• A history of physical or sexual abuse

• Excessive exposure to violence

• Problems with alcohol or drugs

• Persistent bullying (in person or online)

• Wrestling with gender identity issues and/or same sex attraction

• Facing an unwanted pregnancy or having a sexually transmitted disease

• Ongoing conflict with family members and/or peers

• A lack of or refusal to utilize available support systems

• Appetite disturbances–usually a loss of appetite (this is not the same thing as eating disorders such as anorexia or bulimia) 

• Sleeping disturbances–this can manifest as the inability to fall/stay asleep (hyposomnia) or difficulty waking/getting up (hypersomnia) 

• The inability to cry or grieve 

• Blunted (restricted/constricted) emotions or a flat affect (nearly no emotional expression, speaking in a monotonous voice, and/or diminished facial expressions)

• A depressed mood and/or expressing an inability to cope any longer–not to be confused with normal adolescent hormonal moodiness

• Apathy, withdrawal, and isolation–no longer wanting to spend time with friends and family members or communicate via texting and other social media outlets

• A noticeable drop in school performance, grades, or interest in extracurricular activities

• Sudden outbursts of fury and rage–often seen without any obvious or apparent reason for the strong display of emotion

• Giving away meaningful, sentimental, or “treasured possessions,” especially to family members and close friends – this can be a way of trying to create a sense of closure in life or of saying, “Good-bye”

• Preoccupation with the notion of death in movies, art, music, literature, clothing, social media, etc.–this can sometimes be confused with the Gothic subculture and its dark and morbid orientation