What do I do about a teen’s troubling secret?

Q: How do I help my daughter’s friend who is hearing voices? My daughter is 14 and has her first boyfriend, and he is very attached. They have known each other since sixth grade and started spending time outside of school with each other this summer.

She recently told me that he confided in her that he sometimes hears voices. He has been concerned enough to research it online and thinks he may have schizophrenia. I cannot betray her trust and tell his parents. I thought about telling the school counselor, but I keep encouraging her to tell him to talk to his mom. Should I do anything else?

A: Thank you for writing in. This is a difficult situation, made harder by the fact that you are hearing everything secondhand. It’s good news that the young man has started his own research, but it can be terrifying to believe you have schizophrenia and to hold on to this secret.

Let’s look at schizophrenia a bit. The onset for this mental illness is younger for men than it is for women, with the youngest being diagnosed around age 13. Symptoms of schizophrenia include hallucinations, delusions, cognitive issues and flat affect. The earliest symptoms tend to be hallucinations, so it makes sense that he came up with schizophrenia as a diagnosis.

But here’s why loving adults, pediatricians and psychologists need to be involved: Hallucinations also can be brought about by the use of drugs, such as methamphetamines and marijuana, or by a serious and chronic use of psychedelics. The voices also could be a sign of other mental illnesses, such as post-traumatic stress disorder, anxiety, major depression or even obsessive-compulsive disorder. Voices also can be related to trauma or everyday stress.

The point is that there are many reasons this young man could be hearing voices, and the sooner he gets support, the more likely he is to receive the proper diagnosis and treatment.

As a parent, you want to keep your child’s confidence. But there also is a time to sit with your daughter and let her know that it is your obligation as a parent and an adult to help this young man. This is really a values discussion with your child. You value keeping your word, but a greater value is the physical safety of a minor. This is life.

Create a list of solutions and their possible outcomes.

Sit down with your daughter, begin a values discussion and talk about the importance of getting clarity around these symptoms for his well-being. Don’t sugarcoat it; just keep focused on safety and his well-being. If you focus on finding a cooperative solution, it will be a good step forward.

If he shows any suicidal ideation or violence toward himself or others, immediately contact his parents. Trust your intuition, but don’t leave your teen to deal with this on her own.