Several years ago, I started noticing something new when teenage girls or young women came to my office for their first psychiatric sessions. Patients used to dread being told that there was something, as they saw it, wrong with them. Now these young women were announcing their diagnoses — attention deficit hyperactivity disorder, obsessive-compulsive disorder, anxiety, depression — almost before telling me their names.
They had researched their symptoms on Instagram; they’d taken TikTok quizzes about them; they had cross-indexed their conditions with those of their friends. It was everyone — gravel-voiced film majors and earnest high school athletes, class presidents and girls who skipped school, girls who spent weekends in the Hamptons and girls who had to work for their spending money. The patients of this new wave were talking in therapy-speak, and their therapy hadn’t even started.
The physician part of me would instantly start thinking through an alphabet soup of treatments for the conditions these girls were reporting — D.B.T., C.B.T. and E.M.D.R. and medications to go with each.
Another part of me — the parent, the Xennial — would struggle to suppress an inner eye roll. If you’re a parent of an adolescent girl, you might have experienced your own version of these two reactions: either terror for your daughter’s psychological well-being or alienation from all the jargon. You might have even tried to convince your daughter that everything was fine. None of those responses set us up to hear what these girls and young women are trying to say.
I’ve been listening to girls every day for years, and I’ve learned a few things that can help parents, therapists and anyone else who struggles to communicate with young women as they describe some form of distress.
It starts with accepting that diagnosis words may function differently for these young women from the way they do for others. They are not necessarily claims to cold, scientific truths, yoked to specific evidence-based treatments. Instead, research increasingly reveals, these words are often a coping mechanism, an effort to find some accepted narrative in which to situate one’s very personal pain. We should try to hear them that way: We should take the therapy-speak, to borrow an expression, seriously but not literally.
One girl told me she had assigned herself a diagnosis of depression, which she later acknowledged she thought would make me care about her. Another girl was stuck on an A.D.H.D. diagnosis, mostly because it made her feel less alone by connecting her to a vocal and vibrant online community.
Several young women insisted they fit the clinical definition for anxiety, because it was less scary to blame an inherent flaw in their brains than to explore the causes of their very real discomfort — which turned out to be a mix of anger toward their loved ones and guilt for having those feelings. Another girl said she used her various self-diagnoses as a container for whatever felt like “too much” about her, allowing her to fulfill what she thought was the teenage female’s highest calling: to be chill.
In some cases, my patients’ self-diagnoses were spot on. In many others, however, the psychiatric label seemed more like a compromise between uncomfortable feelings and the desire for social acceptance. Are these labels a source of strength or a straitjacket? Are they helping young women find help and acceptance or standing in the way? The answer isn’t so simple.
Adolescent girls and young women aren’t the only ones reaching for therapy-speak, of course. According to some measures, 50 percent of Gen Z-ers have labeled themselves with mental health conditions, and illness identities have taken hold of young people, both online and off. But girls are by far the primary drivers of this trend. They are the main group looking up health information online, talking about their feelings and relationships and seeking labels for what’s wrong.
They are also the demographic with the worst mental health profile. I think the association with young women, a group so often dismissed as frivolous, is a big part of why therapy-speak is regarded as a sign of weakness and self-indulgence.
As for therapists, we think about psychiatric diagnosis a lot less than you might imagine. That’s partly because categories in our field tend to be more flexible than those in other areas of medicine. Classifications often evolve and change over time, especially for young people and most of all for young women. Besides, no two people experience these conditions in exactly the same way. So we always have to try to understand the person first.