Parenting Troubled Teenage Girls Can Be Extremely Difficult

When it comes to telling the difference between what is normal teenage misbehavior and what is a mental health concern, parenting becomes extremely difficult. In many cases, undesirable teenage behavior looks like teens with mental health issues. But, unfortunately, it is often just too hard to tell. I was one of those parents who could not see the difference…until it was almost too late.

According to the Georgetown Behavioral Health Institute, mental illness in teens is “remarkably common.”1 Lashing out, spending untold hours alone, and making really poor choices simply looks as much like normal adolescent growing pains as it does teens with mental health disorders.

As a parent of a teenage girl who acted out a lot like this, I did not know whether or not to be primarily concerned. I thought that all this “normally abnormal” behavior would pass in time.

My daughter was anxious, depressed, and making very risky decisions. Some days, things seemed more or less normal, and others seemed like all hell was breaking loose. Over time, instead of getting better, things got worse.

The so-called average days became scarce, and the days of missing school, avoiding even her best friends, and sleeping hours on end became the norm. I knew in my gut something was wrong, really wrong, but my abiding conviction remained that in time we somehow would “get through this.”

My hesitance, my not wanting to know what was going with my daughter, almost cost her life. After not returning from visiting a friend at her house in a nearby neighborhood, I went looking for my daughter. Instead, I found her lying face-down in a sidewalk gutter a couple of blocks away, totally unresponsive. Following an ambulance trip to the hospital, my daughter clung to life in the emergency room into the wee hours of the morning. Needless to say, this was a sleepless night.

It turned out my daughter was lucky. I was lucky. This was my wake-up call. My daughter had known for some time that something was really wrong, and when relief seemed not to be forthcoming, she turned to alcohol to numb her pain.

I finally chose to get serious and sought professional help for my daughter. It was about time. We almost ran out of time. She desperately needed help. This was clearly not something she was going to get over someday.

What Parents Should Look for That is Not Normal Teen Behavior

Medical professionals at the Georgetown Behavioral Health Institute recommend the following ‘red flags’ to pay close attention to:1

*decreasing school performance, and apathy about it

*missing days of school, with an attitude of dropping out

*not wanting to talk or see friends, even those once closest

*little or no interest in doing things that once brought joy

*long hours of sleep, or the opposite, incessant insomnia

*inability to focus on tasks, or even sit still for extended periods

*constant worry about what others think, to a paralyzing degree

*times of excessive high energy, followed by both emotional and physical collapse

*involved in self-harm, including cutting and burning

*prolonged periods of staring off into space

*suicidal thoughts as if somehow it would bring relief

*extreme irritability, leading to frequent tantrums

*hearing voices or feeling as if being controlled by unseen forces

*smoking, drinking and taking drugs

Experts at the National Institute of Mental Health (NIMH) add the following ‘red flags’ to the list to watch for:2

*frequent expression of objects of fears and worries

*frequent stomach and headaches, with no medical reason for occurring

*frequent nightmares

*ongoing expression of fears of gaining weight or being overweight, when the opposite is true

*repetitive behaviors in an attempt to prevent imagined harm

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Most Common Teenage Girl Mental Disorders

The National Institute of Mental Health (NIMH) reports that 49.5% of all adolescents will experience mental illness to one degree or another between 13 and 18 years of age. According to The American College of Obstetricians and Gynecologists (ACOG), the most common mental health disorders include ADHD, mood disorders, major depression, conduct disorders, anxiety disorders, panic disorder, eating disorders, psychotic disorders, and substance abuse disorders.3

Anxiety Disorders

Generalized Anxiety Disorder (GAD)

Excessive apprehensive expectations about events of activities, varying in intensity, duration, and frequency. In other words, when anxiety or worry is out of proportion with the actual likelihood of occurrence.

Social Anxiety Disorder

Persistent fear of social performance situations causing extreme distress and ultimate avoidance.

Panic Disorder and Panic Attack

Recurrent unexpected attacks of panic. Abrupt surges of intense fear or discomfort, resulting in palpitations, pounding heart, accelerated heart rate, sweating, trembling or shaking, shortness of breath or sensations of smothering, feelings of choking, chest discomfort, nausea or abdominal distress, dizziness or lightheadedness, heat sensations, paresthesias, derealization and/or fear of losing control.

Obsessive-Compulsive Disorder (OCD)

Recurring obsession or compulsion to perform certain tasks, including cleaning, maintaining symmetry, avoiding forbidden or taboo thoughts, and to do harm of one sort or another to self or others.

Posttraumatic Stress Disorder (PTSD)

The development of negative symptoms after exposure to actual or threatened death, injury, or sexual violence, including fear-based re-experiencing, anhedonic or dysphoric mood states, arousal and reactive-externalizing, dissociations, or combinations of the above.

Mood Disorders - Adjustment Disorder w/Depressed Mood

The development of emotional/behavioral symptoms in response to an identifiable stressor within 3 months of its appearance, including low mood, tearfulness, or feelings of hopelessness.

Major Depressive Disorder (MDD)

A period of at least 2 weeks when there exists a depressed mood or the loss of pleasure in nearly all activities resulting from an event that causes sadness. For adolescents, the sadness may appear as irritability.

Bipolar Disorder

A pronounced period of abnormal and persistent elevated, expansive or irritable mood and an abnormal and persistent increased activity or energy, lasting at least 4 consecutive days, and requiring hospitalization.

Premenstrual Dysphoric Disorder

Cyclic recurrence of severe, often disabling changes in mood lability, irritability, dysphoria, and anxiety during the luteal phase of a woman's menstrual cycle.

Attention Deficit Hyperactivity Disorder

Symptomatic inattention or hyperactivity or impulsivity for at least 6 months to a degree that causes maladaptive inconsistent with normal development and behavior.

Disruptive Behavior Disorders

Conduct Disorder

Persistently repetitive patterns of behavior that violate the basic rights of others or age-appropriate norms of behavior, including aggression to others, destruction of property, deceitfulness, theft, or violation of rules regarding curfew and truancy.

Oppositional-Defiant Disorder

Negativistic, hostile and defiant behavior that includes losing temper, arguing with adults, refusing to follow rules, annoying others, blaming others, acting resentful of others, and being vindictive.

Somatization Disorders

The sensation of chronic pelvic pain, severe dysmenorrhea, vulvovaginal pain or itching, or ovarian cysts. An extreme patient may think she is pregnant, have amenorrhea, abdominal enlargement or other pregnancy symptoms without evidence of being pregnant.

Body Dysmorphic Disorder, or an obsessive preoccupation with some aspect of one's body as being flawed in some way, usually begins in adolescence and can be associated with OCD and social anxiety.

Borderline Personality Disorder

High sensitivity to rejection and fear of abandonment, which causes a demand for frequent attention. Includes impulsive behavior that leads to binge-eating, high-risk sexual behavior, self-harm, and attempts at suicide.

Psychotic Disorders

Schizophrenia includes disorganized speech and being inordinately out of touch with reality. Though teens are often not diagnosed during the adolescent years, the early onset of psychotic disorders like Schizophrenia begins before they reach 18 years of age.

Eating Disorders

Eating disorders involve teen girls having a distorted feeling that they are overweight, which leads to feeling out of control and resorting to extreme dieting, not eating at all, or binge eating followed by forced vomiting.

Substance-Abuse Disorder

Adolescents who abuse drugs and alcohol also often suffer from other conditions, including depression, anxiety, ADHD, and Oppositional Defiant Disorder. Often, drug and alcohol use ends up in the mix, adding layers of addictive/dependency issues of their own, in a misguided effort to self-medicate to deal with other mental and emotional issues they are struggling with.

Most Common Treatments for Teenage Girl Mental Disorders

One thing parents and struggling teens must know and understand is that mental illness is treatable. And through the hands of gifted professionals, the best treatment options available can be spelled out and made available. Among the most common treatments are Cognitive-Behavior Therapy, Interpersonal Therapy, Family Therapy and Educational Interventions.5

Cognitive-Behavior Therapy

Cognitive-Behavior Therapy helps teens recognize and change the negative thinking patterns and behaviors to those that are actually good for their mental and emotional health.

Interpersonal Therapy

Interpersonal Therapy shows and guides teens in how to interact with others (peers, family, and others) more comfortably and positively.

Family Therapy

Family Therapy guides the entire family of troubled teens in how to work together to work through and manage whatever mental illness and resulting behaviors are present.

Educational Interventions

There are many educational interventions teens can learn that will help them to more effectively manage their time, focus, and their participation in the classroom where they go to school.

Other Effective Treatments for Troubled Teen Girls

Other treatment options are also available and are as effective as those we have heard most about, including Solutions-Focused Therapy, Psychodynamic Therapy, Mindfulness-Based Therapy, and Equine-Based Therapy.

Solutions-Focused Therapy

Solutions-Focused Therapy is future-focused, goal and outcome-directed, and solutions-oriented, instead of focusing on the problems that brought the teens to seek therapy.6

Psychodynamic Therapy

Psychodynamic Therapy involves a more sustained focus on the interpretation of mental and emotional processes rather than behavior. It is designed to help find patterns in emotions, thoughts, and beliefs to gain insight about a self that leads to particular behaviors.7

Mindfulness-Based Therapy

Mindfulness-Based Therapy helps individuals to better understand and manage their thoughts and emotions in order to achieve relief from their distress. This approach is relatively new, having been developed in 2000.8

Equine-Based Therapy

Equine Therapy assists troubled teens to open up to various issues using the element of contact and interaction with horses. Much of this treatment involves actually riding horses with the assistance and training of an equine-certified therapist.

Faith-Based Mental Health Treatment

Apart from the perhaps better-known secular treatments outlined above, one growing and important option to seriously consider for helping troubled teens can be found in faith-based treatments. Many across the nation who participated in faith-based treatment programs credit religion as playing a positive role in their recovery. 9

The correlation between religiosity and reduction in hypertension, depression, substance abuse, suicide, non-marital childbearing, and delinquency, reports Morgan Cox and Betsy Mathews, in the Journal pf

Correctional Philosophy and Practice, suggests that faith-based treatment may be the best way to address these critical needs.10

Faith-Based programming has a long history of success in the corrections field, Cox and Matthews also report. The first correctional institutions were premised on the belief that incarceration should be a time of hard work, solitude, and reading the Bible, along with continual reflection on how such incarcerated persons might change their sinful ways.10

Secular treatment programs characteristically focus on healing physical, mental, and emotional damage…with some including a personal faith-based component. Faith-Based Treatment focuses first and foremost on spiritual healing, and the healing effects it has on the physical, mental and emotional aspects of our lives.

“For example, Christian-Based counseling includes accepting God and scientific best practices for cognitive therapy.”

--Faith-Based Recovery PT 3: Is Faith-Based Addiction Treatment More Effective”

The key to Faith-Based treatment is the focus that all re-building efforts centralize a person’s spiritual beliefs. All other goals for recovery come from a foundation of recovery in the spiritual domain.

Such treatment efforts have long been practiced in the U.S., beginning with Native Americans after the arrival of the first settlers to America. Such programs were focused on abstinence from alcohol and the return to original spiritual traditions. God-fearing settlers concluded that the drinking problems of Native Americans were rooted in poor moral character.10

Christian churches got more heavily involved in dealing with drug and alcohol addiction in the 1950s when juvenile addiction in urban areas began to skyrocket. The Islamic churches also became involved in the 1960s when addiction became popularized and began to lay waste to a generation of America’s black youth.10

What Parents Can and Should Do for Their Troubled Teens

You love your children. Keep loving them, even when they are struggling, and accept the fact that you may need assistance in giving them the help they most need. And when your children become troubled teens don’t ignore them or throw your hands up in defeat.

If you see the red flag behaviors in your teen, similar to those outlined above, seek professional help. Talk to your child’s school counselor. Consult a doctor. Contact a therapist or other mental health professional. Tell them what’s going on. Tell them what you’ve already done. But don’t stop there.

Talk to your teen. Consider your relationship with your teen, and if it needs improvement, start work on that. And please, please, don’t take their struggling personally. It’s not a reflection on you as a parent. Focus, instead, on your teen's most immediate needs. Be there for them like never before.

Expect anger and even rejection. Your teen may not yet think they have a problem and don’t need help. They are likely to lash out. Verbal abuse might even become violent. Be ready, if need be, to contact neighbors, relatives, even the local police. Do not put up with it. Confront it…constructively.

*establish or clarify boundaries, rules, and consequences

*try to understand what’s truly behind the anger and outbursts

*get to know and watch for triggers for unleashing violence

*help your teen use constructive ways to relieve pent up anger

*know when to and give your teen space when needed to retreat

*manage your own anger in response to your teen’s behavior

*help your teen make healthy lifestyle changes, look for options together

*exercise, healthy eating and plenty of sleep can work wonders

And remember always that this kind of misbehavior is treatable. You don’t have to take all this on your own. Seek and ask for support and intervention when needed.11

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1 “Normal Teenage Behavior or Mental Health Issue? Know When to Seek Help,” Georgetown Behavioral Health Institute, February 2018.

2 “Child and Adolescent Mental Health,” National Institute of Mental Health, November 2020.

3 “Mental Health Disorders in Adolescents,” The American College of Obstetricians and Gynecologists,” (ACOG), Reaffirmed 2020, from 2017.

4 “Most Common Teenage Girl Mental Illnesses,” BNI Treatment Centers, 2020.

5 “Mental Illnesses in Children and Youth,” heretohelp, 2014.

6 “What is Solution-Focused Therapy?” The Institute of Solution-Focused Therapy, 2020.

7 “Psychodynamic Psychotherapy Brings Lasting Benefits through Self-Knowledge,” American Psychological Association, 2010.

8 “Mindfulness-Based Cognitive Therapy,” Good Therapy, 2020.

9 “Faith in Recovery Pt. 3: Is Faith-Based Addiction Treatment More Effective?” World Religion News, 2017.

10 “Faith-Based Approaches for Controlling Delinquency of Juvenile Offenders,” Morgan Cox and Betsy Matthews, Journal of Correctional Philosophy and Practice, 2007.

11 “Help for Parents of Troubled Teens,” Lawrence Robinson and Jeanne Segal, HelpGuide, 2020.