ANXIETY IN TEENAGERS

Anxiety, it’s a natural and important emotion. It is the signaling through stirrings of worry, fearfulness, and alarm that danger or a sudden threatening change is near. Anxiety can also be a dramatic, unhealthy response. With many changes and uncertainties teenagers face, anxiety often hums along like background noise. For others, anxiety becomes a chronic, high-pitched sound, interfering with their ability to attend school and to perform up to their academic expectations/potential. For example, participating in extracurricular activities, making/keeping friends, and maintaining a supportive, flexible relationship within the family can become difficult. Sometimes anxiety is limited to generalized, free-floating feelings of uneasiness. Other times, it develops into panic attacks and/or phobias.

Identifying the Signs

Anxiety disorders are very different in every teenager. Symptoms are usually excessive fears/worries, feelings of restlessness, and a tendency to be very cautious, even in the absence of actual threats. Some teenagers feel constant nervousness, restlessness, and/or extreme stress. In social settings, anxious teenagers may appear more dependent, withdrawn, or uneasy. They either seem overly restrained or overly emotional. They might complain about muscle aches/tension, fatigue/exhaustion, or discomfort regarding changes that happen during puberty. 

Those who suffer from extreme anxiety also experience a range of physical symptoms, such as those mentioned before, as well as headaches and/or pains in limbs/back. Anxiety during teenage years usually centers on the changes regarding  how the teenager’s body looks,  if they feel any lack of social acceptance and if they are experiencing any conflicts about their independence. They may avoid their usual activities, and might even refuse to engage in new experiences.

 Protesting whenever they are apart from their friends, or in an attempt to diminish/deny their fears and worries, are signs of the possibility that teenagers might engage in risky behaviours. For example, drug experimentation, alcohol indulgence, and even compulsive sexual behaviours are some actions/effects that can result from anxiety. Panic disorders are more commonly found in girls than in boys. Panic disorders tend to emerge in adolescence, usually between the ages of fifteen and nineteen. Feelings of intense panic are common and can appear out of nowhere without any noticeable/visible causes or they might be triggered by specific situations, in which case, they are referred to as panic attacks. 

A panic attack is an abrupt episode of severe anxiety with accompanying emotional and physical symptoms. During a panic attack, the teen may feel overwhelmed by fear/discomfort, a possible sense of impending doom, the fear they might be going crazy, and even possible sensations of unreality. 

Emotional symptoms such as shortness of breath, sweating, choking, chest pains, nausea, dizziness, numbness/tingling may appear. During an attack, some teens might feel as if they are dying/can’t think. Following a panic attack, many teens worry that another attack is waiting to happen. They may try to avoid situations which they feel could trigger the attacks. As a result, teens sometimes begin to avoid normal activities and routines.

PHOBIAS

Many fears of younger children are mild and usually do not last very long. These fears are considered within the range of normal development. However, teenagers can develop very extreme, usually inexplicable fears called phobias. These phobias usually centre on specific objects or situations. 

These intense fears can limit a teenager’s activities. The fear generated by a phobia is excessive and typically not a rational response to a situation. The objects of a phobia sometimes change with age. While very young children often fear  the dark, monsters, or real-life dangers such as losing loved ones, and death, teenager’s phobic fears tend to involve school and social performance.

Multiple studies have revealed an increase in school avoidance in middle-school (or junior-high-school) years. With school avoidance, excessive worries about performance or social pressures at school might just be at the root of the reluctance to attend actual school regularly. 

This usually leads to a cycle of anxiety, physical complaints, and school avoidance/absences. When the cycle escalates with the worsening of physical complaints such as stomach aches, headaches, and menstrual cramps, visits to the doctor generally fail to uncover general medical explanations. The longer a teenager stays out of school, the more difficult it becomes for them to overcome that fear and anxiety to return to school. They might feel increasingly isolated from school activities or they might feel different from other students their age.

Some teenagers are naturally more timid than others. As their bodies, voices and emotions change during adolescence, they sometimes feel more self-conscious. Despite that initial feeling of uncertainty, most teens can join in with social groups such as clubs at their local community center or their school, if given the time to observe and warm up. In extreme cases, called social phobia, the teenager becomes so withdrawn that even though they want to take part in social activities, they are unable to overcome that intense feeling of self-doubt and worry. 

Gripped by this anxiety, when faced with entering a new or unfamiliar social situation, teenagers with social phobia become hostage to their unrelenting fears of other people’s judgement and/or expectations. Teens might deal with their social discomfort by fretting about health, appearance, or overall competence, even if they behave in a clowning or boisterous fashion. Unfortunately, their anxiety can possibly lead  to the consumption of alcohol as a coping mechanism.

Much of a teenager’s social life is played out in school. Social phobia can overlap with, and be hard to distinguish from school avoidance. Some teenagers with social phobia might try to sidestep their anxious feelings altogether by refusing to attend/participate in school. Classroom and academic performance fall off, involvement in social and extracurricular activities lessen, and as a consequence, self-esteem declines.

Some teens may experience such a high level of anxiety that they cannot leave the house. This is called Agoraphobia. This seems to stem from feelings about being away from parents and fears of being away from home rather than fear of the world. Several children who demonstrate severe separation anxiety in early childhood go on to develop agoraphobia as teenagers and adults.

Causes and Consequences

Most researchers believe that if one parent is naturally anxious, there’s a good chance that their child will also have anxious tendencies. A parent’s own uneasiness can often be communicated to the child, compounding the child’s natural sensitivity. A cycle of increasing uneasiness may also be established. 

By the time this child reaches their teenage years, their characteristic way of experiencing and relating to their world is covered with anxiety.

In many cases, anxiety disorders in teenagers stems from separation anxiety. The tendency to become flooded with fearfulness occurs whenever seperated from home or from those the child is attached to, this person is usually a parent. Teenagers can also have separation disorders. These teens might deny having separation anxiety, yet it might be reflected in their reluctance to leave home and resistance to being drawn into independent activities. 

Separation anxiety is often behind a teenager’s refusal to attend or remain in/at school. School avoidance can follow a significant change at school, such as the transition from elementary school (primary school) into middle school (junior high). 

It might also be triggered by something unrelated to school, such as divorce, illness, or a death in the family. Teenagers living in areas frequented by street gangs may also be fearful about gang activities or the lack of safety in school.

A worried teen performs less in school, sports, and social interactions. Too much worry can result in a teenager failing to achieve their goals and can become detrimental to their health. 

A teenager who struggles with anxiety may be overly conforming, perfectionistic, or unsure of themselves. They might redo tasks or procrastinate in an attempt to avoid disapproval. The anxious teenager often seeks excessive reassurance about their identity and wonders if they are good enough to meet the standards of their peers.

Some teenagers with anxiety disorders can also develop severe mood disorders and/or eating disorders. Some teenagers who do experience persistent anxiety may also develop suicidal feelings or engage in self-destructive behaviours. 

These situations require immediate attention and treatment. Anxious teenagers might also use alcohol and drugs to self-medicate or self-soothe in an effort to reduce/prevent anxiety.

How to Respond

Listen carefully and respectfully to a teenager if they are willing to talk about their fears and anxieties. Without discounting their feelings, help them understand that increased feelings of uneasiness about their body, performance and peer acceptance, and feeling uncertain are all natural parts of being a teenager.

By helping your teenager trace their anxieties to a specific situation(s) and/or experience(s), you might help them reduce the overwhelming nature of their feelings. Reassure them that, although their concerns are real, the likelihood of them being able to handle them when they get older is very high. They might develop different techniques to be able to deal with the stress and anxiety that comes with life.

Talking to someone you trust about your fear in a safe environment, the only issue with that is you have to make sure that the person is unbiased to the situation and won’t make you feel uncomfortable about expressing your feelings. 

Remind your teenager of the other times when they were initially afraid, but still managed to enter into new situations, such as middle school (junior high) or camps. Praise your teenager when they take part in something despite being nervous about it. Let it be known that you are proud of your teenager’s ability to act in the face of anxiety. Remember, your teen might not always be comfortable talking about their feelings that they may view as signs of weakness. While, in the  moment it may seem as though they are not listening, later they could be soothed by your attempts to help them.

If fear begins to take over your teen’s life and their activities start to become limited, or if the anxiety lasts for up to six months, please seek professional advice. Their doctor or teacher will be able to recommend a child psychiatrist or other professional that specializes in treating children and teenagers.

Managing anxiety disorders – as with any adolescent emotional disturbance – requires a combination of treatment interventions. The most effective plan must be individualized to the teenager and their family. While these disorders can cause a lot of distress and disruption to the teen’s life, the overall prognosis is good.

Treatment for an anxiety disorder begins with an evaluation of symptoms, family and social context, and the extent of interference/impairment to the teen. Parents, as well as the teenager, should be included in this process. School records may be cited to identify how the teenager(s) performance and function in school has been affected by the disorder.

The evaluating clinician will also consider any underlying physical illnesses or diseases that could be causing the anxiety symptoms. Medications that might cause anxiety (such as some drugs used in treating asthma) will be reviewed. 

Since large amounts of caffeine in coffee and/or soft drinks can cause agitation, a clinician might look at the teenager’s diet as well. Other biological, psychological, family, and social factors that might predispose the teenager to anxiety will also be considered.

If a teenager refuses to go to school, a clinician will explore other possible explanations before labelling it school avoidance. Perhaps the teenager is being threatened or harassed, is depressed, or has an unrecognized learning disability. They might also be skipping school to be with friends, not from anxiety about performance or separation.

If the teenager has engaged in suicidal or self-endangering behaviour, is trying to self-medicate through alcohol or drug use, or is seriously depressed, these should be addressed immediately. In such cases, hospitalization might be recommended in order to protect the teenager(s).

Lifeline is the National Suicide Prevention Hotline, where you can call/text a real person to talk either about yourself or another person you know and you worry about them. It’s strictly anonymous but, they do ask you for your name so they can connect with you on a personal level. 

NIMH is the National Institute for Mental Health. They have tons of research articles on a large range of subjects.

John Hopkins Medicine is a very reputable All Children’s Hospital where not only do they have articles about Teenage Anxiety but, they also have information about a very large range of different topics, not just about mental health but physical health, health risks and signs that you or a loved one might need medical attention.

In most cases, treatment of anxiety disorders focus on reducing the symptoms of anxiety, relieving distress, preventing complications associated with the disorder, and minimizing the effects on the teenager’s social, school, and developmental progress. If the problem manifests in school avoidance, the initial goal will be to get the teenager back to school as soon as possible.