Nine Signs Your Teen Needs a Mental Health Evaluation

Adolescence – that interesting, exciting, and challenging period of life that every one of us has to go through.  Of course, some seem to stay perpetually stuck there emotionally, long after they’ve left their teen years behind.  But for most, it’s a several-years-long transition from childhood to adulthood.  The journey is often bumpy, even for the teens that seem to have things reasonably together. 

Unfortunately, though, some teens really struggle during this phase of life – beyond what would (or should) be considered normal adolescent ups and downs.   It can be hard, as a parent, to know when to take the attitude of “this, too, shall pass” versus “it’s time to seek professional help for our son / daughter”.   Sometimes there’s a significant gray area, and multiple factors need to be considered.  But more often than not, the signs are pretty clear – if you’re paying attention; that can be a challenge for parents with harried schedules and plates overflowing with obligations and responsibilities.

Since this phase of your child’s life will have a significant impact on his or her future, the sooner mental health issues are addressed, the better.  Following is a list of indicators that your teen likely needs mental health treatment – or at the very least needs an evaluation by a psychologist or other mental health professional.  If after reading through them, you’re still hesitant or unsure, at least take your teen in for an evaluation to determine whether or not treatment is necessary.

Remember, many parents tend to view their teens through at least somewhat rose-colored glasses, minimizing or turning a blind eye to serious issues.  Sadly, doing so can have very serious repercussions down the road.  Better to err on the side of caution than to ignore problems or assume things will work themselves out.  If treatment is warranted, it’s absolutely in your teen’s best interest to take that step now rather than later (or even worse, never).

1. Your teen is having problems functioning on a day to day basis.  One of the primary criterion for practically every disorder listed in the DSM (the diagnostic manual used by mental health professionals) is that the symptoms are severe enough to interfere with day to day functioning or significantly impact at least one or more major area of life (e.g. relationships, school, or work).  For example, it’s normal to occasionally feel sad or blue, but it’s not normal to self-mutilate when sad or angry, or become completely withdrawn for weeks at a time.

Signs that your teen isn’t functioning normally may include:

  • A notable drop in grades
  • Frequent absences or tardiness at school or work
  • Decrease in personal hygiene
  • Difficulties concentrating
  • Bizarre behavior
  • Low energy
  • Difficulties making decisions
  • Inability to cope with minor frustrations

Some psychiatric problems develop quickly, while others develop slowly over time.  It’s always important to note any negative changes from your teen’s prior behavior. While it may be temporary, it can also be a sign of something serious.

2. Your teen appears depressed, sad, withdrawn or “blue” much of the time, or is often tearful or irritable.  Each of these is a potential indicator of depression.  As mentioned above, feeling sad or blue from time to time is perfectly normal – it’s part of being human.  But it’s important to realize that, even with teens, an often depressed mood is not normal and needs to be addressed.

Many children and teens struggle with undiagnosed depression, suffering in silence for months or even years. Parents and other adults may mistakenly attribute an introverted, quiet demeanor to their personality rather than realizing depression is the real culprit.  With proper treatment, a formerly depressed, withdrawn teen can become surprisingly outgoing.

9 Signs Your Teen Needs a Mental Health Evaluation  It’s important to note that a significant loss (e.g. the death or loss of a friend, close relative, or beloved pet, or even a major move) can trigger profound feelings of sadness in your teen.  However, while grieving is normal, healthy, and necessary, some teens don’t cope well with loss and get stuck in their grief.  A major loss can trigger depression as well as exacerbate an existing depression.

While an episode of depression can be short-lived (e.g. a few weeks), it can also last for years – especially if left untreated.  It can also lead to other serious problems for teens, increasing their risk for suicide, substance abuse and addiction, and serious academic problems.  A drop in grades can make it difficult for them to get into college, and an ongoing or recurring battle with depression can negatively impact their performance if they do get in.

3. Your teen has intense or rapid mood swings.  Adolescent angst – it’s normal, right?  Well, yes – to some degree.  After all, teens are notorious for being moody, which is often attributed to hormonal changes and fluctuations. However, while occasional or mild moodiness may be normal, frequent intense or rapid shifts in moods shouldn’t be ignored.

Even in teens, a generally upbeat (or at least neutral) mood is a good indicator of healthy psychological functioning and emotional stability.  Significant deviations from that may be a sign of psychiatric problems, including depression, bipolar disorder, or borderline personality disorder.

Keep in mind, if your teen is using alcohol or drugs, those substances can also cause erratic or intense mood fluctuations.  Significant stress (e.g. parental separation or divorce, or a recent breakup with a boyfriend or girlfriend) can also make your teen moodier than usual.  If the mood swings are persistent, an evaluation is warranted.  Even if stress is the primary cause (as opposed to a diagnosable disorder), a skilled therapist can help your teen learn healthy coping skills that will be beneficial for years to come.  If substance abuse is the cause, early intervention is essential.

4. Your teen is frequently using alcohol or drugs (which can include prescription drugs, OTC medications, and inhalants) to cope with stress or negative emotions, or fix a problem.  It goes without saying that substance use in teens should never be taken lightly.  Teens may think it’s expected and acceptable to drink with their friends and experiment with drugs, but the consequences can be devastating.  Not only are many substances potentially addictive (leading to more serious long-term problems), they will also impair your teen’s judgment.

With regards to the need for mental health treatment, many teens start drinking or using regularly as a way to “self-medicate” psychiatric symptoms, such as anxiety or depression.  They may also turn to illicit substances to enhance athletic performance, quickly drop unwanted pounds, or stay alert while studying for exams. A few beers can quiet racing thoughts, while a friend’s ADHD medication can temporarily boost a negative mood.  Your teen may think they’re harmless enough (especially if they are “acceptable” substances, like alcohol or prescription drugs), but it’s an especially serious matter when they’re used to escape, cope, or fix a problem.  This is because every time they provide even a little relief or benefit, the desire to use them again is significantly reinforced.

If your teen has a substance abuse problem and a mental health condition, he or she would be a good candidate for what’s known as “dual diagnosis” treatment.  Treating only the substance abuse issue or only the mental health disorder will set your teen up for failure.  Treating both disorders simultaneously is the best way to ensure a positive outcome and prevent a relapse down the road.

5. Your teen is preoccupied with his or her weight or physical appearance, and / or has notable issues with eating and food in general.  Body image issues and eating disorders often emerge during adolescence.  Teens experience significant growth spurts and hormonal changes – both of which can cause problems such as acne and unwanted weight gain (as well as being too thin).  They’re also becoming keenly aware of their sexuality.  This can be particularly scary for teens with a history of sexual abuse (who may try to thwart the development of curves by starving themselves or binge eat in order to gain enough weight to be undesirable).  Other teens feel a desperate need to make themselves more attractive typically involves being thin.

Combine society’s pressure to be thin and beautiful (or muscular and athletic), poor coping skills, and a fragile self-esteem, and you’ve got the perfect recipe for an eating disorder (such as anorexia or bulimia) or  another, lesser-known disorder known as “body dysmorphic disorder” (BDD).  Eating disorders and BDD not only often go hand in hand; they can also trigger or worsen other disorders, such as depression, anxiety, and substance abuse disorders.

Eating disorders can be especially serious because they often cause significant medical health issues and, for some, permanent physical damage.  Anorexia, which is one of the most well-known eating disorders, is also one of the most deadly mental health conditions.

It’s important to note that serious body image issues and a severely dysfunctional relationship with food don’t just affect females. Adolescent males are also vulnerable to developing eating disorders as well as BDD.

6. Your teen is often anxious or fearful, struggles with obsessions or compulsions, or worries excessively.  Anxiety disorders are quite common in children and adolescents.  Problems with anxiety can develop gradually or appear suddenly.  An abrupt onset is often triggered by a traumatic incident, such as a natural disaster, a school shooting, or being the victim of a violent or sexual assault.

Problems with anxiety often include irrational fears, such as obsessing about having a serious illness or being contaminated by germs, or being terrified by something like spiders or dogs (even if it’s only a photo of a dog or the spider is securely encased in a glass terrarium).  Nightmares, nervous habits (e.g. fidgeting, nail biting) and difficulties sleeping are not uncommon in anxious teens.

Occasional fear and worry are normal.  However, when anxiety becomes constant, excessive and/or irrational, it can be paralyzing and interfere with every aspect of your teen’s life.

7.  Your teen is hostile, violent, aggressive, and / or has difficulty managing anger.  A teen who’s often angry, irritable, destructive (to self or others), violent, or hostile is a teen who needs help.  When any of these behaviors or emotions occurs – especially frequently or regularly – it’s a red flag that needs to be taken very seriously.

Angry kids often become angry – and destructive – adults.  They’re more vulnerable to accidents, substance disorders, suicide attempts, depression, and abuse or violence towards others.  They’re also going to have serious problems at school, at work, and in their relationships.

These particular behaviors and emotions may be due to a variety of factors, including substance use (e.g. steroids, alcohol, or stimulants), trauma, mood disorders, psychosis (e.g. grandiose or paranoid delusions), and personality disorders.  Even if your teen doesn’t meet the criteria for a specific disorder, therapy can help him or her learn to manage intense emotions and aggressive impulses.

8. Your teen has experienced a recent trauma.  Although not every teen needs therapy after being subjected to a traumatic event, it’s always wise to have him or her evaluated.  Traumatic events are difficult enough for adults with good coping skills and a strong support system. Teens, however, often have yet to fully, or at least sufficiently, develop the skills required to sustain them when their world is turned completely upside down by trauma.

If your teen is having flashbacks, frequent nightmares, experiencing depression or anxiety, having trouble sleeping, or avoiding people, situations, or places that remind him or her of the trauma, treatment is likely necessary.

9. Your teen is preoccupied with, is threatening or has attempted suicide.  Adolescence is one of the highest risk age groups when it comes to suicide.  One of the reasons for this is that teens tend to be very impulsive.  They also have a difficult time seeing the bigger picture and realizing that they can and will get through something that – at least in the moment – feels absolutely unbearable, such as the devastating, unexpected end of a romantic relationship.

Suicidal talk, threats, and attempts should always be taken very seriously.  Countless parents who have lost a son or daughter to suicide would be quick to say they’d give anything to go back in time and heed the signs – signs that, in retrospect (at least in their minds), should have been so obvious.

Any preoccupation with suicide and death can be a potential clue that your teen is toying with the idea of ending his or her life.  Threats are an even stronger indicator.  Although some threats are idle, don’t make the mistake of assuming that your teen is just being dramatic.  An angry or upset impulsive teen may make a serious attempt, resulting in permanent physical damage or death – even though he or she had no real intention of dying and just wanted to get your attention.

A suicide attempt – even if non-life-threatening – should always be taken very seriously.  A naïve teen may think 4 or 5 Tylenol pills or a superficial cut to the wrist are enough to cause death.  Don’t underestimate the seriousness of their actions.  Additionally, one of the greatest predictors of future suicide attempts is a history of prior attempts.

Keep in mind that suicide isn’t always due to depression.  Even when it is, the signs of depression may be subtle.  Some teens may get involved in a suicide pact with friends for various reasons.  Others may have been depressed, but once they made the decision to end their life they started feeling better. Ironically, a decision to commit suicide can be empowering and actually boost one’s mood, leaving others more baffled than ever when the person – who no longer seemed depressed – ends his or her life.

Any and all suicidal talk, threats, and behaviors warrant an evaluation by a mental health professional as soon as possible.

As a parent, you have a huge responsibility.  Teens often lack the insight and maturity to realize when they need help.  They also may mistakenly believe that what they’re experiencing is normal or that no one could possibly understand or help them.  And, of course, some teens don’t want anyone prying into their personal life.  That’s why it’s important to pay attention, keep the doors of communication open, and be ready to take action when needed.

Yes, your child may be mad at you for a while if you make him or her “see some stupid shrink”.  But wouldn’t it be far better to endure a brief  period of adolescent petulance than watch your precious child suffer for months or years with an undiagnosed, untreated mental health issue – especially one that could have been overcome or significantly alleviated and managed with proper (and early) treatment?

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