If you suspect a teenager is or has been abused, consider three questions.

1. Has his or her behavior suddenly and uncharacteristically changed?

Physical, sexual and emotional abuse, as well as neglect, can cause behavioral changes that may mimic typical teenage rebellion. A dramatic shift from typical behaviors may be an indication that a child is suffering from abuse.

Common behavioral shifts among teenagers include:

  • Increasing and deepening feelings of guilt or shame
  • Loss of interest in activities or interests they previously enjoyed
  • Major changes in sleep patterns
  • Physical or verbal aggression
  • Self-harming, such as cutting, biting, burning, hitting themselves or pulling out his or her own hair
  • Significant increases or decreases in appetite and avoidance of eating around others or with family
  • Sudden decline in academic performance

Girls may be more susceptible to isolating themselves from friends and loved ones, but boys may also withdraw from social interaction.

Such general signs may indicate abuse, but each type of abuse carries specific signatures.

Physical abuse may leave visible evidence, such as hand- or belt-shaped bruises, but teenagers may also develop associated maladies indirectly caused by physical confrontations with their abuser.

“Some teenagers develop physical symptoms — such as headaches, stomach cramps, chest tightness or shortness of breath — that are connected to anxiety or fear that stems from abuse,” said Farlie Chastain, LCSW, director of Social Services at Parkridge Valley Hospital, Child & Adolescent Campus.

Emotional abuse may cause teens to bottle up their feelings and become uncharacteristically or unhealthily emotionless. In some cases, facial features may even appear dull and expressionless.

Alternatively, emotional abuse can cause seemingly unprovoked emotional breakdowns that may include crying, screaming and even self-harming behaviors such as cutting.

Emotional abuse can also take the form of neglect. Teens are often left unattended at home for hours or days at a time and suffer no adverse consequences. But for those who have grown up in a home environment that was not safe and do not have the skills to attend to themselves, such inattention can cause physical and cognitive harm.

“Teens who aren’t safe or secure and are not capable of creating a safe environment for themselves often develop anxiety and begin to isolate themselves from the world around them,” Chastain said. “Sometimes neglected teens will have evident healthcare and nutritional needs.”

Neglect may also lead to feelings of inferiority. Children who receive no affirmation or who are told they are not good at anything and are worthless are more likely to develop strong feelings of inferiority and have difficulty achieving goals.

“Everyone at every age needs some affirmation that they’re a good person: Children must have someone who loves them unconditionally for healthy development,” Chastain noted.

2. What is he or she doing to feel safe?

Dramatic behavioral shifts caused by abusive situations may reflect the abuse teens experience. In an effort to protect themselves, teens may enact the abusive behaviors that have become part of their daily lives.

“Children who grow up in abusive families write that into their daily lives and often do not understand the difference between what they have experienced and normal acceptable behavior,” Chastain said. “Children who were abused will often recreate the pattern of behavior that happened to them, so they will touch, abuse or manipulate other people.”

At the other end of the spectrum, teenagers may develop maladaptive behaviors during a childhood of abuse in an effort to keep themselves safe. For example, a teenage girl who was sexually abused when she was younger may be fearful of men and wear shoes to bed because the bedroom environment was never a safe place, and she needed to be able to run. A teenage boy who was physically abused by a family member may keep a knife under his pillow because he developed a need to be able to protect himself from his abuser.

3. Who is he or she talking to about the problem?

Teens who have been abused need a safe place to talk about their experience.

“If a teen displays sudden and drastic changes in behavior, the worst thing an adult can do is not say anything,” Chastain said. “If the teen is unfamiliar, find an adult who knows him or her better. If there is no adult with a close relationship, engage the teen in conversation.”

Chastain offered several guidelines for beginning such a conversation:

  • Avoid yes or no questions. Instead, ask open-ended questions, such as, “Can you tell me what’s going on in your life?”
    • State the obvious: “You look or have looked sad, angry, lonely, upset. Will you tell me a little about what’s going on?”
  • Do not be confrontational. Asking a question such as, “Did you have sex with him,” puts the teen on the defensive and can come across as casting judgment.
    • “Ask questions from a position of concern, not condemnation,” Chastain suggested.
  • Make every effort to make the teen feel safe in the situation.

Creating a safe place in which teenagers feel comfortable confiding their feelings may be challenging, but it is critically important for their wellbeing.

Child abuse can have many, complex effects on teenagers. If a child has suicidal or homicidal ideations with plan, take him or her to the nearest ER immediately to remove the child from danger. If a child is safe but struggling with thoughts or feelings to harm themselves, call Parkridge Valley Hospital’s RESPOND line at (423) 499-2300 to schedule an appointment for an assessment.