Negative Body Image, Depression, Anxiety, Suicide. Is Your Teen “At-Risk?”

time bomb

Talk to most parents and they’ll tell you their teenagers are “pretty normal.” Sure, they might throw in a complaint about moodiness, messiness or even a little recklessness, but other than that, normal.

But what if normal isn’t okay? What if the “new normal” for teens is to be at risk of obesity, depression, anxiety, undiagnosed behavior disorders like anti-social conduct, ADHD and OCD or even suicidal thoughts and desires?

What if all the factors influencing teen life in America were driving our teenagers toward risky behaviors like binge drinking, drug experimentation and use, carrying and using weapons or high-risk sexual behaviors?

What if you, as a parent, had no idea any of it was happening?

Your teenagers should be worrying about things like whether the boy or girl they like likes them back, making the team, curfew times and when they can see their friends. But instead, the things that even adults have a hard time dealing with are squeezing the life out of the next generation of adults and parents.

And that should scare the hell out of all of us.

I realize this all sounds pretty alarming. Good. It should be. Because your normal kids are at risk for some pretty scary outcomes as a result of some things most of us would consider pretty routine or commonplace.

Let’s take a look, shall we?

We know from a University of Colorado at Boulder study published in the journal Addiction in August of 2018 that “adolescents with serious conduct and substance use problems are five times more likely to die prematurely than their peers.” (1)

Yeah, I know, not your kid. But how serious is serious? And at what degree of seriousness of the conduct problems do the increased risks of death begin? Most teens have a “rebellious phase,” right? The answer is yes, but…

protest rebellion teen

Stay with me here.

The researchers weren’t necessarily talking about gang members, nerdy, brooding potential school shooters and psychotic jocks or cheerleaders. They specifically mention anti-social behavior and rule-breaking tendencies. How does that rebellious phase sound now?

Now, to be clear, there are circumstances under which we can all agree that extreme behavior problems are to be expected. Like it or not, and without delving into the politics of it, life in the inner city, especially in the poorest parts of those cities, tends to foster some unique challenges and problems related to teen behavior and health.

But life in the suburbs, posher neighborhoods and even gated communities doesn’t mean the risk of these kinds of behavior issues is necessarily eliminated. In fact, in many ways, kids from the ‘burbs may be more at risk than the inner city kids.

Why, you ask? Because we think they’re insulated from it and as a result, we often don’t see it coming. But there are predictive factors that we can be aware of and take action to circumvent.

For example, how much sleep is your teenager getting? With the responsibilities of school, sports, activities and trying to have a social life, sleep may suffer significantly. Add screen time to that and there’s a real risk your kid is sleep deprived.

In a JAMA Research Letter published in October of 2018, researchers at Brigham and Women’s Hospital in Boston found a link between insufficient sleep and engagement in risky behaviors.

“Compared to students who reported sleeping eight hours at night, high school students who slept less than six hours were twice as likely to self-report using alcohol, tobacco, marijuana or other drugs, and driving after drinking alcohol. They were also nearly twice as likely to report carrying a weapon or being in a fight. Researchers found the strongest associations were related to mood and self- harm. Those who slept less than six hours were more than three times as likely to consider or attempt suicide, and four times as likely to attempt suicide, resulting in treatment. Only 30 percent of the students in the study reported averaging more than eight hours of sleep on school nights.” (2)

That means a whopping 70 percent of American high school children are sleep deprived. According to Dr. Elizabeth Klerman of the Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, this creates a multitude of personal and public health and safety risks. These risks include mental health, substance abuse and motor vehicle accidents.

In case you’re wondering, it doesn’t take months of sleep deprivation to cause problems. Researchers at the University of Pittsburgh found that the areas of the brain involved in goal-setting and reward response were negatively affected after just 1 or 2 nights of sleeping just 4 hours. (3) That means your kids begin to lose their sense of the value of rewards and setting and achieving goals can become less important after just a single night of insufficient sleep.

We know that a lack of sleep can affect a teenager’s ability to focus, concentrate and learn. Grades can slip and we all know what that means. A sense of failure, reduced self-worth and maybe even some retribution, mom-and-dad style. Talk about a vicious cycle!

Sleep isn’t the only problem. We hear endless chatter about childhood and adolescent obesity. Teens are acutely and painfully aware of their own bodies and compare themselves constantly to their peers. It’s estimated by the CDC and others that between 70 and 90% of teenagers are on diets at any time.

Why does this matter to our discussion? I’m glad you asked.

According to a University of Waterloo study, girls who are dieting are significantly more likely to engage in risky behaviors than those who are not. The study found that female teenage dieters were 1.6 times more likely to smoke and skip breakfast and 1.5 times more likely to smoke and binge drink than their non-dieting peers. (4)

According to Amanda Raffoul, the study leader, “Our findings suggest that dieting and other risky health behaviors may be related to common underlying factors, such as poor body image. Post-puberty changes often lead to weight gain among girls and there is incredible pressure from social media and elsewhere to obtain and maintain the ideal body.”

Other studies have found similar links between dieting, mental health problems and risky behaviors in teenage boys as well.

Which leads us to the next factors influencing your teenagers emotions, behaviors and outcomes. Negative body image, social media use and screen time are linked in ways that can’t easily be explained in a short piece like this one. But there have been several recent studies which shed light on the connections between these three things and your kids’ behaviors and mental health.

A study by University of Southern California in July of 2018, researchers found that teens who used digital media frequently were twice as likely to be diagnosed with ADHD as those who did not. (5)

A Duke University study found that children who used digital media extensively not only experienced ADHD symptoms and difficulty learning, but were prone to behaviors like lying, fighting and anti-social attitudes. Teens were also likely to experience conduct problems and problems with self-regulation — the ability to control one’s behavior and emotions – for up to 18 months after a period of extended digital media use! (6)

Social media is full of photos and videos of people “living their best life.” In other words, only showing the shiny, happy side of their lives and portraying themselves as beautiful, happy, rich, perfect, etc. So when your teen checks out the Instagram page of their favorite singer, actress or, God forbid, fitness model, all they see is “better than.”

tweek south park

The teen brain practically lives on comparison. This creates a nightmare scenario for body image as well as self-worth and self-esteem. A University of Haifa study found that the more time a teenage girl spends on Facebook or social media, the higher the likelihood she will develop an eating disorder like bulimia or anorexia. Increased social media time also led to more physical dissatisfaction, negative physical self-image and a negative approach to eating. (7)

Negative body image and negative physical self-image are linked to a variety of mental disorders and conditions in teens, both boys and girls. It’s pretty common for a negative physical self-image to be accompanied by depression or anxiety, especially in a media and social media overloaded world.

A study done at Brown University Medical School and two other hospitals showed that teens “with negative body image concerns are more likely to be depressed, anxious, and suicidal than those without intense dissatisfaction over their appearance, even when compared to adolescents with other psychiatric illnesses.” (8)

In other words, having a negative physical self-image may be more dangerous than a diagnosed psychiatric illness for your teens, at least as it relates to anxiety, depression and suicidality. Let that sink in for a moment.

A related study from the University of Missouri – Columbia in 2017 found correlations between physical self-image and the use of alcohol and tobacco in teens. The risk seemed equal for both girls and boys.

In this study, the correlations took some interesting turns. Teen girls who perceived themselves to be too fat were more likely to use tobacco and alcohol. Boys who thought themselves too fat were more likely to binge drink, while boys who thought they were too skinny were more likely to smoke.

The researchers also looked at the relationship between perceived attractiveness and substance use. Girls who believed they were very attractive were more likely to binge drink. Girls who thought they weren’t good looking were more likely to smoke. (9)

Teens who spend a significant amount of time using digital media (very few don’t in the modern world) are far more likely to be active on social media. This one-two punch provides more than enough fodder for them to develop negative physical self-image and slide toward depression and anxiety.

Negative body image, coupled with the frequent co-occurrence of depression and anxiety, boosts the likelihood that those teens will engage in risky behaviors, experience conduct and behavior issues and possibly even consider self-harm or suicide.

And yes, this could even happen to your teen.

So what to do about it?

I have 3 short, simple suggestions for a challenge which doesn’t lend itself to the simple.

1. Be cautious and thoughtful in the words you choose to speak to your teens. It’s nearly inevitable that you will have to reprimand, correct or guide your kids through some missteps and screw-ups. Be careful to avoid shaming words and phrases. Just because you think your teen daughter would benefit from losing a few pounds is no license to call her fat or anything close to it. Calling your teens lazy, weak, irresponsible or any of the other thousand descriptives that pop into your head when you’re angry at them won’t make them better. It’s more likely to drive them deeper into the behavior states that lead to the representative actions.

2. Listen to them. Don’t just wait to answer your teens, but listen to what they say, the words they choose and the tone, inflection and emotions behind the words. Help them find answers (when appropriate,) don’t just tell them. This one is hard for us as parents, but will go a long way to gaining trust and giving our teens a true “safe space” to express themselves. I really don’t like the phrase safe space because of how it’s been ruined by the political and academic class, but it applies here.

3. Avoid comparison to peers or siblings. For that matter, avoid comparisons to anyone, unless you’re pointing out the positive quality of their actions, attitudes or experiences vis-à-vis someone you know they admire or look up to. Comparison is part of the challenge here. Your teens are overloaded with false or misleading messages and images about who they should be, how they should look and what their lives should be. Don’t make it worse by adding fuel to the fire.

The harsh reality in the 21st century is that because of the broad availability of marketing, social media and other messages that are often false, misleading or otherwise dangerous, our teens are at risk of developing a negative physical self-image, depression, anxiety, ADHD and a host of other mental and emotional disorders. But all hope is not lost.

As adults, we’ve navigated some of that journey already. With our deeper level of perception and emotional experience, we’re in a position to help them make sense out of some pretty serious nonsense. It’s up to us to help them keep a level head and understand their world so they can enjoy good mental and emotional health as adults.

After all, they’re the next generation of parents, so our grandkids are counting on us, too!

Keep the faith and keep after it!




  1. Richard Border, John K. Hewitt, et al.. Independent predictors of mortality in adolescents ascertained for conduct disorder and substance use problems, their siblings and community controls. Addiction, 2018
  2. Matthew D. Weaver, Elizabeth B. Klerman, et al., Dose-Dependent Associations Between Sleep Duration and Unsafe Behaviors Among US High School Students. JAMA Pediatrics, Oct. 1, 2018
  3. American College of Neuropsychopharmacology. “Lack of sleep could cause mood disorders in teens.” ScienceDaily. ScienceDaily, 6 December 2017
  4. Amanda Raffoul, et al., Dieting predicts engagement in multiple risky behaviours among adolescent Canadian girls: a longitudinal analysis. Canadian Journal of Public Health, 2018
  5. Chaelin K. Ra et al. Association of Digital Media Use With Subsequent Symptoms of Attention-Deficit/Hyperactivity Disorder Among Adolescents. JAMA, 2018
  6. Madeleine J. George, et al., Concurrent and Subsequent Associations between Daily Digital Technology Use and High-Risk Adolescents’ Mental Health Symptoms, Child Development, 2017
  7. University of Haifa. “Facebook users more prone to developing eating disorders, study finds.” ScienceDaily. ScienceDaily, 7 February 2011
  8. Lifespan. “Negative Body Image Related To Depression, Anxiety And Suicidality.” ScienceDaily. ScienceDaily, 6 June 2006.
  9. Virginia Ramseyer Winter, et al., Adolescent Tobacco and Alcohol Use: The Influence of Body Image. Journal of Child & Adolescent Substance Abuse, 2017

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