Anxiety, Depression, and Sleep Issues in High School Students

Difficulty breathing while speaking / depression / emotional regulation / insomnia

Hello, doctor.
I am a high school sophomore art student.
My personality type is INFP.
For this month, even though my eyes are tired and my head feels heavy, my mind keeps racing, making it hard to sleep.
I usually get up around 2 PM and can only fall asleep around 5 AM when it gets light outside, which is somewhat regular.
Last week, I tried to quickly adjust my sleep schedule by staying up all night.
Although I successfully moved my schedule forward by three hours the next day, it only lasted for that day.
Now, I rely on listening to sleep music to quiet my mind, but I still can't adjust my sleep schedule back.

About four months ago, I discussed the art class student council elections with my dorm classmates (two seniors and two classmates).
While speaking, I noticed everyone was staring at me, and my breathing became increasingly difficult, causing my body to tremble slightly.
This was the first time this happened during a casual conversation.
Previously, I only experienced this when asking questions one-on-one with a teacher.
Gradually, I realized that whenever there is more than one person quietly listening to me speak, even if it’s just one person—whether it’s family, teachers, or classmates—regardless of the seriousness of the topic, as long as I know they are people I will interact with in the future, I experience the same situation.
I slowly recalled a few days ago when I dreamt about my elementary school days and woke up crying.
In first grade, I was wild and confused; the teacher often scolded me in front of everyone, and sometimes I was curious why...
but I really didn’t mean to forget my homework.
In second grade, I began to passively resist and give up on myself, which gave the teacher even more reason to scold me.
Being reprimanded in front of teachers from other classes, receiving cold stares from seniors, experiencing obvious differential treatment, having friends distance themselves from me, and being whispered about behind my back—all of this was humiliating.
The feeling of everyone looking at her while she pointed at me...
I once complained to my mom, but it didn’t help; I thought it was my problem.
My sister always said I deserved to be bullied.
All I could do was fill a piece of paper with the homeroom teacher's name in red ink, cursing those people to die, then smiling as I returned to my bed to cry.
Now, the hatred and grievances from six years ago have not changed.
Middle school was my happiest time, with teachers who were willing to understand and support me.
I changed; I studied hard in class, no longer clashed with my family, interacted with others with high emotional intelligence, and followed the path my sister took to attend an art preparatory school, working hard to get into the art class.
The art studio teachers valued their students and had high hopes for us, wanting to send us to the top high school, but I didn’t perform well and just missed it, becoming the top of my second choice.
In high school, the art class is located in a separate building, and since the majority of students in the art class are boarders, interactions among seniors, juniors, and peers are frequent.
High school students are very different from what I imagined; my classmates are not very capable, noisy, and even put on makeup during class.
The dorm seniors are always talking about others' faults, even about speaking habits and ways of doing things...
they have something to say about everything.
I hate my high school, and I have to live and eat with them.
Yet, I am still afraid of their judgment; in front of them, I dare not speak much and carefully do my own things, not wanting to be caught and gossiped about.

I used to attend ballet classes to relieve stress, but now I don’t want to go anymore.
I can’t quite explain it, but I feel a sense of loneliness in what is supposed to be a group setting, as if I shouldn’t be there.
My art classes were also forcibly stopped by my dad due to the high tuition fees.
In the past, I gave up on myself and was a true underachiever.
But now, I am at the top of my school, and only those in the same art studio and dorm know this.
Although it sounds impressive, it is merely a result of a high-pressure environment, with less than a year of practice.
In the past, everyone always compared me to my sister and others, constantly putting pressure on me.
Now, I have achieved better results than my sister, have the support of my art studio teachers, and my family and relatives have high expectations for me.
The high art fees, classmates speculating about who the top student is, and the overwhelming amount of academic and artistic homework leave me sleep-deprived.
I don’t want to lose to others or let down the expectations of those who believe in me.
My temper is getting increasingly irritable, and my emotions change in an instant.
I argue with my family, curse, throw things, and get so angry that my vision turns from white to black, only to regret and apologize afterward.
I don’t know how to face those people with a smile; I just want to live in my own room.
Sometimes, I really want to find a tall building and jump off to be completely liberated, abandoning all ideals and goals for the future.
I asked my mom if I could skip school.
She said I always avoid things, escaping from regular classes to art classes, quitting dance, and now not wanting to study...
School starts in two weeks, and I really want to run away...
I don’t know if I have a problem; going to the hospital feels like I’m just pretending to be pitiful, so I wanted to ask first...
I’m sorry for the long message; I hope the doctor can help me with my questions.
🙏

Jun, 10~19 year old female. Ask Date: 2021/08/19

Dr. Lin Mianzhang reply Psychiatry

Hi Jun,
Thank you for being willing to express your feelings.
It seems that school life is putting a lot of pressure on you.
I'm not sure if you have any outlets for expressing yourself when you're under stress or feeling down.
Do you have friends you can talk to? Are there activities that make you feel happier? If you find that you don't have many ways to express your emotions, it might be worth considering visiting a mental health specialist to talk things over.
Seeing a doctor doesn't mean you're sick; it just seems that your situation may benefit from professional help.
A doctor can assess whether you are experiencing a level of illness and can also discuss ways to improve your current situation.
Even if you are not at a level of serious illness, psychological counseling can help you relieve emotions and reduce stress.
Therefore, I recommend that you seek care from a mental health professional to receive the support you need.
Wishing you success in your studies!

Reply Date: 2021/08/19

More Info

It sounds like you are experiencing a significant amount of emotional distress, which is not uncommon among high school students, especially those facing academic pressures, social challenges, and past trauma. Your symptoms, including anxiety, sleep disturbances, mood swings, and feelings of hopelessness, could be indicative of underlying mental health issues such as anxiety disorders or depression.

Firstly, it's important to recognize that the feelings you are experiencing are valid. Many adolescents go through periods of intense emotional turmoil, especially during high school when they are navigating complex social dynamics, academic expectations, and personal identity development. The pressure to perform well academically, particularly in a competitive environment like an art school, can exacerbate feelings of anxiety and depression.

Your description of feeling overwhelmed in social situations, particularly when you sense that others are watching or judging you, suggests that you may be experiencing social anxiety. This can manifest as physical symptoms like difficulty breathing or trembling when you are in a group setting. It's also common for individuals with anxiety to ruminate on past experiences, especially negative ones, which can lead to feelings of sadness and frustration.

The sleep issues you mentioned—staying up late and then sleeping excessively during the day—are also concerning. Sleep is crucial for emotional regulation and cognitive function, and disruptions in sleep patterns can worsen anxiety and depressive symptoms. It’s good that you are trying to use sleep music to help you relax, but it may also be beneficial to establish a more consistent sleep routine, which includes going to bed and waking up at the same time each day.

Your past experiences of bullying and feeling ostracized can have long-lasting effects on your self-esteem and mental health. It’s understandable that these memories would resurface, especially when you are under stress. The feelings of anger and frustration you described, along with thoughts of self-harm or escape, are serious and should not be taken lightly. It’s crucial to talk to someone who can help you navigate these feelings, such as a mental health professional.

You mentioned feeling like you are "putting on a show" or "pretending" when you are around others, which can be exhausting. It's important to find safe spaces where you can express your true feelings without fear of judgment. This could be through talking to a trusted friend, family member, or a counselor. Professional help can provide you with coping strategies and tools to manage your emotions more effectively.

In terms of seeking help, I encourage you to consider reaching out to a mental health professional. This could be a school counselor, a psychologist, or a psychiatrist. They can provide a safe environment for you to discuss your feelings and experiences, and they can help determine if you are dealing with a mental health condition that requires treatment. Remember, seeking help is a sign of strength, not weakness.

Lastly, it's essential to practice self-care. Engage in activities that you enjoy and that help you relax, whether it's drawing, listening to music, or spending time in nature. Physical activity can also be a great way to relieve stress and improve your mood.
In summary, your feelings are important, and you deserve support. Don't hesitate to reach out for help, as there are people who can guide you through this challenging time. You are not alone in this, and with the right support, you can find ways to cope and thrive.

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