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Parents and teens today face a variety of issues that require
both understanding and education to address. We hope this article,
written by Dr. Judy Smith, can assist you and your child in
overcoming anxiety. |
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Anxiety and the Adolescent
1 in 10 teens struggle with anxiety at some time in their life. Feelings can range from excess worry and self-consciousness to panic and fear. Anxiety may interfere with all areas of life, just one or two, or make it hard to function at all. One way of thinking about what anxiety is like is that your body and mind react as if you are facing a dangerous or even life-threatening event even when you are not.
In the caveman era, if you took an early evening stroll to the water hole, and discovered a saber tooth tiger there that appeared interested in hunting you, your body would go through many automatic changes. Your heart would beat faster, your breathing would become more rapid and shallow, digestion of dinner would stop, your blood vessels would constrict, your senses would only focus on the threat ahead of you screening out other information, and adrenaline would course through your body. Every part of your body chemistry would be primed to either run and escape the tiger, or turn and fight the tiger.
When non-life threatening events sent off similar body reactions on a regular or predictable basis that interferes with normal functioning, we think of anxiety disorders. There are several. Some of the most common include:
- Panic Disorder -- Panic disorder results in sudden feelings of terror that strike repeatedly and without warning. Physical symptoms include chest pain, heart palpitations, shortness of breath, and fear of dying. Children and adolescents with this disorder may worry a lot and be very self-conscious.
- Post Traumatic Stress Disorder - These symptoms occur after experiencing a trauma such as abuse, natural disasters, or extreme violence. They include nightmares; flashbacks; the numbing of emotions; feeling angry, irritable, and distracted; and being easily startled.
- Phobias -- A phobia is a fear of something that poses little or no real danger. The fear leads to avoidance of objects or situations. Phobias can center around objects (e.g., dogs) or situations (e.g., heights). Symptoms for children and adolescents with "social" phobia are great sensitivity 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 can indicate a generalized anxiety disorder. Children and adolescents with this disorder often expect the worst and may complain of frequent body complaints like fatigue, tension, headaches, and nausea.
- 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, but still become distressed when they are prevented from carrying out their compulsive habits. Compulsive behaviors may include repetitive hand-washing, counting or arranging.
Parents often have many questions about anxiety disorders and how to deal with them. Here are a few common ones:
Does anxiety run in families?
There is some evidence that anxiety disorders do run in families. We believe there may be a genetic component. Also, children that grow up with anxious adults may learn some of the same coping patterns.
My child worries a lot, but doesn't seem to fit any of the patterns described above. Does my child need help?
There are adolescents who just "naturally" seem to react to events in a worried way. They are hesitant to take risks, self-conscious, quick to retreat from situations in which they might fail, have more headaches and stomach aches than many other teens, show low self-esteem, and have a much harder time adjusting to the peer give-and-take that goes on in school. Yet the pattern or intensity of their symptoms may not result in a diagnosis of an anxiety disorder. However, counseling is still often very helpful. Through counseling, the child may learn to better identify the triggers that start the anxiety, how to "defuse" these triggers, and may increase self-esteem and assertive communication skills.
What other kinds of problems come along with anxiety disorders?
Teens with anxiety disorders often have low self-esteem, and may feel different than their peers and depressed by their symptoms. They are more at risk for school and peer problems. Highly anxious teens may be more prone to turn to alcohol and other mood-altering substances to help make themselves feel better. Anxious teens may also have more physical problems (stomachaches, headaches, fatigue) that result in more doctor visits and missed days at school or work. Each teen is different.
Does my teen need medication?
The answer to this will depend on the severity, frequency and types of symptoms your teen has. Consult a child psychiatrist. If there is not one in your area, consult a physician who works a lot with teens and families.
What kind of counseling does my teen need?
First make sure that you consult a qualified therapist, ideally one licensed in your state to provide care. You want a therapist experienced in working with anxiety issues in teens. There are different approaches to the treatment of anxiety. The following stories illustrate this (note: real names and identifying information has not been used).
John's father left his mother to pursue an affair. John's parents' marriage ended in divorce. Whenever John's mother spoke of dating someone, John became very upset, nervous and worried. He had his first panic attack the night his mother was two hours late in returning from a date. When seeking professional help, the counselor advised individual and family counseling. A focus of the work was helping John deal with his feelings about the father's departure and his fear that his mother would do the same.
Amy was avoiding school regularly. When she would attend, she would become very anxious and found it hard to breath. She felt that everyone was looking at her and criticizing her. Her grades had dropped. She was too anxious to approach teachers effectively about her assignments. She only felt safe when she was at home. Therapy for Amy will involve working with the school and parents to help them understand Amy's problem. Amy will work on learning how the chain of anxiety starts. She may practice strategies that help her picture being able to take the steps of attending school with less anxiety, and then gradually practicing these in real life. Medication may be helpful; as well as tutoring and some work on the social anxiety and shyness that she feels.
Treatment for anxiety can involve individual, parent-child and family approaches. Cognitive-behavioral approaches are often helpful. In these approaches, teens learn to listen to their internal self-talk that fuels an anxious reaction. For example, Amy may wake up on a school morning, with the thought "I'm not going to be able to manage school, I'll be too worried, I can't do it, it will be awful, everyone will look at me, my teachers will be mad at me, etc..." As these thoughts continue, her stomach may begin to hurt and her heart may begin to race. Cognitive-behavioral approaches might teach her to challenge some of her self-statements and learn to relax her body (if your body is relaxed, its hard to be as worried). It may help her learn to use words and images that encourage her to gradually approach and succeed with school attendance.
How can I help at home?
It is important to understand that your teen does not choose to worry and be anxious. Telling your son or daughter to just stop worrying is like telling the wind to stop blowing. It won't work. Your teen may already be feeling bad about their symptoms. Let your teen know that you understand that what they feel is real and that they are not trying to be anxious. Let them know that many adults struggle with anxiety and that it is a problem that can be helped. Avoid criticisms that tear at the teen's self-esteem. Encourage your teen to get help, assist them by finding appropriate counselors and help your son or daughter to attend.
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