Psychological Complications of Chronic Illness in Adolescence
Adolescence can be a stressful developmental process even for physically healthy teens. Acute or chronic illness occurring during adolescence can further complicate adolescent development.
Medical issues, treatment requirements, hospitalization and surgery (when necessary) all intensify concerns about physical appearance, can interfere with the process of gaining independence, and disrupt changing relationships with parents and friends. Also, adolescent developmental issues can complicate a teen's transition toward taking responsibility for managing their illness and learning to comply with recommended treatment.
Developmental Complications of Chronic Illness
Adolescents who are faced with acute or chronic illness are more likely to experience increased concerns and fears when their illness or healthcare needs conflict with the following normal developmental issues:
Body Image Issues Adolescents are normally focused on the physical changes occurring in their bodies. Chronic illness can intensify these concerns with fears or distortions related to their illness (such as fearing a surgical scar will interfere with physical attractiveness or the ability to wear certain clothes). Things that may improve these issues:
- Share concerns related to their body and how it may be affected by their illness or treatment.
- Discuss anticipated physical effects of medications and treatment with your physician. Encourage discussion about ways to reduce or cope with the effects.
Developing IndependenceChronic illness frequently interferes with an adolescent's comfort in becoming less dependent on parents. Parents of chronically ill adolescents often are more resistant to adolescent's efforts to act independently. Some ways to address the conflict between normal development of independence, while still addressing healthcare needs of the chronic illness include the following:
- Adolescents must be involved in health-related discussions (i.e., current concerns about their illness, treatment choices)
- Adolescents need to be taught self-care skills related to their illness. This is a process that should start before adolesence if possible.
- Adolescents need to monitor and manage their own treatment needs as much as possible
- Adolescents need to develop coping skills to address problems or concerns that might arise related to their illness through discussion with other individuals with similar illnesses, health care providers or other professional support
Relationships with PeersChronic illness and treatment often interferes with time spent with peers or in the school setting, which is an adolescent's primary social environment. Self esteem issues related to acceptance of one's self and concerns about acceptance by others are intensified by chronic illness and related treatment needs. To address these concerns, consider the following:
- Spending time with friends as much as possible
- Plan what to share with friends and how to share that information
- Find ways to respond if teased by peers
- Develop an ability to see humor in the situation in terms of both illness and interaction
- Foster friendships that are supportive
Non-adherence with Medical Treatment
As adolescents with chronic illness learn more about their illness and are encouraged to take responsibility for its management, attempts to make their own decisions about management are common. Trials of decreasing their medication or not taking it without consulting a physician often occur.
While this behavior may be developmentally normal, it may create the need for additional healthcare intervention. Angry or self-conscious feelings related to having a chronic illness, or poor judgment in how to cope with their feelings about their illness, might also affect compliance with recommended treatment or management techniques.
It is important for parents and healthcare professionals working with adolescent patients to help the adolescent develop emotionally healthy ways of living with their chronic illness and its management requirements. Some ways to help adolescents deal with the complications chronic illness often imposes on development may include the following:
- Encourage adolescents to share their ideas and concerns with healthcare professionals.
- When an adolescent's chronic illness reaches an unstable state due to not following treatment recommendations, encourage discussion of what happened rather than reprimand non-compliance.
- Teach and encourage use of problem-solving skills related to their illness. Ask questions such as: "What do you think you would you do if**?", "What do you think would happen if**..?" or "What would make it easier for you to**..?" Encourage adolescents to ask you the same kinds of questions.
- Seek mental health services when:
- an adolescent seems overwhelmed with emotional issues related to living with a chronic illness
- a pattern of not following medical treatment recommendations continues
- an adolescent's development regresses, overly dependent behavior continues, and/or the adolescent withdraws from or gives up interest in age-appropriate activities
Contact Us
For additional information on this or any Health Topic, please call the Family Resource Center, 513-636-1606, your pediatrician, or the Psychiatric Intake Response Center (PIRC) at Cincinnati Children's Hospital Medical Center, 513-636-4124.
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