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Opinion It’s the girls who suffer more: Why young women face increasing anxiety

Lisa Damour is the executive director of Laurel School’s Center for Research of Girls, and is a senior adviser to the Schubert Center for Child Studies at Case Western Reserve University. Her latest book is Under Pressure: Confronting the Epidemic of Stress and Anxiety in Girls, from which this essay is adapted.

On a chilly Monday afternoon in November, I found myself in an emergency psychotherapy session with Erica, a seventh grader whom I’d seen on and off for a few years, and Janet, her very worried mother. Janet had called my practice that morning when Erica became so overwhelmed by anxiety that she refused to go to school.

“Erica had a rough weekend,” explained Janet over the phone, “because a big group project that’s due soon went off the rails over some social drama.” She added that her daughter hadn’t eaten breakfast for the past two weeks because she had woken up every morning with stomachaches that didn’t let up until midday. Then, through tears I could hear over the phone, Janet added, “I can’t believe that she’s not at school today, but I couldn’t figure out how to make her go. When I told her that I’d even give her a ride instead of making her take the bus, she looked at me like I was offering to drive her to a firing squad.”

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Feeling really concerned, I asked, “Can you come in today?”

“Yes, we have to,” said Janet. “She’s got to be able to go to school. I’ve got a meeting early this afternoon that I can’t miss. Can we come in after that?”

“Of course. And don’t worry,” I offered earnestly, “we’ll figure this out. We’ll get to the bottom of what’s going on.”

Something has changed. Anxiety has always been part of life – and part of growing up – but in recent years, for young women such as Erica and so many others, it seems to have spun out of control. I’ve been a psychologist for more than two decades, and in that time I’ve watched tension rise in girls in my private practice and in my research. I also hear about the mounting pressures girls feel as I spend part of each week at an all-girls school in my community and travel to talk with groups of students around the United States and around the world.

At work, I’m able to observe and learn from girls in so many ways, and when I’m home, I gain another perspective on them as the mother of two daughters. Girls are my world, and if I’m not with them, I’m often chatting about them with teachers, pediatricians or fellow psychologists. In the past few years, my colleagues and I have spent more and more time discussing the scores of young women we’ve met who are overwhelmed by stress or who feel intensely anxious. And we talk about how it wasn’t always this way.

Alarmingly, what we are observing on an intimate daily scale is confirmed by sweeping surveys. A recent report from the American Psychological Association found that adolescence can no longer be characterized as an exuberant time of life, full of carefree experimentation. Except for during the summer months, today’s teens now, for the first time, feel more stressed than their parents do. They also experience the emotional and physical symptoms of chronic tension, such as edginess and fatigue, at levels that we used to see only in adults. Studies also tell us that the number of adolescents reporting that they are experiencing emotional problems and are highly anxious is on the rise. For example, one study found that twice as many teenagers reported experiencing five or more symptoms of depression or anxiety in 2006 compared with 1986.

But these trends do not affect our sons and daughters equally. It’s the girls who suffer more.

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As confirmed by report after report, girls are more likely than boys to labour under feelings of psychological stress and tension. A 2017 study found that a staggering 31 per cent of girls and young women experience symptoms of anxiety, compared with 13 per cent of boys and young men. Studies tell us that, compared with boys, girls feel more pressure, and that they endure more of the physical symptoms of psychological strain, such as fatigue and changes in appetite. Young women are also more likely to experience the emotions often associated with anxiety. One study found that the number of teenage girls who said they often felt nervous, worried or fearful jumped by 55 per cent from 2009 to 2014 while remaining unchanged for adolescent boys over the same time period. A different study, from last year, found that anxious feelings are becoming more prevalent among all young people but are growing at a faster pace in girls.

These gendered trends seen in anxiety are also mirrored in the climbing rates of depression – a diagnosis that can serve as a proxy measure of overall psychological stress. Between 2005 and 2014, the percentage of teenage girls in the United States experiencing depression rose from 13 to 17. For boys, that same measure moved from 5 per cent to 6 per cent. While we hate to see emotional distress rise for our daughters or our sons, we should probably be paying attention to the fact that girls between the ages of 12 and 17 are now nearly three times more likely than boys to become depressed.

The gender imbalance in stress symptoms that begins in middle school doesn’t end after high-school graduation. The American College Health Association found that undergraduate women were 43 per cent more likely than their male counterparts to report feeling overcome by anxiety within the past year. Compared with male undergrads, college women also felt more exhausted and overwhelmed, and they experienced higher levels of overall stress.

When mental-health professionals hear and read about statistics such as these, we jump to attention. From there, we typically adopt an appropriately skeptical stand and wonder whether there has actually been a dramatic change in the number of girls who are feeling pushed to the limit, or if we are simply getting better at detecting problems that have been present all along. Researchers who study these questions tell us that we haven’t just pulled our heads out of the sand to discover a crisis that we have long ignored; the available evidence tells us that we are truly seeing something new. Nor does research indicate that girls are now simply more willing than they have been in the past to tell us that they are suffering. Rather, the situation for girls does actually seem to have gotten worse.

Experts point to a number of possible explanations for this emerging epidemic of nervous girls. Studies, for example, show that girls are more likely than boys to worry about how they are doing in school. While it’s nothing new for our daughters to strive to live up to the expectations of adults, I now hear regularly about girls who are so fearful of disappointing their teachers that they skip sleep to do extra-credit work for points they don’t need. Research also tells us that our daughters, more than our sons, worry about how they look. Although teens have always experienced moments of high anxiety about their physical appearance, we are raising the first generation that can, and often does, devote hours at a time to fretfully curating and posting selfies in the hopes that they will receive an avalanche of likes. Studies also suggest that girls are more likely than boys not only to be cyberbullied but also to dwell on the emotional injuries caused by their peers.

There are also sexual factors that apply uniquely to girls. Our daughters hit puberty earlier than our sons do, and the age of puberty for girls keeps dropping. It is now no longer unusual to see a fifth grader sporting an adult woman’s body. To make matters worse, girls develop their grown-up bodies while being inundated by images communicating the strong and distinct message that women are valued mainly for their sex appeal. In years past, these images were at least limited to those put out through conventional media outlets. Today, girls are just as likely to come across a sultry selfie posted on Instagram by a sixth-grade classmate.

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Thanks to digital technology, our daughters now conduct their social lives on multiple planes and, as we know, run into conflicts both in person and in cyberspace. But even when girls are getting along online, they can find that their social-media activity takes an emotional toll.

Growing up in the digital age almost certainly plays a role in the spiking levels of stress and anxiety we see in today’s teenagers. While the available evidence does not support exaggerated claims that smartphones are turning our kids into psychologically stunted screen-zombies, omnipresent technology has, beyond question, changed how we live. Not all of those changes are for the better, and adults are still coming to terms with what it means to raise children in a fully wired world.

The more that we, as parents, understand how the digital environment shapes our daughters’ interpersonal lives, the better equipped we’ll be to help them ease some of the tension that comes with being plugged in. Experts note that adolescents aren’t enthralled by technology – they’re enthralled by the peers on the other end of the technology they happen to be using. Indeed, teenagers have always been obsessed with their friends. Decades ago, we wanted to connect with our peers just as desperately as our kids now want to connect with theirs.

At this point, you might be thinking, “Okay, fine. But not like today’s teenagers. With their surgically attached phones and their mortal fear of missing out on even the most frivolous peer communication? We were never addicted to each other like that.”

Actually, we were. To plug into our own peer-obsessed pasts, we need to remember how we employed the connective technologies of our time. I, for one, can easily summon the memory of that hot, damp and even slightly painful ear sensation that would set in after spending hours with the family phone pressed to the side of my head. I even recall that, most evenings, a point would arrive at which my ear became so uncomfortable that I finally had to interrupt my friend at the other end of the line to say, “Wait … hold on a minute … I have to switch sides.” To which she would reply, “Yeah. Me, too.”

And do you remember when call waiting came out? That changed everything. Before call waiting, there would come a time each evening when my mother would interrupt me mid-call to say, “You have to get off the phone. Someone might be trying to reach us.” I’d stall, hang up eventually, and – now completely disconnected from my friends – sullenly resign myself to doing my homework. With the arrival of call waiting, I became the self-appointed family receptionist who commandeered the phone for the entire evening on the promise that I would hand over the line if (and only if) my parents happened to receive a call or wanted to make one.

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We really were no different from our own children. We just had lame technology.

Once we recognize that there’s nothing new or strange about young people’s intense desire to be connected to one another at all times, we can remember something else: Being connected to one’s peers can be very stressful. As much as I loved being on the phone with my friends, there was often a lot of drama going on.

Even with our limited technology, we found ways to simultaneously script and follow the latest episode of our own adolescent soap opera. We’d get together to listen in on each other’s conversations, maintain a frenzy of connections by ending one call to take another before calling the first (or second or third) person back or use call waiting to toggle back and forth between two conversations at once. When my mother eventually kicked me off the phone for the night (even, sensibly, after we had call waiting), I’m sure that my outward resentment was secretly lined with a modicum of relief.

Girls’ relationships with one another have always been charged. Today’s unprecedented capacity for connection only makes these interactions more complex, consuming and flat-out stressful than they ever were before. In the old days, we took much-needed breaks from interacting with our friends, simply because we had no choice. Now, we need to help our daughters push the pause button on their social lives – to engage in some conscious compartmentalization – so that they can get their much-needed breaks, too.

Accomplishing this can be fairly straightforward, but you should not measure the success of your approach by how enthusiastically your daughter embraces it. Limiting a young person’s access to technology is rarely a popular decision, but making unpopular decisions is, to be sure, an important part of being a parent.

You can reduce the resistance to any rules you make by holding the whole family to them. Many parents (myself included) are as absorbed in their technology as their teenagers are and can benefit from placing some limits on their own use. It can also be easier to draw lines around the time we spend on digital media when we make it clear that we’re not so much against technology as we are for other things. Here are some aspects of your daughter’s life that you might actively look to protect from the intrusion of technology: enjoying face-to-face conversations with family members, having uninterrupted time to concentrate on homework, being physically active, pursuing hobbies, playing outdoors and being able to fall asleep quickly and stay asleep through the night. Needless to say, digitally mediated social interactions pose a threat to each of these.

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Involve your daughter in deciding how she wants to implement any rules you lay down. Some will be relatively straightforward, such as setting the expectations that phones are never guests at your dinner table, that her technology shuts down by a certain time each night and that she engage in meaningful activities that require her to take breaks from social media. Others rules will be trickier to make and enforce. It is often the case that teenagers use digital technology to do their homework together, each from her own home. Accordingly, you’ll need to talk with your daughter about how she’ll know when being connected to her friends while doing homework lowers her stress by helping her get her homework done or when it only adds to it.

Don’t underestimate your teenager’s capacity to come up with smart solutions. Plenty of girls figure out that they complete homework more efficiently when they use “do not disturb” settings to turn off pinging text notifications and site-blocking software to silence the siren song of their favourite social-media sites. A colleague who works at a girls’ school discovered a particularly inventive way that several high school juniors barred themselves from social media for the duration of finals. They handed over their passwords to one another and authorized their friends to change them, setting them back again once the exams were over.

That said, girls cannot always be counted on to taper their own social-media use when it is causing them more stress than joy, or when it gives rise to poor decision making. I especially admire parents who notice when social media is taking an especially heavy toll on their daughter and, at least for a little while, reduce her access to technology or adjust her smartphone to turn it into a dumb phone for a few days. Every parent I know who has done this has told me the same story. At first, they encountered fierce resistance from their daughter, who had no interest in scaling back her social-media use. Soon thereafter, she seemed more relaxed than she had been in a long time and became her happy old self again.

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