Introduction
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 last 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.”
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 like 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 last 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.
But these trends do not affect our sons and daughters equally.
It’s the girls who suffer more.
As confirmed by report after report, girls are more likely than boys to labor under feelings of psychological stress and tension. A recent study found that a staggering 31 percent of girls and young women experience symptoms of anxiety, compared to 13 percent of boys and young men. Studies tell us that, compared to 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 percent from 2009 to 2014 while remaining unchanged for adolescent boys over the same time period. A different study 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 experiencing depression rose from 13 to 17. For boys, that same measure moved from 5 to 6 percent. 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 twelve and seventeen 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 percent more likely than their male counterparts to report feeling overcome by anxiety within the past year. Compared to 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 like these, we jump to attention. From there we typically adopt an appropriately skeptical stance 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. Though 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. Making matters worse still, widely seen marketing content often exploits young girls—think of commercials with a “naughty school girl” angle—or targets them as consumers, as in advertisements now peddling thongs and push-up bikini tops for seven- to ten-year-olds. 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.
These prevailing explanations for why girls feel more pressure than boys are helpful, if not altogether surprising. But knowing about some of the particular difficulties girls face is not the same as knowing what we can do to address them.
If you are reading this book, then you have probably tried numerous ways to help your daughter feel less anxious and more joyful. You have reassured her that she should worry less about what she scored on that last quiz and do her best to ignore hurtful online chatter. You’ve already told her that she is beautiful or that looks aren’t important. (Most loving parents, myself included, have said both!) You’ve taught her to question and critique cultural messages suggesting that a girl’s worth hinges on how she looks, and you’ve worked to limit the amount of time she spends posting or scrutinizing digital images. Yet, despite your best efforts, you may still find yourself raising an absolutely terrific girl who spends far too much time feeling nervous or unhappy.
This book examines the forces that fray girls’ nerves and suggests how we can help our daughters feel more at ease. I’ll describe what I’ve learned from the growing research, my psychotherapy clients, my colleagues, girls at schools, and my own daughters about the steps we can take to shield young women from toxic stress and anxiety. At times, I illustrate my ideas with examples from my work, but I have altered identifying details and in a few cases presented composites in order to maintain the confidentiality of those who have shared themselves with me.
Under Pressure will start by building our understanding of stress and anxiety. From there, it will consider how tension finds its way into the many facets of girls’ lives, examining chapter by chapter the difficulties that invariably arise for our daughters in their home life, in their interactions with other girls, in their dealings with boys, in their role as students, and in their participation in the broader culture. As parents, we may wish that we could clear our children’s path of any source of discomfort, but there really are no stress-free routes from infancy to adulthood; even if we could make this happen, it would not serve our children well in the long run. That said, it’s much easier to feel relaxed about the stressors that await our daughters when we know what to expect.
Anticipating the difficulties our girls will encounter as they age allows us to respond more helpfully when they become upset. And how we respond to a girl’s worries and fears matters a lot. Every time your daughter scraped her knee as a toddler, she looked first at her knee and then at your face. If you remained composed, she felt better right away. Had you scooped her up and rushed her to the emergency room, she would have become unnecessarily terrified. Reacting with alarm to normal difficulties can make them worse and even contribute to a girl’s unhealthy levels of stress and anxiety. With this in mind, Under Pressure won’t simply itemize the concerns that arise for girls and young women, it will also offer strategies to help you reassure your daughter on the days that she feels she is falling apart and to help her manage on her own when she is ready.
Many of the stressors that come with growing up are age old, while others are new to the scene, such as the omnipresence of digital technology and the increasingly intense college admissions process. We’ll consider how parents can help their daughters deal with both the old and new challenges effectively. This book should help your daughter to feel less anxious, but it cannot take the place of treatment for a diagnosable psychological disorder. If your daughter already suffers from crippling anxiety, you should consult with her medical provider or a licensed mental health clinician about the treatment options that make the most sense for her.
Under Pressure considers the burdens borne by girls, but don’t be surprised if some of its guidance also helps with raising a son. It’s true that our daughters are statistically more likely than our sons to be anxious, but plenty of boys struggle with feelings of tension and stress as well. And though Under Pressure looks at the topic of psychological pressure through the lens of gender, it will touch on ways that financial insecurity or minority status can add to the challenges that all girls encounter.
When it comes to reckoning with the mental and emotional pressures our daughters feel, there are no easy answers, nor quick fixes. But taking a detailed, comprehensive look at the problem opens a world of new approaches to solving it. We love our girls, we hate to see them suffer, and there is a great deal that we can do to help them feel happier, healthier, and more relaxed in the face of the challenges we know will come their way.
Let’s get started.