Q. My son is a very strong high school student, always getting great grades and pushing himself to take the most challenging classes – including a Japanese class at the university. He seems to be handling it all in stride – but he has this condition where his lip swells up periodically. The doctors can’t seem to pin it to any food allergy. We have medication to treat it now – but is it possible this is entirely stress induced? If so, do you have tips on how to help a teen – who prefers to be alone or with friends or his girlfriend – de-stress?

A. Lip swelling due to stress would be unusual, but not out of the question. Stress has a way of manifesting as almost any kind of physical problem. I like to call it “the great imitator.”  In regards to your son, it sounds like he is doing well. Beside his lip swelling and his preference to spend time alone or with peers (in other words – not with you), his resume is impressive.  I do believe that it was a good idea to have a physician evaluate the swollen lip.  I feel if it may be valuable to have a dentist evaluate him as well.  Too often, people will attribute an unusual physical symptom to stress when there is a real medical problem.

contemplative teenI always have my patients evaluated medically when their history involves physical complaints. The reason for this is that it can take intense mental and even physical energy to “bottle up” stress and not deal with it.  Stress build-up can be conceptualized as steam pressure; if it keeps building up with no outlet, things can “blow up.”

It is important that once a child is medically cleared, the focus be shifted from talk of the medical problems to helping him or her express feelings more. People who have somatic symptoms that are not explained by a medical work-up, and therefore likely related to stress, can tend to pursue more and more medical evaluations.  This can lead to perseveration on their having a medical problem and then take the focus away from where it should be; learning how to deal with stress.  It is imperative that once the work-up is completed, and negative for a medical problem, that there be no further medical evaluations.  This holds true unless the physical problems worsen to a degree of impairment or seem to evolve into worsening illness.

It would not surprise me if your son has some level of stress.  He is very busy and does push himself hard.   I am not surprised that he does not talk to you about it. It is normal for teens, especially males, to internalize their feelings. Our culture is based on males being “tough” and not letting emotions “get the best” of them.  There is pressure to always look calm and cool and seem like everything is fine even when it is not.  This is especially relevant in the parent/child interaction. Teens tend to be more reticent with their parents as they develop and work towards becoming more independent.

Stress busting includes:

  • Regular exercise
  • Yoga
  • Socialization and activity
  • Talking about feelings
  • Sunlight
  • Avoidance of drugs and alcohol
  • Relaxation techniques
  • Good sleep

A good resource on sleep hygiene and relaxation techniques can be found at the Sleep Disorders Center at the University of Maryland Medical Center. At this point, with no clear signs of an anxiety problem, it may be that all you can do is gently suggest these stress-busting techniques. It sounds like he already has the social part down. You can encourage openness and communication. A great way to do this is through active listening.

If he begins to demonstrate symptoms of a true anxiety disorder – insomnia, irritability, restlessness, frequent headaches and stomach aches, poor concentration, fatigue, drop in academic performance, isolation, persistent negativity or tearfulness, he should be evaluated for an anxiety disorder by a professional.

The good news is that, all things considered, it sounds like you have a great kid there.

Editor’s note: There have been many conversations about the stress American students are under since the release of the documentary film “Race to Nowhere.” Watch a clip about the film featuring Katie Couric and the film’s director.