A number of highly talented young adults are living through what might be termed an “existential crisis.” Typically these are young men and women in their late teens or early-to-mid twenties, with a track record of tremendous academic and extracurricular success, who seem to “hit a wall” while in high school, college or graduate school. Dramatically and seemingly without warning, they become depressed, angry, and “lost.” Their life as they and their parents have come to know it grinds to a halt. They rebel against and at times abandon their prior styles of driven accomplishment, energetic involvement in multiple pursuits, and pride of achievement. Their traditional values of a strong work ethic, academic excellence, predictability, pleasing the adults in their life, future orientation, and linear goal-seeking is abandoned, and they and their parents struggle to make sense of it all. It is a time of high anxiety and great uncertainty for those who love them, and the young adults and their parents endure significant emotional pain and despair.

Prior to this crisis, there are a number of common characteristics that are shared by this group. Many tended toward perfectionism, and were very high achievers. They took enormous pride in being at the top of their class academically while managing multiple extracurricular activities. As “stars” they received many awards – distinguishing themselves at a young age – while seemingly basking in the glow of their parents’, teachers’, and personal pride.

What themes emerge as they engage in psychotherapy? To begin with, as they develop trust in their therapist, a history of hidden but intense fears and anxieties over the failure to perform at the very highest level began years before. Their fears would devolve into panic attacks at times – particularly when they would not turn in a top performance – and they would become severely self-critical and filled with self-loathing. In some respects they became their own “tough act to follow” through a history of near-flawless performances. They would fear being given poor grades (sometimes describing failure as achieving a “B”) and losing their “star status.” Other fears include disappointing their parents, worrying about whether they would continue to be loved or be severely criticized if they let up on their perfectionistic strivings, or did not gain admission into one of the most prestigious colleges or graduate schools. A history of emotional sensitivity, and delayed social maturity characterized by challenges in dating and finding a boyfriend or girlfriend, feeling unpopular, being identified as “nerds” or “kiss ups,” favoring adults over peers, and an unusual degree of empathy and compassion are common characteristics. At times there is a history of attention deficit disorder, inattentive type, which was masked until later in their lives because of high intelligence and a strong work ethic.

The existential crisis may be precipitated by extreme disappointment in one or more love relationships; the death of a loved one such as a friend, parent or grandparent; the transition from high school to college, college to graduate school, or university into the real world; or may have no apparent precipitant at all. Commonly, in one form or another, there is a “loss of an ideal,” and what previously provided meaning, guidance and purpose is actively repudiated.

Treatment involves initially establishing an open and non-judgmental rapport, helping the young adult understand what has happened to them, and assisting them in making sense of the dramatic turn of events in their relationship with themselves. A judicious use of medication to help them with overwhelming symptoms of anxiety and depression is not uncommon. As the therapy unfolds they begin to differentiate between values that they were taught, and values that truly represent their core personality. They distinguish between the passions they previously shared with their parents, and newfound passions that feel rock solid, and are theirs alone. Rejecting a more traditional and secure path into self-sufficient adulthood, they experiment and explore, they wander. They make mistakes. Their parents must learn to tolerate and accept ambiguity and uncertainty, feelings of great helplessness, and recognize that they have no control of their child’s life and must let go while continuing to provide love and support. While there may be many sleepless nights (at times including their therapist!), there are newly forged understandings that feel right and true, as opposed to the “falsehoods” they have been living out in the past. It is helpful to bring their parents in for sessions along this journey, to assist them in understanding, bring comfort and support, allay anxieties and fears, and develop a shared knowledge of what was and what is to become, as their child fashions a new identity.

Meaning, purpose, satisfaction, and happiness are newly discovered through self-knowledge and a greater understanding of their place and potential in the world. These overly-perfectionistic young adults learn how to play, and to love aspects of themselves unrelated to performance and stardom. Their ride, and for those that ride along with them, is filled with potholes, and unexpected twists and turns. With patient and persistent hard work they eventually launch themselves – this time with an aim that is true.