APRIL/MAY 2003

Question: What Are Anxiety Disorders?

Anxiety disorders are the most common mental, emotional, and behavior problems that occur during childhood and adolescence. The disorders include Generalized Anxiety Disorder; Separation Anxiety; Phobias; Panic Disorder; Obsessive Compulsive Disorder; and Post Traumatic Stress Disorder. Young people with an anxiety disorder are typically so afraid, worried, or uneasy that they cannot function normally. As many as 1 in 10 young people may have an anxiety disorder. Among adolescents, more girls than boys are affected. Anxiety disorders can be long lasting and interfere greatly with a child's life. About half the children and adolescents with anxiety disorders also have a second anxiety disorder or other mental or behavioral disorder, such as depression. If not treated early, anxiety disorders can lead to missed school days or an inability to finish school; impaired relations with peers; low self-esteem; alcohol or other drug use; problems adjusting to work situations; and an anxiety disorder in adulthood. The three most common anxiety disorders in children are Social Phobia, Separation Anxiety, and Generalized Anxiety Disorder.

 

Social Phobia

•  A marked and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he or she will act in a way (or show anxiety symptoms) that will be humiliating or embarrassing. Note: In children, there must be evidence of the capacity for age-appropriate social relationships with familiar people, and the anxiety must occur in peer settings, not just in interactions with adults.

•  Exposure to the feared social situation almost invariably provokes anxiety, which may take the form of a situationally bound or situationally predisposed Panic Attack. Note: In children, the anxiety may be expressed by crying, tantrums, freezing, or shrinking from social situations with unfamiliar people.

•  The person recognizes that the fear is excessive or unreasonable. Note: In children, this feature may be absent.

•  The feared social or performance situations are avoided or are endured with intense anxiety or distress.

•  The avoidance, anxious anticipation, or distress in the feared social or performance situation(s) interferes significantly with the person's normal routine, academic or occupational functioning, or social activities or relationships, or there is marked distress about having the phobia.

•  In individuals under age 18 years, the duration is at least 6 months.

 

Separation Anxiety Disorder

•  Developmentally inappropriate and excessive anxiety concerning separation from home or from those to whom the individual is attached, as evidenced by three (or more) of the following:

•  Recurrent excessive distress when separation from home or major attachment figures occurs or is anticipated

•  Persistent and excessive worry about losing, or about possible harm befalling, major attachment figures

•  Persistent and excessive worry that an untoward event will lead to separation from a major attachment figure (e.g., getting lost or being kidnapped)

•  Persistent reluctance or refusal to go to school or elsewhere because of fear of separation

•  Persistent and excessive fear or reluctance to be alone or without major attachment figures at home or without significant adults in other settings

•  Persistent reluctance or refusal to go to sleep without being near a major attachment figure or to sleep away from home

•  Repeated nightmares involving the theme of separation

•  Repeated complaints of physical symptoms (such as headaches, stomachaches, nausea, or vomiting) when separation from major attachment figures occurs or is anticipated

•  The duration of the disturbance is at least 4 weeks.

•  The onset is before age 18.

•  The disturbance causes clinically significant distress or impairment in social, academic, or other important areas of functioning.

 

Generalized Anxiety Disorder

•  Excessive anxiety and worry (apprehensive expectation) on more days than not, for at least 6 months, about a number of events or activities (such as work or school performance).

•  The person finds it difficult to control the worry.

•  The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more days than not for the past 6 months). Note: Only one item is required in children.

•  Restlessness or feeling keyed up or on edge

•  Being easily fatigued

•  Difficulty concentrating or mind going blank

•  Irritability

•  Muscle tension

•  Sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep )

Source: DSM IV

 

What can parents and family members do?

• Listen to the youth's concerns with openness and compassion.
• Share your observations and concerns.
• Talk with the youth's physician.
• Look for a mental health professional who has training and experience

•  working with children and adolescents;

•  working closely with the parents as well as with the child;

•  using cognitive-behavioral or behavior therapy; and

•  prescribing medications for this disorder or, if appropriate, cooperating with a physician who prescribes medications.

What can mental health professionals do?

Psychosocial

•  Systemic Desensitization

•  Modeling  

•  Contingency Management

•  Cognitive Behavioral Therapy (CBT)

•  "Coping Cat" Child Behavior Treatment  

•  CBT + Parent Training

•  Family Therapy•  Cognitive Behavioral Group Therapy for Adolescents (CBGT-A)

 

Medication

•  Selective Serotonin Reuptake Inhibitors (SSRIs) Fluoxetine [Prozac]

U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, 5600 Fishers Lane, Room 13-103. Rockville, MD 20857. Telephone (301) 443-2792.