Adolescence is a transition stage of physical and psychological development from puberty to adulthood. It corresponds to the teenage years. The World Health Organization defines an adolescent as someone between the ages of 10 to 19 years.
This is the stage when there are hormonal changes in the body, but the brain has not reached the full potential of maturity. Self-identity has not been fully established. Teenagers are in a psychosocial moratorium. They don’t want parents’ guidance. They like advice from their peers who are equally immature — this is funny but true. Physical development gives rise to sudden bodily changes and growth spurts, which can cause confusion. Weight increases, teens become health-conscious. They tend to restrict their diet. Social media influencers tout a muscular body and slim figure. Hence teens tend to say “Oh God! I am too fat!” — even if their body structure is normal. Influenced by social media, teens want to be slim, stop eating anything. There is an unrealistic perception of body weight, and a strong fear of gaining weight or becoming “fat”.
To prevent weight gain, teens usually severely restrict the amount of food they eat. They may control calorie intake by vomiting after eating or by misusing laxatives, diet aids, diuretics or enemas. They may also try to lose weight by exercising excessively. No matter how much weight is lost, they continue to fear weight gain. This is known as anorexia nervosa. Sometimes, it has another aspect called bulimia nervosa — the teen may secretly binge on food, and then purge to get rid of the calories in an unhealthy way, such as self-induced vomiting, misuse of laxatives, weight-loss supplements, diuretics or enemas after bingeing. Fasting, strict dieting or excessive exercise are other ways that youngsters try to reduce their weight. In both these disorders, anorexia and bulimia, teens are preoccupied with their body shape and weight. They practically live in fear of gaining weight.
So eating and body weight become a challenge, and it leads to some negative perception of the body. Rubina is a teenage girl whom I treated for depression. Her depression started with body shaming — she felt she was overweight and dark. She would look at herself in the mirror and blame herself. She would feel her face is big; her shoulders are too broad; her abdomen is too large; her thighs are too thick. She would not find a single body part to be pretty. She would keep on crying. She would avoid visiting her relatives, avoid all social functions. She would feel she is very dark, and she would blame God for the same. It shattered her confidence, and her self-esteem had become very low.
It started about a year previously, when some of her classmates teased her about her skin colour and weight. This is called body shaming. Almost 90% of teens in the age group of 10 to 19 undergo body shaming. Teasing and name-calling is not fun and is never funny. But many adolescents are bullied like this. This is another challenge of teenage years — bullying. It is hurtful teasing, threats, domination, intimidation or use of force, coercion of the less powerful by a more powerful person. It is often repeated and habitual. Bullying can be physical, verbal, relational and cyber-bullying.
Verbal bullying includes the acts of name-calling, nicknaming, threatening, laughing at or mocking, spreading rumours or lying about someone. Yelling or talking in a derogatory tone, mocking someone’s way of speaking, using body language like giving the middle finger are also examples of verbal bullying. Repeated verbal bullying can lead to physical bullying, like shoving, hitting and fighting. Relational bullying is bullying in a relationship that is used to hurt someone. It intends to hurt the reputation or social standing, and uses verbal, physical or cyber-bullying. Social exclusion (making someone feel left out) is the most common, and is often prevalent in teenage girls. It is meant to control others; it is not overt and can continue for a long time.
Cyber-bullying is the use of technology to harass, threaten or embarrass someone. It uses instant messaging, email or social media. Research has shown that it is more common in secondary school than primary school. All types of bullying has a detrimental effect on the mental health of teenagers. I have seen many teens develop depression and anxiety disorders due to bullying. Loneliness and lack of self-esteem can be results of such acts. Bullying also results in maladjustment. My friend’s 14-year-old daughter was very irregular in her school. She would not attend school after lunch, would spend time in the playground. Sometimes she would go out of the school perimeter into some garden. She had become irritable at home. Her grades were declining. When we started counselling, it was apparent that her deviant behaviour had resulted due to bullying in school as well as cyber-bullying.
A mental health report has also found that bullying is linked to eating disorders, anxiety, body dysmorphia and other negative psychological effects. Both victims and perpetrators have been shown to exhibit higher levels of loneliness. Both need guidance and treatment. Peers become the prime influence on behaviour during adolescence. Peer pressure is an important part of the adolescent experience. Adolescence is the time when a person is most susceptible to peer pressure — the feeling that one must do the same things as other people of one’s age and social group in order to be liked or respected by them. Peer pressure can be verbal or nonverbal. A friend might say, “Come on, one cigarette won’t hurt.” This is the verbal type. In nonverbal type, the teen might feel like doing it as it is the norm of the group — it can be direct or indirect. Eg, one teen might hand over the cigarette to another. Then the other person has to decide then and there itself. Or it could be indirect like teens attending parties where everyone is drinking and smoking. Another type is positive or negative peer pressure. In the positive type, the person is engaged in beneficial type of behaviour like exercising or studying. Negative peer pressure is the influence a person faces to do something they wouldn't normally do, or don't want to do, as a way of fitting in with a social group. Teens often face negative peer pressure to drink alcohol, do drugs, or have sex.
We have seen peer pressure, bullying, body shaming and eating disorders in teens as challenges in growing years. In the next article, we will take a look at drugs, sex and relational issues of teenagers.
(Dr Shailesh Umate is a consultant psychiatrist, sexologist and addiction specialist, whose mission is spreading awareness about mental health and well-being)