It's possible for there to be both. I have my own mental health issues, as some people do. When I don't deny who I am, those issues are fairly minimal, and I'm much more stable than when I try to fight against my natural inclinations. My kink desires have little to do with my issues, in that they tend to take a backseat when I'm not feeling very well, and become a non-issue. I don't think that mental issues are necessarily causative. They can be correlative, depending on what your specific issue is and how it's expressed, or they can be fairly separate.
And yes, major major life changes at twenty.![]()