Anxiety in Teens

The number of teens that are anxious are increasing every day.  6.3 million teens ages 13 to 18 have had an anxiety disorder. That number represented 25% of the population in that age group in 2015.  Schrobsdorf, S. (2016). 

It's important to keep in mind that all anxiety isn't an anxiety disorder. Feeling anxious in general isn't necessary bad, it's only when it rises to the level of a disorder that it becomes a problem. This page will explain some general issues that can become problematic for teens and some things you can do as a parent to spot when anxiety in teens rises to the level of a disorder. 

A good rule of thumb is that if your teen is exhibiting behavior that is interfering with their ability to function in specific expected domains in their lives, such as school, family, or friendships, then you want to get them checked out to see if they may be suffering from anxiety that may be more serious. 


What Kinds of Anxiety do Teens Have?

  • Generalized Anxiety Disorder (GAD)

Teens with GAD worry about everything They may have symptoms such as difficulty concentrating, tension in their body fatigue and sleep problems. They may frequently engage in behaviors to reduce their anxiety such as asking you for reassurance or avoiding things that make them anxious. You can learn more about GAD here.

  • Obsessive-Compulsive Disorder (OCD)

Teens who have OCD have obsessions and compulsions. Obsessions are repetitive intrusive and often unwanted thoughts, images, or urges, which cause anxiety or distress. Teens with OCD perform behaviors or mental acts to decrease the anxiety/distress associated with obsessions. These behaviors trap them in a cycle of anxiety. Learn more about OCD here.


  • Panic Disorder

Panic Disorder is characterized by unexpected panic attacks. The panic attacks are usually driven by the worry of having another panic attack. Teens who have Panic Disorder engage in behaviors such as avoidance of places where they had panic attacks or people and situations that reminded them of the panic attacks. Learn more about panic here. 

  • Social anxiety disorder (SAD)

is often recognized in early to mid adolescence. SAD is characterized by marked and persistent fear of social situations or performing situations with the core fear of being embarrassed or negatively judged. Teens with social anxiety will avoid these situations or have great distress when forced to endure them. Teens with social anxiety may also have substance abuse problems and coo curing depression.  Learn more about it here.

  • Phobias

A phobia is defined  an excessive, irrational fear toward an object or situation. Teens who have this anxiety disorder will often avoid situations that remind them of their phobia. A common phobia I see in my office is fear of vomiting.  Teens who have phobias  have significant impairment in their functioning due to that fear. 

  • Separation Anxiety 

Although more common in early childhood, teens can also suffer from this. A teen with separation anxiety feels unusual distress about being separated from a person or pet ( could be a parent, boyfriend etc) Thoughts usually are around the other person being harmed if they are left alone and there is often fear of being left alone. Learn more here. 

Anxiety in Teens: Behavior can Mask the Symptoms

Anxiety in teens may often be expressed through defiance and avoidance, especially in boys but also in girls. Anxiety in teens can appear to be bad behavior. In my office, this behavior is often truancy, mild drug use, and oppositional or argumentative behavior at home. Parents often unknowingly will reinforce a child’s anxiety if their symptoms are primarily behavioral because they avoid doing things that upset the child, thus feeding their anxiety.

If parents are not tipped toeing around the teen anxiety than they are engaging in conflict over the teens' behavior, thus leading to stressful and uncomfortable home life. This can contribute to teens anxiety and depression as well.

Both of these approaches fail to address the real issue, the teen's anxiety.



Anxiety in Teens: Common Stressors

Dating

Anxiety in teens can be caused by life stressors, especially if the teenager is already prone to stress. Girls, in particular, are very vulnerable to anxiety over dating issues. Girls are often at a loss for how to behave and what to expect when dating. Half of the time I spend with my teenage clients amounts to dating advice. Teen anxiety around dating is particularly likely if there haven’t been explicit discussions in the house about dating and an open attitude that cultivates and exchanges between the teenager's parents around sex and dating. If kids are left to fend for themselves they will make a mess of figuring it out. Without the skill to pick good dating partners, to know how to make good choices within that relationship, and how to stand up for themselves, they are overwhelmed. Dating is a huge source of anxiety in teens. This is the case with teenage boys as well. Click here for more information about teen dating.

Body Image

Body image issues are another source of anxiety in teens. Girls are under a tremendous amount of pressure to be thin and beautiful. As far as women have come over the past few decades, this remains an issue we have not been able to escape from. Teenage girls are judged by their appearance and are surrounded by media images of perfectly gorgeous and thin women who don’t exist in reality. I have noticed, in particular, that girls who present with anxiety over body images are more likely to have mothers who have body image issues.

Poor Communication Skills

Difficulty communicating and problem solving is often a source of anxiety in teens. These are rarely issues that are mastered in adolescents ( or adults). Teens who have not mastered the skill of assertiveness and who have trouble verbalizing their thoughts and feelings are particularly vulnerable to anxiety. This is an issue of constant focus in my therapy practice. I will hear stories in therapy about how hurt teens were feeling when someone criticized them or ignored them or stepped on their feelings. When I ask “what did you say?”, the response is "nothing". Walking around with your feelings stuffed inside all day long will cause you anxiety and depression! Click here for more information about assertiveness.

Although it may not be apparent, teen boys can have very complex emotional lives. They are often taught not to verbalize their feelings, to be strong, and are sometimes not even able to recognize their feelings. They may be avoidant and more hesitant to let you know what is happening. Inside they are feeling anxious, but outside they may appear depressed and angry.

Social Media

Social media can hurt teens as it does for adults. They can feel pressured to keep up a social image, a beauty image, and can also be victims of bullying and sexual harassment. Parents often have no awareness at all of their kid's online life. It is important to know what your teen is doing on social media. 

School

Academics can be a stress on a teen especially if they have an undiagnosed learning disability. This is very often the case with teens that come to see me. In the event that this is the case, or suspected, a referral is made for a psychological evaluation, and this can uncover what may be contributing to their school difficulties. Often a 504 or IEP can assist greatly in alleviating their anxiety.


What can you do as a Parent if your Teen is Suffering from Anxiety?

1. Keep Communication Lines Open


Creating a safe environment for teens is tough to do. As a parent, we want to ensure we are doing the right thing. That often transfers into lecturing, managing, and controlling behavior on parts of the parents especially when we start to get concerned about how our kids are doing. This is the last thing we should do. This shuts our kids down, makes them feel criticized, and often more anxious. Good parenting doesn't come naturally to most of us. Listening to and respecting our teen should be a big part of what we strive to do while encouraging them to explore their feelings and seek us out when they are stuck. 


2. Model Emotional Regulation

Resist the urge to yell, punish or act out when you are angry at your teens or anxious about what is happening. Instead, ask them calmly about what is going on. Share your observations and your thoughts. Let them know you are a resource for them, and encourage them to think about what might be going on with them, and how you might help them solve their problem. 


3. Develop mental health literacy in your home.


Anxiety can be hidden by teens. One thing you can do to ensure that your teen is not hiding their anxiety because of fear of stigma is to reduce the stigma in your home around anxiety, depression, or mental illness in general.

  • Learn about anxiety and depression and develop stigma free language
  • Educate yourself about how these illnesses work and how people heal from them
  • Share with your teen the experiences of people that you know or those of members in the family who suffered from depression or anxiety
  • Focus on people your teen identifies with as being functional or successful ( many who suffer from anxiety and depression are)!
  • If you go to therapy don't hide it. Talk about therapy openly as a thing you do to seek help and improve yourself. 


4. Encourage them to identify their anxiety, and not use it as a reason to avoid doing things.


5. Protecting your child from ordinary disappointment and feelings or working through their difficulties will deprive them of opportunities to acquire coping skills and learn how to regular their emotions. Don't constantly step in to help your child as it will make their anxiety worse. 


6. On the flip side, ease up on parental pressure. In my practice, I see many adolescents who suffer from anxiety because of too many expectations from parents. Try to examine whether your expectations might be contributing to your teen's anxiety. 


7. Err on the side of getting help. It's never a bad idea to get therapy for yourself or your teen. Meet with a therapist if you think your teen is having a difficult time. It's never a bad idea to meet with a therapist and get an assessment to check-in. There may be things you can do to help yourself or your teen through this difficult time, and a professional can give you an objective opinion about these issues.

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References for anxiety in teens


EJ, Garland. (2001). Rages and Refusals: Managing the Many Faces of Adolescent Anxiety. Can Fam Physician , 1023-1030. 

Schrobsdorf, S. (2016). The Kids Are Not All Right. Time International (South Pacific Edition)188(19), 44. Retrieved from http://search.ebscohost.com.proxy141.nclive.org/login.aspx?direct=true&db=f5h&AN=119170445&site=ehost-live

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