Q: Many adolescents have taken to Internet forums to discuss their struggles with psychiatric disorders not ordinarily diagnosed in persons under 18 years old (eg, bipolar disorder). Do you believe there has been an actual increase in the number of adolescent psychiatric disorders, or is a heightened awareness of mental illness leading impressionable teens to “mimic” behaviors and attitudes of persons with mental illness as a way to receive attention and compassion?
A: Childhood and adolescence is characterized by periods of transition and reorganization, and the range of normal development is wide. While many youth may experience symptoms that mimic a mental disorder only a minority meet full diagnostic criteria and even a smaller percentage typically receive a professional diagnosis and treatment.
There is well-documented growth in the diagnosis of psychiatric disorders in adolescents. This is partly the result of our increased awareness and knowledge of adolescent mental health by the psychiatric community. Also, some researchers have also found that more adolescents have mental health issues than previous generations. In addition, mental health professionals are now better trained to recognize and treat psychiatric disorders in children.
Society at large has experienced a similar awareness and acceptance of mental illness in children and adolescents. Thus it has become more acceptable for these youngsters to seek treatment.
However, there continues to be significant concern about over-diagnosis and misdiagnosis of mental illness in children. Many studies have shown that the diagnosis of “bipolar” has dramatically increased in all ages, but especially among children. This finding raises many concerns. According to a 2007 study, there was a 40-fold increase in the diagnosis of bipolar disorder in children and adolescents between 1994 and 2003. By comparison, there are no studies that show an increase in the diagnosis or prevalence of borderline personality disorder in adolescents.
The modern pop culture portrayal of mental illness may play a part in teens proclaiming to have a psychiatric disorder. To some teens a “psychiatric diagnosis” may translate into “unrestricted by social conventions and unique.” This type of counterculture perception may draw some to identify with the persona of a diagnosis. This may allow troubled teens to perceive they are a part of something others are unable to understand. Having a label for their feelings makes it more understandable to them and allows them to find others with similar feelings.
People write blogs or broadcast their information as a form of self-expression to share their experiences with others and find others with similar problems. Blogs can be anonymous, which helps a lot of people share information without the fear of being identified. This is not a new phenomenon, but the potential for expression via current digital media options makes it difficult for us to fully grasp the positive and negative potential.
It would be unfair to say that those who speak about their illness by blogging or other means do not have a psychiatric diagnosis or are simply seeking attention. Ultimately, however, there is concern about people who self-diagnose and then impart advice or “information” to others.
Dr Sharma is Assistant Professor with the University of Texas Medical Branch School of Medicine, Division of Child and Adolescent Psychiatry, in Galveston.