By Arthur Buchanan
ALCOHOL AND DRUG ABUSE
In the 15-24 year age range, 50 percent of deaths (from accidents, homicides, suicides) involve alcohol or drug abuse. Drugs and alcohol also contribute to physical and sexual aggression such as assault or rape. Possible stages of teenage experience with alcohol and drugs include abstinence (non-use), experimentation, regular use (both recreational and compensatory for other problems), abuse, and dependency.
Teen use of tobacco and alcohol should be minimised because they can be ‘gateway drugs’ for other drugs (marijuana, cocaine, hallucinogens, inhalants, and heroin).
Warning signs of teenage drug or alcohol abuse may include:
a drop in school performance, a change in groups of friends, delinquent behaviour, and deterioration in family relationships.
There may also be physical signs such as red eyes, a persistent cough, and changes in eating and sleeping habits. Alcohol or drug dependency may produce blackouts, withdrawal symptoms, and further problems in functioning at home, school, or work.
Anorexia Nervosa occurs when an adolescent refuses to maintain body weight at or above a minimal normal weight for age and height. The weight loss is usually self-imposed and usually results in a weight of less than 85 percent of expected weight. The condition occurs most frequently in females, though it can occur in males too.
Physical symptoms can include:
absence of regular menstrual cycles, dry skin, low pulse rate and low blood pressure.
Behavioural changes commonly occur such as:
social withdrawal irritability moodiness, and depression.
Without treatment, this disorder can become chronic and with severe starvation, some teenagers may die.
Anxiety is the fearful anticipation of further danger or problems, accompanied by an intense unpleasant feeling (dysphoria) or physical symptoms. Anxiety is not uncommon in children and adolescents. Anxiety in children may present itself as:
Separation Anxiety Disorder: Excessive anxiety concerning separation from home or from those to whom the child is attached. The youngster may develop excessive worrying to the point of being reluctant, or refusing to go to school, being alone, or sleeping alone. Repeated nightmares and complaints of physical symptoms (such as headaches, stomach aches, nausea, or vomiting) may occur.
Generalised Anxiety Disorder: Excessive anxiety and worry about events or activities such as school. The child or adolescent has difficulty controlling worries. There may also be restlessness, fatigue, difficulty concentrating, irritability, muscle tension and sleep difficulties.
Panic Disorder: The presence of recurrent, unexpected panic attacks and persistent worries about having attacks. Panic Attack refers to the sudden onset of intense apprehension, fearfulness, or terror, often associated with feelings of impending doom. There may also be shortness of breath, palpitations, chest pain or discomfort, choking or smothering sensations, and fear of ‘going crazy’ or losing control.
Phobias: Persistent, irrational fears of a specific object, activity, or situation (such as flying, heights, animals, receiving an injection, seeing blood). These intense fears cause the child or adolescent to avoid the object, activity or situation.
ATTENTION DEFICIT/ HYPERACTIVITY DISORDER (ADHD)
ADHD is usually first diagnosed during the elementary school years. In some cases, symptoms continue into adolescence. A teenager with Attention Deficit/Hyperactivity Disorder has problems with paying attention and concentration and/or with hyperactive and impulsive behaviour. Despite good intentions, a teenager may be unable to listen well, organise work and follow directions. Cooperating in sports and games may be difficult. Acting before thinking can cause problems with parents, teachers, and friends. These teens may be restless, fidgety, and unable to sit still.
BIPOLAR DISORDER (MANIC DEPRESSION)
Bipolar Disorder is a type of mood disorder with marked changes in mood between extreme elation or happiness and severe depression. The periods of elation are termed mania. During this phase, the teenager has an expansive or irritable mood, can become hyperactive and agitated, can get by with very little or no sleep, becomes excessively involved in multiple projects and activities, and has impaired judgment.
A teenager may indulge in risk taking behaviours, such as sexual promiscuity and anti-social behaviours. Some teenagers in a manic phase may develop psychotic symptoms (grandiose delusions and hallucinations).
BULIMIA NERVOSA (BULIMIA)
Bulimia Nervosa occurs when an adolescent has repeated episodes of binge eating and purging. Binges are characterised by eating large quantities of food in a discrete period of time. The teen also has feelings of being unable to stop eating and a loss of control over the amount of food being eaten. Usually, after binge eating, they attempt to prevent weight gain by self-induced vomiting, laxative use, diuretics, enemas, medications, fasting or excessive exercise. The teen’s self-esteem is strongly affected by weight and body shape.
Serious medical problems can occur with Bulimia Nervosa (e.g. esophageal or gastric rupture, cardiac arrhythmias, kidney failure, and seizures). Other psychological problems such as depression, intense moods, and low self-esteem are common. Early diagnosis and treatment can improve outcome and decrease the risk of worsening depression, shame and harmful weight fluctuations.
Teenagers with conduct disorder have a repetitive and persistent pattern of behaviour in which they violate the rights of others, or violate norms or rules that are appropriate to their age. Their conduct is more serious than the ordinary mischief and pranks of children and adolescents.
Severe difficulties at home, in school and in the community are common, and frequently there is very early sexual activity. Self-esteem is usually low, although the adolescent may project an image of ‘toughness’. Teenagers with this disorder may also been described as ‘delinquent’ or ‘anti-social’.
Though the term ’depression’ can describe a normal human emotion, it also can refer to a psychiatric disorder. Depressive illness in children and adolescents includes a cluster of symptoms which have been present for at least two weeks.
In addition to feelings of sadness and/or irritability, a depressive illness includes several of the following indicators:
Change of appetite with either significant weight loss (when not dieting) or weight gain.
Change in sleeping patterns (such as trouble falling asleep, waking up in the middle of the night, early morning awakening, or sleeping too much).
Loss of interest in activities formerly enjoyed. Loss of energy, fatigue, feeling slowed down for no reason, (‘burned out’). Feelings of guilt and self blame for things that are not one’s fault. Inability to concentrate and indecisiveness. Feelings of hopelessness and helplessness.
Recurring thought of death and suicide, wishing to die, or attempting suicide.
Children and adolescents with depression may also have symptoms of irritability, grumpiness, and boredom. They may have vague, non-specific physical complaints (stomach aches, headaches, etc).
Learning disorders occur when the child or adolescent’s reading, maths, or writing skills are substantially below that expected for age, schooling, and level of intelligence.
Students with learning disorders may become so frustrated with their performance in school that by adolescence they may feel like failures and want to drop out of school or may develop behavioural problems.
OBSESSIVE- COMPULSIVE DISORDER (OCD)
Teenagers with OCD have obsessions or compulsions or both. An obsession refers to recurrent and persistent thoughts, impulses, or images that are intrusive and cause severe anxiety or distress. Compulsions refer to repetitive behaviours and rituals (like hand washing, hoarding, ordering, checking) or mental acts (like counting, repeating words silently, avoiding). The obsessions and compulsions also significantly interfere with the teen’s normal routine, academic functioning, usual social activities or relationships.
Physical abuse occurs when a person responsible for a child or adolescent’s welfare causes physical injury or harm to the child. Examples of abusive treatment of children include hitting with an object, kicking, burning, scalding, punching, and threatening or attacking with weapons. Children and adolescents who have been abused may suffer from depression, anxiety, low self esteem, an inability to build trusting relationships, alcohol and drug abuse, learning impairments, and conduct disorder.
POST- TRAUMATIC STRESS DISORDER (PTSD)
PTSD can occur when a teenager experiences a shocking, unexpected event that is outside the range of usual human experience. The trauma is usually so extreme that it can overwhelm their coping mechanisms and create intense feelings of fear and helplessness.
The traumatic event may be experienced by the individual directly (e.g. physical or sexual abuse, assault, rape, kidnapping, threatened death), by observation (witness of trauma to another person), or by learning about a trauma affecting a close relative or friend.
Symptoms include: Recurrent, intrusive, and distressing memories of the event.
Recurrent, distressing dreams of the event. Acting or feeling as if the traumatic event were recurring. Intense psychological distress when exposed to reminders of the traumatic event and consequent avoidance of those stimuli. Numbing of general responsiveness (detachment, estrangement from others, decreased interest in significant activities). Persistent symptoms of increased arousal (irritability, sleep disturbances, poor concentration, hyper-vigilance, anxiety).
Psychotic disorders include severe mental disorders which are characterised by extreme impairment of a person’s ability to think clearly, respond emotionally, communicate effectively, understand reality and behave appropriately. Psychotic symptoms can be seen in teenagers with a number of serious mental illnesses, such as depression, bi-polar disorder (manic-depression), schizophrenia, and with some forms of drug and alcohol abuse. Psychotic symptoms interfere with a person’s daily functioning and can be quite debilitating. Psychotic symptoms include delusions and hallucinations.
Delusion: A false, fixed, odd or unusual belief firmly held by the sufferer. The belief is not ordinarily accepted by other members of the person’s culture or subculture. There are delusions of paranoia (others are plotting against them), grandiose delusions (exaggerated ideas of one’s importance or identity), and somatic delusions (a healthy person believing that he/she has a terminal illness).
Hallucination: A sensory perception (seeing, hearing, feeling, and smelling) in the absence of an outside stimulus. For example, with auditory hallucinations, the person hears voices when there is no one talking.
A psychotic disorder characterised by severe problems with a person’s thoughts, feelings, behaviour, and use of words and language. Psychotic symptoms often include delusions and/or hallucinations. These delusions in schizophrenia are often paranoid and persecutory in nature.
Teenage sexual abuse occurs when an adolescent is used for gratification of an adult’s sexual needs or desires. Severity of sexual abuse can range from fondling to forcible rape.
Suicide is the third leading cause of death (behind accidents and homicides) for teenagers. Statistics for this region are not available, but in the US alone each year more than 5,000 teenagers commit suicide. The warning signs and risk factors associated with teen suicide include depression, previous suicide attempts, recent losses, frequent thought about death, and the use of drugs or alcohol.
A teenager planning to commit suicide may also give verbal hints such as “nothing matters”, or “I won’t be a problem for you anymore”. They may also give away favourite possessions or become suddenly cheerful after a long period of sadness.
Tourette’s Syndrome is characterised by multiple motor tics and at least one vocal tic. A tic is a sudden, rapid movement of some of the muscles in the body that occurs over and over and doesn’t serve any purpose. The location, frequency, and complexity of tics changes over time. Motor tics frequently involve the head, central body, legs, and arms.
They may result in simple movements such as eye blinking, or more complex movements such as touching and squatting. Vocal tics can include sounds such as grunts, barks, sniffs, snorts, coughs, and obscenities.
Teens with Tourette’s Syndrome often have additional problems with obsessions, compulsions, hyperactivity, distractibility, and impulsiveness.
All the problems described in the glossary are treatable and some can be prevented. In every case, the sooner a teenager gets help, the better.