Anxiety is part of the human condition and is beneficial to us at certain levels. This is no different for children. However, there comes a point where the amount of anxiety experienced becomes overwhelming and difficult to control and a diagnosis of an anxiety-related disorder may be made. The primary anxiety-related disorders include generalized anxiety disorder, panic disorder, specific phobia, social anxiety disorder, posttraumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD). But how do these diagnoses differ from each other and from child to adult?
Generalized anxiety disorder
Generalized anxiety disorder (GAD) is defined by excessive and uncontrollable worry about numerous events. Physical symptoms often accompany the worries such as heart palpitations, upset stomach, headaches, and restlessness. A key determinant in GAD is the excessive worry regarding many different topics (e.g., generalized) that can include personal safety or the safety of family members, natural disasters, school or sports performance or competence, and future events (e.g., college). The difference between non-diagnosable anxiety and GAD is the frequency and intensity of the worry regarding the same circumstances. GAD diagnosis also requires adverse impact in functioning in multiple domains (e.g., poor grades, social functioning). Kids with GAD are often self-critical and may avoid activities they feel they cannot perform perfectly. Like other anxiety-related disorders, a common observable behavior is reassurance-seeking from parents and teachers; however, while the reassurance decreases anxiety momentarily, it is fleeting and not sustainable. Other symptoms include sleep disturbance, irritability, fatigue, inattention, and apprehensiveness. GAD presents gradually and symptoms often worsen in times of stress. Treatment should be pursued when symptoms are noticed, as untreated GAD has been associated with increased risk for other anxiety-related and depressive disorders. Treatment of GAD often includes cognitive behavioral therapy (CBT) and is sometimes coupled with psychiatric medication.
Panic disorder (PD) is characterized by recurrent panic attacks and persistent concern of future episodes of panic that affects daily functioning for longer than one month. A panic attack is defined by an isolated episode of intense fear with physical symptoms (shaking, heart palpitations, sweating, numbness) and cognitive symptoms (fear of choking, dying, going “crazy”). Panic symptoms present quickly (within 10 minutes) and last anywhere from a few minutes to over an hour. There can be certain triggers to the attack (e.g., specific place like grocery store) or they can seemingly happen “out of the blue.” There is often avoidance of certain places or situations if the child feels an attack might occur there. When severe kids might refuse to leave the house or require a “safety person” to accompany them. Cognitive behavioral therapy (CBT) and psychiatric medication are common treatments. Typically, treatment involves learning how to control the panic symptoms (perhaps through relaxation and breathing exercises), increasing awareness of triggers to attacks, and teaching the child to confront situations that produce anxiety.
A phobia is an excessive fear of an object or event and persists for 6 months or longer. Common phobias in children include bugs, blood, heights, animals, insects, or flying. Children who are shy, have experienced a traumatic event early in life, or have family history of mental health challenges are at increased risk of developing a specific phobia. Symptoms vary from child to child but include shaking, sweating, increased heart rate, chest pain, fear of dying, fear of choking, or shortness of breath. When four or more of these present within approximately a ten-minute period, the child may be having a panic attack. Treatment typically involves some form of exposure therapy and may include psychiatric medication management. An important aspect of treatment is helping the child learn to cope with the fear and overcome it.
Social anxiety disorder
Social anxiety disorder is characterized by intense fear of social situations rooted in a deep fear of scrutiny from others. The child or teen feels embarrassed, humiliated, or judged by others and constantly feels stupid or foolish. Public places are avoided or tolerated with intense anxiety or distress. Children with social anxiety disorder often have few friends and may not participate in social activities. Common symptoms include refusing to go to school, poor eye contact, fear of using public bathrooms or eating in front of people, difficulty articulating thoughts, and being afraid to get called on in class. Exposure therapy is an effective treatment for social anxiety disorder. Often a list of feared activities is created hierarchically and gradually approached. Therapy might also entail social skill training (e.g., such as building self-assertion). Psychiatric medication is also commonly prescribed.
Posttraumatic stress disorder
Posttraumatic stress disorder (PTSD) is a condition of ongoing stress and adverse reaction following traumatic event exposure. The exposure can take the form of experiencing the traumatic event personally or witnessing another person be injured or harmed. Examples of traumatic events include physical or sexual abuse, exposure to persistent violence, transportation accident, natural disaster, or being diagnosed with a life-threatening illness. Physical proximity to the event and perceived lack of support following the traumatic event also influence the PTSD presentation. It is important to note that not all children who experience these events develop PTSD. Symptoms in children include bedwetting, irritability, sleep difficulty, startle response, loss of interest in once-enjoyable activities, inattention, lack of responsiveness to others, flashbacks or reexperiencing of the event. Other symptoms include displaying behaviors they have grown out of (e.g., thumb-sucking, wanting to sleep with sibling or parent) and crying. Treatment includes cognitive behavioral therapy and gradually discussing the traumatic event that promotes a new way of thinking about the experience. Relaxation techniques and new sleeping habit development may be incorporated into treatment. The role of the parent or caregiver is important, as a strong support system is correlated with better outcomes.
Obsessive-compulsive disorder (OCD) is a type of anxiety disorder characterized by obsessions and compulsions. Current prevalence rates range from 1-3%. OCD is defined by its predominant symptoms of obsessions (cognitions) and compulsions (behaviors). Compulsions, either physical or mental, are performed generally to minimize anxiety resulting from the obsessive loops. The obsessions are intrusive thoughts that are unwanted and often incongruent with who the child feels they are (e.g., “I am a bad person” may be a core fear). OCD is cyclic in nature where an intrusive thought pops into one’s mind, increases levels of distress/discomfort due to said thought, and leads to engaging in a compulsion to reduce the distress. Common obsessions include extreme fear of dirt and germs, repeated doubts (e.g., the door is not locked), intrusive thoughts about violence, hurting someone, or hurting oneself, preoccupation with order or symmetry, or being troubled by thoughts that are against one’s personal beliefs. Treatment depends on how severe the symptoms are. Common treatments include a type of cognitive behavioral therapy called exposure and response prevention and psychiatric medication.
Family therapy and school collaboration are often beneficial based on the child’s needs.
As you can see, several overlapping symptoms are present in each anxiety-related disorder; therefore, it is important to reach out to a mental health professional if you or your child are experiencing symptoms that impact daily functioning. Let us help!