National Alliance on Mental Illness
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Anxiety Disorders in Children and Adolescents

What are anxiety disorders?

Anxiety disorders cause people to feel excessively frightened, distressed, and uneasy during situations in which most others would not experience these symptoms. Left untreated, these disorders can dramatically reduce productivity and significantly diminish an individual’s quality of life. Anxiety disorders in children can lead to poor school attendance, low self-esteem, deficient interpersonal skills, alcohol abuse, and adjustment difficulty.

Anxiety disorders are the most common mental illnesses in America; they affect as many as one in 10 young people. Unfortunately, these disorders are often difficult to recognize, and many who suffer from them are either too ashamed to seek help or they fail to realize that these disorders can be treated effectively.

What are the most common anxiety disorders?

  • Panic Disorder -- Characterized by panic attacks, panic disorder results in sudden feelings of terror that strike repeatedly and without warning. Physical symptoms include chest pain, heart palpitations, shortness of breath, dizziness, abdominal discomfort, feelings of unreality, and fear of dying. Children and adolescents with this disorder may experience unrealistic worry, self- consciousness, and tension.
  • Obsessive-compulsive Disorder (OCD) -- OCD is characterized by repeated, intrusive, and unwanted thoughts (obsessions) and/or rituals that seem impossible to control (compulsions). Adolescents may be aware that their symptoms don’t make sense and are excessive, but younger children may be distressed only when they are prevented from carrying out their compulsive habits. Compulsive behaviors often include counting, arranging and rearranging objects, and excessive hand washing.
  • Post-traumatic Stress Disorder -- Persistent symptoms of this disorder occur after experiencing a trauma such as abuse, natural disasters, or extreme violence. Symptoms include nightmares; flashbacks; the numbing of emotions; depression; feeling angry, irritable, and distracted; and being easily startled.
  • Phobias -- A phobia is a disabling and irrational fear of something that really poses little or no actual danger. The fear leads to avoidance of objects or situations and can cause extreme feelings of terror, dread, and panic, which can substantially restrict one’s life. "Specific" phobias center around particular objects (e.g., certain animals) or situations (e.g., heights or enclosed spaces). Common symptoms for children and adolescents with "social" phobia are hypersensitivity to criticism, difficulty being assertive, and low self-esteem.
  • Generalized Anxiety Disorder -- Chronic, exaggerated worry about everyday, routine life events and activities that lasts at least six months is indicative of generalized anxiety disorder. Children and adolescents with this disorder usually anticipate the worst and often complain of fatigue, tension, headaches, and nausea.

Other recognized anxiety disorders include: agoraphobia, acute stress disorder, anxiety disorder due to medical conditions (such as thyroid abnormalities), and substance-induced anxiety disorder (such as from too much caffeine).

Are there any known causes of anxiety disorders?

Although studies suggest that children and adolescents are more likely to have an anxiety disorder if their caregivers have anxiety disorders, it has not been shown whether biology or environment plays the greater role in the development of these disorders. High levels of anxiety or excessive shyness in children aged six to eight may be indicators of a developing anxiety disorder.

Scientists at the National Institute of Mental Health and elsewhere have recently found that some cases of obsessive-compulsive disorder occur following infection or exposure to streptococcus bacteria. More research is being done to pinpoint who is at greatest risk, but this is another reason to treat strep throats seriously and promptly.

What treatments are available for anxiety disorders?

Effective treatments for anxiety disorders include medication, specific forms of psychotherapy (known as behavioral therapy and cognitive-behavioral therapy), family therapy, or a combination of these. Cognitive-behavioral treatment involves the young person’s learning to deal with his or her fears by modifying the way he or she thinks and behaves by practicing new behaviors. Ultimately, parents and caregivers should learn to be understanding and patient when dealing with children with anxiety disorders. Specific plans of care can often be developed, and the child or adolescent should be involved in the decision-making process whenever possible. Permission is granted for this fact sheet to be reproduced in its entirety, but it must include the NAMI name and all contact information.

Reviewed January 2003