Taking Care: Child and Youth Mental Health ANXIETY WHAT IS IT?

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1 Taking Care: Child and Youth Mental Health ANXIETY WHAT IS IT? Open Learning Agency 2004

2 WHAT IS IT? Anxiety is a normal human feeling characterized by worry, nervousness and fear. Not only does anxiety allow us to respond effectively to threatening and potentially dangerous situations, it also enables us to experience heightened sensations in stressful or new circumstances, which can propel us to achieve and excel in our endeavours. The stresses of modern day life can often provoke sensations of stress and anxiety, most of which are perfectly normal. A lot of kids experience anxiety from time to time and that s a normal and expected reaction; we can all remember being scared of monsters under the bed and that is not considered an anxiety disorder. But when a child starts to experience significant anxiety and when it begins to interfere with their schooling, social activities and home life, then it s time to question whether the child might have an anxiety disorder. Extreme or continual anxiety can become a crippling problem, leading to avoidance of specific situations and the inability to function effectively at school, work or home. So when does anxiety go from normal to abnormal? When it continues beyond several weeks and begins to interfere with normal functioning; when intense and prolonged feelings of fear and distress occur out of proportion to the actual threat or danger. For children and youth, abnormal levels of anxiety may compromise social, emotional and intellectual development, causing fear, apprehension or unusual behaviours that lead to dysfunction. According to the Anxiety Disorders Association of America, 2-5% of school-aged children refuse to attend school because of anxiety. Left untreated, anxiety can not only become chronic, but can lead to the development of other disorders, alcohol and drug abuse, and social withdrawal. In particular, people with untreated anxiety disorders are at a high risk for developing mood disorders, such as depression, as well. Prevalence Anxiety disorders are the most common mental health problem. About 60,000, or 6.5% of children and youth in BC are coping with at least one anxiety disorder. Most children are on the mild end of the anxiety continuum, while approximately 2% are at the more extreme end with significant impairment in daily functioning. Age of onset The average age of onset for an anxiety disorder in children is roughly 10 to 12 years old. However, symptoms of anxiety typically start much earlier, and children as young as five can develop full-blown anxiety disorders. Development of the disorder often progresses gradually and becomes worse over time if left untreated. However, it is also common for teenagers to have a sudden onset of anxiety-related symptoms, which can later disappear. For example, many kids will have a panic attack around puberty and never develop panic disorder. In one community study, Page 2 of 6

3 19% of 13 year olds had early signs of Obsessive Compulsive Disorder (OCD) and most of those never went on to develop OCD. SYMPTOMS There are four main types of anxiety-related symptoms: psychological, physiological, emotional and behavioural. Younger children will primarily describe their physical symptoms, while teenagers may be more aware of their psychological and emotional responses to anxiety. Children with anxiety disorders can have varying reactions from upset and worry to anger, uncooperative behaviour and even aggression. Among the various types of anxiety disorders, the most common symptom exhibited by children is excessive worry or nervousness in response to something they are afraid of. This often results in children and youth being unable to attend school. Common symptoms include: Psychological Sleep problems Worried thoughts Negative thoughts Fear Inability to concentrate Physiological Racing heartbeat Stomach aches Muscle tension Fatigue Rapid breathing Emotional Tearfulness Anger Irritability Behavioural Clinginess Avoidance Withdrawal Inflexibility Aggression Inattentiveness Refusal to go to school Page 3 of 6

4 CO-MORBIDITY It is common for people with anxiety to have more than one mental health condition, such as a combination of anxiety and depression, or two different types of anxiety disorders. This is referred to as co-morbidity or concurrent disorders. In fact, about 50% of people with an anxiety disorder also become depressed. The Kaiser Foundation, which assists BC communities in preventing and reducing the harm associated with problem substance use and addictive behaviours, reports that studies show that 30% to 60% of people with one disorder actually meet the criteria for another mental disorder. The National Institute on Mental Health (NIMH) in the United States found that 51% of individuals who have a psychiatric disorder also have at least one substance abuse disorder. Depression caused by anxiety disorders often goes away upon successful treatment of the anxiety. TYPES There are seven main types of anxiety and each has mild, moderate and severe forms depending on the number and intensity of the symptoms. Separation Anxiety Most common in young children, this disorder is characterized by extreme anxiety that occurs upon separation from their caregivers. They may exhibit a refusal to go to school or to bed alone, and may even fear the sudden loss of their parents. These fears cause significant distress or impairment in social, academic or other areas of functioning. Generalized Anxiety Disorder (GAD) GAD is characterized by excessive, unrealistic worry that lasts six months or more. The disorder involves multiple worry themes, such as school, family and friend issues, health concerns, world issues (such as terrorism), personal performance issues, etc. In addition to chronic worry, GAD symptoms include trembling, muscular aches, insomnia, upset stomach, dizziness and irritability. Some people with GAD experience panic attacks due to extreme anxiety associated with excessive worry. Some will engage in behaviours such as excessive checking, reassurance seeking, distraction or self-medicating, none of which are effective in treating the disorder and can lead to worse problems. Phobias People with phobias have overwhelming feelings of terror or panic when confronted with a feared object, situation or activity. Some people experience a panic attack in such a situation. Many phobias are common, such as a fear of enclosed spaces, airplanes or spiders, but are only diagnosed as phobias if they interfere with school, work, social or daily functioning. Specific phobias can develop at any age including childhood. They can be caused by exposure to a traumatic or frightening event, or by learning to fear something because others do. Page 4 of 6

5 Panic Disorder Panic attacks involve a sudden feeling of intense fear and impending doom. They are characterized by shortness of breath, rapid heartbeat, trembling and shaking, sweating, a feeling of choking, chest pain, nausea, dizziness, a feeling of disconnect from reality and even a fear of dying. Though they are generally short in length, they can increase in frequency if left untreated. This disorder often develops in the teen years and can result in specific avoidance of situations that can cause anxiety and an inability to go on with daily activities. In many cases, panic symptoms are so dramatic and physical that children or teens are checked for all kinds of medical problems. Factors that can trigger panic attacks include lack of sleep, poor nutrition, caffeine, drugs and alcohol, overwhelming stress, medical problems and some medications. Obsessive-Compulsive Disorder (OCD) Less common, this disorder is characterized by compulsive acts which the sufferer uses as a way of coping with the anxiety created by an obsession, which is a recurring unpleasant thought, image or impulse. These thoughts occur repeatedly in spite of efforts not to think about them, and include fear of germs, violent thoughts, frightening or rude mental pictures, fear of doing something wrong, self-doubt and a need for things to be even or symmetrical. Compulsions are generally repetitive behaviours, such as hand washing, or mental acts such as repeating words. OCD usually begins during adolescence or early childhood and can onset suddenly or build gradually over time. In children, OCD may be characterized by unreasonable anxiety, temper tantrums, stubborn habits, lack of cooperation or other behavioural problems. In teenagers, it may lead to avoiding school or friends and fighting with parents. People with OCD are very stressed and can be irritable, angry and withdrawn. Social Anxiety Disorder This form of anxiety comes in response to social or performance situations and is characterized by palpitations, tremors, sweating, gastrointestinal discomfort, diarrhea, muscle tension, blushing or confusion. In severe cases, it may lead to a panic attack. People with social anxiety disorder have one thing in common: excessive fear of embarrassment or being negatively judged by other people. Recent studies suggest that social anxiety disorder is the most common anxiety disorder with approximately seven to 13 out of every 100 people meeting the criteria at some point in their lifetime. Post-traumatic Stress Disorder (PTSD) This anxiety disorder involves re-experiencing traumatic events through nightmares, flashbacks, persistent frightening thoughts and memories, anger or irritability. The symptoms of post-traumatic stress disorder include emotional numbness, an overall sense of anxiety and dread, or guilt about one s own survival. A child s risk of developing PTSD is related to the seriousness of the trauma and whether it was repeated. Following the trauma, children may initially show agitated or confused Page 5 of 6

6 behaviour, intense fear, helplessness, anger, sadness, horror or denial. Children who experience repeated trauma may develop a kind of emotional numbing to block the pain; this is called dissociation. Children with PTSD may also worry about dying at an early age, lose interest in activities, experience physical symptoms such as headaches and stomach aches, have problems sleeping and concentrating, and act clingy or whiny. The symptoms of PTSD may last from several months to many years. Page 6 of 6

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