Learning
ANXIETY in Marin County Teens
Anxiety disorders vary from teen to teen.
Teens can be diagnosed with different kinds of anxiety depending on what they are struggling with. In this
guide you'll learn the signs and symptoms of different anxiety disorders, and how they are treated.
SOCIAL ANXIETY DISORDER
Teens with social anxiety disorder are excessively self-conscious, making it difficult for them to socialize
with peers and participate in class.
For a diagnosis of social anxiety disorder, a child's fear of being humiliated during social encounters must
be severe enough to interfere greatly with her normal functioning.
Symptoms include:
- Actively avoiding anxiety-inducing social situations or suffering through them with intense distress
- Panic reaction (shaking, sweating, shortness of breath) in response to social situations or, among young children, tantrums and crying
- Fear of appearing anxious and being judged negatively for it
SELECTIVE MUTISM
Teens with selective mutism have a hard time speaking in some settings, like at school around the
teacher. This difficulty goes beyond typical shyness - kids with SM are "frozen" with anxiety and feel
unable to speak.
For a diagnosis of selective mutism, the following criteria must be met:
- Must be able to speak in some settings but not in others
- The condition must have lasted for a month (not including the first month of school)
- The inability to speak must interfere with schooling and social activities
- The inability to speak must not be attributable to a communication disorder or a lack of knowledge of the language being spoken
GENERALIZED ANXIETY DISORDER: RISK FACTORS
Teens with generalized anxiety disorder worry about a wide variety of everyday things. Their anxiety can
be distinguished from typical worry in its excessiveness, duration and lack of precipitating events. Kids
with generalized anxiety often worry particularly about school performance and can struggle with perfectionism.
A diagnosis of GAD can be made when a teen's anxiety is beyond her control, is focused on a number of
different activities, causes significant distress or impairment, and is present "for more days than not" for at
least 6 months.
Symptoms include:
- Restlessness
- Feeling on-edge
- Fatigue
- Loss of focus
- Irritability
- Muscle tension
- Trouble sleeping
PANIC DISORDER
Teens with panic disorder experience repeated, unpredictable panic attacks that can cause feelings that
are often misinterpreted as impending death and heart attack-like symptoms, and can result in a
disconnection from reality.
A diagnosis of panic disorder often occurs only after medical explanations for signs and symptoms, as
well as other psychiatric disorders - including OCD and PTSD - are exhausted. A professional will
diagnose panic disorder if attacks are recurrent and unexpected, and if one attack is followed in the
ensuing months by other signs including:
- Preoccupation with the possibility of further attacks
- Fear of the effects of an attack, including the feeling of having a heart attack or "going crazy"
- A considerable change from normal behavior following the attacks, such as avoiding places associated with them
OBSESSIVE-COMPULSIVE DISORDER
Teens with OCD have intrusive thoughts and worries that make them extremely anxious, and they
develop rituals they feel compelled to perform to keep those anxieties at bay. OCD can be diagnosed
when a child has obsessions, compulsions or both.
- Obsessions are unwanted and intrusive thoughts, images or impulses.
- Obsessions make them feel upset and anxious.
- Compulsions are actions or rituals they are driven to perform to get rid of their anxiety.
SPECIFIC PHOBIA
A teen with a specific phobia has an excessive and irrational fear of a particular thing, like being afraid of
animals or storms. The object of a specific phobia must be something not normally considered
dangerous, and avoiding that object will cause significant impairment to the child's ordinary functioning. It
is common for individuals to have multiple phobias.
Specific phobias are commonly classified in five categories:
- Animal Type, if the phobia concerns animals or insects
- Natural Environment Type, if the phobia concerns objects such as storms, heights or water
- Blood-Injection-Injury Type, if the phobia concerns receiving an injection or seeing blood or an injury
- Situational Type, if the phobia concerns a specific situation like flying, driving, tunnels, bridges, enclosed space or public transportation
- Other Type, if the phobia concerns other stimuli such as loud sounds, costumed characters, choking or vomiting
TREATMENT FOR ANXIETY
Anxiety is best treated with either behavioral therapy or a combination of behavioral therapy and
medication.
The evidence-based therapy of choice for anxiety is cognitive behavioral therapy, or CBT. CBT is based
on the idea that how we think and act both affect how we feel. By changing thinking that is distorted, and
behavior that is dysfunctional, we can change our emotions.
One of the most important techniques in CBT for teens with anxiety is called exposure and response
prevention. The basic idea is that kids are exposed to the things that trigger their anxiety in structured,
incremental steps, and in a safe setting. As they become accustomed to each of the triggers in turn, the
anxiety fades, and they are ready to take on increasingly powerful ones.
Medication can alleviate symptoms of anxiety as well, and may make behavioral therapy more effective
for some teens. SSRIs, or selective serotonin reuptake inhibitors, have proven effective at managing
anxiety.
MORE ABOUT GENERALIZED ANXIETY DISORDER
A teen with generalized anxiety disorder (GAD) has pervasive worries that cause distress about a variety
of everyday things, including doing well in school or sports. He worries too much about everything. In this
guide you'll find common signs and symptoms of GAD, criteria used for diagnosis and up-to-date treatment options.
Generalized Anxiety Disorder: What Is It?
Generalized anxiety disorder, or GAD, is a condition characterized by pervasive worry. It takes the form of
undue distress about a variety of everyday things beyond the scope of more specific anxieties and
phobias. In children the anxiety is often focused on performance in school or sports and may drive
extreme studying or practicing. A key distinguishing factor in GAD is that the anxiety is focused not on
exterior triggers like social interaction or contamination, but internally.
These anxieties may make a teen with GAD feel restless, fatigued, tense, or irritable, and she may have
trouble concentrating or sleeping. GAD rarely emerges before adolescence, and is more prevalent in girls
than boys. The anxiety impacts a teen's quality of life and the ability to participate in social activities and
school.
Generalized Anxiety Disorder: What to Look For
A teen might have GAD if she worries incessantly about everything, but particularly over her own
performance in school or other activities, or her ability to meet expectations. Teens with GAD tend to seek
reassurance in an attempt to assuage their fears and worries (Will we get there on time? What if I can't
fall asleep the night before the test?). Their anxiety can make them rigid, even irritable and restless. The
stress they experience can lead to physical symptoms, including fatigue, stomachaches, and headaches.
The anxious thoughts of a teen with GAD are exaggerated but they tend to focus on tangible, real-life
issues. Unlike social anxiety disorder, they're focused on her own perfectionism rather than what others
will think of her. And unlike in adults with GAD, who realize that their pervasive anxiety is not an
appropriate response to their actual situation, children with GAD may not immediately recognize that their
fears are outsized. It should also be noted that many of the symptoms of GAD are also symptoms of
other, more specific anxiety disorders, and differentiating them can be difficult.
Generalized Anxiety Disorder: Risk Factors
There are some genetic factors in developing generalized anxiety disorder. Teens who develop the
disorder are more likely to be avoidant and have inhibited behaviors and negative temperaments. Girls
are also more at risk.
Generalized Anxiety Disorder: Diagnosis
A diagnosis of GAD can be made when a teen's anxiety is beyond her control, is focused on a number of
different activities, causes significant distress or impairment, and is present "for more days than not" for at
least 6 months.
GAD is distinguished from typical worry in its excessiveness, longer duration, lack of precipitating events,
and occurrence, even when the performance or activity is not being evaluated.
To be diagnosed, a teen must also have one of these symptoms: restless, on-edge feeling, fatigue, loss of
focus, irritability, muscle tension, or trouble sleeping.
Generalized Anxiety Disorder: Treatment
Treatment for GAD usually has a psychotherapeutic and a pharmacological component. In therapy, the
family plays an integral role in aiding the child in her quest to control her anxiety and its effects; teens
really need their parents' help in working through the symptoms of GAD.
Psychotherapeutic
GAD is often treated with cognitive behavioral therapy. Exposure therapy, in which a therapist exposes a
child to stressors in gradual increments and teaches her techniques to manage the anxiety response, can
be effective for GAD, but difficult because of the wide range of stressors. Another technique involves
teaching the teen how to recognize symptoms and how her thinking contributes to anxiety, and to
understand that her anxiety response is out of proportion to the things that trigger it. This is referred to in
some circles as "decatastrophizing." A course of CBT for GAD can be relatively short-10 or 20 sessions
-with the child and her family practicing learned skills in the world outside the office.
Pharmacological
GAD often responds very well to the group of antidepressant medications called selective serotonin
reuptake inhibitors, or SSRIs. Anti-anxiety drugs are often prescribed if these do not provide the desired
result. Buspirone is one which can be taken over the long term. The benzodiazepines are stronger, fastacting
sedatives that work well to curb bouts of anxiety but are prescribed sparingly, as they may be habit
forming.
Generalized Anxiety Disorder: Risk For Other Disorders
People with generalized anxiety disorder are more likely than the rest of the population to be diagnosed
with depression.
Sources:
NIMH,
Paradigm Malibu
The information contained on this website should not be used as a substitute for the
mental healthcare of a professional, such as a psychiatrist, pediatrician or therapist.