmentalhealth.org. As you read through each one, remember that most negative emotions are not a sign of a mental illness, but if you are concerned about your child, talk to your child’s doctor.
Vanessa Bruce Little
Vanessa Bruce Little is the Knowledge Translation Lead at TeenMentalHealth.org (IWK Health Centre/Dalhousie University), a role for which she relies heavily on her background in Clinical Psychology, clinical training, and experience working with youth and families with behavioural, emotional, and social issues. In addition to developing the content of many of Teen Mental Health’s resources, Vanessa also coordinates large-scale projects and supervises students from a variety of disciplines. She strongly believes that you have to communicate in a way people will “hear” and that the quality of the content is irrelevant if your audience can’t understand it.
Read the entire blog series:
Depression Is More Than Just Having A Bad Day
