Integrated theoretical overview of mental pain in adolescence

Adolescent mental health has deteriorated globally, with rising rates of depression, suicidal behaviors, and non-suicidal self-injury (NSSI), particularly in the context of a rapidly evolving post-pandemic sociocultural context and the widespread prevalence of dysregulated social media use. However, existing models do not fully explain why adolescents exposed to similar stressors exhibit markedly different psychological outcomes. To propose an integrated developmental–ecological framework of mental pain in adolescence that explains variability in clinical outcomes by linking developmental vulnerability, emotion regulation, affective control, and mental pain tolerance, with particular emphasis on the transition from psychological distress to intolerable mental pain and suicidal behavior. An overview of empirical and theoretical literature on adolescent mental health, including studies on emotion regulation, developmental neuroscience, suicidality, social context, and digital environments. Priority was given to recent longitudinal and clinical studies, as well as foundational theoretical models. Mental pain in adolescence emerges as a multidimensional process involving emotional distress, social disconnection, cognitive overload, and self-regulatory difficulties. Emotion regulation functions as a central transdiagnostic mechanism, while affective control provides the cognitive foundation supporting emotion regulation processes. A key refinement of the proposed framework is the distinction between mental pain intensity and mental pain tolerance, with tolerance acting as a critical moderator of developmental and clinical outcomes. Environmental stressors, including pandemic-related disruptions and digitally mediated experiences, interact with developmental vulnerability to amplify or attenuate psychological distress. Variability in outcomes, including suicidal behaviors and self-harm, may be better understood through differences in regulatory capacity, distress tolerance, social and relational determinants, existential concerns, and the subjective experience of unbearable psychological pain. Adolescent mental pain reflects a dynamic imbalance between emotional demands and regulatory capacity within a socio-relational context. Integrating emotion regulation, cognitive control, and mental pain tolerance provides a more precise framework for understanding psychological distress and suicidality. Beyond symptom reduction, this model highlights the clinical importance of identifying and relieving the causes of intolerable psychological suffering while strengthening regulatory skills, distress tolerance, relational connectedness, and supportive social environments.