Anxiety is a very common feeling amongst adolescents, who are constantly facing new changes, challenges, and pressures in their daily life as they approach adulthood. A normal part of growing up involves taking on new responsibilities, exposure to different experiences, exploring limitations and testing boundaries, and developing a sense of identity. Social peer groups are in constant flux, where “fitting in”, self- acceptance and self- doubt are often battled with.
Most common anxiety occurs in short bouts, usually lasting a few hours or up to a day, or a few days at most. Normal anxiety extends to unhealthy levels if the anxiety occurs in intense and excessive amounts, or over an extended period of time, such as weeks or months. Distinguishing between normal and unhealthy levels of anxiety in teenagers, is crucial for preventing longer term mental health consequences for them in the future.
Anxiety in teens becomes problematic and may demonstrate symptoms of developing into a disorder if an individual loses their ability to engage in and manage their (previously) normal daily activities, such as socialising, learning and concentrating at school or in hobbies or tasks. Studies have indicated that anxiety disorders established in the early stages of life, when young people are still mentally and physically developing, can lead to serious mental health repercussions if left untreated as they approach adulthood.
Although the symptoms of an anxiety disorder may be easily recognised by the individual themselves, they may be more difficult for others to observe. Teenagers are good at hiding their emotions, and may express their feelings through aggressive behaviour or withdrawal, making it even more challenging to differentiate between the normal behavioural changes expected in adolescence, and the symptoms of developing a severe anxiety problem. Alternatively, some teenagers experiencing anxiety may focus excessively on achieving well, spending most of their time studying, at the detriment of self-care or relaxation.
Common physical and observable symptoms of an anxiety disorder:
- Muscular aches or tension, headaches, stomach aches, nausea, racing heart, nervous sweating, shortness of breath, chest pains, dizziness or lightheadedness
- Sleep patterns are disrupted: may have trouble falling asleep or have broken sleep; difficulties waking up in the morning
- Constantly tense, can’t sit still or seem to relax, always on edge
- Worrying about what could happen or what has already happened
- Increased sensitivity to criticism, high levels of self-consciousness and extreme discomfort or embarrassment in social situations
- Has obsessive, unwanted mental thoughts that won’t go away, or make it difficult to concentrate on other things
- Has a negative outlook on life, catastrophizes the worst outcome to occur in situations
- Avoidance of new opportunities or challenging situations
- Procrastinates or finds it difficult to begin or complete activities or loses concentration easily
- Loses interest or motivation for engaging in hobbies or daily tasks
- Begins to isolate themselves socially, or displays increased introverted behavior
If you are concerned that you or your loved one may be experiencing any of the symptoms mentioned above or similar, over a prolonged period exceeding two weeks, it is strongly recommended to seek professional advice. It is also worth noting that there are many different forms of anxiety disorders, and an individual may experience different symptoms across each case.
- Social anxiety/phobia: an intense fear of being publically embarrassed, judged or ridiculed, or fear of social situations in general
- Generalised anxiety disorder (GAD): overwhelming worries about everyday tasks and responsibilities
- Specific phobias: extreme fears of being confronted with a particular situation or contact with an object (for example fear of heights or spiders)
- Panic disorder: having reoccurring panic attacks, where the individual experiences a crippling sense of unrealistic fear in situations most people would not
- Agoraphobia: afraid of being ‘stuck’ in an inescapable situation where help may be limited if problems were to occur, or feeling an untamable sense of claustrophobia (for example, fear of being stuck in an elevator, in a car, or in a plane
- Separation anxiety disorder: experiencing high distress of about being separated from home or a loved one
- Selective mutism: stops children speaking in certain social situations, such as in school lessons. This usually affects young children, rather than teenagers.
- Obsessive Compulsive Disorder (OCD): intrusive mental thoughts and obsessions are usually associated with compulsive ritualistic mental acts and/or physical behaviour(s), the individual feels the need to perform to alleviate or reduce their distress.
- Post- Traumatic Stress Disorder (PTSD): children become extremely fearful, anxious or irritable, often associated with people, places or activities, after experiencing or being part of a highly distressing/ shocking scene or harrowing life event.
A teenager may experience a combination of one or more of these anxiety disorders, and various other physical symptoms or mental health disorders can also coincide, such as depression, eating disorders or attention- deficit/hyperactivity disorder (ADHD).
The main difference in anxiety when comparing teenagers to adults, is the topic areas their anxieties may be centered on, and their behavioural responses to these. Teenagers undergo significant changes and adaptations in adolescent years, naturally invoking high levels of associated stress, self-doubts and insecurities. This is typically where the main focus for teenage anxiety disorders seem to be centered around. Expectedly, as life stages progress, maturing from adolescence to adulthood, a different set of responsibilities, expectations, and therefore associated anxieties evolve.
However, diagnostic criteria are generally the same for anxiety disorders in children and adults, with slight differences in how each age-group expresses their anxiety behaviourally. For example, children may express their distress in different forms that may be age inappropriate or socially unacceptable for adults to engage in. Having less independence than adults, teenagers may also have limited opportunities to engage in avoidance compared to their adult counterparts. Adolescents may also find it more challenging to distinguish and describe anxiety as a result of the normal emotional changes they are experiencing, and their difficulties communicating their internal states of emotion.
There are various methods for treating adolescent anxiety, and their effectiveness varies across each individual case. However, for both teen and adult anxiety, the most common types of treatment involve Cognitive Behavioural Therapy (CBT), and several medication options, if indicated.
Cognitive Behavioural Therapy (CBT) is based on targeting the somatic, cognitive, and behavioural aspects of the individual’s anxiety. The therapy begins by educating the individual on identifying their somatic (physical) responses to anxiety (such as sweaty palms, flushed cheeks, racing heart) and educating them on practicing relaxation techniques when these identified responses occur. The second stage, involves cognitive reconstruction, where the individual identifies their negative and irrational thought processes and learns to challenge and replace these with positive, realistic ones. The psychologist teaches them techniques on managing their anxieties, and assists them in gradual exposure to their fears. In the final stages of treatment, relapse prevention techniques are implemented and follow up progression check-ups are planned.
- Talk to them
If parents have concerns that their teenager(s) may be demonstrating the symptoms of an anxiety problem, they should approach them and encourage them to talk about their feelings and any troubles they may be dwelling on. It is important the individual feels they are able to talk openly and honestly about their anxieties and confide in someone they trust, and that help and treatment is both available and attainable. Therefore, it is critical for parents to offer their children ongoing support and reassurance that it is not their fault, and that they may need help from a healthcare professional.
- Don’t wait to seek help & see a professional
While it is common for individuals’ to avoid situations that may trigger their anxiety, (with treatment being one of these), it is absolutely essential parents and their teens seek help as soon as possible. The adolescent brain is still developing, and treatment is critical to prevent long term, engrained behavioural responses, and other more serious mental health issues that can arise as in adulthood. Anxiety problems in children have the potential to have a ripple effect in all areas of their life, including disrupting their performance in schoolwork or extra- curricular activities and missing out on engaging in normal social events. If left untreated, this impinges upon their ability to develop the essential social skills and life competencies required as an adult. Studies have also suggested prolonged anxiety to incur a higher risk for substance abuse, alongside developing other mental health disorders, like depression. If you have any concerns, it is always best to be on the safe side and take your teen to see a healthcare professional for a formal evaluation. At Anxiety House, one of our clinical psychologists will be able to make a formal assessment and diagnosis of your teen’s anxiety. From there, they will advise you on the various treatment options available depending on the individual case.
- Be patient and supportive
Treating severe anxiety is an ongoing process and will require patience and commitment. Unfortunately there are no immediate fixes, and expecting the psychologist to wave their ‘magic wand’ and resolve everything at once will only lead to disappointment. The fact is, treatment takes time, and will involve the patient confronting their fears, under the guidance of their psychologist, as they learn to replace their existing behaviours with new methods of managing their distress. The good news is, with persistent support from family members and regular psychologist sessions, overcoming teen anxiety can be achieved and maintained effectively. Parents should also be mindful to encourage a healthy lifestyle, with adequate sleep, regular exercise and regular nutritious meals, while limiting caffeine intake for their teens, as these are linked to overall physical and emotional health and wellbeing.
Who we recommend
Dr Angela Randell
Dr Kris Ojala
Dr. Anthony Teoh
Kendall, P. C., Aschenbrand, S. G., & Hudson, J. L. (2003). Child-focused treatment of anxiety. Evidence-based psychotherapies for children and adolescents, 81-100.