08 Feb Adolescence and Mental Illness – Dr Helena Du Toit, Consultant Youth Psychiatrist, Brighton and Hove Clinic
Adolescence (Latin) means ‘to blossom and to grow’. However, this period of flux and development comes with its own challenges. It is a time of rapid physical growth, sexual maturation and in our modern society, it also coincides with rapidly increasing academic pressures. It is the time when young people develop their personality and start to find their identity within society. This involves making the shift from dependence on parents and care givers, to being independent adults with their own freedoms and responsibilities.
Although physical growth is usually complete by the age of 18, the brain is not fully developed until the age of 25. Adolescents have well developed limbic systems (where emotions are formed) and cognitively their intellect is very similar to those of adults, but the frontal circuits that control and modulate these processes are still developing – i.e. their mental engines are running at full steam, but the brakes are not yet fully functional!
Many serious and enduring mental illnesses present for the first time during adolescence. Schizophrenia, Recurrent depression and Bipolar disorder often present with a first episode during adolescence. These episodes often coincide with a period of life stress/change, which can make the condition difficult to notice, or at least to realise the full significance of its presentation. This can lead to delayed diagnosis and treatment and longer suffering for the individual and their families.
Eating disorders are quite unique in that the onset of the illness is frequently during early adolescence and the condition often goes unnoticed for many months. The illness very often affects high achieving, intelligent and perfectionistic young women; who are extremely driven (academically, socially and/or athletically). (However, the incidence in young men is increasing.) They often come across as confident and outspoken, and therefore their body image disturbance and lack of self-esteem often slip beneath the radar for a long time. The food restriction, weight loss and compulsive exercise that often accompany an eating disorder can help the young person to feel more in control of an otherwise demanding and unpredictable world, and therefore they frequently do not see their behaviour as problematic in any way. This is additionally reinforced by society’s view that being slim is desirable, and synonymous with beauty and success. For this reason, young people may be struggling for a long time and often become very unwell before the illness is picked up and they are able to access appropriate help. Added to this, we know that Anorexia Nervosa caries the highest mortality rate of any psychiatric illness. If it is not treated early, the condition frequently becomes chronic and can cause marked impairment in physical health, social and occupational functioning.
Therefore it is critical that professionals working with young people pay attention to any sudden or dramatic changes in a young person’s behaviour and give this due consideration. Do they seem sad, anxious or withdrawn a lot of the time? Have there been sudden changes in food preference or eating behaviours? Have they lost a lot of weight, or are they suddenly doing a lot more exercise? If you notice any of these changes it is important to address this with the young person, but it is equally important to ensure that you take a caring and non-judgemental approach. Eating disorders often go hand in hand with a lot of shame and guilt – both for the young person and their family. It is important that they know they are not being judged, and that help is readily available. The first port of call should be a referral to their GP or school nurse, but specialist Tier 3 CAMHS services are available nationally and provide intensive community treatment and support for families struggling with an eating disorder.
Dr Helena du Toit – Consultant Youth Psychiatrist, Brighton & Hove Clinic Specialist Eating Disorder Unit
Brighton & Hove Clinic provides specialist inpatient care and treatment for children and young people aged 12 -18 years old with an eating disorder.
Our expert multi-disciplinary team provide person-centred care that is tailored to meet the physical and medical/mental health needs of each individual. We work actively with Tier 3 community teams to facilitate shorter periods of admission and a streamlined return back to normal life.
If you would like to know more about our service or you would like make a referral, please email Beth Jerram-Adams, Referral Manager Brighton & Hove Clinic.