During teenage years, there will be a noticeable change in the behaviour of young people. Many mental illnesses have their onset in adolescence, including those that run a chronic course resulting in significant disability.
So what is so distinct about this age group? Adolescence is the period in life marking the transition from being a child to being an adult, and it overlaps with teenage. In other words, it is a phase where one gradually moves from being a dependant to becoming an independent person. This is the time when one’s personality starts to evolve. There is physical, social and intellectual development. This period is one of the busiest times of life; there is so much happening.
Using structural and functional MRI scans in their research on adolescents, a team of scientists in London found that strangely the brain reduces in size by a tiny proportion, losing some nerve cells during the phase. It is reported that some connections between nerve cells are eliminated by discarding some neurons, while strengthening those connections is deemed important. The brain development that is correlated with hormone-related to puberty, usually occurs at the beginning of teenage for boys and just before teenage for girls. The scientists rightly argue that there is a biological reason for what happens during the adolescent period of life.
At this age they develop curiosity to explore and experiment. They have reduced communication with parents and start spending more time with friends in school and college. They come under peer influence easily. Scientists found that there is high risk-taking behaviour, especially if they perceive motivation by peers watching them closely. However, they seem to perform well when they are not being watched by peers. There is also an urge to perform an act to stand out or do something exciting. Because the front part of the brain is evolving, that creates inhibitions to certain kinds of behaviour. There will be mood swings, and decision-making is likely to be inconsistent.
Fear of peer rejection
It is common for young people to start spending excessive amounts of time with friends, more than with family members. Very few people prefer to remain aloof or alone during this period. Peers can influence ways of thinking, although thoughts are generated in their own mind. In fact, it is the individual who has to take responsibility for their own thoughts. If they feel they are having frequent and excessive intrusive thoughts, termed automatic thoughts, then they should seek advice without delay. Being hypersensitive towards the reaction of peers is very common, but at the same time they can be hypersensitive in terms of emotional reactions towards family members. It is believed that the commonly occurring mood swings around this time can lead to conflicts about decision-making, hinder communication with family members as they easily misread the expression and body language of the family members.
Another reason for this is that their social development is still taking place and they are beginning to learn social interactions. Lots of activities occur as group activities and no one likes to be left out of a group. The person feels indirectly forced to accept an offer of alcohol or drug by peers, just to be part of a group, feeling that otherwise they will be isolated. There is the risk of using the substance weighed up against the risk of being isolated. Individuals at teenage may become extremely anxious over the prospect of being rejected, and this could lead to using substances. Thus they become vulnerable to peer influence. On the positive side, peer influence motivates the person to attend college regularly and take part in physical activities such as sports or cultural activities. It can be difficult to pick and choose. Some peer group behaviours and activities can be unpredictable.
Social development
There is a change in the social interaction patterns occurring due to changing roles. From being daughter or sibling, roles change to being a friend, college student, then employee. The individual is moving from dependency to independence during this time. The person is expected to take up new responsibilities. There will be direct or perceived family expectations that the person, after completing his or her education, could take up paid employment in the next few years. This could even create a conflict if goals that are set are not in line with expectations.
Impulse control and addiction
The urge to do an act develops through the stimulation of the limbic system, which is the area that deals with emotions, with the intention of seeking instant rewards. Therefore the acts that give instant fun to the individual through this process get reinforced. The person gets into the vicious circle of seeking immediate reward and performs acts. This can be one of the main reasons for behaviours such as smoking, and drug or alcohol use. Involvement in social media groups for prolonged lengths of time that affects daily functioning, academic performance and the ability to work towards their own goals needs early intervention. At this stage, the front region of the brain that is to do with inhibition of impulses, called the pre-frontal cortex, that is generally well-developed in humans, is slowly evolving, towards making a person’s mind mature. Teens also go with the trend of phone use, gadgets, social media use and clicking selfies. Several deaths have occurred during clicking of selfies due to risk-taking behaviour. Alcohol or drug use could persist through adulthood, and often such behaviour has its beginnings at this age.
Lots of change
There are changes in so many dimensions, that the person may struggle to adapt if not given support. There is change in physical body structure in girls and boys. Girls start to have regular monthly periods. There are hormonal changes that can lead to changes in emotions and this in turn can affect thoughts. Sexual orientation develops and a few can have excessive sexual urges. Adaptations are required to cope with the new roles of the person. Career choices may need to be made. Generally they may feel under the influence of their parents and agree with them, but may later feel it was not their own choice. Some people may struggle in their careers and manage somehow, but it can trigger anxiety and depression in some.
Body image perception
In a survey, a majority of teens reported that they needed to maintain a certain body shape and size, being influenced by magazines. Media influences the image perception of self. An individual may develop a fear of gaining weight and appear obese, may become preoccupied by intrusive impulses, urges or thoughts, which take precedence over any other activity for them for weeks and months. These conditions are Anorexia nervosa and Bulimia nervosa , one concerning eating disorders that is commonly seen in a small percentage of girls. Again these may be due to the fear of being rejected by peers, or may even have been a result of bullying for being obese in the past. Missing meals and significant reduction in quantity of food intake in order to lose weight are common. Sometimes, immediately after a round of binge-eating, to avoid the guilt, they induce vomiting to avoid gaining weight. These behaviours need early attention, so the deterioration to the extent of harm to physical health can be prevented. Even though they may be significantly and morbidly low in weight or in body mass index, they still can get intrusive thoughts of feeling obese, or there is a part of their body seen in the mirror as fat. This condition needs attention, and assessment by psychiatrists and suitable treatment must begin at the earliest.
Suicides and mental illness
Mental Illness and suicides are prevalent, and rising in this age group. As per Census in 2011, 30% of the population of India was between 10 and 24 years of age. The mental health care needs of the segment is increasing. Public health education and engaging teens are ways of early identification and prevention of breakdown, anxiety and depressive illness. Even if there is illness, with appropriate engagement and consultations with psychiatrists this can be treated.
Self-esteem and identity
At this age, individuals are searching their own identity — who they are and how they fit into the society. For some, they will not know what’s really going on with so many changes happening. They should try avoiding comparisons with their peers. They can start to set small achievable goals that they can achieve. With every small achievement, their self-esteem increases. Self-appreciation is something that needs to be emphasised in colleges. Because of low esteem they try seek attention, and they cannot cope with rejection by peers. They may slowly indulge in risk-taking behaviour, try drugs or alcohol or smoking. They need to be aware of the influence that their peers can have on them. They need to be able to weigh the pros and cons and learn to be assertive, and say “no” at times.
Coping mechanisms
Everyone tries to cope with stressful situations when face them and develop certain coping mechanisms. Mal-adaptive coping mechanisms include use of substances, self-harm, shouting, screaming, abusing or use of foul language. It is the time they need to learn adaptive coping mechanisms, which include sports, hobbies, ignoring, self-distraction, meditation, exercise, yoga and reading, and focus on higher achievement or charity work.
Cognitive behaviour therapy
Principles of cognitive behaviour therapy (CBT) involves examining one’s own thoughts, challenging own thoughts and slowly changing them to adaptive thoughts, by understanding their influence on emotions and their own behaviour. A negative thought brings about anger or sadness, which leads to a person becoming less sociable, whereas a positive thought would cheer up, leading to more socialising. Understanding their own thought patterns and working on them by keeping a diary of their own thoughts, might help.
Mindfulness
Lots of countries are reportedly trying to help adolescents learn to practise mindfulness, which is learning to experience only the present moment. This may generally work well if it is combined with a suitable meditation technique. Practising meditation regularly will give the individual good control over thoughts.
Tackling peer pressure
Remain aware of the extent of the influence. Set your own goals and focus on your disciplined routine, including with regard to sleep hygiene. Learn to be assertive. Examine your own self-esteem level and work on them. Take time to make decisions as you may have mood swings that have interfered with your decision-making. Discuss with mentors or even with your sibling or mother. You should believe in your abilities. Fear of rejection or even rejection would not be the end of the world in reality. It is just an anxiety of becoming lonely as people do fear loneliness.
There are lots of reasons for lots of things happening around adolescence. Society should focus on them. They are able to start learning as it is considered the best time to learn what can sustain for life. Educating teens regularly about their behaviours can be made a part of their curriculum. Positive changes brought about can bring them on the right track that can make their future bright, thus creating great advantage to society.
(The author is a consultant psychiatrist practising in Bengaluru. Email: drvijaysh@gmail.com )
