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Book Review

Young Adult Mental Health

Matthew Kleban, MD

Published: June 15, 2011

Young Adult Mental Health

edited by Jon E. Grant, MD, MPH, JD, and Marc N. Potenza, MD, PhD. Oxford University Press, New York, NY, 2010, 448 pages, $79.95 (hardcover).

Young adulthood is a time of transition. Typically defined from age 18 to 29 years, this period encompasses milestones including starting college, entering the workforce, and establishing independent social function, with a gradual loosening of ties to one’s family of origin. Although it is a time of greater responsibilities, it is, to a certain extent, a time of personal exploration, with a moratorium on taking full adult roles. Young adulthood can be a period of emotional growth, with perhaps a deepening spiritual consciousness and a greater interest in the community-at-large. Alternatively, decreased parental supervision and an absence of social control agents associated with moving away from home, combined with a not-fully-mature brain function, increase vulnerability to an assortment of psychiatric disorders, particularly those involving impulse dysregulation. In Young Adult Mental Health, Jon E. Grant and Marc N. Potenza have assembled a multidisciplinary group of authors to explore various aspects of this distinct developmental period.

The first chapter, like all chapters in this book, starts with a vignette and describes a compelling real-world case of an individual who overcame delinquency in youth, reversed course in his early 20s, and went on to a career as a surgeon. The chapter presents data describing how, for some individuals, young adulthood presents "turning-point" opportunities, brought about by interpersonal strengths as well as external factors such as supportive mentors. Risk taking, another hallmark of the transition from adolescence to adulthood, is explored in several other introductory chapters. While some novelty seeking is considered normal for young people, who possess neural substrates that promote the evolutionary need "to move away from the familial net and explore new territories" (p 20), the college environment presents "an array of social activities that involve opportunities for risk taking" (p 50), contributing to substance abuse and risky sexual behaviors. These opening chapters, while somewhat theoretical, provide a foundation for a discussion on psychopathology later in the text.

The next series of chapters address healthy psychological development, emphasizing the more quotidian. A chapter entitled "College and Career" describes postsecondary educational issues, including interpersonal conflict that may arise from random roommate selection in dorms, a problem the nonmatriculated, who generally choose with whom they live, may encounter, discovering that "idiosyncrasies that are accepted in a friend are frequently sources of stress in a roommate" (p 86). Another survey chapter, on romantic relationships, describes how friendships in preadolescence serve as a "practice ground" (p 161) for later intimacy and concludes by describing sexual attitudes of young adults, including a definition of the newly-coined friends with benefits, in which relationships are "emotionally intimate, involve occasional sex, but for some reason are not labeled as ‘ boyfriend/girlfriend’ " (p 163). The chapter on parenthood is primarily devoted to a hypothesis stating that women raised by insensitive caregivers choose reproductive strategies characterized by the rapid production of multiple children with different partners, perhaps explaining why some women have children at a very young age despite the social costs. Another chapter presents research showing that marriage generally has salutary effects on mental health, possibly accounting for the overall strength of this institution despite trends of cohabitation and delay. Interestingly, marriage does increase the risk of being overweight, a fact that "contradicts the general argument that marriage is a panacea for health" (p 175).

The final 13 chapters describe psychiatric disorders, each chapter containing familiar subheadings (epidemiology, etiology, treatment, etc) and each emphasizing unique aspects to this cohort. The first chapter, on depression, includes a reminder that for young adults, "the index of suspicion for bipolar disorder should be high" (p 218). A chapter on obsessive-compulsive disorder (distinct from a larger chapter on anxiety disorders) notes that women have a bimodal age at onset, with a spike in cases corresponding with life events such as pregnancy or miscarriage. There are several excellent chapters on substance disorders, including a description on how alcohol use peaks during young adulthood, often a result of being in an environment that promotes use, and generally declines by the third decade of life. Cessation generally happens without deliberate self-change efforts, but rather from "maturing-out" (p 300) as heavy drinking becomes incompatible with adult roles such as marriage and parenthood. Following a similar natural history, impulse control disorders, such as kleptomania, which begins in the late 20s after a prodromal period of episodic shoplifting, as well as (the non-DSM) compulsive sexual behavior and compulsive buying, are associated with heightened dopaminergic activity and immature brain circuitry and "can be conceptualized as belonging to a larger constellation of developmental addictions" (pp 335-336).

The book is packed with references and information, yet there is acknowledgment from many contributors of a dearth of clinical studies specifically pertaining to young adulthood. Those looking to formulate treatment decisions about this age group often must extrapolate from either adolescent or general adult data. The book’s greatest strength, and where it most stands out from other general texts, is its thorough depiction of how the myriad transitions of this period can impact mental health. For instance, the intense social environment of college can worsen body image and cause an eating disorder, or the enhanced responsibilities that occur when leaving college and entering the workforce, "with much more being at stake than just receiving a failing grade" (p 146), can foster internalizing problems. While recent health care legislation may ease logistic barriers to services (allowing children to remain on their parents insurance until age 26), there remain normative barriers, including "universal skepticism" (p 201), typical for this age, or stigma, to which young adults are particularly susceptible as they are "in the process of establishing themselves in several arenas" (p 198). Containing numerous such pearls, this book presents a scholarly, yet highly readable, panorama of the young adult period, appealing to both general clinicians and those with specialized interests.

Matthew Kleban, MD

Author affiliation: Albert Einstein College of Medicine, New York, New York. Potential conflicts of interest: None reported.

Volume: 72

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