With the prevalence of conversations surrounding mental health, it is becoming increasingly important to clarify terms pertaining to mental health and spread awareness for the many mental health issues that those in our community may struggle with. This article attempts to aid readers in navigating conversations about mental health and to answer several of the questions that may be preventing these discussions.

What is anxiety? How can I differentiate anxiety from worry?

Anxiety presents in several different forms, and therefore, is hard to generalize. It encompasses many subcategories including social anxiety, performance anxiety, separation anxiety and panic disorder. It also may correlate to eating disorders, compulsive behavior or depression.

Although most people have anxious feelings, not everyone has anxiety.

“Everyone has anxiety to a certain extent. Everyone has emotions, everyone gets sad, everyone gets happy,” psychologist Sarah Lee said.

However, anxiety is very common. According to the Anxiety and Depression Association of America (ADAA), 1 in 8 children between the ages of 8 and 15 are affected by anxiety.

According to middle school psychologist Kelly Decker, it is important to recognize the difference between anxious feelings and anxiety in order to respect the struggles that those who fight anxiety encounter. A helpful way to differentiate anxious feelings and anxiety is distinguishing stress from worry.

“Worry is a really common symptom of anxiety and…is ruminative. It causes you to get stuck. Maybe you have a bio test and you’re worried about it, but worry doesn’t motivate you to study or to focus on your studying. Worry acts as a distraction and keeps you from doing what you need to do. It can take over and may interfere with your sleep, appetite and how you spend your time,” Decker said.

Additionally, although anxiety is a relatively common mental illness, a significantly lower number of teenagers experience panic attacks.

“Teens have a wide range of anxiety responses. The percentage that actually have panic disorder is few. A true panic attack comes on out of the blue, when you’re relaxed and possibly happy and not stressed about anything … Panicking in response to something is not a true panic attack, it is a panic response … Panic disorder is almost random,” Decker said.

Anxiety may be often treated with medication or therapy. If you feel like you or a peer may have anxiety, available resources are listed at the end of this article.

What is depression? How is it different from sadness?

Depression can manifest itself in many different ways. Although suicidal thoughts are certainly tied to depression, they are not the only indicator of it, and no two cases of depression are identical.

Decker recognized that though temporary sadness can be upsetting, true depression must fit multiple criteria in order to classify as diagnosable depression. One of the two main criteria is a sad and depressed mood that causes you to lose interest in the things you love, which is known as anhedonia or the inability to feel pleasure. The second criteria is when the depressed mood is present most of the day and persists for nearly two weeks or more.

Additionally, in order to classify as true depression, it normally interferes with routine activities in your life.

“Managing real depression day to day is taxing,” Decker stated. “It can be hard to get up, to get dressed, to brush your teeth. Even just sitting in class can feel overwhelming, even for someone who is very bright academically.”

Even basic functioning, such as eating, may feel like a chore. Because it is so hard to live with, depression often goes hand in hand with anxiety.

“If you’re worried and anxious all the time, it’s exhausting,” Decker said. “That can predispose you to being vulnerable to depression.”

Decker mentioned that although true depression likely requires help, it does not always require medication.

“It’s unusual that a true major depressive disorder will go away and improve on its own. You will probably need to find … outside help,” Decker stated.

If you believe you or a peer may suffer from depression, resources are listed at the end of this article.

How can I tell if a friend is struggling with something pertaining to their mental health? What is the best way to approach the conversation surrounding mental health?

If you notice a friend is acting out of character, it can be important to check up on them. Changes may be seen in a peculiar mood or avoidance of people, places or things. According to therapist Emily Kiedman however, confrontation is not always the answer as they may be simply having a bad day or week. If the behavior persists over a span of time or after an initial check up, it is important to address your concerns with you friend.

The conversation may be tricky. According to Lee, it is important to reassure others they are not alone in their struggles.

“I think the most important thing when you are talking about a struggle someone is having is making sure that they know what they are experiencing is normal, they are not the only person to have experienced it and finding help for it is nothing to be embarrassed about,” Lee said.

Decker believes the best way to carry out the conversation is to convey care and concern for the friend. Bring the ways in which they haven’t been acting like themselves to their attention and let them know you care. Finally, establish your availability to support and help them.

“[They may deny anything is up.] If you are really concerned and it persists and if your other friends are aware too … I think a good friend would reach out to a parent, a sibling, or someone in the home,” Decker said. “If you feel that you’ve exhausted all you can give them as a friend, then maybe you need to think about getting some outside source.”

Finally, it is crucial to carry out all conversations surrounding mental health with respect.

“You never know what someone is struggling with,” Decker said. Even your closest friend or closest family member, you never really know because we don’t walk in each others shoes all day long. I think we all need to be more kind, more thoughtful, more empathic and think about the potential impact of what we say.”

What are eating disorders? How could I talk to a friend struggling with an eating disorder?

Eating disorders are a wide range of behaviors characterized by abnormal eating habits. Often stemming from an obsession with food or body image, eating disorders include anorexia (restricted eating), bulimia (binging and purging), binge eating disorder and pica (craving of non-food substances). Eating disorders may result in social, physical and psychological damage.

“Eating disorders and compulsive disorders, like all kinds of mental health issues, have to do with control and regulation [of] our thoughts, emotions and actions,” Decker stated. “With eating it’s about regulating ourselves … [It is] when we’re feeling so insecure about ourselves that how we think about our body and our body image becomes so important that we end up making these choices to restrict our eating or to binge and purge… That dictates all the choices we make and can start to become kind of problematic.”

The process of talking to a friend about an eating disorder is similar to that of talking to them about any portion of their mental health you may be concerned with. Decker noted that the first step to addressing a friend that you may suspect is coping with an eating disorder
is to take a step back and reflect on potential signs. Some of these signs can include skipping meals or experiencing hunger-related fatigue.

When discussing this with your friend, Decker says it is crucial to refrain from confrontational language and simply point out the change that you have noticed. Simply bringing the change to their attention from the perspective of a concerned friend is normally the best way to approach the conversation.

“Reflecting it back in an open way can be a gentle way to put the person at ease and not make them defensive or self-conscious,” Decker stated.

If no change is made after the initial conversation, then begin discuss possible resources they may contact for help, which allows for adjustment and makes a friend more susceptible to your feedback.

How can I help myself when I am stressed or disappointed?

Stress and disappointment is a very normal aspect of every middle and high schooler’s life. Dealing with and minimizing disappointment can be done by fortifying yourself compassion and giving yourself time to recover from an obstacle.

“When you struggle or have any disappointments or rejection, what you need is self compassion to get you through those losses,” Decker stated.

It is important to note, however, that the negative feelings will fade.

“If we get a bad grade on a test or we don’t do well on a swim meet, or whatever it may be, it may bum us out for a day or for a weekend but, beyond that, most of us bounce back,” Decker said.

Though it can sometimes feel difficult to give yourself the time to recover from rejection, treating yourself and reaching out for emotional support can help in balancing your emotion.

“Give yourself permission to not be perfect,” Decker said, “Accept that maybe you disappointed yourself or a parent or a friend or a teacher, and be able to let that go and turn your attention away from negative thoughts that the disappointment may be triggering. Recognize that it happened and focus on what you have control of moving forward. Take care of yourself in the moment.”

In addition, Kiedman felt it is significant to give yourself time to relax and destress, whether it’s by talking to friends, painting or doing anything else that relieves stress. Although many people sacrifice their mental health for success, maintaining mental health is actually crucial to success, and keeping yourself from experiencing extreme stress can actually be very productive.

Lee also emphasized the importance of giving yourself time to relax.

“I feel like self care is something that people in this day and age really thrust to the side. … Sometimes its hard in the midst of [everything] to think about what might you need to keep yourself grounded and not so stressed out all the time,” Lee said. “Think about one or two things for yourself that really keep you grounded and bring your nervous system back down to a calm state … [Try to] incorporate them on a daily or semi-weekly basis [into your life], depending on how big or small that is.”

What is perfectionism?

According to Kiedman, mental health should be everyone’s top priority, especially at a school like Harvard-Westlake where expectations to succeed are so high. Such high expectations create an incredibly competitive environment, causing children to compare themselves to others and breeding perfectionism, the desire to constantly strive for perfection.

Decker explained that although perfectionism is often depicted as a strength, it presents major obstacles to maintaining a healthy mind.

“Perfectionism is an irrational drive to do better…[which] is never satiated. It can also get in your way of…being in the present, doing what you need to do, and enjoying all your successes. When you do do well but you struggle with perfectionism, it’s hard to enjoy that moment because your worried about the next test… A high achieving school can breed that,” Decker said.

To deal with perfectionism, Decker recommended reminding oneself to stay in the present and become familiar with one’s limits.

“Be secure with yourself, learn what kind of balance you need and prioritize that,” Decker said.

Beyond medication, what are ways to deal with mental illness?

There are many different resources for those struggling to maintain a healthy mental state. According to Decker, research has proven psychotherapy and cognitive behavioral therapy are safe and effective for treating adolescents.

“We know it works,” she said, “It’s on a case by case basis, but if [your state of mental health] is interfering in how you feel about yourself, how you’re performing academically, onstage or on the field, with you being able to be the best version of yourself or with your friendships, then it probably makes sense to get some help.”

Beyond therapy, there are several ways one can help themselves or a friend. Preventative work on a daily basis is also crucial to retaining control over one’s mind. Activities for doing so may be in the form of meditation, exercise, seeing friends or staying offline. According to Decker, a recent study from University of California San Francisco established a correlation between high rates of screen time with an increase of anxiety and depression.

Even though there is a social component to [technology], generally speaking you are by yourself … It can be very isolating,” she said.

As anxiety and depression also are very isolating, Decker believes this sense of loneliness is the tie between the two trends.

There are also several methods to help someone actively struggling to regain control. To calm down, Decker said sensory stimulation in the form of a hot shower, loud music or exercise, can help the body to regain control. For example, holding ice as stimulation can help to distract the body from dark thoughts.

“Engaging your senses in some way can help give relief from that horrible feeling or thought you are having,” Decker said.

Inversely, helping someone experiencing a panic attack may seem challenging. A true panic attack spans for 3 to 5 minutes, during which the person usually feels like they are experiencing a heart attack. Although they may be aware on a rational level it is just a panic attack, the sudden nature of panic disorder can make the person feel like they need to go to the emergency room.

Decker says that while the person has the panic attack, it is important to sit with them and coach them through it. Remind them it will end soon and they will survive. It may take a while for the body to calm down due to the high levels of adrenaline which circulate the body during a panic response.

If someone is experiencing a panic response, breathing is key to regaining control. Decker recommends going to an isolated area and putting one’s head between one’s knees to force the circulation and respiration rates to control. Kiedman recommends closing one’s eyes and listening to the sounds in the room in order to ground oneself. If there is not a lot of sound, one can look for a certain color. Lee recommends deep, slow breaths in through the nose and out of the mouth, as well as tapping each leg alternately. Whether or not one struggles with an anxiety disorder, these tricks to regulate airflow can be used to calm the body in times of extreme stress or worry.

Overall, it is crucial to turn to the support to others.

“I think it’s really common at your age and stage that when people are struggling to keep it secret,” Lee said. “That’s a really tricky position to be in. I think important guidelines to keep in mind for yourself are
be there for your friend, support your friend, and think about the appropriate adult that needs to know what they are going through. It is way too much pressure for yourself to keep something a secret if someone might be in danger. If you feel like they are a risk to themselves or someone else, you always need to inform an adult, whether it be their parent, someone from school or your own parent.

For those who do not feel comfortable talking to a parent or teacher, hotlines like the Suicide hotline or Teenline present opportunities for people to receive necessary help often confidentially. In a crisis requiring immediate attention; however, please call 911.

Teenline:1-310-855-4673. Open 6 p.m. to 10 p.m. Pacific time, every night.

National Suicide Prevention Hotline: 1-800-273-8255. Open 24 hours, every day.

Los Angeles County Department of Mental Health Hotline: 1-800-854-7771. Open 24 hours, every day

Substance Abuse and Mental Health Services Administration Hotline: 1-800-662-4357. Open 24 hours, every day

National Alliance on Mental Illness Hotline: 1-800-950-6264. Open 10 a.m, to 6 p.m., Monday to Friday, Eastern time.