Anxiety is a normal human emotion and is part of life. Anxiety is only considered a disorder if it causes significant distress and/or keeps a person from keeping up with at least one part their life, including school, work, relationships, responsibilities or enjoyable activities. Anxiety disorders often persist over time and generally do not go away on their own. When anxiety disorders are left untreated, many people develop depression because of the toll that the anxiety has taken on their life. Anxiety is treatable by a mental health professional with short-term therapy if there are no other challenges or concerns.
We spoke to several pediatric psychologists at CHOC Children’s for an overview on the six major types of anxiety disorders.
Phobias are intense fears of specific animals, objects or situations. This would include a fear of dogs, spiders, heights, blood draws, the dentist, or anything else. A person with a phobia either goes out of their way to avoid the feared objected or situation, or they face it, but they experience extreme distress. The fear has to last at least six months before it is considered a phobia. Children with age-appropriate fears are not the same as phobias; e.g., a 3-year-old who is afraid of the dark.
Generalized anxiety is when someone worries about a range of different topics, which may include school or job performance, finances, world events, natural disasters, relationships with others, and other topics. These worries are hard to control and keep popping up, making it hard for people to focus on their activities. Worries happen often and intensely enough that they make it difficult to concentrate and may cause or worsen headaches, stomach aches, muscle tension, and irritability.
Panic disorder is when someone experiences panic attacks that get in the way of their life in some way. Panic attacks can include any combination of sensations, including racing heart, rapid breathing, chest pain, dizziness, nausea or abdominal pain, blurred vision, sweating, shaking, feelings of doom, feeling like the word isn’t real (as though you are in a dream or a movie), or experiencing the moment as though you are outside of yourself. The person may also experience fear of losing control, or fear of dying or going crazy. Panic attacks can be triggered by something specific, or they can occur seemingly out of the blue. They usually reach their peak intensity within 15 minutes. It is important to note that someone can have panic attacks without having panic disorder. When someone has panic disorder, they either avoid situations that they think will cause a panic attack (such as going to the mall, going to the movie theater, or driving), or they experience ongoing worry that they will experience another attack. In the case of panic disorder, panic attacks should not be better explained by a specific phobia or by social anxiety.
Social anxiety disorder (also known as social phobia) is a persistent fear of being judged or evaluated by others, accompanied by intense discomfort interacting with others. Someone may be intensely afraid of saying the wrong thing or feeling stupid or embarrassed. This anxiety can happen in just one specific situation, such as giving presentations at school, or in many situations wherein a child is very uncomfortable interacting with peers and adults. As a result, the person with anxiety may avoid interacting with others but still feel comfortable with close friends and family. The person with anxiety may also request that others speak for them, such as ordering food for them at a restaurant. There is a difference between shyness and social anxiety disorder. Shyness involves some minor discomfort interacting with people in certain situations, whereas social anxiety disorder actually gets in the way of the individual’s functioning at home, school, work or in their social circle. Occasional, fleeting discomfort in social situations is not necessarily an indicator of social anxiety disorder.
Obsessive compulsive disorder (OCD) and Post-traumatic stress disorder (PTSD) used to be grouped with anxiety disorders, but now they are classified under their own category because they have unique causes, unique brain structures involved, and unique treatments that make them separate from anxiety disorders.
Separation anxiety disorder is when someone has persistent and excessive worry about being separated from or losing a caregiver or attachment figure. Separation anxiety can be a normal part of a child’s early development, but when the anxiety becomes excessive it can impair their development. Separation anxiety generates thoughts about what will happen to their caregiver when they are separated, such as whether the caregiver die or become ill. The individual also worries about what would happen to themselves if they are separated from their caregiver, such as will they get hurt or will something bad happen to them. Due to this heightened level of anxiety, the person can come across as “clingy” toward their caregiver and have difficulty leaving their side to go to school, be home alone, or go to sleep by themselves. Often, separation anxiety can occur after a stressor or loss. For example, for a young child after the loss of a pet, or for a young adult when they move out of their parent’s home for the first time.
The important thing to remember is that anxiety is both common and treatable. If your child is experiencing anxiety that is getting in the way of their activities or responsibilities (like school or chores), medical care, or relationships with others, consider reaching out to their primary care physician or a mental health provider about available treatment options.