As the old saying goes, “be careful what you wish for.” Some young adults who are eager to leave the comfortable and safe confines of their parents’ homes may need to do so with caution.
Managing this new level of independence comes with unexpected challenges, stressors, and responsibilities — and it is also often times the period in life when mental health issues start to emerge.
Many people with severe mental health disorders such as major depressive disorder (F33.0), schizophrenia (F20.3), and bipolar disorder (F31.6) commonly begin to exhibit symptoms between the ages of 18 and 24. Even if an individual is born with a genetic predisposition to certain mental illnesses, they may not start to experience the effects of these disorders until reaching a certain age, or being exposed to certain types of stress.
So, how can young adults and their families stay vigilant, and identify these disorders if they appear? What symptoms, behaviors, or struggles indicate that someone may need to seek out treatment?
First understand what particular mental health disorders tend to show up at this stage in life.
The three that tend to begin to show the most in the late teen/early adult stages of life are schizophrenia, major depressive disorder and bipolar disorder.
- For schizophrenia in women, it usually starts as late as the early 30’s. In men, it is usually 5-8 years earlier.
- Bipolar disorder can be developed by children; however it is more likely to occur between ages 18-24.
- Major depressive disorder has a broader spectrum of emergence. It can start as early as adolescence or as late as adulthood.
So what is the reason that symptoms of these disorders don’t become apparent until young adulthood?
There is no solid evidence as to why this is so. One current school of thought is that genetic factors influence the likelihood of certain conditions, and other variables later in life determine whether or not those conditions manifest. It is both a “nature” and a “nurture” situation. SOme of the variables that can trigger a mental health disorder can be:
- Family medical history
- Issues during pregnancy
- Any sort of injury to the head as a child
- Home, school, and social environments
- How the brain develops
Some researchers believe that hormones have something to do with developing mental health disorders. Research has gone into how estrogen and testosterone fluctuate in teenagers who are showing mental health symptoms or other behavioral problems.
What significance can stress play into the emergence of a mental health disorder?
Stress alone does not cause mental illness, but certain intensely-stressful experiences can trigger symptoms of a disorder in those who are genetically predisposed to it.
When people seek help for their symptoms, the doctor/therapist will often ask them if any major life events occurred right before the symptoms appeared. Some sort of trauma or major event often precipitates the onset of mental illness in young adults. The severity of the event is less important than its impact on the individual–anything from a demanding new job to the loss of a loved one can activate these dormant disorders.
Does substance use or abuse play a part in triggering these disorders?
Yes. For years, studies have shown that many different types of illicit drug exposure can precipitate a mental health episode. Cannabis, cocaine, and other hallucinogens can trigger symptoms to come to surface that originate from schizophrenia and/or bipolar disorder.
A lot of undiagnosed or misdiagnosed young adults will start to self-medicate with alcohol or prescription drugs, often without knowing what they are doing, the potential detriment it could cause or even why they feel the way they do. Obviously, this does not address the mental health problems themselves, and can easily lead to substance abuse and addiction. It is nearly impossible for anyone to self-medicate in a “healthy” way.
How do you recognize schizophrenia in your young adult child?
The pop-culture idea of schizophrenia makes it seem obvious and easy to spot, but in reality, the symptoms can be much subtler. Schizophrenia is characterized by experiencing at least two of the following symptoms for at least one month:
- Disorganized speech (e.g., frequent derailment or incoherence)
- Grossly disorganized or catatonic behavior
- A set of three negative symptoms (a “flattening” of one’s emotions, alogia, avolition; see below)
Schizophrenia itself often manifests in one of several patterns of behavior, according to the DSM-IV:
- Paranoid schizophrenia — a person feels extremely suspicious, persecuted, grandiose, or experiences a combination of these emotions.
- Disorganized schizophrenia — a person is often incoherent but may not have delusions.
- Catatonic schizophrenia — a person is withdrawn, mute, negative and often assumes very unusual postures.
- Residual schizophrenia — a person is no longer delusion or experiencing hallucinations, but has no motivation or interest in life.
Schizophrenia can show itself almost overnight or it can come on very slowly. It is easier to diagnose when it appears quickly — an individual developing hallucinations and paranoia seemingly out of nowhere — but it is important to keep a lookout for the more gradual symptomatology as well.
Medical professionals will ask about any clear change in behavior specific to family interactions, academics, work, etc. A young adult or teenager who was active in academics, work, sports, or social circles that starts to regress and isolate can be very concerning. Something else to watch for is increased difficulty with communication — if the individual is struggling to put their thoughts and words together in a clear manner, when they previously had much less trouble making themselves understood.
What are the first signs of bipolar disorder?
Bipolar disorder is a mental illness that causes dramatic shifts in a person’s mood, energy, and ability to think clearly. People with bipolar experience high and low moods — known as mania and depression — which differ from the typical ups-and-downs most people experience. Manic and depressive episodes can last for two or more weeks, and can affect sleep patterns, energy levels, and appetite. Continued non-diagnosis can lead to process addictions such sex, gambling, video-gaming, or shopping. Bipolar patients are also 30 times more likely to die by suicide.
Manic episodes often involve feelings of euphoria, restlessness, and impulsivity, while depression brings fatigue, hopelessness, and isolation. If you observe these fluctuations in your child’s behavior, consult a mental health professional.
What are the signs of major depressive disorder?
Some of the symptoms of major depression can mirror those of bipolar disorder or schizophrenia. If a young adult starts isolating themselves from family and friends, or loses interest in activities they once enjoyed, this can be a clear sign. Additional symptoms include:
- Misplaced guilt
- Overwhelming feelings of worthlessness
- Inability to concentrate
- Suicidal ideation
Depressive episodes are characterized by experiencing these symptoms for two weeks or longer.
Only about half of young adults diagnosed with major depression will experience only one episode. Even if your child appears to have “gotten better,” it is still a good idea to consult with a medical professional.
Once a diagnosis has been reached, medication often plays a vital role in managing the symptoms of major depression. Every individual will respond differently to different medications, so it is imperative that the treating physician and the young adult patient communicate regularly and keep track of behavioral changes. With the wrong psychiatric and/or therapeutic care, depressive episodes can actually increase.
How severe can the first bipolar, schizophrenia, or major depressive disorder episode be?
The severity of these episodes varies from person to person, but it is not uncommon for those with bipolar disorder or schizophrenia to require a hospital visit for stabilization purposes from the very start, as symptoms such as hallucinations or suicidal ideation can be dangerous. Major depression episodes, however, occur across a wider spectrum. If someone is actively expressing thoughts of suicide or self-harm, then hospitalization is warranted; otherwise, a plan to go forward with a diagnosis, therapy, and medication is the way to go.
Communication and trust are important for maintaining awareness of your young adult child’s mental state.
Whether your child is enrolled in higher education or transitioning into the workforce, check in with them and keep dialogue open. Make sure they know they can talk to you about any mental health difficulties they experience, without fear of judgement or shame.
Know the medical history on both sides of your family. Is there any history of mental health issues? What kind? What were the symptoms? What age did the family member begin to have difficulties? When was the diagnosis?
Have honest conversations with your children and all of your family members about this family history, and any genetic predispositions that they might have. Inform them what symptoms to watch out for in their day-to-day lives, and educate yourself about the steps that should be taken if any of those symptoms appear. Like with any other illness, the earlier you can address and diagnose the problem, the better chance the patient has to regain their health and move forward with their life.