As with all mental health questions, the answer to what is teen anxiety is multifaceted, and there are many points of view from which to observe anxiety in teens, its causes, and its resolution. What is certain is that anxiety, not depression, is the most prevalent psychological complaint in our culture, affecting some 12.6% of the population within any given 12 month period. Anxiety and anxiety-induced insomnia are the most common psychological complaints, and are the reason for approximately 30% of all patient visits to primary care physicians.
Studies have indicated that teen anxiety is associated with negative emotionality, with teen depression, as well as suicide ideation and teen suicide. Youth anxiety has been implicated as a precursor to adult depression, indicating the importance of early treatment. Studies have also shown that teen anxiety disorders often precede teen substance abuse, and that substances are often used to reduce or control anxiety. With so many possible negative outcomes to excessive anxiety in teens, the need for treatment, rather than benign neglect and hoping it will go away on its own, is clear.
Symptoms of Teen Anxiety
Symptoms of five teen anxiety disorders (panic, phobic, obsessive-compulsive, stress related - PTSD and Acute Stress Disorder- , and generalized anxiety) will be individually reviewed. It is useful, however, to discuss these teen anxiety symptoms in a general manner before categorizing different types of anxiety.
It should be kept in mind that some level of anxiety in teens is useful. Humans would not function as creatively or maintain a satisfactory level of personal safety without it. However, teen anxiety symptoms have reached an unhealthy level under the following circumstances:
- When the subjective sense of worry, tension, and general dis-ease about a known or unknown object or event is clearly out of proportion to the objective need. Both Julie and Jason (referred to earlier) were prevented from enjoying normal teen life by their perception of potential failure and embarrassment
- When excessive worry, or hypervigilance, distracts from normal life. When worry causes excessive irritability or insomnia
- When somatic symptoms, such as twitches, muscle aches, and jitters result from worry
- When nervous hyperactivity causes sweating, speeded heart rate, frequent urination, diarrhea, or light-headedness, and is not in response to a true threat
Symptoms such as these should be considered warning signs that the adolescent may be experiencing too much anxiety and is in need of treatment of a teen anxiety disorder.
Teen Anxiety Disorder Subtypes
In order to discuss Panic Disorder, it is necessary to first understand what constitutes a Panic Attack, which is the primary component of Panic Disorder.
Panic attacks may occur in the context of any of the anxiety disorders, and sometimes occur as a component of other mental health disorders, such as substance abuse. Panic attacks are related to perceived, not real, danger. Symptoms of panic attack may be related to the mind, the body, or both, and may include the following:
1. Heart palpitations
3. Trembling or shaking
4. Shortness of breath
A choking sensation
5. Chest pains
8. Derealization, or a sense that one has lost contact with reality
9. Fear of going crazy or losing control
10. Numbing or tingling sensations
11. Fear of dying
12. Chills or hot flashes
A panic attack comes on suddenly, builds to a climax that is often terrifying, is usually accompanied with a sense of impending doom from which one must escape, and usually subsides with 10 minutes or less. The occurrence of panic attacks
- May be completely unexpected
- May be anticipated, but only in specific situations or places
- Or may be likely to occur, but do not always occur, in a specific situation
The experience of two or more unexpected panic attacks, including physiological symptoms such as those listed above, and an ongoing concern about having another attack, defines what it means to be suffering from panic disorder. A panic disorder also implies that the sufferer focuses his or her attention on the feared attack or its consequences (such as not being able to escape the situation or the fear of dying), rather than on the situation or the embarrassment that having an attack might cause. If the sufferer is focused on the situation or the embarrassment, he or she is more likely to be experiencing a phobic reaction to a specific situation, rather than a panic attack related to Panic Disorder.
If the teen develops a fear of going to specific places (shopping mall, a theater), or participating in a particular activity (driving a car, standing in line, drinking coffee), because he or she is afraid that being in that place or participating in that activity will trigger a panic attack and he or she will not be able to obtain necessary help or escape from the dreaded situation, the diagnosis is Panic Disorder with Agoraphobia.
Panic disorder affects over 6 million people in the US, is twice as likely to occur in females than males, and is often associated with depression.
Noah was unexpectedly and severely bitten in the face by a dog when he was five years old. He had mistakenly judged the dog to be friendly and innocently attempted to pet him. Although Noah is now 13 and knows rationally that some dogs are friendly and some are not, he does not trust his judgment and panics when he gets too near a dog of any size or temperament. His heart races, he begins to tremble, he feels he can't breathe, he is afraid of dying, and his only thought is that he must escape immediately. Because Noah has such severe reactions to dogs, he tries to avoid them at all costs. Before accepting an invitation to go to a friend's house, he surreptitiously finds out if the friend has a dog. If a dog is present, he makes up an excuse as to why he can't accept the invitation. Specific phobias, which are irrational or grossly exaggerated fears of certain objects or events, occur only in the presence of those objects or events and are therefore predictable. The object or event will either be endured with great discomfort or avoided altogether. In order to be diagnosed as phobic, the individual must suffer extreme distress or impairment of normal functioning.
Phobic individuals may be irrationally afraid of certain beings that occur in nature (dogs, spiders, snakes). They may also be afraid of things in the environment (storms, heights), blood or injections, situations (bridges, elevators), and other objects or events (clowns, vomiting, loud sounds). Having one phobia increases the likelihood of developing another. The first symptoms of specific phobias usually, but not always, occur in childhood or adolescence, and usually at a younger age for women than men.
Noah represents the case of a specific phobia whose origin was very clear, and the resolution of which was easily accomplished. While the origin of a specific phobia is not always so clear, Noah's experience serves as a clear example of a specific phobia with panic attacks.
Specific phobia affects approximately 8.7% of individuals in the US, of whom twice as many are female than male.
Teen Social Phobia - Teen Social Anxiety Disorder
Social Phobia, sometimes called Social Anxiety Disorder, affects approximately 6.8% of the US population, and affects males and females equally. Let's take a brief look at a case:
Jason's school has lots of great social events for students. He plans to go to almost every one, but as the event nears, he begins to have fantasies of being horribly embarrassed in front of the whole school. It almost makes him sick just thinking about the upcoming event, so he plans some elaborate excuse to tell his friends why he can't go.
Teen Social Phobia, or Teen Social Anxiety Disorder
Teen Social Phobia, or Teen Social Anxiety Disorder, typically first appears during early to mid-teens, but is often preceded by a history of shyness or social inhibition. The primary feature of social phobia in teens is extreme dread of a social or performance situation, and includes a grossly exaggerated fear of embarrassment. Situations that would provoke anxiety related to social phobia are avoided, or endured with great distress. Adults usually recognize that their fear is unwarranted and to at least some extent acknowledge that it is generated in their minds, but adolescents may not be as self-aware. Symptoms may be very similar to those experienced during a Panic Attack (see Panic Disorder).
Common symptoms or signs that accompany Teen Social Phobia are the following:
1 Hypersensitivity to criticism
2 Negative self-evaluation
3 Fear of rejection
4 Social passivity (fear of assertiveness)
5 Low self-esteem (feelings of inferiority)
6 Poor social skills
7 Noticeable signs of anxiety
Jason, the young man described above, talked about his fear of attending a school dance:
For months I thought about the end-of-the-year dance, long before anybody else even seemed to know it was coming. A few weeks before the dance, everybody was excited and happy to be going, talking about who they were taking and how much fun it was going to be. But for me, just the thought of the dance was enough to make me begin to sweat and feel shaky, almost nauseous.
For one, I didn't really know how to dance, and I was terrified of looking like an idiot. I couldn't for the life of me figure out how everyone else had learned. It wasn't like kids in our town took dance lessons. They just seemed somehow to know, and had known since middle school. For me, any time I walked into a room where music was playing, I panicked, afraid someone would ask me to dance. What would I do? Just stand there like an idiot, I suppose, until I passed out with embarrassment. At the time, I had a girlfriend, but that just made things worse, because there was no way she could understand what I was feeling, and how much I wanted to take her to the dance and be a normal kid. But I'd have rather killed myself than go to that dance. Yeah, now that I've said it, I know it's true; being dead would have been better than having to go to the dance.
As you probably remember from your own youth, social comfort is critical for optimal development in teen years, and Teen Social Phobia prevents that timely development from taking place. If you believe that your teen is displaying the symptoms of Teen Social Phobia, or Teen Social Anxiety Disorder, it is recommended that you get professional help.
Causes of Teen Anxiety
Biological Causes of Teen Anxiety
Biological research has shown that anxiety disorders, like many mental health disorders, have a genetic component and are therefore more prevalent among related than non-related individuals. Biological studies have also helped define different types of anxiety, such as Teen Specific Phobias, Teen Social Phobia, also called Teen Social Anxiety Disorder, Post Traumatic Stress Disorder (PTSD), and Generalized Anxiety Disorder. While such classifications and definitions are useful, particularly in the prescribing of medication, the idea that anxiety is solely a medical illness and that symptoms can and should be treated with medication oversimplifies the problem; specifically, some of the ensuing problems are:
- First, such a narrow approach to the problem and its solution does not facilitate understanding of what the patient is anxious about, an important aspect of successful treatment.
- Secondly, medication treatment without simultaneous psychotherapy puts the solution entirely outside of the patient, rather than empowering the patient to take control of his or her own life
- Finally, the classification of anxiety into such distinct categories ignores the fact that most individuals who suffer from anxiety experience it in many forms, not in a distinct and single manner
The diffuse nature of most anxieties is more complicated than strict biological thinking implies, and studies that include only individuals with one distinct form of anxiety are misleading in the sense that they do not represent the typical individual who is seeking understanding and relief.
Temperament, an inborn, biological trait that is relatively consistent over an individual's lifetime, is a factor in the experience of anxiety (see The Importance Of Temperament) . Behavioral inhibition, an aspect of temperament, has been shown to negatively influence the outcome of social experiences. For example, children who are behaviorally inhibited are more prone to experience a difficult social experience as being traumatic, and the traumatic experience is more likely to influence the development of social phobias, which usually first appear in early adolescence.
Environmental Causes of Teen Anxiety
There are various environmental factors (factors which originate outside the child) that affect a child's level of anxiety, two of which are caregiver style and vicarious learning.
Studies have shown that parenting or caregiver styles (coupled with offspring temperaments) can influence the development of child and adolescent anxiety. Anxious caregivers tend to
- Exhibit less warmth toward their children
- Grant less autonomy
- Tend to be more critical
- Model high control needs and fear
- Elevate the child's own concern about risk
An anxious caregiver may effect the child's own anxiety level in several ways, such as the following:
- The adolescent may come to believe that he or she is not competent to handle new situations
- Learning may be reduced by the lack of exposure to novel situations
Recent studies have indicated that anxiety and phobias can be learned through early observation. Studies have related primarily to the effects of children learning from their parents, however, there is some indication that susceptible children can even learn to be fearful or anxious from watching movies and TV. Timidity, or behavioral inhibition, increases the child's vulnerability to learning anxious behaviors.
Anxiety related to specific and social phobias, as well as OCD, are not random in nature, but are usually related to objects and situations that were dangerous at one time in our evolutionary history. For example, specific phobias are usually related to heights, snakes, spiders, and the like. Social phobias seem to be related to the dominance and submissive hierarchies found among animals (For more on this, see Contributing Factors To Teen Depression). OCD type obsessions are most often related to dirt, contamination, and safety, and OCD type compulsions are most often about cleaning and checking for danger.
Understanding the evolutionary relationship between former survival needs and today's phobias and fears may be helpful in gaining a degree of understanding and objectivity about human anxiety. It should be noted, however, that intellectual understanding does not usually alter the emotional impact of mental disorders. A new experience is usually required in order for change to take place.
Psychological Causes of Teen Anxiety
Anxiety usually has both conscious and unconscious components. Conscious anxieties are exemplified by phobias of specific objects (spiders) and events (giving a speech). Anxieties based on unconscious factors are more complex, as well as more difficult to understand and resolve. In most cases, anxiety has both conscious and unconscious components. As an example, Laurie, in the case described above, was conscious of her urge to shout an obscenity in the school library, and of the ritual of book counting. Many sessions of therapy were required, however, before she began to understand the unconscious aspects of her obsessive thoughts and compulsive behavior. The attention she was beginning to receive from boys who found her attractive had provoked unconscious fears related to the prolonged sexual abuse she had endured as a young child. Laurie's understandable need to prevent the painful memories from surfacing had to be brought to consciousness and fully processed in a safe environment before she began to experience relief and symptom reduction. It was also not coincidental that Laurie's OCD symptoms emerged in the library, a place of quiet where activity and conversation could not completely drown out her painful and repressed memories.
Treatment For Teen Anxiety
Psychological Treatment for Teen Anxiety
Effective psychotherapy can
- Help your teen understand anxiety, its possible causes, and what can be done about it
Normalize his or her experience and reduce fears of losing control or "going crazy"
- Expand his or her tolerance of anxiety; i.e., how much anxiety can be held inside without the need to act it out in the form of self-defeating behaviors
- Help your adolescent understand the difference between adaptive and maladaptive anxiety
- Expand the teen’s feeling of competence to handle what happens to him or her, rather than solely relying on outside aids, such as medication
- Avoid the possible side effects of medication
- Address the multiple anxieties that most anxious individuals experience
Biological Treatment For Teen Anxiety
Psychotherapy alone will be sufficient for the treatment of many of the anxiety conditions that adolescents experience. However, when that is not the case, biological interventions (medications) should be considered.
Several medications have been found to be effective in the treatment of anxiety disorders, including selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, benzodiazepines, beta blockers, and monoamine oxidase inhibitors (MAOIs).Your physician, preferably a psychiatrist, working in consultation with your therapist (who generally will know your child much better because of the amount of time spent with him or her) can best determine the specific medication and dosage for your child.
The Anxiety Workbook for Teens: Activities to Help You Deal With Anxiety & Worry