Mental health basics 

Let’s face it, there’s a lot going on inside our brains. And most of the time, it seems like we don’t have much control over how our thoughts and feelings come and go.

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Our Author:

Kerry R. McGee, MD, FAAP

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Kerry McGee, MD, is a pediatrician with a special interest in the unique health and mental health needs of teenagers. Before she went to medical school, Dr. McGee earned a master’s degree in psychology from Washington University in St. Louis. Although she was studying research psychology and not the kind of psychology that is useful for doing counseling or therapy, she developed a strong appreciation for the many ways our minds can fool us.

After completing her medical training at the University of Virginia and Oregon Health and Science University, Dr. McGee worked in adolescent primary care at a busy urban clinic in the Midwest. There, she got to know many teenagers who did not have access to specialized mental health therapists or counselors. She thinks about those kids all the time, and hopes she was able to help make the challenges of their teenage years a little bit more manageable.

When you have a mental illness, the activity in your head starts to mess up the rest of your life

This can happen if your emotions are overwhelming. For example, you could be stuck in worry-mode for so long you don’t remember how to relax. Or you’re so full of guilt or despair that you can’t find any happiness in your life. It can happen if you feel bombarded with upsetting thoughts that just keep coming back. For example:

• You can’t stop thinking about calories, so you can’t enjoy food or meals.

• You’re always focused on ways to get back online, and that’s getting in the way of concentrating at school.

• You make up rules for yourself to block out thoughts that bother you, but that takes up all your time.

Often, teens with mental health conditions know things aren’t OK. But they don’t know what’s wrong, and they don’t know what to do about it.

Mental health conditions can sneak up on you

It can be hard to know when emotions or thoughts are normal and when they are a problem. A behavior, feeling, or thought that started out OK can grow and take on a life of its own. Many mental illnesses seem like everyday emotions that have gotten so large they’ve started getting in the way of living a normal life.

On top of that, our mental lives are complicated, and our brains can play tricks on us. It’s possible to feel like you have things under control even when you don’t. Sometimes, it takes a wake-up call from someone else to recognize when you have a mental health problem. For example:

• A friend might mention that you seem stressed out all the time.

• Your coach might ask why you’ve been missing so much practice.

• Your teachers might be concerned because you can’t focus on your classes.

Mental illnesses can seem scary, but they’re not, really

Mental illnesses are medical disorders that run in families, just like diabetes and high blood pressure. They are treated by doctors with prescriptions, the same way asthma is, as well as therapy, similar to how you might get physical therapy for a knee injury.

Having a mental illness doesn’t mean you’re broken or hopeless. But it does mean you might benefit from expert help.

As a teenager, it can be hard to know where to turn if you have concerns about mental illness. The adults you trusted for advice when you were younger can sometimes have trouble seeing your point of view. They might not like the way you live your life. They might still want to treat you like a child. And you might be worried they will misunderstand or overreact.

Take the first step by learning more. The more you know about mental health, the more you can take steps to find help if you need it. Here’s a guide to some of the most common mental health issues teenagers face.

Could you have a mental health condition?

Mental illness happens when emotions or disturbing thoughts start to control your life. Over time, the pattern of being controlled by your emotions starts to impact your life in negative ways.

All teenagers, even mentally healthy ones, have strong emotions

Having strong emotions isn’t mental illness — it’s normal. Everyone experiences times of:

• Joy

• Worry

• Sadness

• Anger

• Embarrassment

• Jealousy

All of these feelings can be powerful. Mentally healthy teens experience strong emotions and, when life needs them to move on, they do.

But being able to move on from strong emotions is really hard. For people with mental health conditions, it can feel impossible. Some folks learn strategies by going to counseling, or they learn over time through life experience. Others benefit from treatment with medications or specialized therapies.

Watch out for things that threaten to upset your life

Your life is made up of:

• School

• Family

• Job

• Community

• Relationships

It also includes activities that are important to you, like sports or arts.

If any of these things are suffering because of your moods or behaviors, then you are not doing OK. For example:

• You’re too exhausted to perform well in your sport because your worries keep you awake every night.

• You drop out of your activities because you feel empty or numb all day long.

• You’ve started doing unhealthy things because you don’t like the way you look.

The line between being OK and not being OK is crossed when your feelings, thoughts, and behaviors start to interfere with the life you want to lead.

It’s OK to not be OK

Many teenagers struggle to stay mentally healthy. In fact, about half of all teens in the U.S. deal with some kind of mental health condition.

So if you have one, you’re not alone.

People with mental health conditions often choose to keep their struggles private. And that’s OK. But one of the consequences of all the privacy is that other people with mental health conditions tend to think they’re alone.

Fighting a mental health condition is one thing. Thinking you’re the only person who has ever faced it is even worse.

What to do if you think you’re not OK

As hard as it sounds, the most effective first step is to tell someone you trust.

For serious issues, an adult is the best choice, but talking to a friend can help, too. Being connected to other people is a critical part of staying mentally healthy. Just talking through your problems can make things clearer. And if you are facing something that requires more help than your friend can give you, they can provide moral support while you contact a professional.

Asking for help doesn’t mean you have a mental health condition

There are many different mental health conditions, and it takes an expert to sort through the details of exactly who has one and who doesn’t.

It’s confusing that the names of mental illness are often used in ways that aren’t accurate. For example, lots of people say they are depressed. But the medical diagnosis of depression is complicated. Mental health professionals watch their words very carefully when they decide if someone has a mental illness.

The precise definition of every mental health condition is spelled out in a book called the Diagnostic and Statistical Manual (DSM). Although this book is written for professionals, it is useful for all of us to know that it exists.

If you think you have a mental health condition, talking to a professional counselor can help you understand what’s going on. Your problem might not be as big as you thought. And if you do have a mental health condition, a professional can help you find the treatment that will work best for you.

Having a mental health condition is OK, too

Many people misunderstand mental health conditions. They might think being “mentally ill” means you don’t, or can’t, have a normal life. But all sorts of people have mental health conditions, and people with mental health conditions lead all sorts of lives. Your mental health condition is not who you are. It is just one more part of your life.

Having a mental health condition might mean you’ll face some challenges. It can make certain parts of life more difficult. But, like any medical problem, there are experts who can help. Plenty of people have walked this same road before you. And everyone who cares about you wants you to have a full and rewarding life.

Staying mentally healthy

Just like your physical health, your mental health is affected by many factors. Some of them — like your genetics — are things you can’t change. But there are things we can all do to stay as mentally healthy as possible.

You can support your mental health every day

Staying mentally healthy is closely tied to staying physically healthy. After all, your brain is part of your body, too.

• Exercise: Getting regular exercise is a powerful way to fight back against mental health conditions. When you exercise, your brain releases hormones that naturally lift your spirits. These are the same hormones that are targeted by antidepressant medications, so getting some exercise can have a chemical effect very similar to the effects of an antidepressant. Even if you haven’t been exercising recently, it’s never too late to start.

• Sleep on a schedule: Keeping a regular sleep schedule might be more important than you realize. Your brain releases a variety of different hormones through the day and night that regulate sleep. When you don’t follow a regular schedule, these patterns can get disrupted. Lack of sleep is linked to mental health problems, but so is sleeping too much. Keep yourself on a schedule for the best effect.

• Balance work and play: Finding time to do the things you enjoy is important for everyone. Hanging out with friends, watching a movie, making art, or reading a book are all worthwhile things to do. Whatever you choose, relaxing is an important part of staying healthy. At the same time, remember that working hard and doing your best also feel great. Pay attention to your obligations, and take pride in the successes that come with meeting them.

• Watch out for social media: The people who control social media are not worried about your mental health. Although there are benefits to staying connected online, there are serious downsides, too. For one thing, the world that appears on social media isn’t real. Happiness, beauty, love, and success can all look real online, even when they’re fake — and that can bring you down. Plus, experiencing your full range of emotions in the real world will help you build resilience for facing the future.

• Connect with others: Real-life relationships with friends, classmates, coworkers, and family members are part of a healthy life. After all, we are all going through this world together. While these relationships might have their ups and downs, the connected emotions are part of what supports us through our most difficult times.

• Be OK with being human: Remember, nobody is perfect. We all have flaws, and we all make mistakes. Everyone has done things that they regret or are embarrassed about. Learning to accept, apologize, and move on is part of life. Mental health conditions are more common in people who internalize their emotions, or people who take things very personally. Practice being OK with your own mistakes. Being able to laugh at yourself is a healthy skill.

Ask for help if you need it

There are many options available to you if you are struggling with your mental health. Talking to a parent, family member, or friend is often the best place to start.

Reaching out to your usual healthcare provider can be very effective. Chances are, your healthcare provider talks to people about mental health conditions all the time. In fact, many providers use a private mental health questionnaire at every visit. They do this because mental health conditions are common, and they want to help people bring up topics that are hard to talk about.

If that doesn’t work for you, here are some other places you can turn:

• A trusted teacher or your school counselor

• Your religious or spiritual leader

• A social worker, psychologist, or therapist in your community

• A free hotline, helpline, or textline

• Online therapy websites or apps

How to help a friend in need — and look after yourself too

Sometimes, teens find themselves trying to be a therapist for a friend. Sharing our thoughts and emotions with each other is part of life and part of being a good friend. Most of the time, just the act of listening and caring is enough to help get someone through a rough patch of life.

Occasionally, though, you might be faced with a friend or family member who is facing a major mental health problem. This is a difficult position to be in, because you don’t have the training or resources to deal with a situation that could get out of control.

What you are doing right now — educating yourself about mental illness — is a solid first step. There are other things you can do as well. Be supportive and listen. Reassure your friend that you care, even though you can’t fix their problems. And keep in mind that if a person’s behavior is frightening or dangerous, especially if they are talking about dying by suicide or harming other people, you can’t help anything by keeping it a secret. Talk to a trusted adult — it can be lifesaving. Being a good friend means you’ll use your judgement to decide when more help is needed.

Remember, too, that every good therapist needs support for themselves sometimes. If you find yourself carrying an emotional burden for someone with a mental health problem, it can be overwhelming. Do what the professionals do: Talk to a mental health professional yourself.

Anxiety

Worrying is normal, but worrying that gets in the way of sleeping, working, or studying is a problem. So is worrying that keeps you from having healthy relationships, enjoying life, or striving to reach your goals. When worrying becomes overwhelming — or when it just won’t go away — it becomes a medical disorder called anxiety.

This isn’t a complete list of all the types of anxiety, but these are some of the most common anxiety disorders teens can face.

Sometimes anxiety is there all the time

Generalized anxiety disorder (or GAD) is anxiety that just won’t stop. Folks with this condition stress out about all sorts of situations or possibilities that are unrelated to each other. No matter what’s going on, it seems like there’s always something bad, dangerous, or risky on the horizon.

Sometimes anxiety just shows up in certain situations

The difference between normal anxiety that comes and goes and a mental health condition is how intense the worry is — and how much it affects your life.

Social anxiety

If worries about being around other people are holding you back, you could have social anxiety. Folks with social anxiety go out of their way to avoid being with others. They might try to avoid people-filled situations like social events, activities, or even school — and that can really cause problems.

Performance anxiety

Teens with performance anxiety, a type of social anxiety, have trouble when they need to give a speech or perform in front of an audience. Being nervous in these situations is normal. But turning your life upside down in order to avoid these things is a problem.

Phobias

A fear of a specific situation or object is a phobia. When someone has a phobia of something, they go out of their way to avoid it. If they’re forced into a situation where they have to face it, they feel intensely anxious. Common phobias involve:

• Spiders

• Dogs

• Storms

• Needles

• Heights

• Elevators

• Airplanes

Panic attacks

A panic attack is a sudden case of overwhelming fear. It starts suddenly and lasts for a few minutes. People who get panic attacks might worry they are going crazy. They might feel chest pain or have trouble breathing. Most of all, they go out of their way to avoid having another panic attack. When panic attacks happen out of nowhere, it could be because of a condition called panic disorder.

Depression

“Depressed” is a word that people throw around all the time. But are they really depressed? Depression just won’t go away, and it involves feeling:

• Hopelessness

• Emptiness

• Guilt

• Despair

Depression is different from sadness. Everyone gets sad sometimes. Sadness is often linked to something specific, like a missed chance or something that was lost. Sadness feels different from hopelessness: When you are sad, you know there will be better times ahead. A person who is depressed has trouble seeing a brighter future.

Sometimes depression is there all the time

Depression that doesn’t go away for months could be a condition called persistent depressive disorder. If you have this condition, you always feel blue. You might have low energy, tiredness, and a feeling of hopelessness. It can affect many things, like your:

• Appetite

• Sleep

• Decision-making

• Ability to concentrate

Your self-esteem might be low. The fact that your mood has been down for so long is really taking a toll on your life.

Sometimes depression comes and goes

For some people, depression seems to come in waves. In between periods of depression, you might feel just fine.

Premenstrual dysphoric disorder

Anyone who gets a monthly menstrual period could be at risk for premenstrual dysphoric disorder. In this condition, your monthly hormone cycles — the same hormone cycles that cause your period — cause a feeling of depression that lasts for a week or two. Although the episodes might be short, they can be intense.

Major depressive disorder

If you go through periods of intense depression, followed by periods of feeling normal, you could be suffering from major depressive disorder. During the times when you’re depressed, you might stop caring about everything. This can result in failing grades, lost opportunities, and destroyed relationships. Major depressive disorder is linked to substance abuse and suicide.

Bipolar disorder

People with bipolar disorder face episodes of depression that alternate with periods of high-energy activity. The depressive episodes are similar to the ones that come with major depressive disorder. The high-energy times, which are called manic episodes, are times of intense activity — and they can be just as harmful as the depressive times.

Body image disorders

It’s normal for teenagers to spend time thinking about how they look. Sometimes, though, worrying about looks can go too far.

Eating disorders

If you can’t stop thinking about food, fat, or calories, you might be dealing with an eating disorder. These disorders can make you do things that are harmful to your body because you are focused only on your weight.

Anorexia nervosa

Even when they have food around, people with anorexia nervosa eat less than they need to be healthy. If this is you, you might be worried about controlling how much you eat. You might think you have more body fat than you should, even when others say your body weight is healthy. You might think you’d be a better person if you weighed less. Keeping track of your calories or body fat might be taking over your life. People who have anorexia nervosa don't see a true version of themselves. They can become dangerously thin and suffer from malnutrition or starvation. Long-term changes to your heart, bones, and brain can all be caused by this condition.

Bulimia nervosa

Binge eating — and then trying to make up for it by vomiting or using medicines — is the main symptom of bulimia nervosa. If you have this condition, you might feel like you often lose control and eat too much food all at once. Then, you might try to get rid of the calories by vomiting, exercising, or taking medication. Most people with bulimia nervosa experience this cycle a couple times per week, and are embarrassed about it happening.

Binge eating disorder

A person with binge eating disorder occasionally loses control of themself and eats a very large amount of food all at once. The amount that they eat is much more than they need to be healthy, and they feel guilty about it afterward. The loss of control can feel scary. Sometimes, people with this condition might try a strict diet in between binge eating episodes, but those episodes happen over and over again in an unhealthy way.

Body dysmorphic disorder

If you have body dysmorphic disorder, you don’t see yourself accurately. When you look at yourself, you see an image that is distorted. You might see yourself as:

• Too thin

• Too dark

• Too pale

• Having too many pimples

• Having other physical problems

Most people with body dysmorphic disorder describe themselves as ugly or deformed.

Body dysmorphic disorder is different from an eating disorder because it doesn’t always have to do with being thin. It is also different from having low self-esteem. If you have low self-esteem, you might not like the way you look, but you can see the good with the bad. You can also take satisfaction in your ability to make changes.

Obsessive-compulsive disorder

If thoughts or urges push their way into your brain and you can’t stop them, you could be dealing with obsessive-compulsive disorder, or OCD. People with OCD are in a constant battle with images or ideas that just won’t leave them alone. Often, the thoughts are upsetting or disturbing.

Sometimes, people with OCD come up with rules that they follow, or actions that they do over and over again, to make the thoughts go away. For example, they might feel that counting their footsteps down the sidewalk will keep them from imagining getting hit by a car. They might spend hours a day trying to control their intrusive thoughts and behaviors.

Addiction

When you’re addicted to something, you can’t stop thinking about it. You want more all the time. You’re willing to do harmful, or even illegal, things to get it. And it seems like you can never get enough.

Most of the time, we think about addiction as it relates to chemicals: alcohol, nicotine, or drugs. But it’s possible to be addicted to certain behaviors, too. The common link is that your brain just keeps pushing for more.

Here are some clues to knowing you are addicted to something:

• You try to stop using it, but you keep going back.

• You feel like you need it in order to calm down.

• Using it is causing problems in your life or relationships.

• You have to steal or break the law to get it.

• Trying to get more makes you do things you don’t want to do.

• You keep wanting or needing larger amounts of it.

• Using it gives you medical problems, or you wind up in the hospital.

There are many resources available for people struggling with addiction. It is a difficult thing to fight, but it’s not impossible. Many people have succeeded. But for most people, it’s not something you can do alone.

Drugs

Being addicted to something is different from trying it for the first time. But the trouble with drugs, alcohol, and nicotine is that you never know when addiction is going to start. It can sneak up on you. And for some people, addiction can happen after just a single use.

• Prescription medications: Prescriptions come with instructions typed on the bottle, including the name of the person the medication is for. Using prescription medication in any other way is illegal and unsafe, but it still happens. When these strong medications are taken for the wrong reasons, they can end up causing an addiction.

• Alcohol, nicotine, and marijuana: Kids aren’t allowed to use alcohol or nicotine, but these chemicals are legal for people who have reached a certain age. In some states, this is also true for marijuana. Because of this, many teens feel it’s safe to use these things. But these chemicals can have dangerous effects — and they can set you up for a lifetime of struggles.

• Illegal drugs: It goes without saying that using illegal drugs is a bad idea. For one thing, they are not made or controlled by anyone who cares about keeping you safe, and the effects they have on your body can be deadly. For another, being addicted to something illegal sets you up for a cycle of risky behaviors that can send your life into a devastating spiral.

Other types of addiction

It’s possible to be addicted to things that aren’t chemicals. Behavioral addictions happen when you’re addicted to doing a certain thing, over and over again. Again, the mental health issue comes up when your behaviors are causing damage to other areas of your life.

• Gambling disorder: A person with this condition is so focused on betting games, like playing the lottery or fantasy sports, that it starts to cause big problems in their life.

• Internet gaming disorder: Although addiction to internet video games isn’t officially a mental health condition yet, experts recommend that it be added to the list. People with this condition spend so much time playing and thinking about online games that their lives end up suffering as a result.

Deliberate self-harm

Sometimes, people do things to hurt themselves. They might be minor things, like scratching at their skin or picking at a scab. Others might pull out their hair or eyelashes, or cut their skin. Some people go even further and do things that can cause serious injury.

Body-focused repetitive behaviors

Like everything else, self-harm is not all-or-nothing. For example, many people bite their nails or pick off scabs — habits that aren’t exactly good for your body. Although these sorts of behaviors usually aren’t a big deal, sometimes they do cause problems, and there are a couple of mental health conditions that fall into this category.

• Trichotillomania: People with this condition pull out their hair or eyelashes.

• Skin picking disorder: This disorder is also called dermatillomania, or excoriation disorder. It involves picking at your skin until you get scabs or scars.

• Cheek biting: People who bite or chew on the insides of their cheeks might have this disorder, which is also called morsicatio buccarum.

Nonsuicidal self-injury

Occasionally people hurt themselves on purpose in order to cause pain. This is called nonsuicidal self-injury, or NSSI, and it can be a difficult thing to understand. People who do it say the pain gives them a way to deal with stress, sadness, or other strong emotions.

NSSI is different from trying to die by suicide, because it doesn’t have anything to do with wanting to die. Instead, people with this condition are struggling to find a way to deal with life.

Suicide

Suicide means ending your own life. For some teens, suicide can seem like the best way out of a difficult situation. Suicide isn’t always caused by depression. Many different types of mental illness — including eating disorders, addiction, and others — have strong links to suicide.

When someone is suicidal, they believe things will be better if they die. Often, they don’t talk about it much to others. If someone has tried to die by suicide, there is a strong chance they could try again.

If you feel suicidal

There are times when life just seems impossible. Maybe someone is hurting you. Maybe you have to hide your true self. Or maybe you’ve done something that you feel terribly guilty about. All of these feelings can be overwhelming. It might look like there just isn’t any way forward.

If you feel like you can’t go on, reach out to another person, like a:

• Parent

• Friend

• Healthcare provider

• Counselor

• Teacher

• Religious leader

If you don’t know anyone, call or text a crisis line. There are supportive professionals out there who can help you find the way to a better future.

If your friend feels suicidal

Connection with other people is a powerful force against suicide. If your friend has told you that they’re thinking about hurting themselves, you play an important role.

Of course, if you think your friend could be in immediate danger, find a trusted adult or call a crisis hotline immediately. This is especially true if your friend has a specific plan for how or when they would die by suicide. These clues can mean they’ve been thinking about it for a long time.

Sometimes, people talk about hurting or killing themselves because they don’t think anyone realizes how much they are going through. In these cases, just listening can make a big difference. If your friend tells you something shocking, and you respond in a calm and accepting way, it can make an impossible situation feel bearable. Maybe they will begin to see that things aren’t as hopeless as they thought. Remember, you don’t have to fix your friend’s problems — just letting them share their feelings can help.

Keep in mind

Having a mental illness is private. When you talk with a professional, the things you say won’t be shared with anyone else, often including your parents. These professionals include:

• Healthcare providers

• Counselors

• Therapists

• Social workers

These privacy laws exist to protect you. You don’t have to worry about your teachers, friends, or anyone else finding out about your mental health. You can be honest and open with your healthcare and mental healthcare providers.

Of course, since no one talks about the mental health conditions they face, no one realizes how common they are. In reality, there are probably many people in your life who struggle with mental health problems. But, unless they have chosen to share their stories with you, you might be surprised to know who they are.

Although our society still has a long way to go, it makes sense for us all to stop being embarrassed about mental illness. After all, mental illnesses are medical conditions that we don’t choose to have. Staying connected to others, and to mental health experts when we need them, are the keys to managing them.