The Kids Are Not All Right
Pandemic stress has triggered an alarming increase in anxiety, depression and self-harm among teens. Now what do we do?
*Some sources in this story used pseudonyms or withheld their last names for privacy.
In October 2021, at the start of her senior year at Meridian High School in Falls Church, Olivia* checked into a clinic with hopes of freeing herself from the eating disorder that had been slowly taking over her life.
“I realized I couldn’t live like that anymore, that I couldn’t focus on school or participate in sports,” says the track athlete, who also has a second-degree black belt in taekwondo. She was in the middle of applying to colleges and grateful for the return to in-person school, but she knew something was broken that she couldn’t fix on her own.
Amid the stresses of the pandemic, Olivia had been waging a daily battle against gastroparesis, a chronic gastrointestinal disorder that often made her feel disproportionately full or nauseated after regular meals. To manage the condition and regulate her digestion, she had to be extremely regimented about her food intake. That’s how the slide toward disordered eating began.
The isolation that came with social distancing made it worse. “I’d never really liked my body, so I saw it as an opportunity to become smaller,” she says. “When you’re having struggles with eating, the worst possible thing is to be alone. It was much better for me to be around friends and keep busy.”
As Covid restrictions took away her extracurricular activities—which, in addition to athletics, included volunteering as an English tutor for Spanish-speaking students and teaching science lessons at a local elementary school—she began restricting her eating even more to regain a sense of control.
“When I was losing weight, I felt like I was accomplishing something,” she says. “I knew that I was unhealthy and scary-looking, but at some point, it became more about the achievement than the appearance.”
Eventually her resting heart rate dropped dangerously below 30 beats per minute. Unable to do the things she enjoyed, Olivia realized the means by which she’d gained a sense of control had spun out of control.
With support from her parents, she found an outpatient program at the Center for Discovery in Old Town, Alexandria. Over the next several months, she returned to a healthy weight and established an eating plan that allowed her to stay active.
But missing out on classes and school activities during treatment left some of her friendships damaged.
“My physical health is better now, but my mental health is still a challenge,” says the 18-year-old. “I lost a lot of friends at school. It’s been really hard for other people to understand what I’m going through, and that I might not be the same version of myself as I was [before]—which can turn into problems that feel like my fault. I think about who I used to be and envy that person.”
“Covid-related anxiety, depression, loneliness and decreased stress tolerance increased the intensity of crisis calls—especially with teens.”
Olivia is not alone—sadly, not even close. Her story is just one of the as-yet immeasurable traumas triggered or exacerbated by the pandemic.
“During the first three months of lockdown, our inquiries went up 420%,” says Christie Dondero Bettwy, executive director of Rock Recovery, an Arlington-based therapy and support program for teens and adults with eating disorders. “When the pandemic hit, people’s built-in support networks were disrupted, and those who were hiding eating disorders could no longer hide.”
In the first year of the pandemic, the National Eating Disorders Association reported a 40% increase in calls to its helpline.
For many, Dondero Bettwy says, food became a coping mechanism and the one thing they could control at a time when everything else felt out of control. Even now, as the threat of a new Covid variant looms, Rock Recovery is still receiving twice as many inquiries as it did in the before-times.
“It can seem very illogical to people who aren’t struggling,” she says, “but eating disorders actually aren’t just about the food. There’s another illness there; food is how it shows up.”
The increase in disordered eating dovetails with other mental health shockwaves observed nationwide. From April to August 2020, the number of ER visits involving mental health emergencies increased 31%, according to the Centers for Disease Control.
A May 2020 Gallup poll noted nearly one in three parents concerned that their child was experiencing harm to their emotional or mental state as a result of social distancing and school closures. Those fears were confirmed in late March of this year when a CDC survey found four in 10 teens reporting that they felt “persistently sad or hopeless.” One in five said they had contemplated suicide.
Resources are stretched thin, says Joseph Getch, CEO of the Oakton-based nonprofit PRS, which runs CrisisLink, Virginia’s crisis intervention and suicide prevention hotline, text and chat service.
“In 2020, 36% of callers to CrisisLink identified Covid-19 as the primary stressor in their lives, with a third of those experiencing acute suicide thoughts. PRS case managers reported seeing younger children with increasingly aggressive behaviors and teens with increased hospitalizations, suicide ideation, risky behaviors and drug use,” he says. “Covid-related anxiety, depression, loneliness and decreased stress tolerance increased the intensity of crisis calls—especially with teens.”
That the pandemic has had a dramatic impact on teens’ mental health is not the least bit surprising. “When schools closed and kids lost their routines, their connections to each other, they also lost their ability to create meaning in their lives,” says Falls Church therapist Elisa Nebolsine, author of Your Amazing Teen Brain. “Kids need to create meaning in order to find happiness, and the inability to do so led to a huge uptick in depression.”
But as anyone who has tried to engage a therapist, psychiatrist or support group during the past two years has likely discovered, the increased need for mental health care has far outpaced the systems that are in place to address these issues. In 2021, 41% of psychologists surveyed by the American Psychological Association said that they weren’t able to keep up with the demand for their services.
“Our fractured mental health system existed pre-pandemic but has been exacerbated in the last couple of years,” says Barb Solish, director of youth and young adult initiatives at the National Alliance on Mental Illness (NAMI), based in Arlington. “The pandemic shone a spotlight on the youth mental health crisis that already existed.”
In 2021, 41% of psychologists surveyed by the American Psychological Association said that they weren’t able to keep up with the demand for their services.
Amid the dearth of professional support, parents have had to triage midnight emergencies and become experts in a host of maladies, all while staving off their own Covid-related anxieties and burnout. And teens—who should have been out having fun with their peers and making mistakes that they could grow from—have been cooped up with their parents, fumbling to learn how to name and negotiate the complicated layers of their own psyches.
Local mental health professionals are scrambling to keep up with demand. “I don’t know any therapists who aren’t desperately trying to find ways to fit [more] people into their schedules,” says psychologist Aaron Dodini, founder of Dodini Behavioral Health in Arlington.
A father of four himself, Dodini says a lot of parents see their kids struggling but have anxiety about saying the right thing. “They’re paralyzed by a lack of confidence—will this help my child or will it hurt? Sometimes parents will default to saying nothing in fear of saying the wrong thing.”
Instead of silence, he counsels parents to choose empathy, vulnerability and humility. “How do you approach helping from a stance that’s as encouraging and nonjudgmental as possible? The answer is often a series of conversations where you ask your child for the benefit of the doubt—and the opportunity to reframe whatever you get wrong. And if we parents say something that doesn’t land quite right, we get to show them how to say we’re sorry.”
Parents may wonder whether the stress their kid is experiencing is worth escalating to a professional—particularly when appointments are hard to come by. Some find it hard to get past the stigma of asking for help. But ignoring the problem won’t make it go away.
“Don’t try to convince your kid that nothing’s wrong—that’s not very helpful,” says Ellie*, who was diagnosed with depression and generalized anxiety disorder pre-pandemic, as a 10th-grader at H-B Woodlawn. At first, she says, her parents didn’t know how to make sense of her despondent feelings.
“I was crying every single day. I’d have to leave class. I knew that something was wrong, but I didn’t know what,” says the 19-year-old, now in college at Loyola University Chicago. “I went to my parents to ask for help, and my mom helped me find a therapist.”
With cognitive behavioral therapy (CBT), Ellie developed coping mechanisms to manage her depression and anxiety. Those same strategies helped her get through the stress of pandemic isolation and the transition to college. “Now my parents mostly understand what I’m dealing with,” she says, “but knowing that I can talk to them even if they don’t have all the answers is helpful.”
During Covid times, the usual power dynamics between parents and teens became even more strained. Social opportunities were squashed at a time when teens normally would be separating from their parents, seeking independence and exploring their identities.
Family conversations turned into constant negotiations over the risk factors of everyday activities.
“If a kid wants to go to his friend’s house, not only do you—and they—have to consider the normal safety concerns, like who’s driving and how late will they be out, but now you both have to constantly evaluate new risks,” says Kitty Wicks, a therapist in Arlington.
“Will they be indoors or out? How many people will be there? Is everyone vaccinated? If I get sick, am I putting my family members at risk?” The constant assessments created a type of decision fatigue that was uniquely relevant to teens and their parents, she observes.
Wicks says she’s seen a lot of dysthymia (persistent, low-level depression) as well as other mood disorders in her teen patients. “In addition to the firsthand trauma many people experienced from Covid, we’ve had two years of being exposed to microtraumas—to stories of death, illness and isolation—which are vicariously traumatic,” she says. “This creates a lack of security and safety in the world as it once was, leading to an unsustainable state of high alert. These are the ingredients for complex PTSD, panic attacks, anxiety and depression.”
Parents, who have many more decades of life under their belts, are better equipped to put these traumas in context, Wicks points out, whereas teens have had a significant chunk of their lives overshadowed by a pandemic. “A lot of teenagers started to believe that life will never be good again,” she says.
Ladan Eshkevari, a nurse anesthesiologist and professor at Georgetown University, sees many teens who are struggling with feelings of hopelessness at Avesta, her ketamine-infusion and wellness clinic, which has locations in McLean, Bethesda and D.C.
Ketamine has been used as an anesthetic for decades, but has recently emerged as an alternative treatment for people who have not responded to traditional antidepressants, anti-anxiety medications and therapy. The drug has been discovered to create dissociative, psychedelic-like effects that allow the brain to form new neural pathways for healing. Clinical trials conducted by the National Institutes of Health and Mount Sinai Hospital in New York have found that a few weeks of intravenous ketamine, combined with traditional psychotherapy, can significantly help 70% to 80% of adults and older teens struggling with mood disorders, such as depression and PTSD.
“When I founded the clinic four years ago, it was unheard of to have parents of teens reach out for treatment,” Eshkevari says. Now, about a quarter of the calls Avesta receives each week are from teens or their parents.
“These are highly educated, resourceful parents who are at a loss for how to help their child,” she says. “Every mental health professional is inundated—no one can get in to see a therapist or a psychiatrist. Parents are just working with their pediatrician and looking for additional practitioners who are out-of-the-box thinkers. We have kids who are so depressed that even taking a shower is a struggle, kids who just need to get through that acute phase of treatment.”
“We’ve had two years of being exposed to stories of death, illness and isolation. This creates a lack of security and safety in the world as it once was, leading to an unsustainable state of high alert. These are the ingredients for complex PTSD, panic attacks, anxiety and depression.”
Even now, the prevailing statistics about teens and mental health are probably underreported. With students out of school and many afraid or unable to seek treatment, countless teens were left to suffer undiagnosed.
As a high-school student, Amelie* lived with five other family members in a two-bedroom Arlington apartment, spending as much time as possible out of the house. Though her father forbade her to attend parties and sleepovers, she was allowed to participate in extracurricular activities at school. She took advantage of every opportunity that presented itself. “My dad would say he brought me here to learn, not to have fun,” says the teen, who immigrated to the U.S. in 2014.
During school vacations, she stayed with her mother, who lives in Maryland.
Before the pandemic, Amelie was “doing all right, for the most part” but when schools closed in March of her junior year, her world shut down, too.
“I wasn’t allowed to go out to meet friends. I could go for a walk by myself, but I had to avoid crowds. I wasn’t even allowed to see my mom,” she says. Her father was worried about the risk of Covid exposure and her ability to take her studies seriously.
Harder still, “the environment at home was always loud. My dad would come home from work and start yelling at my little brother, who would be playing instead of doing schoolwork.”
To escape the chaos, Amelie would retreat to her room, skipping meals and forgoing the opportunity to get fresh air. She lost a concerning amount of weight and struggled to stay on top of her schoolwork.
More than once, she wondered if it might be easier not to be alive.
“I never sought any kind of mental health diagnosis,” she confides. “That’s still a big stigma in my culture.”
In November of her senior year, Amelie finally asked a school counselor for help. “[My counselor] helped me come up with a plan. I wrote down all the things I wanted to say to my dad. I told him that I was really struggling, and that if he wanted me to do well academically, I needed to be able to stay with my mom.”
To her surprise, her father let her go. She moved in with her mother and finished the school year virtually, attending prom and graduation in person. “Things were so much better once I got to my mom’s,” says the 18-year-old, now a freshman at VCU. “I had quiet space and could go outside whenever I wanted, and I got to spend time with other family members, too.”
Amelie also found support in Sources of Strength, a peer-led suicide prevention and wellness program used by all Arlington Public Schools (APS) high schools. The program gained particular momentum during the pandemic, with students convening for virtual meetups. “It’s a safe space for students to talk about their feelings, connect with others, feel less alone, and find ways to get through the tough spots,” Amelie says.
Fairfax County Public Schools offers similar programs, including Our Minds Matter, a mental wellness and suicide prevention program that provides student resources and support.
“Social supports like [these] are super powerful,” says Kristin Devaney, APS supervisor for counseling services. “Another thing that’s changed since the pandemic is that all school staff have been charged with incorporating social-emotional learning [SEL] into their instruction—not just our counselors, psychologists and social workers. Now everyone’s talking about it, normalizing it…so that we can all learn how to cope.”
The Virginia Department of Education is rolling out statewide SEL practices for schools, emphasizing prevention and early intervention for students in emotional distress, as well as skills to help kids self-regulate, solve problems, build empathy and manage their emotions.
“Our school counselors are the leaders,” says Devaney, “but it’s the responsibility of all adults to understand it, model it, teach it.”
Every school tackles mental health and wellness a little differently. In Arlington, Devaney says it’s up to the leadership at each school to decide which support programs will best address the needs of that school’s population. Some programs are more robust than others.
Students are also stepping up. At Meridian High School, Olivia and her classmates in 2020 co-founded the Mental Health Advocacy Club with the twin goals of raising awareness and offering peers a safe space to learn effective coping strategies.
Still, some families remain confused about where to turn first for help. Wendy Carria, APS supervisor for school psychologists and social workers, encourages people to reach out to whomever they know best.
“There’s no wrong door,” she stresses. “If you feel comfortable talking to a counselor, knock on the counselor’s door. If it’s the social worker, try them. We’ll connect you if needed. We’re interested in your concerns—you don’t have to wait until the child you’re concerned about is in crisis before you call us.”
The road to wellness is seldom linear. After their 16-year-old son was diagnosed with an eating disorder in February 2020, Stephanie* and her husband struggled to find the right treatment for their son and support systems for their family. “There’s a lot of trial and error with finding the right psychologist,” she says, “and it was hard enough to find someone who was taking on new patients.”
Through NAMI, Stephanie connected with a support group for parents of teens with eating disorders. The group offered encouragement, a list of professional resources and the assurance that she and her husband didn’t need to chart the waters alone. “I was really nervous to go talk to a bunch of strangers, but it turned out to be incredibly helpful for us,” she says.
“If you want your kid to be a better athlete or a better musician, you get them a coach, trainer or teacher. Therapists are coaches for your brain.”
Previous generations did not talk openly about mental health. Now, as we emerge from the darkest days of a horrific plague, the stigma is eroding.
“I do think all the efforts we’re putting into destigmatizing mental health issues are working,” says Devaney of APS. “Yes, there’s a mental health professional shortage right now, and that’s frustrating for families, but the reason there’s a waitlist is because we’re getting better at identifying the need.”
Sarah*, an Arlington mom, encouraged all three of her teenage girls to meet with a therapist after they started talking to her about social anxiety, isolation fatigue and the stress of transitioning back to in-person school. To her, it was a no-brainer.
“For parents who are reluctant to engage a therapist, I say, if you want your kid to be a better athlete or a better musician, you get them a coach, trainer or teacher. Therapists are coaches for your brain,” Sarah says. “If you’re going to give them the skills to succeed in all the other facets of life, why wouldn’t you want to give them a therapist?”
Another silver lining, observes Nancy Marin of Marin Psychology Associates in McLean, is that the pandemic has given teens opportunities to build empathy for their families and their peers. “Kids are having to think about their community members outside themselves—checking in on each other, sending care packages, being a little extra kind to each other.”
Teens like Olivia appreciate the generational shift in mindset.
“People today are more educated on eating disorders than they were in previous generations,” says the Falls Church senior. “When I was in a bad place, older people used to say things to me like, ‘You lost so much weight, you look great,’ which just made things worse. I feel grateful that people in my school community asked how I was doing but never commented on my weight loss.”
Nebolsine, the Falls Church therapist and author, agrees that the path to wellness is paved with empathy.
“One cool thing that’s emerged in the past couple of years,” she says, “is that now kids talk more openly about their stuff with each other. And if they can make sense of it and learn something from it, they can build meaning into it. Then they wouldn’t choose to undo it because of how they’ve grown from it.”
Arlington-based writer Adrienne Wichard-Edds is a mom of two teens and co-founder of The Essay Coaches, which helps high school juniors and seniors find their voices and tell their stories on college applications. Follow her on Twitter @WichardEdds.
Mental Health Resources
Arlington County Children’s Mobile Crisis (CR2)
Arlington County Youth Emergency Services
CrisisLink Regional Hotline
Text: CONNECT to 85511
National Alliance on Mental Illness
National Suicide Prevention Hotline