Teenage Anxiety Disorders: Beyond “Typical Worries”

When does “normal worrying” in teens become an anxiety disorder? This article will help you identify the symptoms of teenage anxiety and learn about common treatment options, including therapy and medication.

We’ll discuss frequently asked questions about adolescents and anxiety, including how to tell the difference between “normal” worrying and anxiety, signs and symptoms of anxiety disorders, and what to do if you think your teen is struggling with anxiety. 

“Normal Worry” vs Anxiety: What’s the difference?

Everyone worries! In fact, worrying about potential obstacles and concerns in life can lead to helpful problem-solving strategies. However, there are important differences between helpful worrying and unhelpful anxiety. 

Helpful worrying leads someone to think through a specific and concrete problem. After the person comes up with a solution or the problem is resolved, worry fades away. 

Anxiety, on the other hand, leads someone to think about many potential problems that may or may not actually happen. The person might come up with potential solutions, but the anxiety persists. Additionally, anxiety is characterized by catastrophizing, or always thinking about the worst case scenarios. While helpful worrying is temporary and focused, unhelpful anxiety is longer lasting and more generalized. 

Take this common teenage concern of getting a good grade on a test. A teen who is engaging in helpful worrying will think of problem-solving solutions like making a study plan, meeting with the teacher to ask questions, and taking a practice test. After the test is over, the worry stops. 

A teen who is struggling with unhelpful anxiety, however, might also come up with some problem-solving solutions to help study for the test or they may avoid studying or put off studying until the last minute. Instead of just thinking about this test, unhelpful anxiety may lead to the teen thinking about future tests in this class, tests in other classes, times in the past they haven’t gotten good grades, and the consequences of getting a bad grade. After the test is over, the anxiety persists. 

Signs and Symptoms of Teenage Anxiety Disorders

Anxiety in teens is very common. According to the National Institute of Mental Health [1], a little over 30% of all teens meet criteria for an anxiety disorder.

Common symptoms of teenage anxiety include:

  • Frequently feeling nervous or stressed
  • Increased irritability with friends, family members, and teachers
  • Having difficulty concentrating or focusing on schoolwork, chores, or other activities
  • Feeling “on edge”, fidgety, jumpy, or needing to move often
  • Avoiding schoolwork, extracurricular activities, or spending time with friends
  • Difficulty sleeping and lower energy levels
  • Change in eating habits, either eating more than usual or less than usual over several weeks
  • Physical symptoms such as a racing heart, shallow or fast paced breathing, nausea or other GI symptoms, dizziness, shaking or trembling, and more

The focus of anxiety can also change throughout the lifespan. Anxiety in children is often characterized by fear of something external; bugs, monsters under the bed, or losing a parent to name a few. In adolescence, anxiety often becomes more internalized, characterized by fears of how parents, peers, teachers, and coaches are judging or assessing them. Additionally, teens may also experience increased judgment and anxiety towards themselves.

Types of Teenage Anxiety Disorders

Generalized anxiety disorder

Characterized by anxiety about a number of different things. This anxiety is persistent and causes significant disruptions in a teen’s day to day functioning. 

Panic attacks

Characterized by physical symptoms when experiencing anxiety, including symptoms like difficulty breathing, a racing heart, nausea, shaking, dizziness, and more. Panic attacks may occur in response to a specific trigger or might be completely random. 

Social anxiety disorder

Characterized by difficulty participating in social interactions due to intense fear of embarrassing oneself or being harshly judged by others

Specific phobias

Characterized by intense fear of a specific situation or thing. Common specific phobias include fear of spiders or other bugs, heights, or getting blood drawn.

Causes and Risk Factors for Anxiety Disorders

While there is not a single, direct cause of anxiety disorders, if your teen has multiple risk factors it can make it more likely they develop an anxiety disorder. Common risk factors include:

  • Experiencing a traumatic event or child abuse
  • A family history of anxiety
  • Having a chronic illness or other medical or mental health condition
  • Substance use

It’s important to note that having a risk factor does not mean your teen will develop an anxiety disorder. 

Additionally, teens experience unique stressors that may also contribute to the development of anxiety disorder. These stressors include:

What’s the Difference Between Anxiety and Depression?

While anxiety and depression can occur together and have some overlapping symptoms, there are distinct differences between the disorders. The key difference is the overall mood your teen experiences. Anxiety leads to feelings of nervousness and stress, while depression leads to feelings of sadness and hopelessness. 

Here are some questions you can ask your teen to help determine if they are experiencing anxiety:

  • Have you noticed an increase in nervousness or worrying over the past few weeks?
  • Do you feel like you’ve felt more irritable or easily annoyed lately?
  • Do you have difficulty controlling or stopping your worrying?
  • Are you worrying about multiple things?
  • Is it hard for you to relax?
  • Do you feel more fidgety or restless than usual?
  • Have you noticed an increased sense of dread or fear that something bad might happen?

If your teen answers “yes” to any of these questions, consider getting an evaluation from a licensed mental health provider.

How to Talk with Your Teen about Their Anxiety

While some teens are able to identify when they are anxious, other teens may not even realize they are experiencing anxiety. One of the best ways you can support your teen is looking out for symptoms of anxiety. Additionally, checking in with your teen and talking about any upcoming stressors and helping them problem-solve can reduce anxiety. 

Ensure your expectations for your teen are realistic and achievable - high expectations can help push teens to succeed and can also lead to increased anxiety if the demand on them is too high. If you notice your teen is experiencing anxiety symptoms, talk to them about the treatment options available to them.

Getting an Anxiety Disorder Diagnosis

The best way to determine if your teen is struggling with an anxiety disorder is to get an evaluation from an experienced professional. An assessment from a primary care provider, psychologist, or other licensed mental health provider can help provide clarity on which mental health diagnosis, if any, best fits your teen’s symptoms and provide guidance on the best treatment options.

Treatment Options: Therapy and Medication

It’s really important for anyone struggling with an anxiety disorder, or related symptoms, to get mental health support. The most effective treatments for anxiety disorders include therapy and medication. 

Cognitive behavioral therapy, or CBT, focuses on the relationship between your teen’s thoughts, emotions, and behaviors. While doing CBT, your teen will learn relaxation techniques, ways to challenge their catastrophic thinking, coping skills to use when they’re experiencing anxiety, and how to approach situations they are afraid of or are avoiding. Research has shown CBT is effective in treating anxiety symptoms. 

Selective Serotonin Reuptake Inhibitors, or SSRIs, are a type of antidepressant medication frequently prescribed for anxiety disorders. SSRIs work by increasing the brain chemical serotonin. They are typically the first kind of medication prescribed for teens with anxiety disorders and are also the most common type of medication prescribed for teenage anxiety. Common SSRIs prescribed for teenage anxiety include Prozac (fluoxetine) and Lexapro (escitalopram). SSRIs may come with side effects, including flu-like symptoms, gastrointestinal (GI) distress, and an increase in suicidal thoughts. It’s important to talk to your teen’s prescriber if they experience any side effects.

If you think that any of the anxiety disorder symptoms apply to your teen, know that you are not alone and there is help available for your teen and your family! 

The fastest way to determine if your teen may have an anxiety disorder and find relief, is to connect to a licensed professional who specializes in evidence-based care, like the clinicians at Joon Care. If you’d like to explore therapy options and see how Joon Care can support your teen and family, you can schedule a free consultation call with our team.

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March 1, 2023
Lauren Hammond, PhD | Clinical Content Manager

Lauren Hammond, PhD | Clinical Content Manager

Lauren Hammond, PhD, is a licensed clinical psychologist who received her PhD in Clinical Psychology from Seattle Pacific University. Dr. Hammond provides services to adolescents and adults using evidence-based treatments from a cognitive-behavioral framework, including Dialectical Behavior Therapy and Prolonged Exposure. Dr. Hammond has specialized training in treating mood and anxiety disorder, trauma and PTSD, personality disorders, and self-harm and suicidality.

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