Why do young adult women so often come to treatment after a mental health crisis?
It’s estimated that 26% of women in the United States today live with a mental illness, and that’s only what’s reported. Women are often pressured to hold it all together, or to keep silent from fear of dismissal or being labeled as “dramatic” and “unstable”, until that slow buildup becomes impossible to contain. By the time many arrive at treatment, the crisis has already happened.
As clinicians and providers, we have to consider: are we asking the right questions to support the women of today? From underdiagnosis to overdiagnosis, and the biases we carry, how can we open the dialogue to catch these crises before they break?
We sat down with The Dorm’s two site Directors, Amie DiTomasso, LICSW, MPH and Alexa Connors, LCSW, to have an in-depth conversation on this topic in honor of Women’s History Month. In a discussion that is unfiltered, honest and also personal, they touch on overdiagnosis, biases, stigma, and the facets of treatment that actually move the needle: validation, authentic connection, and creating spaces where young adult women feel safe enough to self-advocate.
Key Article Takeaways
Addressing challenges of overdiagnosis, diagnostic blind spots, biases and stigma
Amie: When we think about what young adult women need in treatment today, we have to start by looking at what currently stands in the way of accessing quality care. Women’s mental health history is one marked by missed and dismissed diagnoses and enormous disparities in care.
Historically, medical research has centered white men, creating outcomes that are not representative of the female experience. In a study on sex bias in medical research, significantly more males (56%) than females (44%) were enrolled in clinical research. There is also a disparity amongst women: white women are more likely to get diagnosed with an eating disorder; women in smaller bodies are more likely to get diagnosed than women of color, Black women, or women in larger bodies.
This is all without getting into the fact that mental health in women is extremely underreported.
With that being recognized, it can be difficult to acknowledge our own biases as clinicians and providers, and our tendencies to over- or under-diagnose women. But for treatment to truly meet the needs of young adult women today, that’s exactly the challenge we have to face.
Do you or a loved one need help with mental health?
The Dorm is here.
Over-Diagnosis: BPD, EDO and Anxiety
Alexa: Within the young adult population we treat, we observe a disproportionate number of women coming to us with a diagnosis of Borderline Personality Disorder (BPD). This raises a red flag because BPD can easily become a “catch all term” to encompass being “overly-emotional.” Critically, this misses the root causes of trauma and PTSD as precipitating factors for BPD.
Amie: This is something our teams discuss often: personality disorders need to be a nuanced conversation – they exist on a spectrum. Almost every person has traits of different personality disorders, so, as clinicians, we need to move past the surface level. We have to be curious in our assessment: Where did those strategies for interacting with others come from? How did this view of self manifest? So often, it comes from trauma, attachment issues, a lack of support earlier in life, or a lack of opportunity.
Importantly, it’s not a “female problem”.
Alexa: As female clinicians, we have to be aware of our own countertransference when working with a client of a similar gender. We have our own biases, and we can easily perpetuate prejudices if we’re not careful. This pattern also applies to other diagnoses that tend to skew more female, including eating disorders and anxiety.
Under-diagnosis: AUD, ADHD, and OCD
Alexa: Conversely, we see women historically (and continually) under-diagnosed with substance-use disorders, attention challenges, executive functioning challenges, or ADHD and Autism Spectrum Disorder.
While diagnostic rates for ADHD and autism are starting to improve, it’s estimated that 80% of girls with Autism are undiagnosed by the time they turn 18 and that it is still diagnosed 3 to 4 times more in boys than in girls. A lot of this is linked to the difference in how symptoms present in women versus men. Women are socialized to internalize a lot of emotions and needs; men are not. This is how diagnoses and challenges can get missed, overlooked or downplayed, and then young women don’t get the help or support they need.
Amie: We also see this with diagnoses like OCD. Consider reassurance-seeking, one of the main hallmarks of the diagnosis. The first thought might be “what does that have to do with women?” But society expects women to be more anxious and likely to seek assurance, to play out scenarios and react with: “I did this thing wrong.” So, instead of an OCD diagnosis, a woman might be diagnosed with anxiety, PTSD, or situational stress – which can be problematic since OCD requires a different treatment approach entirely.
It’s preconceived biases like these that we may not even be aware of that shape, and limit, women’s mental health treatment.
Hormonal health: ignored, misunderstood, and understudied
Alexa: An important issue that deserves far more attention, research and discussion in treatment is the intersection of hormones and mental health.
Premenstrual Dysphoric Disorder (PMDD) is a relatively new diagnosis to the DSM and, while it’s positive that this is finally being acknowledged as having a real impact, it underscores just how far behind we remain.
Women with PMDD can feel like they ‘become a shell of themselves’ in the days leading up to their period. In some cases, it can cause suicidality and intense anger. It can look like BPD or anxiety disorders but it needs to be managed and supported with a very different lens. When we ignore a major part of a woman’s hormonal and physical health, we miss a fundamental part of her life.
Confronting media, societal norms and messaging
Amie: We can’t talk about young adult women’s mental health without talking about the influence of social media, and AI. It touches everything: not just rising rates of depression and anxiety, but how our clients view friendship, experience isolation, connectedness, and personal self-confidence.
I think of, for example, the rise of GLP-1 marketing on social media and the reinforced message that as a woman: you can never win. From a societal lens, you can’t exist in a larger body without horrible things being said to you, but then a celebrity such as Amy Schumer goes on a GLP-1 and gets attacked for “cheating.”
There is relentless criticism of what it means to be in a woman’s body—you’re either too big or too small, you did it the wrong way, or you should have done it differently. The threshold for doing anything exactly right is an incredibly fine margin. These impossible standards have always existed, but the volume is turned up on Instagram or TikTok. The ‘shoulds’ pile up, the judgments multiply, and suddenly nothing ever feels quite enough.
Alexa: As women you “should” have a career, but also kids, and be married, and be emotional, but not too emotional, and assertive but not too assertive.
These shoulds are amplified in our current environment, especially with the messaging that exists about women: their bodies, their rights, and how different genders are being characterized. There is a lot of confusing messaging about what it means to be a woman, and particularly a young adult woman. As a female clinician it can be helpful and important to validate that experience right now: the challenge, the confusion and the emotion of it.
Cultivating community, validation, representation and self-advocacy for long-term outcomes.
Amie: When I think about what young adult women need from treatment spaces today, a central theme that stands out is community and solidarity. Validation, not correction or asking women to “look on the bright side,” is key to feeling seen in treatment. Being in a community-oriented space, like at The Dorm, allows young adult women to come together and recognize shared life challenges and milestones, normalizing the highs and the lows.
Alexa: It can also be socially corrective. Not all of our clients have experienced authentic community — grounded in shared humanity. They don’t know that connection does not have to mean comparison, and community does not have to become competition. Being in a community space like ours — intentionally designed for trust and vulnerability — is itself a key part of the treatment process.
Amie: Related to community and solidarity, I would add the importance of working with female clinicians who share client identities: forming a therapeutic alliance with professionals who can actually relate to your lived experience and look like you is crucial. Representation is key.
Alexa: I completely agree. And building on this theme of validation, our team talks a lot about the problematic societal expectations placed on women to be able to handle a lot emotionally, and often be silent about the issues affecting them. Experiences like miscarriage, fertility issues, or perimenopause – it’s almost completely taboo to talk about. So when there is a struggle, it’s not always taken seriously. It’s chronically downplayed or dismissed.
We see a lot of young adult women trying to keep it all together for a long period of time, and then a huge mental health crisis happens because of a slow buildup that’s become a runaway train. We need to take young adult women’s concerns seriously right from the start, and open the dialogue earlier.
Amie: From a clinical perspective, it’s important that we ask more questions, that we lean into discomfort and normalize talking about things that maybe our mothers or grandmothers didn’t or wouldn’t dare talk about.
Treatment can be an opportunity to discuss what may be considered “taboo subjects”, whether that’s pleasure and sex, or challenging heteronormative expectations that have been placed on women for generations.
Alexa: So much of women’s value and identity is tied to other things – family expectations, the ability to have children and relationships. There is still stigma and societal pressure around settling down for women and this internalized message that someone “better do it while they’re still pretty, and still wanted” is pervasive. Working with young adult women, we often hear this question of: Am I valuable? Am I worthy? Is my worth connected to another person, or is it rooted in myself, my own gifts, my own being?
The answer is, of course, yes. But it can take work to understand that.
Amie: This is why our team is so passionate about the identity and values work we’re able to do with our clients, through modalities such as Acceptance and Commitment Therapy (ACT), or Narrative Expressive Therapy, values-driven CBT and practical mindfulness work. Guiding clients to clarify their values and explore whether they are living in alignment with them can be both illuminating and empowering.
Alexa: I can’t tell you how often young women are asked, “Do you want to have kids? You would be such a good mom.” From a young age there’s pressure to figure out early what you want long-term. As clinicians, we can help our female clients recognize that they don’t have their values set in stone. That they are permitted flexibility, to change their mind, that they can evolve and that they are allowed to value things outside of gender norms. This opens a window and then a door for them to speak up about their wants and needs and begin to self-advocate.
Amie: Yes, and that’s ultimately what we are here to do. Treatment is, of course, about reducing mental health symptoms — but that’s just the beginning. When care for young adults is done well, it’s about so much more: helping them leave with a stronger sense of self, a toolkit of skills to advocate for themselves, and the ability to navigate all of life’s inevitable bumps in the road. To watch them step forward more capable, more self-assured, and better equipped for what lies ahead is the greatest reward of this work.
Thank you, Alexa and Amie, for sharing your insight.
Conclusion
Young adult women’s mental health too often goes unaddressed until a crisis forces it into the open. Driven by social pressures, fear of dismissal or being labeled as “dramatic”, alongside the expectation to hold it all together, the barriers to speak up are real—and as clinicians and providers, it’s on us to ask the hard questions.
In honor of Women’s History Month, we asked our two Site Directors what young adult women truly need in treatment today. Their answer? Know your own biases, resist the pull toward under- or overdiagnosis, validate their experiences, and create spaces for authentic connection with other women.
We hope that you came away from this interview with practical strategies to begin implementing with your young adult women clients today.
Young Adult Women Treatment at The Dorm
At The Dorm, we help young adult women through individual therapy, coaching, and dedicated groups that allow clients to build community, connect with peers, process emotions, and develop critical social and emotional skills in supportive therapeutic environments. Women’s Process Group is just one example of the affirming, identity-based spaces we create at The Dorm.
As a result of our Women’s Process Group, 90% of female-identifying clients at The Dorm are able to build confidence, strengthen their voice, and feel more empowered in their sense of self-worth and agency as a woman.
Whether you’re a young adult seeking support or a parent exploring treatment options, we’re here to help. Learn more about who we treat and our unique community model.
