Their role in mental health development for nurses
Bradley, a 14-year-old boy in high school, often feels like everyone is watching him. He is self-conscious and will often spend a lot of time looking into the mirror to make sure his hair is combed just right or his clothes are matching the latest trends. Sometimes he feels like he is the coolest kid in class and that is why he is being watched, but other times he feels there might something wrong with him, or that he is being judged.
Because he senses being watched he feels he is unique, and that others cannot possibly understand what he is going through. This is part of the egocentrism seen in adolescents when they enter what Piaget called the formal operations stage of development. They can now hypothesize and think abstractly.
Due to this uniqueness, Bradley often feels invincible. Psychologists call what Bradley is going through as the imaginary audience and personal fable. It tends to start between the ages of
11-13, peaks at around age 14, and declines as teens go through middle to late adolescence.
Imaginary audience is the belief that many people are enthusiastically observing, listening to, and interested in them. The personal fable is a stage where the teen thinks he is unique, and due to this others cannot possibly know how they feel. If they are in love, they feel no one has ever felt ‘this much in love before’ or if they are emotionally hurt ‘no one has ever felt this bad before.’
No neurological component seems to be identified with this other than the ongoing brain development that tends to end in the early 20s. It has been viewed as a developmental phase essential to self esteem and identity. One possible drawback is because of this feeling of uniqueness and invulnerability, adolescents often will often engage in risky behaviors. This will diminish with further brain and cognitive development until emerging adulthood.
If this developmental milestone is not experienced and withstood, is there a consequence in future mental health development? One observation is that many teens start the process of ‘cutting’ in early adolescence. This is done to relieve emotional pain. Does the personal fable of believing no one else has ever felt this way or can understand what I feel contribute to cutting? Teens at this age will often not express their feeling. Getting them to talk about their feelings is an important part of treatment, and often with supportive listening, cutting will lessen or end.
Many features of the personal fable and imaginary audience are symptoms of mental illness that develop early in adulthood. Schizophrenia can have delusions of persecution. This includes thoughts of paranoia including the idea the individual is being watched, listened to, or that others are interested in or jealous of them similar to an imaginary audience.
These symptoms are also present in paranoid personality disorder. Bipolar disorder and schizophrenia can include delusions of grandeur. These are like the personal fable only on a much grander scale. Narcissistic personality disorder include a special feeling of uniqueness and the despair that others can’t see how wonderful or unique that they are.
The imaginary audience may lead to obsessive-compulsive behaviors as frequently checking one’s appearance or changing clothes. Elements of the imaginary audience and personal fable can found in many other psychological disorders, including personality disorders, anxiety disorders, and depression.
Little research has been completed regarding this developmental stage and its effect, if any, on the development of future mental health disorders as adults. Nurses can be aware of this developmental phase and identify symptoms that can help in determining whether these are normal parts of adolescence, or symptoms of an emerging illness.
For example, a nurse aware of the personal fable works with a 13 year old girl who broke up with a boyfriend and has started cutting. This nurse can get the patient to open up and talk about her feelings by providing empathy and supportive listening.
A 16-year-old who refuses to go out and eat in public because he feels he is being watched is probably past the stage of an imaginary audience. This may indicate having an emerging psychological disorder as social anxiety, panic attack symptoms or even a paranoid thought disorder. These should be ruled out.
In summary, the imaginary audience and personal fable are normal developmental stages adolescents go through to develop their identity and self esteem. Little research has been done to determine whether these stages, if unresolved or extended, can lead to psychological disorders. Nurses who are aware of teen developmental processes can help identify symptoms overlooked and receive earlier intervention.