Closed Off and Opening up: A Continuum of Authenticity in the Relational Experiences of Youth Living with Mood and Anxiety Disorders

Background and Purpose: Relationships are essential for growth and development, while perceived social isolation is a risk factor for both physical and mental health.  Psychiatric symptoms and stigma can serve as barriers to connection for youth and thwart opportunities to develop interpersonal skills, such as communication, reciprocity, and self-disclosure. Poverty, trauma, and marginalization can also make it difficult for youth to form trusting relationships.  Yet little is known about how marginalized youth subjectively experience their interpersonal relationships.  Within the larger context of a federally-funded feasibility study of a psychosocial intervention, this qualitative study explored how young people navigated issues of trust, reciprocity, and connection/disconnection in their peer relationships.

Methods: Data were collected as part of a larger study of transition-age youth living with mental illness. Eligible participants were ages 16-20 and receiving services for a DSM-V Axis I mood and/or anxiety disorder at an urban outpatient mental health clinic. All participants (n=47) completed a brief qualitative interview on relationships in their social network. A sub-sample of women (n=11) completed 2 in-depth interviews, 3 months apart, on their relationships with professionals, family and peers. Participants were from low-income families and were ethnically diverse; 8 out of 11 participants in the sub-sample reported histories of child maltreatment. Semi-structured interviews included open-ended questions about trust, reciprocity, and conflict (e.g. “How do you decide what personal information to share with your friend?”). Interviews were audio recorded and professionally transcribed.  Two coders analyzed transcripts using thematic analysis.

Results: Participants’ social networks featured both kin and non-kin relationships. Nearly all participants (n=43; 92%) included a friend, close friend, or best friend on their social network maps. Seventy-four percent (n=35) identified friends as trusted peers, and 70% (n=33) mentioned friends as sources of emotional, cognitive, or instrumental support. In-depth interviews revealed nuanced variation in how participants demonstrated a willingness to be authentic and vulnerable in their friendships, with young women falling on a “continuum of authenticity.” At one end were behaviors that reflected authentic presence, supported vulnerability, and a willingness to repair disconnections in peer relationships. Exemplifying this approach is one participant who said, “If you open up to people, then they just understand you better.”  At the other end were friendships with fewer or no examples of authentic relating or supported vulnerability, alongside examples of inauthentic relating to peers, called strategies of disconnection. One example is a young woman who stated, “I’m really quick to just not make people my friends.”

Conclusions and Implications: Peers are valued members of these young people’s social networks. While most interviewees were survivors of family violence, their approaches to relationships varied. Some described relationship patterns that suggested they keep parts of themselves out of relationships, while others demonstrated relational resilience in their ability to represent themselves more authentically. Future research should explore how to cultivate authentic connection in the face of relational violations, as social isolation, including keeping parts of oneself out of existing relationships, is detrimental to young people (Lubben et al., 2018).