Young women are presenting to emergency services and primary healthcare practitioners in greater numbers with deliberate self-harm, eating disorders and various forms of anxiety and depression.
Their mental health issues are not usually considered differently to men.
General assessments plus standard treatments are usually offered, with variable outcomes.
Mental health, as a field, largely continues to pursue a gender-blind approach to the understanding and treatment of most mental ill-health conditions, with little consideration of the specific impact of the biological, psychological, and social or environmental factors that create and perpetuate mental illness in those who identify as women.
Considering the rise in mental health crises in young women, a new approach is desperately needed.
Traditional diagnostic labels and associated treatments do not appear to be working well for young women in particular.
So what's behind this disturbing trend?
Let's start by looking at the social factors at play – particularly trauma.
When young people experience trauma, there is a significant impact on their developing brains.
Girls are greatly influenced by adverse social factors. These early life traumas could include growing up in a harsh or critical family with emotional invalidation, physical abuse, boundary violation or sexual abuse.
In Australia today, the rate of violence against women is unacceptably high and all types of violence can lead to long-lasting mental health issues. Women with a history of early life trauma, who then experience intimate partner or other violence, can suffer significant mental health adverse effects.
In considering the reason for increased mental ill health presentations by young women, the role of trauma is often overlooked.
Trauma of an emotional, physical, or sexual type is often a major driving factor for mental illness in young women.
More needs to be done to prevent it, but also to understand its impact on those for whom prevention is too late.
In addition to the awful impacts of trauma, young women face a number of social challenges and choices in negotiating and developing their identities. These include:
- educational and career aspirations
- good body image
- sexual and relationship preferences
- Social network development and maintenance.
Social media can create schisms and distress for young women, with unrealistic body comparisons and sexual expectations, as well as giving misleading information.
Relationships that mainly occur online can also create situations that exacerbate a sense of feeling unreal and disconnected.
The cost of loneliness
Young women experience loneliness and emptiness far more commonly than is discussed or acknowledged.
Socialisation is very important for most women, and during the recent pandemic lockdowns, young women particularly found the restrictions very challenging.
Many global surveys about the mental health impact of the pandemic have shown that women, particularly young women, have increased rates of depression, anxiety, eating disorders and substance addictions.
Although the pandemic restrictions have largely ceased, the mental health impacts continue to reverberate – especially for young women.
The menstruation cycle also plays a big role
The adverse impacts of trauma in girls and women can also alter brain chemistry, brain circuitry and brain hormone regulation of body and mental processes.
Of course, positive experiences in life can modify these brain changes, but with further life traumas such as bullying at school, or work/intimate relationship difficulties and physical ill health, the brain changes can lead to persistent mental illness.
In more recent times, we have learned of the "protective" role that brain hormones such as estrogen provide.
In girls and women with early life trauma, there is a heightened vulnerability to anxiety and depression related to the menstrual cycle, particularly when estrogen levels are in the lower phase.
At such times, some adolescent girls experience increased impulsivity with deliberate self-harm, if triggered by some reminder of past trauma.
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Some young women experience premenstrual depression — called PMDD — which is a different form of cyclical depression that has a rapid onset and offset.
The hormone cause for this condition is often ignored but can be successfully treated with particular and readily available hormone pill treatments.
This is an example of a female-specific condition that is not commonly considered, with dire outcomes.
Building girls up
Poor self-esteem is common in many girls and women, resulting from experiences of an unstable early life with heightened anxiety and being disempowered.
Anger is a normal emotion, but traditional models of femininity have led to expectations that anger in women is to be suppressed and controlled at all times.
Many women, especially young women with mental ill health, struggle with the expression of anger and can turn it inwards, resulting in self-harm.
Women often employ various psychological coping mechanisms that may not be well understood within a framework of "normal" behaviour — generated predominantly by men over centuries.
Understanding what lies behind a young woman's act of deliberate self-harm is critical.
Understanding the anger, frustrations and resentment driving poor self-esteem and deliberate self-harm, requires time and a sensitive and empowering approach.
Unfortunately, young women who self-harm are still seen as being manipulative, attention-seeking, or worse as "having a personality disorder".
The diagnosis of borderline personality disorder is often given to young women who harm themselves. This particular label carries great stigma and is often equated with being manipulative and fundamentally having a flawed personality — which is the essence of each person.
Such a label is damning indeed! Often, in these women, the trauma underlying the deliberate self-harm is not sought or understood.
Dismissal of the seriousness of deliberate self-harm by labelling it as a personality disorder is a grave injustice for many young women who are facing significant life struggles and looking for compassionate help.
Adding to this injustice is the common myth that women only attempt suicide, but men complete it, hence more attention should be paid to the male with suicidal attempts or thoughts. Clearly, this is incorrect and we need to do better for everyone presenting with self-harm or suicidality.
Rethinking how we support girls
The rise in young women's mental ill health is multifactorial in origin, with biological, psychological and social factors all interacting to produce depression, anxiety, eating disorders and deliberate self-harm.
While we are still not certain about all the causes of mental ill health in this big group, what we can be certain of is that we need a new approach to stem the rising tide of mental illness in women.
Investing in a new, woman-focused approach that is holistic and empowering would be an important step forward.
It is time for a change in the provision of mental health services for young women.
Posted, updated
