How to distinguish between ordinary adolescent turmoil and a real mental health issue …

There was a time when a teenager’s sudden moodiness, withdrawal, or emotional outburst could be understood with a familiar explanation: “It’s just a phase.” That explanation can still be right. Adolescence can be difficult, confusing, and emotionally intense. But today we know enough about what is happening among young people in America to know that “just a phase” can also be a dangerous assumption.

I have concern that we don’t pay as much attention to youth mental health as adult mental health, and we do a poor job of giving any attention to adult mental health! The numbers alone should make us pay attention. The Centers for Disease Control and Prevention (CDC) reported that in 2023, 40 percent of U.S. high school students experienced persistent feelings of sadness or hopelessness. Twenty-nine percent reported poor mental health, one in five seriously considered attempting suicide, and nearly one in ten attempted suicide during the previous year. Federal research also found that 15.4 percent of adolescents ages 12 to 17 — about 3.8 million young people — experienced a major depressive episode in 2024.

Those numbers are talking about two related but different things, and the distinction is important. Mental health is part of everyone’s life. A teenager can be emotionally healthy, struggling emotionally, or somewhere in between without having a mental illness. Mental illness refers to conditions such as depressive and anxiety disorders that can significantly disrupt a person’s life. So when the CDC reports that a young person is experiencing poor mental health, that does not automatically mean that young person has a mental illness.

So how can a parent or another concerned adult distinguish ordinary adolescent turmoil from a real mental health issue? No single behavior provides the answer because many of the same behaviors can occur in both. The distinction becomes much clearer when several specific features of what is happening are considered. Here are the most useful ways to distinguish between the two.

Start with what is normal for this teenager. Adolescents differ enormously from one another, so the most useful comparison is with the young person’s own usual pattern. A teenager who has always been quiet, private, and happiest with one or two close friends should not suddenly be considered troubled because someone has decided teenagers are supposed to be highly social. The American Academy of Child and Adolescent Psychiatry makes an important point here: parents generally know what behavior is usual for their own child.

That gives parents something valuable to watch for — a meaningful departure from the young person’s baseline. If someone who has always enjoyed friends begins persistently avoiding them, the withdrawal carries more significance than it would for someone who has always preferred solitude. If a teenager who has ordinarily cared about school abruptly stops caring whether assignments are completed, that change deserves attention. The same principle applies to sleep, appetite, activities, relationships, motivation, and ordinary responsibilities.

Change itself, of course, is part of adolescence. Interests change, friendships change, young people seek greater independence, and relationships with parents change. Concern rises when the change represents deterioration in the young person’s ability to enjoy life, maintain relationships, or handle ordinary demands.

Consider the intensity of what is happening. Adolescents can experience powerful emotions without being mentally ill. Romantic rejection can be devastating, a serious disagreement can produce anger and withdrawal, and academic disappointment can leave a teenager anxious or discouraged. Concern increases when the emotional response becomes so severe that it begins overwhelming the young person’s ability to cope.

Intensity is best judged in relation to what happened. Being deeply upset after a painful loss can make sense even when the emotion is strong. A reaction deserves closer attention when its severity seems far out of proportion to the circumstances or continues escalating after the immediate situation has passed. The issue is whether the strength of the response can reasonably be understood in light of what the teenager is experiencing.

Pay attention to how long it lasts. Ordinary emotional reactions generally change with circumstances and time. A teenager can have terrible hours, bad days, and difficult periods, but there is usually movement in and out of the distress. A more serious problem becomes increasingly possible when the change persists rather than gradually easing.

The National Institute of Mental Health recommends seeking help when troubling emotions or behaviors continue for weeks or longer, particularly when they cause distress or interfere with life at home, at school, or with friends. That guidance should never become a reason to wait when something is clearly dangerous. Sudden severe deterioration, suicidal thinking, self-injury, psychotic symptoms, or dangerous behavior requires attention regardless of how recently it began.

Notice whether the problem stays in one part of life. Ordinary adolescent turmoil often remains connected to the circumstances that produced it. A conflict at home, for example, may leave a teenager angry and upset without changing how that young person relates to friends, performs at school, or experiences the rest of life. When the situation improves, the emotional reaction generally begins to ease as well.

A mental health problem becomes more concerning when the difficulty no longer remains connected to the situation that first caused distress. Instead, its effects begin reaching into parts of the teenager’s life that had previously been unaffected. A problem that began in one setting may gradually alter how the young person experiences everyday life as a whole, which is a stronger indication that something more serious may be developing.

Look closely at everyday functioning. Perhaps the clearest distinction is what happens to the young person’s ability to function. Adolescence legitimately contains distress. Grief, rejection, social exclusion, academic pressure, and conflict over independence can hurt deeply. Emotional health does not require a teenager to feel good all the time.

A young person who is struggling but still maintaining friendships, participating in school, meeting reasonable responsibilities, enjoying some activities, and recovering after setbacks may be experiencing a difficult period of adolescence. When those capacities begin disappearing, concern should rise. The American Academy of Child and Adolescent Psychiatry considers participation in learning, family relationships, friendships, and age-appropriate activities when evaluating healthy development, while the National Institute for Mental Health points to interference at school, at home, and with friends as an important reason to seek help.

Watch for the ability to recover. A teenager can be devastated on Friday and laugh with friends on Saturday without Friday’s distress having been any less real. Healthy emotional functioning includes an ability to move toward baseline again. Pain can remain while the young person still responds to something enjoyable, reconnects with other people, or gradually resumes ordinary life.

With a more significant mental health problem, that flexibility may diminish. Positive experiences no longer provide much relief, former pleasures lose their appeal, reassurance has little lasting effect, and the emotional state becomes increasingly persistent. The young person appears less able to recover even when circumstances improve.

Look for several changes occurring together. Individual behaviors often tell very little by themselves. Sleeping late may simply mean a teenager is tired. Irritability can follow a bad day, and wanting more privacy can be entirely ordinary during adolescence. Greater concern is warranted when meaningful changes begin appearing together and continue.

Persistent irritability accompanied by withdrawal from friends, abandonment of a favorite activity, substantial sleep changes, loss of interest, and declining school performance presents a very different picture. The significance comes from the cluster. Several changes occurring together can reveal a broader deterioration that would be easy to miss if each behavior were considered separately.

There is also an important middle ground. A teenager does not have to meet the diagnostic criteria for a mental illness before emotional distress deserves attention. A young person can be struggling significantly without having a diagnosable disorder and still benefit from support or professional help.

Certain signs, however, take the question out of that middle ground. Suicidal thoughts or statements, self-injury, hallucinations or markedly distorted beliefs, dangerous eating behavior, serious substance misuse, periods of extraordinarily elevated energy accompanied by a markedly decreased need for sleep, and dangerous or destructive behavior should never be dismissed as ordinary adolescent turmoil. Any behavior or statement suggesting that a young person may harm himself, herself, or someone else requires immediate attention.

Seeking an evaluation does not mean deciding beforehand that a young person has a mental illness. A qualified professional can help determine whether the behavior is developmentally expected, a response to difficult circumstances, significant emotional distress, or an emerging mental health condition. A good assessment considers the young person’s history and temperament, physical health, family and peer relationships, school functioning, recent stresses, the duration and course of the changes, and the adolescent’s own account of what is happening.

Parents have something no diagnostic manual can provide: years of knowing the young person in front of them. That knowledge can make them the first to notice when a difficult period is passing through a teenager’s life and when something more serious is beginning to take hold. Taking that change seriously does not require assuming mental illness, it just requires paying enough attention to find out.

Scotty