Teen mental health is on a spectrum

When are a teen’s changing relationships and heightened emotions a natural part of growing up, and when are they a sign of needing additional support? You might assume that receiving a mental health diagnosis, such as depression or anxiety, identifies a teenager’s needs and opens the door to appropriate support. But not all young people who need help receive a diagnosis, and a diagnosis isn’t always a good indicator of the kind of support they need.

Teenagers are particularly vulnerable to developing mental health problems, and over the past decades rates of these issues have risen. Around 1 in 6 adolescents experiences a mental health problem which can impact school lives, relationships, and quality of life. Unfortunately, many teens remain undiagnosed and untreated.

Getting a diagnosis

Obtaining a mental health diagnosis can be a difficult and long process. Adolescents may be reluctant to seek help because of the stigma around mental health issues. They might face financial barriers due to the cost of travelling to sites that offer support. And when they do decide to speak to a professional, waiting lists can be long.

What happens when a teen overcomes all these barriers and makes it to a clinician? Mental health professionals generally use diagnostic manuals which categorise mental health difficulties based on a set of symptoms, drawing clear distinctions between different diagnoses. For example, a clinician who suspects a teenager has generalised anxiety disorder will often assess them against the criteria for that diagnosis, but might not ask the teen about symptoms associated with depression – even though they may be experiencing them. This “taxonomic” approach is useful in providing a shared language for researchers and clinicians when discussing a teenager’s mental health problems.

“Obtaining a mental health diagnosis can be a difficult and long process.”

However, diagnostic categories do not capture the complexity of a young person’s unique experiences and needs. For example, depression can cause changes to appetite in some young people, leading them to eat more or less than usual. In others, depression may instead affect sleeping patterns, causing them to feel fatigued and interfering with concentration. Furthermore, the symptoms of mental health problems often overlap – for example, certain symptoms of depression are common in anxiety as well. What’s more, changes in sleep patterns are not unusual in adolescence, making it difficult to identify the reasons for certain symptoms. As a result, parents, teachers, and clinicians may struggle to understand the source of a young person’s problem and provide the appropriate support.

A new approach to understanding mental health problems

Instead of focusing on specific diagnoses, researchers and clinicians are starting to take a new “transdiagnostic” approach. This means shifting the focus away from symptoms of specific diagnoses, and instead seeking to identify and address the underlying factors that contribute to mental health difficulties. For example, clinicians may look for a family history of mental health problems, high levels of stress, trauma, physical illness, or family dysfunction. This perspective recognises that mental health difficulties manifest differently in each teen, and that a given person may well experience more than one mental health problem. It also encourages more individualised treatment, based not just on a diagnosis, but on open discussion about the unique experiences of each individual.

The complex changes teenagers go through can cause changes in their mood, sleep, appetite, and school performance. These changes do not necessarily signify mental health difficulties. If they persist or worsen over time, however, the young person is likely to need specialist support. When mental health is seen as a spectrum, rather than in terms of specific categories, it is easier to differentiate between normal mood fluctuations and mental health difficulties.

“When mental health is seen as a spectrum, rather than in terms of specific categories, it is easier to differentiate between normal mood fluctuations and mental health difficulties.”

Transdiagnostic mental health interventions

Recognising the benefits of this transdiagnostic approach, we have adopted it in our own work to help teens. We have developed a new mental health intervention, the ReSET programme, for teenagers who may be vulnerable to developing mental health difficulties. Instead of focusing on separate diagnoses, we are targeting common causes of several mental health problems. Through the programme, students learn skills centred around recognising and managing their emotions and developing healthy relationships. We have chosen to focus on emotion-processing skills and positive social relationships because they contribute to resilience against a range of mental health issues. We hope that training these areas during this important time of development will prevent the onset or worsening of mental health problems.

The transdiagnostic approach represents a shift in how we understand and address mental health problems. By focusing on common underlying factors, instead of rigid diagnostic categories, we are able to address individual needs. We hope that interventions like ours, based on a transdiagnostic perspective, can equip young people with the skills and resilience needed to maintain mental health.   

What are signs that a child might be having mental health difficulties?

• Persistent low mood, anxiety, or fatigue
• Changes in sleep, weight, eating habits, or other everyday patterns
• Changes in personal hygiene
• Loss of interest in activities that were formerly enjoyed
• Withdrawing from social activities
• Signs of self-harm or suicidal thoughts
• Substance use

If you notice any of these signs, express your concerns and encourage your child to speak to a GP or school counsellor. You can also contact Family Lives in the UK (0808 800 2222), an organisation that provides confidential advice to children as well as parents.