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Anthony Katsakis, 17, a senior at Westfield High School in Chantilly, Va., rates his daily stress level at a nine out of 10.

He thinks the stress from schoolwork and his family life triggered a terrifying panic attack that landed him in the hospital last fall.

“I felt like I was going to die. Something was wrong with me. I couldn’t breathe. I don’t really like talking about it,” Katsakis said, staring at his bedroom floor in silence for a moment afterward.

At Liberty High School in Eldersburg, Md., Bryanne Flannery, 16, feels similar pressure to Katsakis. She’s a junior balancing advanced placement classes, varsity cheerleading and Liberty’s Student Government Association.

With college visits scheduled and applications near, she said her stress levels peak at an eight out of 10.

It’s a cycle: sitting in the first class of the day while the sun is still rising, enduring seven more hours of class afterward, mustering energy for extracurricular activities and salvaging whatever motivation is left for homework. It’s a cycle breaking down teens and sending their stress levels past adult levels for the first time.

Flannery is pushing for a letter of recommendation from her guidance counselor to explain the first—and only—C she’s received in high school. C’s stand for “mediocre” in her eyes. The tears still haunt her, but fresh ones threaten to fall if the letter doesn’t help her college admissions.

For Katsakis, a recently ended 15-month relationship breaks his concentration. The sight of her every day makes it worse. He’s trying to get good grades and apply to college, but she’s all he can think about.

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Anthony Katsakis looks over a school assignment

Anthony Katsakis, 17, looks over an assignment. He stays up late finishing schoolwork, and the lack of sleep only worsens his stress levels.

While schoolwork may not send teens crashing, they’re underestimating the burn of stress. According to the American Psychological Association’s 2013 Stress in America survey, teens aged 13 to 17 experience higher stress levels than adults, which negatively impact their health.

Teens reported a stress level of 5.8 on a 10-point scale, whereas adults reported 5.1. Both numbers are higher than what each age group believes is a healthy stress level: 3.9 for teens, 3.6 for adults. Katsakis and Flannery are part of the 27 percent of teens who report levels between eight and 10.

Over 80 percent of teens cite school as the main factor contributing to their stress, but only half believe stress impacts their physical and mental health. Later in life, it could lead to chronic illnesses.

“There’s a big connection between stress and auto-immune disorders, anything from acid reflux to psoriasis to migraine headaches,” according to Jonathon Schettino, depression and anxiety coordinator and staff psychologist at Towson University’s Counseling Center.

He adds that high blood pressure, cardiovascular disease and diabetes could develop, too, if stress isn’t tackled early.

Schettino says the competition of college acceptances, especially among test scores, is worse for teens later in the survey’s age group.

“If you don’t get a particular score, you may not get into the college you want, which could affect you down the road,” he said. “In addition to getting good test scores and having a high GPA, you also have to participate in a variety of different activities and play sports.”

The stakes are high, and the side effects are catching up.

Like many teens their age, Katsakis and Flannery stay up late studying and finishing homework. Fifty-two percent of teens report feeling tired from high levels of stress associated with school. Their bedtime is often hours after parents say goodnight.

Appetites struggle with the presence of stress in the body. According to the survey, more than half of teens (52 percent) overeat or eat unhealthy foods weekly or more due to stress. For 24 percent of teens, eating is their way to manage stress.

But it only works for so long. Sodas and sweet treats caused poor body image, disappointment and feelings of laziness for teens who took the survey.

Exercise patterns don’t provide any better news. While 62 percent of teens consider physical activity and fitness very important, only 51 percent engage in exercise regularly.

Sleep, healthy nutrition and exercise: the pillars of stress management designated by the APA are out of teenagers’ reach.The lack of each causes grades to drop. Time management becomes a feat. Irritability, anxiety, sadness and fatigue make the days seem endless.

In the next year, 34 percent of teenagers expect their stress to get worse.

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In a wrestling ring where school is thrown against sleep, healthy eating and exercise, hits strike teenagers from each opponent.

Just last month, Flannery almost skipped school for her lack of sleep. A study guide for AP world history sat buried beneath AP statistics and English homework finished earlier in the night. The study guide covered two chapters of material in three pages, front and back.

She skipped dinner that night to complete it.

Flannery’s not alone—23 percent of teenagers admit to skipping a meal due to stress. Her night ended with six hours of sleep, which is three hours less than the APA’s recommended amount of sleep for teenagers.

“I was so miserable when I woke up in the morning. Classes were horrible all day. I couldn’t stay awake and I’m pretty sure I didn’t learn a single thing,” Flannery said.

Katsakis is worse, only getting around four hours of sleep on school nights and even less lately as a result of his breakup. College readiness, schoolwork, family, and friends pile on top of the emotions.

“It’s a lot to take in sometimes and it makes me crash where I don’t feel like getting out of bed,” Katsakis said between yawns at his computer desk.

Katsakis admits that while his anxiety is diminishing, fighting depression amidst his stress has become a new struggle.

“I don’t answer her text messages. I can’t think about trying to be her friend when I’ve got college pretesting next week,” he said. “Senior year is the deadline. It’s the year you start really getting your life planned out. It’s stressful trying to figure out what to do with your future.”

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While adults also experience high levels of stress, management becomes just as difficult for them as it is for teens. For those with children under 18, adults are expected to be role models for combatting stress, but when they exhibit poor management skills, it sets a bad example.

Nick Katsakis, Anthony’s father, rates his own stress level at a 10 during the week and an eight on the weekends. In a recent visit to the doctor, he was told his high levels of stress could be a contributing factor to his high blood pressure.

Nick admits that he is not setting the ideal healthy example for his son, but juggling two demanding jobs on top of parenting can prove to be difficult. During the day, he runs production and information technology (IT) for a payroll company. At night, he’s catching up with his own bills on top of late payrolls from clients.

“On busy days it can take three to six hours just to get a cup of coffee or use the restroom. It is hard to find sufficient time to discuss issues that are bothering Anthony, but when we do talk, it seems to help,” Nick said.

Teens should seek a support system in the form of a trusted adult, such as a teacher or guidance counselor, according to Loretta Elizalde, a licensed clinical professional counselor at Psychology Consultants Associated in Towson, Md. She advises trusting parents before friends as well.

No matter how stressed the parents are, Elizalde says that they’re the main source of stress-management skills for teens.

“It’s good for them to not always hear the spoken word, but see the movement that goes with it. Parents tend to say ‘Do not as I do,’ and I think it’s good for them to see that, whether it’s for a walk or taking in some type of dance class or sports class,” Elizalde said.

In the school setting, teens often don’t know what resources are available to them or how to access them, according to Shaunti Taylor, a guidance counselor at Liberty High School who regularly meets with Flannery. She says everyone experiences stress at some point in life, so pointing students toward the proper help is crucial for stress management.

“During adolescence, students are going through developmental changes, dealing with peer pressure and balancing academics and extracurriculars. There’s a lot to manage. People assume students are equipped with skills to multitask in many areas and they’re not,” Taylor said.

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Every hour of Katsakis and Flannery’s life seems ruled by schoolwork and disheveled concentration, but the two do what 55 percent of teens only do three times a month or less: set aside time to de-stress.

During the cheerleading offseason, Flannery works out for at least an hour each day, her release from a packed high-level class schedule.

“That’s the one thing I don’t let homework affect because without a little exercise I can get cranky. My mom always makes me a nice dinner on nights I’m stressing, too. We like to unwind and watch some TV together afterwards,” she said.

With college just months away, Katsakis feels both excitement and nerves. He doesn’t think there’s a way to get rid of his stress entirely right now, and he expects it to increase once he begins college courses at Northern Virginia Community College in the fall.

For Katsakis, there’s no better way to wind down and de-stress from school and the breakup than long drives with friends. When the music blares, his head clears.

“I play guitar to de-stress, and piano. Music is my escape from everything. Music is what calms me down. It reaches out to me and gives me hope.”

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