Sometimes, I cannot breathe with their pain.

When I was a teenager, I lived the social misery of worrying about friends. If I had them. If I lost them. What to do at any given second of time to keep them. So I am no stranger to the social drama that makes up high school. But I absolutely do not remember ever feeling the complete feeling of annihilation my clients are describing in the drama of their social lives. And I do not say this flippantly. My teenage clients are experiencing such exquisite agony that it is derailing their lives.

Is it possible that teenagers today are so sheltered, so spoiled, so mollycoddled that any discomfort sends them reeling? Were teens of a generation ago so much more resilient that they rolled with the punches more effectively? Who is to blame for this? What is to blame for this?

Is it because much more girls are socializing today through phone and text and email in an ongoing manner that alienation—when it occurs—becomes that much more exacerbated? Is social media intensifying relationships without giving the teens the tools to maintain these relationships in the first place?

I don't know. I honestly don't know.

I don't know the whys of this phenomenon. I just know that teens are entering therapy at a rapid pace to cope with what we always thought of as normal teen angst revolving around friendships, inevitable break-ups, cliques, and the ongoing cycle of friendships.

So what is the purpose of this column, you want to know?

To make parents aware of how a break up of a friendship can cause irreparable harm to a teenager and the importance of early intervention.

To educate teachers, principals, and other involved school personnel of the ramifications for a teen who experiences her social interactions as traumatic and how the school can effectively intervene.

To speak to the teenager who is reading this, that she may realize that her acting out behaviors are coming from her distress and she should reach out for help.

This column is not even about bullying. That would be understandable as the psychological damage of relentless bullying is well researched. But no. It's not bullying. It is simply the stuff of teenage angst, the social dynamics of friendships in flux. It's how girls are mean to each other and some pay the price more than others.

What I have been finding in my practice with alarming frequency is how girls who have been doing well socially and even academically, will literally fall apart when a friendship abruptly ends. When her best friend, from one day to the next, simply informs her that they are no longer friends.

By the time parents come with their teen for therapy, they can usually identify the downward spiral of depression, listlessness, unhappiness, and then the acting out from that fateful day, that fateful second when the former best friend announced her withdrawal from the friendship.

These are children. Their actions are thoughtless and often cruel. But not unusual in social settings like blocks, bungalow colonies, schools, and camps. For the most part, if we look into our own histories of our childhood, there often is that friend we lost interest in and dumped. Unceremoniously. There was crying and recriminations and sometimes parental or teacher involvement, but eventually everyone moved on. After all, we are talking about children. They fall. They get up. Today, the friend du jour is Suri, tomorrow it is Chedva. Unpleasant but manageable.

But I am watching teenagers who disintegrate after such a fall out. They do not recover or move on. The spark leaves their eyes, they lose interest in school or camp activities. They refuse to attend school. A trauma has occurred and it impacts their every waking hour. The symptoms of their distress are as obvious as the ear infection when our two year old pulls his ears, moans in pain, runs a fever, and refuses to eat. What we don't really understand is what these symptoms mean.

It is hard to imagine that a broken friendship can give rise to symptoms that we have always thought of as trauma. But it's happening.

So what can we do?

As a parent, when you notice changes in her behavior, address the issue immediately. Even if the friendship won't ever be repaired, the distress can be eased and alleviated with validation and empathy from a parent. If that is not enough, believe it or not, it may be necessary to start new in a different school, or even a different class or camp. If you child tells you she wants to change, then listen to her. It may be easier to start again than to live with the source of the trauma day in and day out in school.

If you are the principal or teacher, it is really important you listen to parents who describe their daughter's misery. The enormity of the child's suffering, whether or not it makes sense to you. School performances or collaborative projects can often alleviate these symptoms by enabling a child to shine and make new friends in her new role. If a parent asks you to give her child a part in a performance, don't jump to an indifferent response of, “You daughter needs to learn she can't have everything she wants.” Or, “Your daughter needs to learn how to handle disappointment. And you as her parent need to help her with that lesson.”

Those comments from thoughtless mechanchim when I work with wonderful parents dealing with their daughter's traumatic reaction are very upsetting.

If you are a teenager reading this, and you recognize your misery is a result of a friendship gone awry, talk to someone. Your parent. Your teacher. Your therapist. There are ways to alleviate the misery even when the friendship is over. You will not remain sixteen forever. There are many beautiful friendships waiting for you. You may always miss what you have lost, but people change. And your friend did. And now you must. It will be hard but you can do it.

I am so glad I am not a teenager anymore.

But I am so glad I am a therapist who can help the teenager I once was.

 THIS WAS ORIGINALLY PUBLISHED IN BINAH MAGAZINE'S COLUMN THERAPY: A SNEAK PEEK INSIDE

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