September 11, 2018

Extreme anxiety is at an all-time high among American teens? Maybe not.

Daily Briefing

    News reports that suggest there's "an epidemic of anxiety disorders" among young Americans do not paint a full picture of the issue, Richard Friedman, a professor of clinical psychiatry at the Weill Cornell Medical College, writes in a New York Times opinion piece. In fact, Friedman argues, "There is little evidence" that such an epidemic is occurring.   

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    Debunking the teenage anxiety epidemic 'myth'

    Friedman, the director of the psychopharmacology clinic at Weill Cornell Medical College, cites several surveys that have been held up as evidence that U.S. adolescents are experiencing anxiety at unprecedented rates.

    For example, the American College Health Association found the rate of undergraduates reporting "overwhelming anxiety" increased from 50% in 2011 to 62% in 2016. Other similar research has been published over the years, but they contain two major flaws, according to Friedman. One, they are limited: The most comprehensive survey conducted to date, according to Kathleen Ries Merikangas, chief of the Genetic Epidemiology Research Branch at the NIH, was published more than a decade ago. And two, they "are based on self-reported measures—from kids or their parents—which tend to overestimate the rates of disorders because they detect mild symptoms, not clinically significant syndromes," Friedman writes.

    That means there isn't a clear picture of how many U.S. adolescents are actually experiencing the clinical symptoms of anxiety, Friedman. So why, he asks, are parents so willing to believe the "myth" and "insist that their teenager has a problem with anxiety?"

    Why some might believe there's a surge in the anxiety disorders

    Friedman poses a few answers to that question. One is that "parents have bought into the idea that digital technology—smartphones, video games and the like—are neurobiologically and psychologically toxic." He explains, "If you believe this, it seems intuitive that the generations growing up with these ubiquitous technologies are destined to suffer from psychological problems. But this dubious notion comes from a handful of studies with serious limitations."

    According to Friedman, there is no definitive research proving increased use of electronic devices result in lower levels of psychological well-being among U.S. adolescents. He writes that studies to date "show only correlation," meaning "[i]t is entirely possible that teenagers who are more anxious and unhappy to start with are more drawn to smartphones to deflect their negative emotions than their better-adjusted peers."

    "The real question," Friedman writes, "is whether digital technology can produce the enduring changes in the brain that addictive drugs do." But so far, he writes, "There is little evidence that this is the case." He notes that a few MRI studies have shown "that kids with online gaming 'addiction' have enhanced activation in their brain's reward pathway when shown gaming images." But that is to be expected, Friedman writes. "If I scan your brain while showing you whatever it is that turns you on—sex, chocolate or money, say—your reward pathway will light up like a Christmas tree. But that hardly means you are addicted to these things."

    What is going on?

    "As a psychiatrist," Friedman writes that he hasn't "seen an increase in the number of patients suffering from true anxiety disorders, who need therapy and often medication to keep their affliction in check," but he has "noticed ... that more of [his] young patients worry a lot about things that don't seem so serious, and then worry about their worry."

    According to Friedman, there is a difference between an anxiety disorder and everyday anxiety. "The first impairs people's ability to function because they suffer from excessive anxiety even when there is little or nothing to be anxious about. The second is a perfectly normal and rational response to real stress. Teenagers—and people of all ages—will and should feel anxious occasionally."

    He recalls a few patients in their early 20s who "were under a lot of stress at work, and were alarmed by a few nights of poor sleep." Friedman writes, "None of them were clinically depressed, yet they were convinced that their insomnia would seriously impair their work or make them physically sick. All were surprised and easily reassured when I told them there was little cause for concern." But his patients struggled to come to this conclusion on their own.

    Friedman writes, "The truth is that our brains are both more resilient and more resistant to change than we think. The myth of an epidemic of anxiety disorder rooted in a generation's overexposure to digital technology reveals an exaggerated idea about just how open to influence our brains really are."

    Friedman concludes, "So don't assume that there's something wrong with your kid every time he's anxious or upset. Our teenagers—and their brains—are up to the challenges of modern life" (Friedman, New York Times, 9/7).

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