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Attention Deficit Hyperactivity Disorder (ADHD);

Introduction: ADHD is a common childhood problem. Teens and young adults with ADHD have a difficult time staying focused, controlling their impulses, sitting still, and often are poorly organized. The symptoms of ADHD can have an impact on every part of daily life – they can cause problems in the classroom, difficulty with school performance, struggles with friendships and relationships, and when untreated, bring a higher risk of substance use and abuse. ADHD can continue through adolescence and into adulthood – the good news is that effective treatments are available.

Prevalence and Impact: ADHD affects approximately one out of ten kids between the ages of 3 to 17 years old. It is most commonly diagnosed, in the elementary school years. It is estimated that a third of children with ADHD continue to have symptoms into adulthood. Males are more likely to have ADHD than females.

ADHD symptoms can make the teen and college years more difficult. In most circumstances a teen or young adult is expected to be able to sit still, pay attention in class, get assignments in on time, notice conversational cues and anticipate the consequences of risky or impulsive actions. Relationships with teachers, friends and family can become strained and success at school can be compromised when a teen or young adult with ADHD does not meet expectations or breaks the rules.

Compared with their peers, teens with ADHD are at greater risk for motor vehicle accidents and are more likely to receive traffic tickets for speeding, failure to obey traffic laws and reckless driving.

Signs and Symptoms: People with ADHD struggle with inattention, impulsivity, disorganization and sometimes, hyperactivity. These symptoms can be the cause of secondary difficulties such as low self-esteem, avoidance, repeated experiences with failure and social awkwardness. People diagnosed with ADHD will have several of the symptoms below present in childhood.

  • Signs of inattention include:
    • Being easily distracted and jumping from activity to activity
    • Getting quickly bored with tasks, daydreaming
    • Often making careless mistakes and lacking attention to details
    • Difficulty organizing tasks and activities
    • Often losing personal items like cell phones, books, paperwork, school supplies, etc.
    • Frequent forgetfulness in daily activities such as getting assignments done, returning texts or calls, remembering class schedule
    • Not listening or paying attention when spoken to
    • Often avoiding, disliking or being reluctant to participate in tasks that require sustained attention
    • Often failing to follow through on instructions, chores and school assignments
  • Signs of impulsivity include:
    • Acting without thinking about consequences
    • Difficulty taking turns, waiting or sharing
    • Interrupting others during conversation
    • Often blurting out an answer before a question has been fully asked
  • Signs of hyperactivity include:
    • Fidgeting and squirming, jiggling legs or tapping fingers on table
    • Often getting up from a chair when remaining seated is expected
    • Often acting restless and antsy as though driven by a nonstop internal motor
    • Often talking nonstop
    • Difficulty doing quiet tasks or activities

Types: There are three different types of ADHD:

  • Combination of inattention and hyperactivity:
    This is called ADHD, combined type and is the most common type of ADHD. People with this type of ADHD have difficulties with attention and hyperactivity, lasting at least six months
  • Inattentive Type:
    People with ADHD, inattentive type, mostly experience difficulties with attention and organization for at least six months
  • Hyperactive-Impulsive Type:
    People with ADHD, hyperactive-impulsive type, show significant symptoms of impulsivity and/or hyperactivity for at least six months

NOTE: The type of ADHD symptoms that a person deals with as a teen or young adult may not be the symptoms they had as a child – for example, it is possible to struggle with hyperactivity as a child, but then as a teenager, to find that attention and impulse control are more of a challenge.

Causes and Risk Factors: While the exact cause is not clear, ADHD tends to run in families. According to the American Academy of Child and Adolescent Psychiatry, it is likely that genetics (gender and family history) and environmental factors (such as food toxins and prenatal history) have a combined role in the cause of ADHD.

Treatment: ADHD can be treated with medication, non-medication therapy or both. A combination of therapy and medication is often the most effective treatment. A person with ADHD can also learn self-management skills that can help lessen the impact of ADHD symptoms on daily life.

Common medications to treat ADHD
There are two main types of medications used to treat ADHD – stimulant and non-stimulant. These medications affect each person differently and may help one person but not another – it is very important to see a medical practitioner for a comprehensive evaluation before taking these medications. These medications should never be taken without a prescription or without ongoing supervision by a professional. The use of any medication for ADHD with other substances should be avoided.

  • Stimulants (psychostimulants)
    These are the most commonly prescribed medications for ADHD. There are short and long-acting forms of these medications which allows for a medication schedule that fits the individual needs of a person with ADHD. Stimulants appear to boost and balance levels of brain chemicals that regulate attention and impulse control.

    • Examples of stimulant medications include: Concerta, Metadate, Ritalin, Dexedrine, Adderall, Vyvanse, methylphenidate, dextroamphetamine and lisdexamphetamine.
      • Possible side effects include stunting growth, decreased appetite and inability to sleep. These medications can make anxiety worse for people who struggle with anxiety.
      • “Drug holidays” are a useful strategy for people who do not need or want to take stimulant medication when on school vacations or on weekends. Drug holidays are also used to avoid growth stunting.
    • Psychostimulants are widely “shared” (called diversion) as an aid for studying – both for staying awake for an “all-nighter,” or to improve focus during long periods of studying. When taken without a prescription, this type of medication can cause anxiety, undesired physical side effects (racing heart) and increase the risk of ongoing misuse and abuse (addiction) in people who do not have ADHD. It is never appropriate to take medications without a prescription.
  • Non-stimulants
    • Non-stimulant medications work by altering messenger chemicals in the brain – serotonin, dopamine and norepinephrine; many of the non-stimulant medications are also used as antidepressants.
    • Names of some non-stimulant medications include: Strattera (atomoxetine), Wellbutrin (bupropion), Effexor (venlafaxine), tricyclic antidepressants such as nortriptyline, imipramine and desipramine. Two newer non-stimulant medications are Kapvay (clonidine) and Intuniv (guanfacine).
    • This class of medication for ADHD takes longer to start working than stimulants – it may take weeks before an improvement can be noticed. Drug holidays are not an option with these medications.
    • The benefit of these medications is that there is low risk for abuse and they are not associated with stunted growth during adolescent years.
    • These medications might be a good choice for people who have not had a good result while taking stimulants, for people who had undesirable side effects on stimulants or for people who have medical issues that get worse on stimulants (such as high blood pressure).

Non-Medication Therapy for ADHD
Individual talk therapy can be very helpful for teens and young adults who have ADHD. Non-medication therapy for teens and young adults with ADHD can include cognitive-behavioral therapy, social skills and life management training and academic or group support. These non-medication treatments are aimed at helping with organizational and time management skills, impulse control, relationship issues, self-monitoring and coping strategies for the pressures and challenges of adolescence and college years.

For teens and young adults in school, three very helpful non-medication therapies are:

  • Lifestyle and self-management skills
    There are many strategies to manage ADHD symptoms so that they do not have a negative impact on daily life in high school or college. Some of the skills that help compensate for the symptoms of ADHD include:

    • Staying organized with to-do lists and setting up ways to organize useful or needed information; using the same routine for storing information every time some new information needs to be filed
    • Breaking down tasks into smaller steps
    • Keeping track of thoughts and personal reminders by writing them down in a notebook or phone and learning to check those notes regularly
    • Keeping a detailed, easily modified and accessible appointment calendar and consistently checking and using it
    • Following a routine for the basic things that come up every day; keys, student ID, assignment book – all go in the same place when not in use
    • Learning about time management
    • Interpersonal skills training including work on listening to others, finding ways to improve attention during interactions with peers, learning to control impulses to blurt out comments during conversation
  • Cognitive-behavioral therapy (CBT)
    Cognitive-behavioral therapy is a practical therapy that teaches a person with ADHD concrete skills that help manage problem behaviors and helps change patterns of negative thinking that interfere with a person’s daily life. CBT can bring about positive change in two basic ways:

    • CBT helps a person learn to depend on and consistently perform new behavioral skills that compensate for inattention, impulsivity and hyperactivity.
    • CBT also addresses the negative thought patterns which are common for teens and young adults struggling with ADHD; these negative thought patterns can contribute to low self-esteem, procrastination and avoidance.
  • Support services
    There are many ways to enhance quality of life and achieve academic success while away at school. These include taking advantage of academic support (tutoring, modification of testing time, classroom modifications, etc), counseling services and support groups aimed at helping students effectively manage their experiences with ADHD.

Alcohol & Substance Use Disorders;

Introduction:

Note: this is the general label that will be used by most mental health and addiction experts for what used to be called “addiction.” We acknowledge that the word “addiction” remains a familiar and easily recognized term for the serious consequences of substance abuse.

What initially begins as social, casual or experimental use of alcohol or other substances (including illegal drugs, medication taken in a way that is not prescribed and/or cigarettes) can escalate into a substance use disorder – people don’t take that first drink, smoke the first joint, or take the first pill thinking about the possibility of a substance use disorder. Over time however, repeated substance use can lead to changes in the brain that affect impulse control and decision making – these changes in the brain end up impairing a person’s ability to make responsible decisions about substance use. What starts out as a way to party or to experiment with feeling the effects of different substances, can lead to abuse and “addiction”– what we currently call a substance use disorder.

In its most serious form, a substance use disorder causes significant impairment at school and in relationships and can have serious, sometimes life-threatening effects on a person’s physical and emotional well-being.

Substance use disorders are difficult to overcome without support and treatment. Substance use disorders (and the consequences of what people used to call addiction) can be a chronic struggle throughout a person’s life but treatment can restore emotional and physical well-being and help a person live life without substances.

Signs and Symptoms: Symptoms of substance use disorder include:

  • Strong desire for the substance
  • An inability to control or reduce use
  • Continued use despite negative consequences
  • Use of larger amounts over time
  • Development of tolerance/dependence (see below)
  • Spending a great deal of time to obtain and use substances
  • Withdrawal symptoms (feeling ill when not using the substance)

Tolerance occurs when larger and larger quantities of a substance are needed to get the same effect – it takes more to get high or to feel the desired effect of any given substance. Often, withdrawal symptoms lead to the need for more and more of a certain substance just to avoid “coming down” again. When a person develops dependence, they are not able to resist using a substance even when they want to quit; they can’t avoid excessive use when they want to cut back. Tolerance, withdrawal and dependence are signs of physical addiction and are an indication that a person has a serious substance use disorder.

Some observable behaviors (signs) that can be seen when a person has a substance use disorder:

Change in Mood

  • Sudden apathy (not caring about things)
  • Feeling down, depression, or acting excessively happy, or “up”
  • Increase in episodes of irritability and anger; hostility when confronted about substance use
  • Frequent mood changes that can’t be explained

Change in Appearance/Physical Changes

  • Weight change – gain or loss
  • Poor hygiene, lack of grooming – looking disheveled and unkempt
  • Lack of eye contact – empty stare
  • Change in the size of pupils, or reddened whites of the eyes
  • Hair and skin changes – thinning, brittle hair, poor complexion
  • Mouth sores or teeth changing color

Change in Behaviors

  • A drop in attendance and poor school performance
  • Change in sleep patterns – either sleeping too much or being unable to sleep
  • Change in appetite with sudden, unexplained weight gain or loss
  • More secretive and suspicious behaviors; increase in lying and deception
  • Change in effort to pay attention to physical appearance and poor hygiene
  • Sudden change in friends or favorite place to hang out
  • Change in motivation to do things that used to be fun or pleasurable
  • Acting silly for no reason

Change in Judgement

  • Using substances in dangerous situations such as while driving
  • Choosing to hang out with people who get in trouble or are known to use and abuse substances
  • Continued use of substances despite problems in relationships, significantly impaired activities of daily living (drop out of school, lose a job), legal consequences, or serious medical issues
  • Using illegal substances or obtaining prescriptions illegally

Change in Thinking

  • Paranoia – feeling deep distrust of things and believing things that are not true about people or circumstances
  • Thought disorder – sometimes substance use can seriously impair a person’s ability to stay in touch with reality – even the first time a drug or substance is used. This includes hallucinations (hearing, seeing or feeling things that are not there) or delusions (believing things that are not true or based in reality)
  • Strong emotional cravings for a substance that make it difficult to think about anything else
  • Confusion, disorientation – a person doesn’t know where they are or what day it is, can’t remember anything, “spaced out”
  • Impaired memory or in some cases, complete amnesia (no memory) of events just before, during or after using a substance – called a blackout

Risk factors for substance use disorders in teens and young adults:

Teens and young adults with substance use disorders are more at risk for academic and relationship difficulties, unintended accidents and injuries; teens and college students with a substance use disorder are at risk for legal problems, unplanned sexual activity and to be victims of sexual assault. The use of substances can lead to unintended death by accidental injury (especially car accidents) or overdose and by causing potentially fatal illnesses such as heart disease, HIV/AIDS and cancers. Substance use disorders affect all ages and cultural groups and cause significant pain, suffering and loss of productivity in individual lives, families and communities.

  • Family history of a substance use disorder
  • Family problems – an unstable or abusive family environment
  • Other mental health difficulties, such as anxiety, sleep disorders, depression, bipolar disorder, stress
  • Social difficulties – not feeling like they fit in with peers
  • Hanging out with a peer group where substance use is the norm
  • Poor self esteem
  • Academic failure – pressure to do better in school can influence a student’s decision to take drugs that will enhance performance

Alcoholism: Also known as Alcohol Use Disorder (AUD), alcoholism is when a person is unable to control their drinking of alcohol, has continued use of alcohol despite problems resulting from drinking, develops tolerance, drinks even when it leads to risky situations, and/or demonstrates withdrawal symptoms (such as sweating, shaking, vomiting) when they stop drinking.

Alcohol use in teens and young adults:

  • Binge drinking:
    Teens, young adults and college students are more likely to binge drink than adults. Binging is a pattern of drinking that brings a person’s blood alcohol concentration (BAC) to 0.08 grams percent or above.

    • As a rule of thumb, binge drinking is when males consume 5 or more drinks, and when women consume 4 or more drinks, in about 2 hours. It is important to remember that the effect of alcohol on a person varies with gender, weight, how much food has been eaten before drinking and even the amount of sleep a person has had.
    • According to the NIAAA, the first 6 weeks of college are a vulnerable time for binge drinking and alcohol-related consequences due to peer and social pressure
    • 90% of the alcohol consumed by people under 21 years of age is by binge drinking
    • Binge drinking brings a higher risk of alcohol poisoning
  • Alcohol poisoning:
    This occurs when a person drinks so much that the brain and vital functions of their body begin to shut down. Alcohol poisoning is an overdose of alcohol.

    • Signs and symptoms of alcohol poisoning are inability to wake up (stupor or coma), slow or irregular breathing, vomiting, seizures and cold, clammy skin that is pale or bluish in color
    • Alcohol poisoning is a medical emergency and if not treated urgently can result in death

In addition to serious injuries, medical issues and lost opportunity, the consequences of teen and college drinking include the following:

  • 4,358 young people under age 21 and 1,824 college students, ages 18-24, die each year from alcohol-related, unintentional injury due to accidents
  • Almost 700,000 college students have been assaulted by another student who has been drinking each year
  • Almost 97,000 students are victims of alcohol-related sexual assault or date rape yearly.
  • 1.2% – 1.5% of students report that they have tried to commit suicide in the past year because of drinking or drug use

Cannabis Use Disorder: Cannabis use disorder is a pattern of marijuana use that causes significant impairment and distress in a person’s life. Problems seen in cannabis use disorder include:

  • Difficulty in cutting back or stopping the use of marijuana even when a person wants to
  • Urges and cravings when not “high”
  • Continued use despite family, social, legal, medical or academic consequences
  • Symptoms of tolerance and/or dependence and/or withdrawal (see card #2 “Signs and Symptoms”)

Cannabis use in teens and young adults:

  • In 2014, a national survey showed that “daily or near daily” marijuana use was reported by approximately 6% of college students. It was the first time that daily marijuana use by college students surpassed daily cigarette smoking.
  • The belief that marijuana is a safe drug is growing among teens and young adults. This may be due to more open public discussions about medical marijuana and its legal status in many states. In addition, some teens believe marijuana cannot be harmful because it is “natural.”
  • Synthetic marijuana (K2, Spice)
    This is a “designer drug” made up of leafy materials (herbs, incense, etc.) that are sprayed with a chemical that is supposed to imitate the effects of THC which is the ingredient that gives the “high” in naturally-grown marijuana.

    • The sale of synthetic marijuana was banned in 2012. In the same year, 11% of high school seniors reported using synthetic marijuana in the past year
    • Synthetic marijuana has the reputation of being safe, non-toxic and non-addictive. This is absolutely not true
  • Medical marijuana
    Active chemicals from the marijuana plant can help people with certain diseases, pain syndromes or nausea during chemotherapy (treatment for cancer). In states where it is legal, teens and young adults who carry a medical marijuana card are able to obtain marijuana from a legal, reliable source. Though this form of marijuana is intended for medical therapies, it is not completely without health risks or side effects and not appropriate or safe for recreational use.

Hallucinogen Use Disorder:

Hallucinogen use disorder is a pattern of use of hallucinogenic drugs that causes significant impairment and distress in person’s life in a 12 month period. Hallucinogens are illegal substances that are either chemically-synthesized (as with LSD, PCP or ecstasy) or may occur naturally (such as psilocybin mushrooms and peyote). The effects of these drugs include hallucinations (seeing, hearing and feeling things that are not there), feelings of detachment, and distortions in time and perception. First time use of hallucinogens has remained relatively steady for the past decade.

  • Ecstasy (Molly, MDMA)
    Ecstasy is a synthetic “club drug” that combines the effects of stimulants and hallucinogens. Like stimulants, it brings a feeling of high energy and like hallucinogens, it brings a feeling of emotional warmth and altered senses and time perception. Ecstasy is particularly dangerous because at high doses it can alter the body’s ability to regulate temperature leading to organ failure, heart failure and death. The use of ecstasy in teens and young adults and the number of ecstasy use-related emergency room visits has increased dramatically in the past decade.
  • In rare cases hallucinogens can cause or accelerate the development of psychotic illness (losing touch with reality), heart failure and flashbacks.

Stimulant Use Disorder: Stimulant use disorder is a pattern of use of amphetamine type substances (cocaine, methamphetamine, bath salts) leading to significant impairment and distress in a person’s life for a 12-month period. Stimulants include a wide range of drugs – some stimulants have historically been used to treat medical and psychological conditions including obesity, attention deficit hyperactivity disorder and, occasionally, depression. While stimulants are safe and effective when taken as prescribed for ADHD, they must always be taken under careful medical supervision and only as prescribed. 1 in 5 college students (20 percent) report abusing prescription stimulants at least once in their lifetime.

  • Cocaine
    Cocaine is a powerful anesthetic and nervous system stimulant that is highly addictive. When first taken, it produces euphoria, high energy, mental alertness and confidence, but as the effect wears off, people experience anxiety, irritability and agitation. Regular use of cocaine causes tolerance. As a person needs more and more to feel the desired effects, they are at risk for dangerous physical reactions, overdose and death. People ages 18 – 25 are twice as likely to use cocaine compared to other adults.
  • Amphetamines
    Amphetamines (also known as “stimulants”) are a class of drugs that increase alertness, energy and can produce a feeling of euphoria. This class of drugs has several medical uses (most commonly ADHD) but also have a significant potential for abuse and addiction. Additionally, this class of drugs causes increased blood pressure and heart rate and in high doses can result in psychosis. These drugs are sometimes misused by students seeking to remain alert but evidence shows that students who use stimulants regularly in this way have lower GPA’s than those who don’t. Because they have legitimate medical use, they are sometimes sold or given to friends by people who a prescription for them. 
  • Methamphetamine
    Methamphetamine is a stimulant similar to amphetamine. It has similar effects on mood, behavior and perceptions as cocaine, but because methamphetamine lasts longer in the body, it can lead to a much longer, unpleasant withdrawal period. Chronic methamphetamine use leads to very serious behavioral changes (violence, paranoia, confusion) and long-term use leads to permanent changes in the brain.
  • Bath Salts
    Bath salts are an illegal amphetamine-like substance from the khat plant, similar to methamphetamine and ecstasy. Use of bath salts can cause serious intoxication (extreme paranoia, panic attacks, hallucinations) and life-threatening health problems (break down of muscle and kidney failure). Death from some forms of bath salts has occurred.

Opioid Use Disorder: Opioid use disorder is a problematic pattern of opioid use that leads to significant impairment and distress in most parts of a person’s life in a 12-month period. Opioids are drugs that include heroin and prescription pain-relievers: oxycodone, hydrocodone, codeine, morphine, fentanyl, Demerol, Darvon and methadone.

  • Opioids reduce pain and when taken under close supervision of a medical professional, can be relatively safe. However, they are highly addictive and when taken without medical supervision, they can lead to serious impairment in most areas of life (job, school, relationships, self-care), serious health problems and death.
  • Abuse of prescription opioids can be a “gateway” to heroin – heroin produces the same effect on the body and brain but is cheaper and easier to obtain. Nearly half the young people who inject heroin reported abusing prescription opioids before turning to heroin.
  • Heroin
    Heroin is a type of opioid that is easy to obtain, relatively inexpensive (compared to prescription opioid pain killers), brings a very quick and intense “high” which is extremely addictive and extremely destructive to the brain and body. Injecting heroin brings a higher risk of HIV/AIDS (through sharing used needles) and death by overdose. In 2014, 1,300 young people died from heroin overdose.

Opioid use/addiction has become a serious public health issue affecting urban and suburban communities, schools and college campuses, males and females and all income levels across the country. In 2014, there were approximately 19,000 deaths in the US caused by overdose of opioid pain relievers and more than 10,000 deaths from heroin overdose.

Tobacco Use Disorder: As with nearly every other substance use disorder, cigarettes are a substance that can lead to a problematic pattern of use associated with tolerance and withdrawal, physical illness (including serious, life-threatening lung, heart and circulation problems, and lung/throat/mouth cancer), and hazardous situations such as smoking in bed or distraction with driving. Nicotine is highly addictive – quitting smoking is very, very difficult.

It is illegal for people under 18 to buy or use cigarettes, e-cigarettes, hookah tobacco or cigars.

  • Dip (chewing tobacco)
    Holding an average size dip in the mouth for 30 minutes is the same as smoking 3 cigarettes. A 2 can-a-week snuff dipping habit is the same as smoking 1 ½ packs of cigarettes a day. Chronic dip use can cause mouth cancer.
  • E-cigarettes
    “Vaping” delivers nicotine and other toxic substances – the harmfulness of e-cigarette use is still not fully understood and is being studied.
  • Hookahs or water pipes
    As with cigarettes, a hookah delivers addictive nicotine when smoked. It is at least as toxic as smoking cigarettes.

Treatment: Treatment options for substance use disorders in teens and young adults includes behavioral and family therapy, medication and recovery support services. Since the impact of a substance use disorder reaches into every part of a teen or young adult’s life and affects so many others in their support system, the most effective treatment usually includes more than one approach. Once sobriety (the person has stopped using the drug for some time) has been achieved, the need for support and treatment continues.

Treatment options for teens include:

  • Behavioral therapy
    Recommended for teens because it provides interventions that actively teach ways to resist drug use, handle stressful situations, and deal with circumstances that lead to drug use.
  • Family therapy
    Since the family can be an integral part of a teen and young adult’s life, it is very helpful and usually important to include the people who would be identified as “family” in a treatment for a teen’s substance use disorder. Family and “systems” work (looking at all the people who have significant impact on a person’s life) identifies family issues and stressors, and engages an entire system in working on ways to achieve sobriety and strengthen recovery.
  • Addiction Medication
    These are medications that are effective in helping a person achieve and maintain sobriety. These medications need to be taken under close supervision of a medical professional.

    • For heroin/opioid addiction
      • Buprenorphine (Subutex), Buprenorphine + naloxone (Suboxone), methadone – these drugs act like heroin in the body but do not produce the “high” – taking these medications by mouth avoids the awful experience of withdrawal and eliminates cravings for heroin. When injected, they cause intense withdrawal symptoms.
    • Nicotine addiction
      • Nicotine patches allow a person to ingest controlled amounts of nicotine in a safer way than through cigarette smoke and also withdrawal from nicotine
      • Bupropion (an anti-depressant) diminishes cravings for tobacco
    • Alcohol
      • Antabuse (disulfiram) which causes a person to feel very sick if they drink alcohol, and naltrexone which lowers the impulse to drink
  • Recovery support
    Support for teens and young adults who are in recovery can be found in the form of groups (such as 12-step), recovery housing on a college campus or other recovery support services at school or in the community. These options are most helpful as an addition to other therapy and/or medication and can provide a supportive structure that helps a person maintain sobriety in daily life, at home or at school.

According to NIDA, adolescent drug abuse treatment is most commonly offered in outpatient settings. As much as possible and appropriate, it is desirable for a young person and their family to work to make the home environment a place where sobriety and recovery can be maintained.

Anxiety Disorders;

Introduction: Anxiety is a normal part of everyday life. For most people, anxiety is a natural reaction to stress that can help a person stay alert and focused, motivate them to action, and stimulate problem solving. Typical everyday-anxiety can be uncomfortable, but it is usually brief and resolves itself when the stressor goes away or a problem has been solved.

An anxiety disorder occurs when these feelings of nervousness, worry or fear become long-lasting, out of proportion to the situation and difficult to control. Dealing with this type of anxiety can interfere with daily life, strain relationships, and/or cause significant emotional or physical distress.

Anxiety disorders are among the most common mental disorders experienced by Americans and one of the most common mental health issues on college campuses.

Prevalence and Impact: One quarter of young people, 13- 18 will experience an anxiety disorder; nearly 6% of 13-18 year olds suffer from “severe” anxiety disorder. Anxiety is the most common concern among college students who present to a college counseling center for counseling services. Nearly 1 in 6 college student report having been diagnosed with or treated for an anxiety disorder in the previous year.

Most people who will experience an anxiety disorder develop symptoms before age 21. Women are 60% more likely than men to experience clinically significant anxiety.

Social phobia in teens and young adults can have an impact on social development (ability to form and maintain close friendships, comfort in a range of social situations), school attendance and academic performance. Some teens who experience chronic anxiety can also develop other mood disorders (such as depression) or eating disorders. Teens and college students with anxiety are at risk for using substances (alcohol, non-prescription medications, marijuana, etc.) to help them deal with their anxiety.

Signs and Symptoms: People who struggle with an anxiety disorder usually experience a combination of emotional and physical symptoms when they are feeling anxious. The extent of these symptoms varies from person to person, however the common characteristics in all anxiety disorders are:

  • A problematic level of fear, worry or fretting about a specific object or situation that is out of proportion to any actual threat;
  • along with the excessive fear and worry there is a pattern of emotional and physical responses that are very distressing and difficult to control;
  • together, these symptoms cause impairment and distress in many areas of a person’s life.

Here are some potential signs and symptoms of an anxiety disorder in teens and young adults – the duration of at least some of these symptoms would be 6 months or more*:

  • Excessive worry that is difficult to control – either about a specific object or situation, or sometimes about nothing specific at all
  • Periods of intense fear or panic – constantly feeling nervous and wary; fears of disasters or natural catastrophes
  • Sleep disturbances – can’t sleep, restless sleep, sleeping too much
  • Recurring nightmares
  • Avoidance of social situations – feeling extraordinarily shy and nervous in social settings; excessive worry about social competence or being publically embarrassed
  • Wide range of emotions from overly restrained (uptight and quiet) to overly boisterous (clowning around and hyper)
  • Difficulty concentrating in school work, more often than not, for at least 6 months
  • Repeated, unwanted thoughts or obsessions (an idea that continually preoccupies or intrudes on a person’s mind) that seriously interfere with attention to tasks at hand. For those who experience them, these thoughts typically focus on physical appearance, social acceptance, personal competence and conflicts about independence
  • Intrusive memories (frequent, repeated experience of memories that can’t be stopped or controlled) of a traumatic event
  • Physical symptoms
    • Nausea or a choking feeling
    • Rapid heart rate, pounding chest
    • Muscle tension and muscle aches, trembling
    • Sweating
    • Face flushing or blotching
    • Dizziness and feeling light-headed
    • Numbness or tingling
    • Difficulty breathing, feeling short of breath without a physical cause
    • Startling easily

Types:

Panic disorder:
A panic attack is a sudden surge of overwhelming fear that occurs without warning. The symptoms of a panic attack can peak within minutes and cause intense emotional and physical discomfort including shortness of breath, a tense feeling in the chest, sweating, an overwhelming sense of dread that something awful is going to happen, fear of death or going crazy, and/or feelings of unreality. Many people can experience a panic attack at some point in their lives and then never have another.
Panic disorder is characterized by recurring, unexpected panic attacks. For people with panic disorder, the episodes of panic can come “out of the blue” — where there is no obvious cause, reason or trigger for the panic episode – or can be triggered by a specific situation. Panic disorder is more common in girls than boys and usually begins during adolescence (between ages 15 to 19). The fear of experiencing another panic attack often causes teens and young adults to go out of their way to avoid situations that might trigger an attack and can cause them to avoid normal activities and routines.

Generalized anxiety disorder (GAD):
Generalized anxiety disorder is excessive, persistent and uncontrollable worry about a number of situations (for example, school and friends) occurring more days than not for at least 6 months. People with GAD tend to spend a lot of time imagining and ruminating (thinking repeatedly) about the worst possible outcomes of any situation; their worry frequently occurs without any reason or cause. This type of anxiety interferes with day-to-day life (school, family, friends, work, outside interests). It is always accompanied by many of the common physical symptoms of anxiety.

Phobias:
A phobia is an exaggerated or unreasonable fear of something that in reality presents little or no danger. Though phobias can center on the fear of specific objects (such as needles, spiders, germs, the dark, etc.), adolescents tend to experience phobias that center on school and social performance. Excessive worries about academic or social performance can lead a person to feel intense anxiety and distressing physical symptoms such as stomach aches, headaches, muscle tension, etc. When the excessive, exaggerated worry about school performance and social pressure causes a student to feel chronically sick, emotionally distressed and unable to attend classes, school avoidance can become a problem.

Social anxiety disorder:
Social phobia or social anxiety disorder occurs when a person experiences intense anxiety in social situations where they feel exposed to the possibility of being judged by others. A person with a social anxiety disorder will go out of their way to avoid meeting new people, having one-on-one conversations, being observed or having to perform in front of others (for example, speaking up in class or in a group). The fear caused by anticipation of or participation in social activities can cause many of the physical symptoms of anxiety.

An adolescent with social phobia tends to feel very self-conscious and full of self-doubt, feelings that cause them to avoid school and involvement in outside interests. Teens tend to deal with the anxiety associated with social phobia by either focusing excessively on their own appearance and competence or by acting over confident and boisterous. Adolescents with social phobia are at risk for using alcohol and other substances to deal with their anxieties and fears.

Causes: There is no single cause for anxiety disorders – it appears that a combination of factors contribute to their development. These disorders tend to run in families and some children are born prone to shyness or nervousness. For some people, an anxiety disorder can be linked to the experience of a stressful or traumatic event such as abuse, the death of a loved one, violence, or prolonged illness. Some anxiety disorders are a consequence of a substance use disorder or a medical condition. For other people, an anxiety disorder develops without a clear precipitating cause.

Treatment: Fortunately, anxiety disorders are manageable with a combination of interventions such as cognitive-behavioral therapy, medication and life coaching/psychoeducation. It is important to include a medical exam as part of the evaluation for an anxiety disorder so that an underlying physical cause of anxiety can be excluded. Physical causes of anxiety include illness (thyroid, diabetes), medication (psychostimulants), or diet (caffeine, sugar, etc.).

The American Academy of Child and Adolescent Psychiatry recommends CBT and psychoeducation for mild to moderate anxiety disorders; for moderate to severe anxiety symptoms, medication with CBT is recommended.

Cognitive-behavior therapy:
Cognitive behavioral therapy (CBT) is an effective treatment for adolescents and young adults who struggle with an anxiety disorder. It involves active exploration of what the person is feeling (anxiety), situations that cause or trigger the feeling, and identification of ways to cope more effectively with similar situations as they come up. CBT provides the opportunity to learn and practice concrete strategies to either avoid trigger thoughts/situations or deal with them in a more positive and productive manner.

Medication:
Prescription medications can be a very effective way to treat anxiety disorders in teens and young adults, especially when they are combined with therapy (CBT). It is very important to get a full psychiatric and medical evaluation before taking these medications and to follow up regularly with a professional once it has been determined that medication may help. It is never good to use alcohol or other substances while taking medications for an anxiety disorder.

  • Anxiety disorders are generally treated with two types of medication – anti-depressants and anti-anxiety medications (anxiolytics).
    Anti-depressants include commonly prescribed medications such as selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs) and older treatments such as tricyclics (TCAs) or monoamine oxidase inhibitors (MAOIs).
  • Tricyclics and MAOIs are not commonly used as first line medication treatment of anxiety disorders in teens or young adults.
  • SSRIs and SNRIs are the medications of choice for the treatment of anxiety disorders in teens and young adults.
  • SSRIs and SNRIs (Prozac, Paxil, Zoloft, Luvox, Celexa, Lexapro, Cymbalta, etc.) may be helpful in the treatment of anxiety disorder, social phobia, phobias and panic disorder.
  • These medications have some side effects, and should not be taken with any other substances. Side effects can include nausea, jitteriness, difficulty sleeping and nightmares. Side effects tend to be worse early in the course of treatment.
  • There is a small risk of increased suicidal thinking in people ages 18 – 24 who take these medications; regular monitoring by a professional is very important.
  • SSRIs are very effective in reducing or eliminating symptoms of anxiety and panic, however these medicines need to be taken daily and it may take several weeks to relieve symptoms.
  • Anti-anxiety medications are also known as benzodiazepines. This type of medication is usually not the first choice of medication treatment for anxiety in teens or young adults – they are addictive, can cause a person to be very drowsy and also have street value as illegal, off-prescription drugs.
    • Common benzodiazepines include Valium, Ativan, Klonopin and Xanax
    • These medications are very effective in the short-term treatment of anxiety symptoms and most bring about relief within minutes to hours; they do not provide long term relief.
    • The use of this type of medication should be reserved for young people who have no response to SSRIs or who have severe anxiety and need short term relief in addition to SSRI treatment.
  • Other medications are also known to help alleviate specific kinds of anxiety. For example, beta-blockers, which are used to treat high blood pressure, can help with performance anxiety. Beta-blockers seem to work by blocking the physical symptoms of anxiety (heart racing, chest pounding, sweaty palms) which, in turn, interrupts the vicious cycle between nervous emotions and distressing physical sensations that go with performance anxiety.

Stress Management and Psychoeducation:

  • Teens and young adults can experience stress in day-to-day life – when that stress becomes a trigger for an anxiety disorder, it can be very helpful to learn to recognize sources of stress and how to manage them.
  • Some sources of significant stress for teens and young adults are school, family issues (divorce, death, abuse, neglect, illness, finances), problems with peers, moving, and changes in their bodies as they mature.
  • There are many positive ways to manage stress including eating a good diet and getting regular exercise, relaxation and coping strategies, avoiding alcohol and drugs, building a network of support through friends and community, modifying environment to reduce or eliminate stress (keeping a dorm room organized, sticking to a schedule, etc.). Another good way to deal with stress is to make use of support services in the community or at college that help with academic stress and relieve social pressure in healthy ways.

Bipolar Disorder;

Introduction: Everyone experiences changes in mood and most people can probably think of a time when their mood went from happy or “up” to sad and “down.” It is common to have a range of moods that last for a brief time and usually pass on their own without impairing a person’s ability to maintain the activities of everyday life or cause symptoms that put a significant strain on relationships. Some people tend not to exhibit their emotions – others seem to be more emotionally expressive, exhibiting more of their ups and the downs. A person with more obvious ups and downs, but otherwise no other impairments in life, probably does not have bipolar disorder – this is more likely to be a normal variation of typical mood swings.

Bipolar disorder (also known as manic-depressive illness) is an illness characterized by distinct mood changes that are extremely distressing, can be very disruptive and are usually a marked change from the normal variations in mood that most people experience. A person with bipolar disorder has distinct episodes of mania (feeling excessively “up”) and episodes of major depression (feeling very “down”) that last longer and are clearly a change from their typical range of emotions. Mania and major depression are much more disruptive and distressing than the typical “ups” and “downs” of daily life. Bipolar disorder is a serious illness that causes extreme and enduring changes in mood, behavior, thoughts, energy level, activity and judgment.

Impact
Given the marked disruptions and personal distress that mood episodes can cause to relationships, school and participation in daily life, it is not uncommon for people struggling with bipolar disorder to have instability in nearly all areas of their lives. The impact of recurring, distressing and life altering mood disturbances throughout the teen and early adult years can significantly impact success in school, relationships with peers and progression toward independence as a young adult.

Prevalence: Bipolar disorder affects men and women with equal frequency – 2.6% of adults in the U.S. meet criteria for bipolar disorder in a given year. The prevalence of bipolar in teens approaches that of adults, 2.2% meet criteria in a given year. Bipolar disorder often develops in a person’s late teens or early adult years with at least half of all cases starting before age 25.

Nearly 80% of people with bipolar disorder contemplate suicide at some time in the course of their illness, and the lifetime risk of suicide in a person struggling with bipolar disorder is estimated to be about 15 times greater than the general population. If a person who is coping with bipolar disorder talks about suicide or thoughts of harming themselves, it is extremely important to seek help immediately.

Bipolar disorder is a serious and chronic illness; however, treatment can help a person manage symptoms, avoid impairment in their daily lives and minimize disruption of their life’s course.

Signs and Symptoms: The following are many of the signs and symptoms that will be present during a manic episode:

  • A constantly elevated, “up,” extremely hyper, irritable mood
  • Extremely talkative, much more than normal – not to be confused with being chatty – a manic person appears to be talking as though their words are under pressure, they switch topics quickly and they can’t be interrupted
  • Very distracted , poor concentration
  • Self-esteem/self-confidence is unrealistically high (inflated) – they can think they can achieve or have achieved much more than is actually true; feel like they have superhuman abilities and achievements
  • Increased goal-directed activity (such as coming up with big plans that they can’t stop thinking about) or physically agitated and moving around without purpose
  • Increased energy, restlessness, being “revved up”
  • Decreased need for sleep – getting only 3-4 hours (or less) sleep per night for days and days without feeling tired
  • Increase in risk-taking behavior – reckless driving, sexual promiscuity, spending money they don’t have (spending spree), abusing drugs
  • Thoughts are poorly organized or they feel like their thoughts are “racing” in their head
  • Poor judgement – for example, unprotected sexual intercourse, gambling or spending much more money than they actually have
  • Psychosis – thoughts or perceptions that are not based in reality such as seeing things that are not there or hearing voices

When a person has bipolar depression, most of the following signs and symptoms will be present most of the day, nearly every day:

  • Low, sad mood
  • Low self esteem
  • Poor concentration and inability to make decisions
  • Fatigue and loss of energy
  • Weight loss, loss of appetite or overeating
  • Loss of interest in most or all activities of daily living
  • Difficulty sleeping or sleeping too much
  • Thoughts of death or suicide

Definitions: Mania or manic episode
Mania (or a manic episode) is a distinct period of persistent and abnormally elevated, irritable, driven mood and persistent and abnormally increased goal-directed energy that lasts most of the day, almost every day for at least one week. In addition, while experiencing the episode of abnormally elevated mood and abnormally increased energy, a person would also show the many distressing symptoms which are a marked changed from how they usually feel or function. In all cases, when a person is struggling with mania their ability to function in their daily lives (school, home, friends, work, outside interests, self-care) can be severely impaired.

Hypomania
Hypomania is a mood state that is elevated above normal, but not as extreme as mania. In hypomania, a person may have a markedly elevated mood, not need much sleep and may be very restless with endless energy, but the mood change does not cause significant impairment. These symptoms typically last for at least 4 days. During a hypomanic episode, a person may not feel that anything is wrong — but family and friends may recognize the mood change as unusual and a shift from typical functioning.

Major Depressive Episode
A Major Depressive Episode in bipolar disorder is when a person experiences a distinct period of low mood (depression) or loss of interest in what usually gives them pleasure and many associated symptoms nearly all day, every day lasting at least 2 weeks. The symptoms of bipolar depression are a significant change from baseline functioning and cause significant distress and impairment in many parts of a person’s daily life including school, friendships, relationships with family and self-care.

Mixed state/mixed features
In some cases of bipolar disorder a person meets the diagnostic criteria for major depression but shows a mixture of symptoms that are associated with mania or hypomania and depression at the same time.

Types:

Bipolar I Disorder
Defined by manic episodes that last at least seven days or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, depressive episodes occur as well, lasting at least 2 weeks. Sometimes, the episodes of depression can be a “mixed state” – this is when a person shows a mix of symptoms that can be seen with mania or depression.

Bipolar II Disorder
Defined by a pattern of depressive episodes and hypomanic episodes, but there are no full-blown manic or mixed episodes.

Cyclothymic Disorder
When a person has numerous episodes of hypomanic symptoms and numerous episodes of depressive symptoms that last for at least 2 years. The difference between these mood swings and those that are seen in bipolar disorder (I or II) is that the symptoms in cyclothymic disorder do not meet the full criteria for hypomania or for major depressive episode.

Causes: The specific biological causes of bipolar disorder are not well understood – though there is clear evidence that the illness tends to run in families. Environmental factors such as stress, sleep disruption (for example, travel involving changing time zones can precipitate manic episodes in some people with bipolar disorder), some medications and drug or alcohol use may trigger the onset or cycling of mood episodes. A stressful event such as a death in the family, an illness, a romantic break-up or other major life event can trigger the first bipolar episode.

What else could it be?
Several other conditions can look like Bipolar Disorder:

  • Medical conditions (e.g., epilepsy or thyroid dysfunction)
  • Psychiatric illnesses that may account for the symptoms (e.g., major depressive disorder, schizophrenia or a severe personality disorder).
  • Additionally, there are a number of conditions that often co-occur with bipolar disorder, including:
    • Anxiety disorders
    • Post-traumatic stress disorder (PTSD)
    • Attention-deficit hyperactivity disorder (ADHD)
    • Substance abuse
    • Migraines

Treatment: Bipolar disorder is treated and managed in several ways – most often and most effectively with a combination of medication and therapy.

Medication
Medications play an important role in successfully managing bipolar disorder – they can reduce the number and severity of manic episodes and may prevent the occurrence of depression. Bipolar disorder can be a complex illness to diagnose, a difficult disorder to treat and it is possible that a person struggling with bipolar disorder might remain on medication for years. Therefore, it is very important to have a comprehensive psychiatric and physical evaluation before starting any medication and to be monitored regularly by a professional who is prescribing the medication.

In general, the types of medication used to treat bipolar disorder are:

  • Mood stabilizers
    • While we are not completely certain how these medicines work, they can alleviate depression, mania and stabilize mood. They can be taken alone or with other medications for treatment of bipolar disorder. People respond differently to specific mood stabilizers so it may take some “trial and error” to find out which works best. Other factors, such as a person’s medical condition, might influence which mood stabilizer can be prescribed. A response to mood stabilizers can take weeks; relapse of symptoms can occur if a person discontinues the medications without medical supervision. Examples of mood stabilizers are: Lithium, Depakote (divalproex), Tegretol (carbamazepine), Trileptal (oxcarbazepine), Lamictal (lamotrigine).
  • Atypical antipsychotics
    • Antipsychotic medications alleviate depression and stabilize mood. They alter the chemical receptors for dopamine and serotonin in the brain – each antipsychotic has a unique mode of action so their effectiveness will vary from person to person. Atypical antipsychotics can be taken alone or with other medications used for bipolar illness. Like mood stabilizers, factors such as a person’s medical conditions need to be considered before a trial of any antipsychotic medication. Though this type of medication works more quickly than mood stabilizers, the side effects are more serious and distressing (such as major weight gain, diabetes, heart problems, feeling “out of it” and confusion) and can make it very difficult to take them long term. Examples of atypical antipsychotics used for bipolar disorder are: Abilify (aripiprazole), Zyprexa (olanzapine), Seroquel (quetiapine), Risperdal (risperidone), Geodon (ziprasidone) and Latuda (lurasidone).
  • Antidepressants
    • When used in combination with a mood stabilizer or atypical antipsychotic medication, anti-depressant drugs can be helpful in the treatment of bipolar depression. Before taking this type of medication, it is important for a person to provide a detailed family and personal history of bipolar illness or manic symptoms because in rare cases, these medications can cause mania or rapid cycling (when the episodes of mania and depression repeat frequently). The types of anti-depressants most commonly used are selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs).

Psychotherapy
In conjunction with medication, therapy can be a helpful part of treatment for bipolar disorder and can provide support, education and guidance to people with bipolar disorder and their families. Some psychotherapy treatments used to treat bipolar disorder include:

  • Cognitive behavioral therapy (CBT)
    • CBT can help people with bipolar disorder learn to change harmful or negative thought patterns and behaviors. In this type of therapy, a person actively participates in developing skills to recognize distressing thought and behavior patterns; CBT interventions guide a person to learn and master concrete and effective ways to either change these negative thought and behavior patterns or learn to cope in more effective, self-preserving ways.
  • Family-focused therapy
    • Family therapy can enhance family coping strategies and help family members recognize and respond to new manic or depressive episodes early. This treatment also improves communication and problem solving within the family and enhances understanding of the ways bipolar illness can impact the entire family.
  • Interpersonal and social rhythm therapy (IPSRT)
    • IPSRT can be an effective adjunct therapy (in addition to medication) that helps people with bipolar disorder manage their daily routines (such school schedule, meals), avoid sleep deprivation, recognize situations that might disrupt their regular schedule and stay on their medication. Research has shown that keeping regular routines and stable relationships has a protective effect on recurrent mood disorders.

Obsessive-Compulsive Disorder (OCD);

Introduction: Obsessive-compulsive disorder is an unavoidable pattern of thoughts (obsessions) and/or actions (compulsions) that are very time consuming (they take more than 1 hour per day and for some people, can be nearly constant) and significantly impair most areas of a person’s life (such as school, social relationships, daily routine).  The routines of OCD differ from the normal routines of daily life (such as wanting to give everyone in the family a hug when a person leaves the house) because they are excessive, too frequent, intense, upsetting and feel unavoidable.

Obsessions are recurrent and chronic thoughts, urges or images that are intrusive and unintentional and linked to the perception that something dangerous is likely to occur. A person with obsessions can experience significant anxiety and distress because obsessions are usually unavoidable and unwanted.  Efforts to block out obsessions usually result in alternative disruptive thoughts or actions (such as performing a compulsive action to relieve the tension that an obsession causes).

Compulsions are repetitive behaviors that serve no real or useful purpose, that are very time consuming and significantly impair most areas of a person’s life. Compulsions are excessive actions that a person feels driven to perform in response to an obsession or according to a rigid set of rules or rituals. Examples of compulsions include hand washing, checking, counting and reciting words. Compulsions generally do not relieve the anxiety and distress they are intended to help and generally are not a realistic solution for relieving the obsessions that trigger them.

Prevalence and Impact:

  • OCD usually begins in adolescence or young adulthood – as many as 1 in 200 children and adolescents struggle with OCD
  • Many children and teens experience brief episodes of obsessive thinking or compulsive behavior which can go away on their own
  • OCD tends to run in families but can occur without family history
  • Some studies have shown a relationship between streptococcal bacterial infection and the development of OCD

Obsessive-compulsive disorder in teens and young adults can cause significant impairment and distress in many areas of daily life. Fears and compulsions can be so time consuming that it is difficult and/or impossible to participate in social situations and can strain family relationships. Excessive obsessions with symmetry and order or excessive urges for perfection can significantly interfere with successful completion of school work and projects. Young people with OCD are more likely to be challenged by developmental milestones (such as achieving independence) when incapacitating rituals lead to school and peer avoidance.

Signs and Symptoms:

  • Presence of obsessions and/or compulsions that are time consuming (from one hour a day to constant repetition) – this leads to long periods of time that a person needs to be alone for unexplained reasons and frequent tardiness
  • Teens with OCD tend to fear that they will become ill with germs, food contamination and/or environmental contamination (for example, will get very sick touching doorknobs)
  • Anxiety and distress; depression; sleep disturbance
  • Unrealistic fears – for example, something horrible will happen if a compulsion is not performed perfectly
  • Frequent social or situational avoidance
  • Behaviors such as hoarding (keeping lots of things that are not actually needed), constant hand washing, checking, arranging things to be in order, always trying to “make it perfect,” and looking for assurance that things have been done “just right”
  • Shame and/or embarrassment, constant questioning of oneself
  • School failure or poor performance due to obsessions/compulsions related to ordering or sequencing things, or excessive need to achieve perfection – constantly re-checking work
  • Physical impact – for example, excessive handwashing leading to skin lesions

Treatment: Most teens and young adults with OCD can be effectively treated with a combination of therapy (cognitive-behavioral therapy) and medication.  Psychoeducation is helpful for family members and friends of people who have OCD.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is an effective treatment for adolescents and young adults who struggle with OCD. It involves active participation to identify erroneous, automatic or unrealistic thoughts associated with a person’s obsessions. With CBT, a person learns to see which thoughts are obsessions and which actions are compulsions and to recognize what can trigger these behaviors and thoughts. CBT provides the opportunity to learn, practice and become competent at using new, more effective, concrete strategies to re-frame obsessional thoughts, to avoid compulsions and to be able to cope with anxiety in more productive, effective ways.

One form of CBT is called exposure and response prevention (ERP). With ERP, a person can learn to do the opposite of what OCD tells them to do. This is accomplished by helping a person with OCD face their fears in small, incremental steps (exposure) without giving in to their compulsive rituals (response prevention). People who are treated with ERP learn that their obsessions will not come true and they can get used to the fearful thoughts without acting on a compulsion.

Medication

The most commonly used medications for the treatment of OCD are anti-depressants. As with any medical treatment, people who take medication for OCD should have a complete physical examination before starting medication and treatment should be carefully supervised by a mental health clinician. It is important to remember to avoid the use other substances (alcohol, drugs) while taking psychiatric medications.

  • SSRIs are used for OCD in teens and young adults – these include Celexa, Lexapro, Prozac, Luvox, Paxil and Zoloft
  • It can take up to three months to see improvement in symptoms with SSRIs
  • Possible side effects include stomach aches, inability to sleep, nightmares, and sedation or feeling revved up
  • Use of SSRIs can help alleviate feelings of depression and anxiety that can be associated with OCD

Youth Suicide;

Suicide is the 2nd leading cause of death for teenagers and young adults so it is very important that friends and loved ones take any indications that a young person is suicidal very seriously.

Warning signs that indicate heightened risk for suicide in young people include:

  • Talking about or making plans for suicide
  • Hopelessness about the future
  • Expressing marked emotional pain or distress
  • Showing changes in behavior including:
    • Withdrawal from friends and family
    • Changes in sleep (increased or decreased)
    • Anger or hostility that seems out of character or out of context
    • Recent increased agitation

The above is adapted from an excellent resource that includes additional helpful information to help prevent youth suicide: Youth Suicide Warning Signs.

If you are concerned that a teenager you know may be experiencing suicidal thoughts, ask them about it and let them know you are worried about them. Do your best to connect them to resources as soon as possible.

If your instincts tell you that someone is in crisis and may be at risk of hurting themselves in the immediate future – strive to get them help right away:

  • Stay with them while you assist them in getting help.
  • Call 911, the campus counseling service (during the day) or campus security
  • You can also text START to 741-741 or call 1-800-273-TALK(8255) to be connected to a skilled, trained counselor at a crisis center
  • Or bring your friend or loved one to the nearest Emergency Department.
  • If someone is agitated or potentially violent, avoid putting yourself in a personally dangerous situation – call 911 rather than bringing someone to the hospital yourself.