ANXIETY

Introduction
It's 1:15 AM and Morgan can't sleep because she's worried about the math test she has in the morning. Actually, it seems like she worries about almost everything these days. What if she oversleeps and misses the bus? Did she remember to put pads in her bag in case she gets her period tomorrow? Why hadn't Maya called her back tonight? How will she work at the store all day Saturday and still have time to write the paper that's due on Monday? It's another 45 minutes before Morgan is finally able to drift off.
It's completely normal to worry about your hectic, complicated life, but if the worries become overwhelming, you may feel that they're running your life. If you spend an excessive amount of time feeling anxious or you have difficulty sleeping because of your anxiety, pay attention to your thoughts and feelings. They may be symptoms of an anxiety problem or disorder.
What Is Anxiety?
Anxiety is a natural part of life, and most of us experience it from time to time. The word "anxiety" usually refers to worry, concern, stress, or nervousness. For most teens, anxiety is limited to particular situations such as tests, important dates (like the prom), or driving lessons.
Feeling anxious can sometimes be a good thing. Anxiety can actually help you by motivating you to prepare for a big test or by keeping you on your toes in potentially dangerous situations. Occasional anxiety isn't something to be concerned about.
But for some teens, anxiety is a constant factor in their lives. When a person has an anxiety disorder, it interferes with their ability to function normally on a daily basis. Anxiety disorders can cause teens to suffer from intense, long-lasting fear or worry, in addition to other symptoms.
Understanding Anxiety Disorders
Anxiety disorders are conditions that involve unrealistic fear and worry. Anxiety disorders are very common - it is estimated that that they affect about 13% of the U.S. population. Anxiety disorders affect people of all ages, including kids and teens.
A teen who has an anxiety disorder isn't "crazy," and certainly isn't alone. Many teens have anxiety disorders, and have feelings of fear, worry, panic, or intense stress that can sometimes make it hard to get through the day. Anxiety can also interfere with things as basic as sleep, concentration, and appetite, not to mention the ability to enjoy life and relax. The good news is that anxiety disorders are very treatable.
There are several types of anxiety disorders that can affect teens. They include:
Generalized anxiety disorder, or GAD, for example, refers to constant, intense worry and stress about a variety of everyday things or situations. Teens with GAD may worry about school, health or safety of family members, the future, and whether they'll become ill or injured. They may always think of the worst that could happen. Along with the worry and dread, they may have physical symptoms, too, such as chest pain, headache, tiredness, tight muscles, stomachaches, or even vomiting. GAD can result in missed school days and avoidance of social activities.
Panic disorder is characterized by panic attacks, or episodes of intense fear that occur for no apparent reason. With a panic attack a person may have a sense that things are unreal, and may have physical symptoms like a pounding heart, shortness of breath, dizziness, numbness, or tingling feelings. Sometimes a person having a panic attack mistakenly feels he may be dying or having a heart attack. The panic symptoms are caused by overactivity of the body's normal fear response.
Agoraphobia is an intense fear of having a panic attack. People with agoraphobia have had a panic attack before, and worry so much about having another that they avoid going anywhere they think it could possibly occur. They are often left with very few places they feel comfortable going outside their own home.
Social anxiety disorder is an intense fear of social situations. Teens with social anxiety may feel too nervous to raise their hand or talk in class. They may fear making a mistake, saying the wrong answer, or looking foolish. They may feel extremely shy and anxious in situations where they have to interact with others, such as parties, the lunch table, or when they meet new people. They may be overly self-conscious about their clothes or hair, worrying that they might be criticized or teased, or that they might stand out or be noticed. With an extreme form of social anxiety called selective mutism, some kids and teens may be too anxious to talk at all in certain situations.
Obsessive-compulsive disorder (OCD) is characterized by obsessions - thoughts or impulses that occur again and again and that a person feels he can't control - and compulsions - behaviors or rituals that a person feels he must perform to control disturbing thoughts and relieve the anxiety the thoughts trigger. With OCD a teen may, for example, have constant worry and fear about illness or germs, and may become stuck in a pattern of washing and cleaning that becomes time-consuming, distressing, and feels impossible to control. The worries (obsessions) with OCD are unrealistic, but are frightening to the person who has them. For example, a teen with illness obsessions may worry that just by reading about an illness or driving past a hospital he could become ill.
Posttraumatic stress disorder (PTSD) refers to anxiety relating to a traumatic or terrifying past experience. With PTSD, a frightening, life-threatening event such as an accident, serious violence (such as rape, abuse, shooting, or gang violence), or a natural disaster (such as an earthquake, tornado, hurricane) causes such a severe fear response that the person may experience flashbacks, nightmares, or constant fear, worry, and stress after the fact. PTSD may occur within days or weeks after the life-threatening event, or it may be delayed and occur much later.
Phobias are intense unrealistic fears relating to specific situations or things (that are not actually dangerous), such as heights, dogs, or flying in an airplane. Phobias usually cause people to avoid what they are afraid of. Some people can work around a phobia if it involves something they do not have to encounter in their everyday life. Other phobias may involve more common situations or things, and may be harder to steer clear of even if people do their best to avoid them. Avoiding these things or situations tends to make the fear stronger each time the person encounters them.
If you have an anxiety disorder, you may feel that it's ruling your life. In addition to worrying much of the time, you may be easily distracted and have trouble concentrating. You may feel stressed and tense or unable to relax. You may experience physical symptoms such as headaches, sweaty hands, upset stomach, pounding heart, and muscle tension. Like Morgan, you may find it nearly impossible to fall asleep. Some people have extremely intense symptoms - for example, people who are experiencing panic attacks may fear that they are having a heart attack or might even die.
But whether you think you might have an anxiety disorder or you know someone who does, understanding the disorder and its treatment can help.
Why Do People Get Anxiety Disorders?
There is no one cause for anxiety disorders. Several factors can play a role, including genetics, brain biochemistry, an overactive "fight or flight" response, life circumstances, and learned behavior.
Anxiety disorders tend to run in families, suggesting that there is a hereditary, or genetic, component to many of these conditions. A person who has a family member with an anxiety disorder has a greater chance of developing an anxiety disorder, though not necessarily the same type.
Genetics influence a person's brain biochemistry, and may make certain people more prone to problems with anxiety. The brain's biochemistry involves the brain's millions of nerve cells (called neurons) that constantly communicate with each other through chemicals called neurotransmitters.
Neurotransmitters are the brain's chemical messengers, and specific neurotransmitters help to regulate mood. Neurotransmitters are released from one neuron and attach to a receptor on another neuron. Sometimes there is interference with this process, such as if the receptor is blocked and unable to receive the neurotransmitter.
This interference can create an imbalance in the levels of the neurotransmitter in the brain, and can cause symptoms of anxiety. There are many kinds of neurotransmitters; two that are involved in anxiety are called serotonin and dopamine. When there's an imbalance of these chemicals, anxiety and other problems can occur.
Certain things that happen in a person's life can also set the stage for anxiety disorders. Frightening traumatic events that can lead to PTSD are a good example.
Early learning also plays a role. Growing up in a family where others are fearful or anxious can "teach" a child to view the world as a scary place. Likewise, if a child grows up in an environment that is actually scary or dangerous (if there is violence in the child's family or community, for example), the child may learn to be fearful or expect the worst.
The brain's automatic reaction to an anxiety-provoking situation also can fuel an anxiety disorder. Here's how this can happen: when a person senses danger (even if it doesn't turn out to be true danger), the brain quickly reacts by sending a signal to a small structure in the brain called the amygdala. The amygdala immediately activates the body's automatic "fight or flight" response, and the body prepares itself for danger. This response is what triggers symptoms like sweating and a pounding heart.
Sometimes it turns out that as soon as the person processes the information in the thinking part of the brain (the cerebral cortex), which happens just moments later, the person realizes there's really no danger. The person then relaxes, and the fight or flight response stops.
But the amygdala is programmed to "remember" the trigger that set this process in motion in case it happens again. This is the brain's attempt to protect the person from future danger by keeping track of all cues that might signal danger. So, for example, if the person encounters the same thing that scared him once before (even if the person later realized it wasn't dangerous), the amygdala may activate the same anxiety reaction. It's possible for the amygdala to begin to overreact, and for the person to mistakenly interpret certain things as dangerous.
How Are Anxiety Disorders Diagnosed and Treated?
Some people go to their medical doctor because they're worried about the physical symptoms associated with anxiety. This is a good idea because symptoms like palpitations, chest pain, stomachaches, vomiting, shortness of breath, shakiness, numbness or tingling, or sleeping problems can be caused by certain medical illnesses.
A doctor can examine a person to determine whether he has any medical conditions that need treatment. But if the doctor doesn't find a medical cause for the symptoms, and sees that there's a certain pattern of physical symptoms, the doctor may diagnose anxiety and refer the person to a mental health specialist.
If you think you may have an anxiety disorder, you need to see a mental health specialist, such as a psychologist or psychiatrist, for an evaluation. Don't wait to ask for help - anxiety can be overwhelming, and it can prevent you from enjoying yourself, your friends, school, and social activities. There are treatments that can help teens with anxiety disorders feel much better, often fairly quickly.
Some people with anxiety try to medicate or relax themselves by using alcohol and drugs (even things like sleeping pills), which may seem to make the anxiety or stress go away temporarily. This is not a good solution for several reasons. Drugs and alcohol create only a false sense of relaxation, can be dangerous, and can lead to lots of other problems, which can make it that much harder to function.
You can expect the mental health specialist to ask about your medical history, your family situation, the symptoms you've been experiencing, and your general well-being. Don't be surprised if some of the questions are very personal - your responses will help the doctor to understand you more fully and create a treatment plan that's right for you.
Treatment for anxiety may include medication, cognitive-behavioral therapy or other types of talk therapy, and relaxation or biofeedback to control tense muscles. A combination of treatments may be prescribed.
When medications are part of the treatment for anxiety, often a certain class of medications called SSRIs is used. This is sometimes confusing to people with anxiety because the SSRI medications are commonly referred to as "antidepressants."
Here's the scoop to clear up the confusion: the SSRI medications were first developed as antidepressants, but it was recognized that they also have anti-anxiety effects. So, how could they work for both? Because depression and anxiety both involve, among other things, an imbalance of the neurotransmitter serotonin. SSRI medications help to restore the normal balance of serotonin, and therefore help with both depression and anxiety.
Though not every teen who has an anxiety disorder needs medication (in fact, most don't), the right medication can help to reduce symptoms of anxiety, and can be a great relief to someone whose anxiety symptoms are causing tremendous distress. Often when doctors prescribe medication, they begin with a very small dosage, and gradually increase to the dosage that works best. It may take some time to get the dosage that works best for you. And it may take several weeks before the full benefits of a certain medication are felt. As with any medication, it's very important to take it exactly as prescribed and to tell your doctor about any side effects.
In psychotherapy, or talk therapy, a teen talks with a mental health professional about the stresses and anxiety he's feeling. Getting support and sorting through problems by talking them through can be helpful to teens with anxiety.
In a particular type of talk therapy called cognitive-behavioral therapy (CBT), teens take an active role in "unlearning" some of their fear. CBT helps teens learn new ways to think and act when confronted with anxiety, and to manage and deal with stress so it doesn't get out of hand. In CBT, teens learn how to detect and measure their anxiety, recognize what triggers it, and practice ways to reduce it. They learn what makes their fear worse and what can ease it. Techniques vary, but may include relaxation and breathing exercises or exposure therapy, where a person is gradually exposed what triggers his fear. If it's done with proper support and new coping skills, exposure helps even intense fear fade away.
Don't hesitate to tell your doctor or therapist about what's working and what isn't - you're a member of your treatment team, and your ideas and feelings are important.
Dealing With an Anxiety Disorder
If you have an anxiety disorder, it may be difficult for your friends or family to understand just how you feel. Sometimes people give unrealistic advice - like telling you to just stop worrying. Though they may have the best intentions, they may not understand that it's not that simple. You may have to explain this to them.
Because others may not always understand, sometimes people are reluctant to let loved ones know what they are going through. Some people may be concerned that their fear or behavior may be seen as childish, silly, or weird. But communication is the key. Close friends and family can be part of the solution, and their care and support can be valuable. Let them know what they can do to help.
If you know someone who has an anxiety disorder, be a supportive friend. If your friend goes to a support group, you might offer to go to one of the meetings too. Tell your friend you're there to listen if he or she would like to talk.

Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Reviewed by: D'Arcy Lyness, PhD
Date reviewed: August 2004