Dr. Leonard Sax is a family physician and founder of the National Association for Single Sex Public Education, who lives in Pennsylvania with his wife and daughter. The author of two previous books concerning the effects of gender differences on learning, Sax argues in his new book, Girls on the Edge, that today’s teens and tweens look confident on the outside but have a dangerously fragile sense of self.

Q: When we spoke two years ago, it was about how poorly boys are doing relative to girls in terms of both motivation and academic achievement. You said boys tend to be lazy while girls tend to be hard-working, driven. So aren’t girls, overall, actually in pretty good shape?
A: On paper, yes. In Canada, about 61 per cent of university undergraduates are women. If you look just at test scores and grades, you get the notion that girls are doing great and boys are struggling. But if you look at the literature, you see that more than one in five girls is cutting herself and/or burning herself with matches. More than one in four high-school girls is binge drinking. Today, one in eight females in the U.S. takes anti-depressants. There’s been an enormous escalation in anxiety and depression among girls and young women.

Q: How do you know girls are actually becoming more anxious, as opposed to simply more likely to seek help?
A: The Hamilton anxiety rating scale is the most frequently used inventory of anxiety, and it was published back in 1959, so for about 50 years psychologists like myself—I’m both a Ph.D. psychologist and a medical doctor—have been asking teenagers the same questions. Jean Twenge, a professor at San Diego State University, compared how kids from roughly the same demographic have answered those questions over time, and she found that 40 years ago, it was rare for teenage girls to answer yes to questions like “Are you ever so anxious you can’t concentrate or focus?” and “Do you ever find yourself waking up in the middle of the night?” Today, it’s very common for girls to say yes. In fact, she found that the average teenage girl today is more anxious than the average girl admitted to a psychiatric unit for in-patient treatment 50 years ago. In 1966, a popular show in the U.S. was Gidget, about a giggly teenage girl. Today it just wouldn’t resonate. Now girls watch Gossip Girl, which is about anxious teens trying to present a sexual persona, who have all kinds of obsessions and neuroses. A whole lot of girls find solace in the notion that anxiety is now the norm.

Q: Boys aren’t anxious?
A: No, not like girls. When you actually sit down and talk to a girl, as I have done in many venues across Canada and the U.S., she will tell you she’s waking up at two in the morning upset about the pizza she ate for supper, and thinks she’s fat even though she’s not, and is frantic about whether she’s going to get into the university she wants to go to. Meanwhile her brother the goofball is enjoying life: eats a whole pizza for supper and doesn’t bat an eye, sleeps in late, and is perfectly content with his online games and pornography, hanging out with two other guys who are just like him. He’s happy! But his sister, who looks so good on paper, is not.

Q: You believe girls’ anxiety is connected to new issues, one of which is “self-objectification.” What do you mean by that?
A: Forty years ago, if you went into a department store and looked at clothes for seven-year-olds, they’d be quite different than the clothes on sale for 17-year-olds. Today there’s no longer any distinction; the same short skirts are sold to girls in Grade 2 and girls in Grade 12. T-shirts that say, “Yes, but not with you” are now sold to eight-year-olds.
Girls understand what these T-shirts are about: pretending to be sexually aware. We have girls who are now putting on a pretense of adult sexuality that they couldn’t possibly feel, and the danger of putting on a show is that you lose touch with your own sexuality. You’re wearing a mask, and when you take off the mask, there’s not a face there. Another thing that’s happening is the acceleration of the onset of puberty. Girls are losing what psychologists used to call middle childhood: eight to 12 years of age, which is the age of Pippi Longstocking and Harriet the Spy, the time for girls to have adventures and develop a sense of who they are as people without worrying about whether they’re hot.

Q: Consequently, are more kids sexually active than 20 years ago?
A Not really, seems to be the answer, though only a handful of studies have addressed that in any quantitative way. But kids may be sexually intimate—the term as I use it includes both oral sex and intercourse—a little earlier and certainly they are much more likely to be having oral sex than they were 20 years ago. There are some troubling new issues. You find a lot of 12- and 13-year-old girls who are providing sexual favours to 16- and 17-year-old boys. In the ’70s and ’80s, sex was about intimacy, trying to give each other pleasure. Today, so many teenage girls I’ve spoken to across Canada and the U.S. regard sex as a commodity that girls provide to boys. Increasingly, unfortunately, that is the case. For many, many girls, the most common form of sexual intimacy is oral sex, with the girl servicing a boy. And neither the girls or the boys see anything wrong with this.

Q: If girls view sex as a commodity, are they frequently the ones pushing it?
A: Yes, they are. A boy in California sent me a letter saying it’s girls who are cornering the boys, and giving them blow jobs. If it were just one boy, of course, I wouldn’t pay any attention, but you hear this from many, many young people across North America. So why does a girl corner a boy? Because if he’s popular and doesn’t have a girlfriend, it raises your status in the eyes of the other girls. I find it troubling that so many girls are using their sexuality in an instrumental way, in order to accomplish some other end such as raising their social status, but not as an expression of their own [feelings and desires].

Q: Turning to what you call the “cyberbubble,” you say that girls get addicted to social networking. That sounds relatively harmless compared to violent gaming. What’s wrong with it?
A: Girls spend a lot of time photoshopping their pictures, making themselves look a little bit thinner than they are and getting rid of the pimples, because they know boys are interested in the photos on these sites. So you’ve got 14-year-old girls essentially presenting themselves as a brand, trying to create a public persona, polishing an image of themselves that’s all surface: how you look and what you did yesterday, not who you are and what you want to be. And that leads to a sense of disconnection from themselves, because in most cases, these girls don’t even realize that their persona is not who they are. They’re just focused on striving to please their market and presenting the brand they think will sell. It’s one thing for Angelina Jolie to be doing this—she’s an adult—but it’s really toxic for a 14-year-old. It gets in the way of the real job of adolescence, which is figuring out who you are, what you want, what is your heart’s desire.

Q: You say that girls who don’t have a sense of self are prone to obsessions with, for instance, fitness. But isn’t this also true for boys?
A: I think there is something qualitatively different. For girls, I use this term “anorexia of the soul,” which I first read in a New York Times article. What I understand it to mean is that this girl is wasting away on the inside. She’s obsessed with surface—being the best student, or the fastest runner—but inside, her sense of self is undernourished, it’s starving. She doesn’t realize it because people keep praising her for being the top student or the fastest runner, and her sense of self gets tied up in that surface. I just don’t see that with boys. You will certainly find a lot of boys who are very comfortable, when you ask them to tell you about themselves, saying, “Well, I’m a really good gamer.” That’s also a pretty impoverished sense of self, but it doesn’t seem to bother the boys. And unfortunately, perhaps, they’re more robust and less prone to existential collapse than girls. That boy who’s a champion gamer is not going to fall apart if some other guy gets to level two in a game before he does. That’s okay, he still has status among other boys. Whereas the girl whose identity consists of being the “smart girl” or “Justin’s girlfriend” tends to crumble if she doesn’t get into the university of her choice or if Justin dumps her.

Q: You say anorexia, not of the soul but the body, is another obsession that’s become akin to a spiritual quest for some girls. Why don’t you view it as a cry for help?
A: Only a minority of girls have diagnosable eating disorders, but so many girls in North America are obsessed with what they eat and how slender they are, or are not. So that girl who really does have anorexia has accomplished what all the other girls talk about but have never achieved. That becomes her defining sense of self: I’m the really skinny girl, that’s an accomplishment. It’s not a cry for help—in fact, they don’t want grown-ups to pay attention because they don’t want someone to take that achievement, that identity, away from them. The pro-ana websites [celebrating anorexia] that girls create promote the idea that skinny girls look good in any kind of clothes, and “I can live on mindpower alone,” and create a very unhealthy online community in which it’s normal to be anorexic. These girls believe it’s a lifestyle choice, not a pathology.

Q: Cutting, self-harm, does seem pathological. How prevalent is it?
A: It used to be very rare, less than one per cent of kids in a community would do this. In a 2008 study from the Yale school of medicine where they talked to girls 10 to 14 years of age, 36 per cent said they had in the past year cut themselves with razors or burned themselves with matches. In a very well-executed study published in the Canadian Medical Association Journal two years ago, a demographically representative sample of young people 14 to 21 years of age was surveyed in Victoria, and there was an overall prevalence of roughly 16 per cent. Although in the abstract there’s no mention of sex differences, if you pull up the tables you see that only eight per cent of boys but 24 per cent of girls were cutting or burning themselves.

Q: Do boys and girls cut for the same reasons?
A: The way to answer that is to talk about who is doing this. It’s a small subset of boys, and they are, bluntly, the boys who have no friends, who are ostracized. The guy who’s captain of the hockey team, who’s popular, is not secretly cutting himself with razor blades. But the girl who’s very popular, captain of the basketball team and doing well in school, is as likely—maybe even more likely—than the average girl to be cutting.

Q: Why would successful girls do this?
A: Because they haven’t been living, they’ve been performing. The girls themselves tell you, “I cut myself because it’s real, it’s not fake.” It’s not a cry for help: most girls don’t want adults knowing they’re cutting, which is why they cut in places we won’t see, like high up on the inner thigh. And they don’t want to kill themselves. There’s research which is quite astonishing to many people: when girls cut themselves, they are getting a release of endogenous opiates—they’re actually getting high.

Q: You cite research showing that nearly one-quarter of American girls begin drinking before the age of 13. How does girls’ use of alcohol compare to boys’?
A: Forty years ago, in an affluent suburb, it would’ve been very unusual to find a girl abusing alcohol. Today, a girl is at least as likely as her brother to abuse alcohol. That’s unprecedented, a huge change from all previous eras of which we have any record. Boys’ use of alcohol has been pretty flat for decades, but girls’ use has increased and research shows that about 55 per cent of university students being treated for alcohol abuse are female. It appears that females metabolize alcohol differently than males, and as a result, a girl having four drinks is the same as a boy having five drinks, even if their height and weight is exactly the same. Alcohol seems to be more toxic for females, milligram for milligram, than for males.

Q: Why are girls suddenly drinking so much more?
A: I’m sure there are a lot of things going on, but one factor is that alcohol relieves anxiety, at least while you’re drinking, and we’ve got a lot more anxious girls. Another reason is that girls are hungry for an authentic sense of self, and some find it in alcohol. This 14-year-old who gets drunk—that becomes, for her, a defining feature. She’s proud that other kids look up to her as the girl who knows how to get booze and who isn’t afraid to drink. It becomes part of her sense of self, and it’s real, it’s genuine, it’s not something she photoshopped.

Q: What are parents doing wrong?
A: Parents have this 1980s mindset that you should give your child autonomy and independence, let your children make their own mistakes. One father said to me, “I don’t think it’s any of my business what my daughter’s doing on her Facebook page.” That ’80s mindset is wildly inappropriate in the 21st century. Parents need to understand it’s a dangerous world these teenagers have created. The story of Phoebe Prince, the girl in Massachusetts who recently committed suicide after cyberbullying, is just one more particularly dramatic illustration that 15-year-olds are not adults, they’re not competent to police themselves, and that’s why they need adults to be engaged in their world.

Q: But many parents feel they just can’t do anything about their kids’ use of the Internet. Realistically, how do you regulate your daughter’s online life?
A: Set limits: “No more than 30 minutes on school nights.” Monitor: there’s software that allows you to know what your daughter’s doing online. And she should not have the computer in her bedroom, it has to be in a public space. She has to know that you know what she’s doing with her email, what kinds of pictures she’s sending and receiving on her cellphone, and her friends need to know that you are keeping tabs. At the very least, take away her cellphone from 10 at night until six in the morning. There are so many girls who take the cellphone to bed with them, and they’re getting a text at two in the morning: “Oh my God, Justin, your so-called boyfriend, was with another girl at the party tonight.” Now the girl is frantically texting back, she won’t be going to sleep anytime soon, so when she stumbles into school the next morning she will look like a girl with ADD, because sleep deprivation perfectly mimics attention deficit.

Q: That’s one thing if she’s 12. But what if she’s 16 and has had a cell and computer in her room for years?
A: I don’t have any easy tips for that situation. The major battles happen when you try to change rules that have been in place for years, which is why I advise parents to start as early as possible. A 16-year-old may well say, “I hate you, you’re totally ruining my life.” But your job as a parent is to keep your child safe, that’s number one. Your child’s anger is something you have to be willing to accept.

Published by: MacLeans.ca
Written by: Kate Fillion
Photo by: Getty Images
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