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Problems of Adolescence
Adolescence is the period of life between puberty and age 19 years. For the great majority of children, the physiological events of puberty signify the end of childhood. Achievement of financial independence from the family of origin through work and formation of love relationships outside the family usually signify the end of adolescence and the beginning of adulthood. In the modern world, these goals may not be attained until the early or middle twenties or later. There are many important developmental phases in adolescence. Although moody, confused and rebellious “adolescent turmoil” is no longer considered the norm for young people, some emotional troubles are fairly common. These may turn out to be symptomatic of nothing more than the stresses and strains of normal development, or they may be the early signs of significant psychological disturbance.
Common problems of adolescence are listed in Table 8.5. Rarely, schizophrenia may have a late adolescent onset. As might be ex-pected, comorbidity is common among disorders of adolescence. Table 8.6 summarizes these patterns.
Disturbances in body image and eating behavior have peak ages at onset during adolescence and early adulthood. Persistence of disturbed eating behaviors into early adulthood is often accompanied by the development of personality disorders in many cases. Bulimia nervosa has been shown to be associated with borderline personality disorder in contrast with anorexia nervosa, which was found to be associated with avoidant personality disorder (Skodol et al., 1993).
Although adolescents tend to sleep late, excessive daytime sleepiness may become a problem during adolescence. Excessive sleepiness may indicate the onset of narcolepsy, a rare disorder characterized by sleep attacks, accompanied by cataplexy (sudden, bilateral loss of muscle tone), and/or hypnopompic or hypnogogic hallucinations or sleep paralysis (Regestein, 1994).
A preoccupation with an imagined or exaggerated defect in appearance may develop in adolescence. Unlike the normal concerns of adolescents with their physical appearances, excessively time-consuming concerns that cause great distress or interfere with functioning suggest body dysmorphic disorder.
Table 8.7 summarizes the estimated prevalence and sex distribution of DSM-IV mental disorders commonly seen in adolescents.
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