17.3 Psychopathology

Most emerging adults enjoy the freedom that modern life has given them. Not all do, however. Although physical health peaks during these years, with almost no new, serious diseases, the same is not true for psychological health. Average well-being rises, but so does the incidence of psychopathology.

Multiple Stresses of Emerging Adults

Except for dementia, emerging adults experience more of every diagnosed psychological disorder (sometimes called mental illness) than any older group. Their rate of serious mental illness is almost double that of adults over age 25 (SAMHSA, 2009). Most serious disorders start in adolescence and emerging adulthood, and most are comorbid and untreated. That means, for instance, that an overly anxious young adult is also likely to be depressed (comorbid) and to have no professional help for either disorder (untreated) (Wittchen, 2012).

The first signs of future illness often appear in childhood, and symptoms typically worsen in adolescence. However, the full disorder often becomes evident and thus diagnosed for the first time during adulthood. This was one conclusion from research on psychological disorders in people in 14 nations (Kessler et al., 2012).

The burden falls not only on individuals and their families, but on societies as well. Although “mental disorders cause fewer deaths than infectious diseases, they cause as much or more disability because they strike early and can last a long time” (G. Miller, January 2006, p. 459).

Why does an increase take place in emerging adulthood? One reason may be the sexual freedom just described, which sometimes causes anxiety, depression, and disease. In addition, parents are less involved in the day-to-day life of their adult offspring than they were earlier, which means that disturbed young adults are on a tightrope without the safety net of parental protection. Further, especially in today’s economy, emerging adults are the age group most likely to be unemployed. They lack the steadiness of a job, and instead experience rejection after rejection—obviously a difficult condition for someone still forming an identity.

Most people can withstand uncertainly in one domain of their lives, but many emerging adults are hit from several directions. Multiple identity crises are likely to cause depression and anxiety (Crocetti et al., 2012). Vocational, financial, educational, and interpersonal stresses may combine during these years because

Most psychologists and psychiatrists accept the diathesis—stress model, which “views psychopathology as the consequence of stress interacting with an underlying predisposition (biological, psychosocial, or sociocultural) to produce a specific disorder” (Hooley, 2004, p. 204). You will recognize this model as related to the dynamic-systems model described in Chapter 1—that all the systems of the body, mind, and social context interact and influence one another as time goes on.

College counselors report an increasing number of students with serious psychological problems (Sander, 2013). This is particularly true for students at small, private, four-year colleges, where about 18 percent of the student body consult college therapists at least once during their four years. Only half as many students go to the counseling center at large public universities. The reason for this difference is unknown. It could have to do with the counseling center itself, or the college support for counseling, or the attitudes of the students. Or it could be the ecological setting: Most students at small private colleges are far from home, living on campus, unmarried, with large debts and uncertain future employment. That combination may be overwhelming.

Strength in any one domain of an emerging adult’s life is protective; the combination of stressors causes the breakdown. Certainly family context has an effect, for better or worse. Having a job may be pivotal, at least according to results from a program to secure employment for adolescents, young adults, and older adults with serious mental disorders. Benefits were particularly apparent for the emerging adults (Burke-Miller et al., 2011).

Thus, the demands of emerging adulthood may cause psychopathology when added to preexisting vulnerability. As a result, many disorders appear: Some (e.g., anorexia and bulimia) we have already discussed, and others (extreme risk-taking and drug abuse) are discussed soon. First we note three traditional categories of psychopathology: mood disorders, anxiety disorders, and schizophrenia.

Mood Disorders

Before they reach age 30, 8 percent of U.S. residents suffer from a mood disorder: mania, bipolar disorder, or severe depression. Mood disorders often appear, disappear, and reappear—which means that the individual, the family, and the society suffer repeatedly. The social cost of mood disorders is estimated to be higher than that of most physical illnesses, including cancer and heart disease, since mood disorders may begin in early adulthood (or before) and can prevent a person from fully functioning for decades (Wittchen, 2012).

The most common mood disorder is major depressive disorder, signaled by a loss of interest or lack of pleasure in nearly all activities for two weeks or more. Other difficulties—in sleeping, concentrating, eating, carrying on friendships, and feeling hopeful—are also present (American Psychiatric Association, 2013). About one-fourth of mood disorders begin in adolescence, and another one-fourth first appear in young adulthood.

Major depression may be rooted in biochemistry, specifically in neurotransmitters and hormones. However, as the diathesis–stress model explains, problems that are more prevalent in late adolescence and emerging adulthood (e.g., romantic breakups, arrests) can trigger latent depression that would not emerge if life were less stressful.

Women at all ages are more often depressed than men, but according to research on thousands of young adults in 15 nations, men are particularly vulnerable to depression from loss of a romantic partner. Marriage typically relieves male depression, but divorce may plummet men into despair (Scott et al., 2009; Seedat et al., 2009). However, day-to-day relationship interaction is particularly important for women, who can be depressed even within a romantic partnership (Whitton & Kuryluk, 2012).

Depression may be debilitating in emerging adulthood because it undercuts accomplishments—higher education, vocational choices, romantic commitment—that normally occur by age 25. Thus, depression at this stage makes the rest of adulthood more difficult (Howard et al., 2010; Zarate, 2010).

Failure to get treatment for depression is common among emerging adults (Zarate, 2010). They distance themselves from anyone who might know them well enough to realize that professional help is needed. Furthermore, depressed people of all ages characteristically believe that nothing will help. For that reason, although effective treatment lifts most depression, sufferers are unlikely to seek it on their own.

Anxiety Disorders

Don’t Worry Isaiah Schaffer was wounded twice as a soldier in Iraq and now suffers from PTSD. Evident in the photo are two ways he is learning to readjust to civilian life. He is buying a book for his young daughter, and he has his trusty service dog, Meghan, by his side. Meghan calms him when being in public suddenly triggers a panic attack.

EVELYN HOCKSTEIN/POLARIS

Another major set of disorders, evident in one-fourth of all U.S. residents below the age of 25, is anxiety disorders. These include panic attacks, post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD).

Anxiety disorders are even more prevalent than depression. This is true worldwide, according to the World Mental Health surveys of the World Health Organization (Kessler et al., 2009). Incidence statistics vary from study to study, depending partly on definition and cutoff score, but all research finds that many emerging adults are anxious about themselves, their relationships, and their future.

Age and genetic vulnerability shape the symptoms of anxiety disorders. For instance, everyone with PTSD has had a frightening experience—such as a near-death encounter in battle or a rape at knifepoint—yet most people who have had frightening experiences do not develop PTSD. Young adults, especially if they have no support from close friends or relatives, are more likely to develop the disorder than are people of other ages (Grant & Potenza, 2010). This is not surprising because young adults face a higher rate of trauma (military combat, rape, serious accidents) and are less protected by parents or spouses (Odlaug et al., 2010).

Similarly, every anxiety disorder is affected by culture and context. In the United States, social phobia—fear of talking to other people—is a common anxiety disorder, one that keeps young adults away from college, unable to make new friends, and hesitant to apply for jobs. In some Latin American cultures, anxiety takes the form of a physical sickness, such as headaches or stomach upsets (Bravo & Roca, 2013).

In Japan, a severe social phobia has appeared that may affect more than 100,000 young adults. It is called hikikomori, or “pull away” (Teo, 2010). The hikikomori sufferer stays in his (or, less often, her) room almost all the time for six months or more, a reaction to extreme anxiety about the social and academic pressures of high school and college. The close connection between Japanese mothers and children—and the fact that Japanese parents usually have only one or two children—makes this particular social phobia more common in that culture. Complications with attachment, coupled with shyness, are thought to cause the problem (Krieg & Dickie, 2013).

Recovering A young Japanese man sits alone in his room, which until recently was his self-imposed prison. He is one of thousands of Japanese young people (80 percent of whom are male) who have the anxiety disorder known as hikikomori.

JAMES WHITLOW DELANO/REDUX

It is easier to see how a culture in a distant nation (Japan) enables a particular anxiety disorder (hikikomori) than it is to recognize how one’s own culture raises anxiety in emerging adults. However, the severe anxiety about food and weight that underlies eating disorders seems more common in the United States than elsewhere. Anxiety seems to rise in emerging adulthood everywhere. Symptoms vary, but the emotion is universal.

Schizophrenia

About 1 percent of all adults experience schizophrenia, becoming overwhelmed by disorganized and bizarre thoughts, delusions, hallucinations, and emotions (American Psychiatric Association, 2013). Schizophrenia is found in every nation, but some cultures and contexts have much higher rates than others (Anjum et al., 2010).

No doubt the cause of schizophrenia is partly genetic, although most people with this disorder have no immediate family members diagnosed with it. Beyond genetics, several other risk factors are known (McGrath & Murray, 2011). One is malnutrition when the brain is developing: Women who are severely malnourished in the early months of pregnancy are twice as likely to have a child with schizophrenia.

Another is extensive social pressure. Schizophrenia is higher among immigrants than among their relatives who stayed in the home country, and the rate triples when young immigrant adults have no familial supports (Bourque et al., 2011). Drug use also increases the risk, another reason the incidence peaks in emerging adulthood, since during these years many people try psychoactive drugs.

The first symptoms of schizophrenia typically begin in adolescence. Diagnosis is most common from ages 18 to 24, with men particularly vulnerable. Men who have had no symptoms by age 35 almost never develop schizophrenia. Women who develop schizophrenia are also usually young adults, but some older women are diagnosed as well (Anjum et al., 2010).

This raises the question: Does something in the body, mind, or social surroundings trigger schizophrenia in emerging adults? The diathesis–stress model of mental illness suggests that the answer is yes for all three.