The laid-back, underachieving boy; the hyperachieving, anxious girl. Over the three decades since I graduated from medical school, and especially over the past 10 years, this pattern has become increasingly common in my practice.

In one case, which is pretty typical, my patient’s parents are concerned about their son. He’s not working hard at school and his grades are sliding. At 16, he spends most of his free time playing video games like Grand Theft Auto or Call of Duty, or surfing the Web for pictures of girls. He’s happy as a clam.

Both parents are actually quite proud of their 14-year-old daughter, who is a straight-A student, an athlete and has many friends. But when I met with her, she told me that she isn’t sleeping well. She wakes up in the middle of the night, feeling remorseful about having eaten a whole slice of pizza for dinner. She often has shortness of breath. Recently she has begun cutting herself with razor blades, on her upper inner thigh where her parents won’t see. She hasn’t told her parents any of this. On the surface, she is the golden girl. Inside, she is falling apart.

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