It is normal for people to worry or feel nervous some of the time but if worry is taking over much of your day or if it prevents you from doing things you would like to be able to do, it is worth seeking help.
Anxiety disorders are so common and so treatable. I really wish people would access help more often as having treatment really can significantly change the life of someone suffering anxiety for the better. Normally within about 3 months, I and my cognitive behavioural therapy, (CBT), colleagues can get you functioning really well and you will have learned new skills that you can take forward with you and use throughout life to manage anxiety. You might need some medication to kick start you feeling better and to take the edge of the anxiety enough for you to do the CBT. If this is the case I only use evidence-based medication and I will talk it through with you in detail to allay any worries, you may have.
In the UK, anxiety disorders are estimated to affect 5-19% of all children and adolescents, and about 2-5% of children younger than 12.
The title “anxiety disorders” covers many disorders, below is an explanation of some of the common ones.
Phobic anxiety disorders
With this type of anxiety a young person normally experiences intense fear or worry from one particular object or scenario, such as spiders, dogs, heights and so on. They normally avoid or dread the cause of their anxiety and I have seen young people who have almost ruled family life by avoiding the item they are scared of. For example, I saw a young lad who would not go out for fear of seeing a dog. He was treated very swiftly to the relief of him and his family.
Panic disorder is a horrible disorder for a young person to have. They find that out of the blue, they cannot breathe, they might have chest pain, dizziness, feel sick, sweaty and at times feel like they or other things are not real. Often they worry they might be dying or might be about to wet themselves or be sick. They then live in fear of this happening again. Often young people will have been investigated for physical health problems and nothing abnormal is found before doctors suggest the young person sees a psychiatrist. Again this is so treatable and I do urge parents to bring a young person who is suffering with this to get them a psychiatric assessment.
This term is used when someone has a fear of leaving home, a fear of open spaces or a fear of crowds. I have seen young people who are terrified of going out, going to shops, going on trains or planes and some have become completely housebound. It is important in these situations to see a psychiatrist, not only to get treatment for the agoraphobia but also to check there is not something else going on for the young person too, such as depression or an autistic spectrum disorder. The earlier this anxiety disorder is caught the easier it is to treat.
Generalised anxiety disorder
This involves excessive anxiety which happens much of the time about anything. I have seen a large number of young people really struggling with this. They find that they lie awake for hours at night worrying about things they have said or what might happen the next day. Often they cannot concentrate in lessons and they might have become quite snappy with the family. Many young people describe feeling exhausted as they cannot switch their brain off from worry. I have seen a multitude young men (and sometimes young women) who isolate themselves to their room “gaming” as that is the only time they can relax. This often really frustrates their parents. It is really important young people struggling with these symptoms see a psychiatrist as many have depression alongside and once there is a clear diagnosis, this again can be treated very effectively.
Social phobia is one of the most common reasons that young people come to see me. Often the young person has a history of being slightly anxious when younger, but not always. However, their anxiety has now grown to the point that they are avoiding many or most social situations. They are often so self-conscious, with a low self-esteem and worry what they look like, what they should say in a social situation and what people are thinking of them. Often their anxiety about these situations progresses to panic attacks which might then lead them to worry there is something wrong with their own health.
I have so many success stories from treating young people with social phobia and it is one of the most satisfying disorders to treat as I see young people getting better month by month until they are different, happy, confident young people who function well.
Obsessive-compulsive disorder (OCD)
Frequently people do not realise that obsessive compulsive disorder is an anxiety disorder. Again this is very common in the young people I see. Often the young people try and hide this as they “feel like I’m going mad”. Parents find this illness very difficult to manage too as it seems so irrational to them and yet it often leads to the whole family life being ruled by it.
The main feature of this disorder is that the young person keeps getting unpleasant thoughts in their head, which they do not want but they cannot get rid of and they keep coming back and back. The thoughts are often about something bad happening to someone they love, or something violent or sexual, so they can be very hard for a young person to talk about to family members. At times the young person may experience these as intrusive images or even urges. Some young people might end up doing routines or rituals to try and get rid of these bad thoughts. Often these rituals do not make any sense to them or those around them. For example, they may need to walk around a chair 4 times anticlockwise before sitting in it to prevent something bad happening to their mother. They do not enjoy doing these rituals but get very distressed if they are not completed perfectly or if they are interrupted. Often family members end up helping with the rituals, such as straightening all the shoes by the door or brushing every crease out of a duvet just to be allowed to get on with the day. These rituals can become very time consuming if not treated.
The good news is that this disorder is also very treatable. Normally those with it need a combination of medication and CBT and at times family therapy. The earlier you access treatment for this the easier it is to treat. Again, it is important that a psychiatrist assesses the young person to be sure that there is not another diagnosis alongside the OCD such as an autistic spectrum disorder.
Post-traumatic stress disorder
This is caused by a young person experiencing something that they perceive as very frightening or life-threatening. It is important to remember that an event that might not be perceived this way by an adult, may have been by a young person. Some young people are more likely to develop this than others if they are already a nervous anxious child, for example. After the trauma, the young person may start having nightmares or memories of the event that they do not want and that distresses them all over again. Often they become quite jumpy and startle easily and they might avoid certain situations that only vaguely resemble the situation of the trauma. At times there is a gap of several weeks or even months between the trauma and the symptoms occurring.
Once the young person has seen a psychiatrist to make the diagnosis it is likely they will be offered talking therapy, either cognitive behavioural therapy or eye movement desensitisation reprocessing and the psychiatrist will monitor to see that these are effective and if medication is needed in addition.
Other anxiety disorders
There are other anxiety disorders that might be diagnosed by a psychiatrist such as “somatoform disorders”, including hypochondriacal disorder. These disorders involve having physical health symptoms without a physical health cause or worrying excessively about a physical health illness. I see these less commonly in young people and when I do often the young person has undergone considerable unnecessary tests for physical illness. Again this is treatable and it is best treated as early as possible in the course of the illness. In children under 12, I often see “Separation anxiety”, where the young person struggles to go anywhere away from their parent, often because they are worried about their parent or that no one will be able to manage their worries like their parent can. Please seek help from a psychiatrist if your child has this difficulty as we can help.