It’s common to worry from time to time. Anxiety is a normal emotion that everyone experiences at some level. In certain situations, anxiety even helps us achieve goals. For example, you need a healthy measure of anxiety to motivate you to write a good report or study for a test (you don’t want to fail, right?). When we are getting ready for an important event, our anxiety kicks in to ensure we do not come unprepared. On the first day of middle school or high school, the butterflies in your stomach probably played a role in figuring out what to wear, or the first impression you were going to make among your new classmates. It’s also common to get anxious before asking out a romantic interest, or getting ready to go on a date. In these situations, some level of anxiety is normal.

However, the problem begins when there’s too much anxiety, too frequently. When one’s anxiety levels are out of balance, a teen may have generalized anxiety disorder (GAD).

Regular Anxiety vs. An Anxiety Disorder

Many teens with an anxiety disorder are constantly and excessively worrying about something or another. These feelings of anxiety are usually exaggerated, do not go away, and exist even when there’s no rational reason to be worried.

All the examples of common anxiety-inducing situations listed above? Teens with generalized anxiety disorder (GAD) may also worry about those experiences, but with more severity and for a protracted length of time. For example, an adolescent with an anxiety disorder may not only get anxious about his first day of high school, but he may be so nervous that he can’t even get out of bed and will refuse to get on the bus.

Effects of an Anxiety Disorder

They may be so worried about what other people think of them that they struggle among their peers and teachers in school as well as in other social situations. Their relationships and friendships may thus suffer. A teen with an anxiety disorder may see any perceived criticism or silence as harsh insults, and may constantly wonder whether a friend is ignoring them. These teens will frequently seek reassurance from their friends or family members (“Are you mad at me?”).  Or, many teens with anxiety will worry about medical issues they suspect they have. They’ll visit the school nurse to ask about these concerns or call their parents to pick them up from school.

Adolescents with anxiety disorder can worry excessively about other things, too, like robbers, kidnappers, flying on a plane, the news, natural disasters, their appearance, their family, and more. They’ll be kept up at night worrying about negative “what-if…” situations. This results in insomnia, too, and a general feeling of tension and restlessness. It’s hard to relax.

Anxiety also impacts students in the classroom. The constant barrage of worrying thoughts in one’s head makes it hard to concentrate on anything else, so many teens with clinical anxiety have resulting academic issues. Parents, not realizing the true root of these issues is really anxiety, may attempt to treat the external academic issues (with extra tutoring, for example) and wonder why it’s not working.

Other Symptoms of Generalized Anxiety Disorder

Some other symptoms of generalized anxiety disorder include:

• Irritability
• Inability to move on about something you’re worried about
• Difficulty making decisions / frequent fear of making the wrong decision
• Complaints about your mind “going blank”
• Overanalyzing possible negative outcomes in a given situation
• Being jumpy or on edge
• Being highly self-critical or perfectionistic
• Feeling as if your worrying will prevent something bad from happening
• Constant sense of dread
• Depressive or suicidal thoughts and behaviors*

 *If you are experiencing suicidal thoughts or behaviors, immediately call the National Suicide Prevention Hotline at 1-800-273-8255 or Emergency at 911.

Teens suffering from generalized anxiety disorder (GAD) often struggle with other mental health and addiction issues.  The most common comorbid issues with GAD are depression, substance abuse, ADHD, eating disorders, and other anxiety disorders like PTSD or OCD.

Teens who have a family history of anxiety are more likely to be diagnosed with anxiety disorders. Experiencing a trauma or highly stressful event—especially as a child—can also induce anxiety symptoms. A sudden move, a divorce, or an assault can be especially traumatic.

If You Think You Have Anxiety

If these symptoms seem familiar to you, you may have clinical anxiety. But, if you do end up being diagnosed with clinical anxiety, just know that you’re not alone. An estimated 32% of adolescents suffer from an anxiety disorder (Harvard Medical School, National Comorbidity Survey, 2007). That’s about one in every three teens! Talk to your school counselor, parent, or friend’s parent and explain to them how you’ve been feeling. They will probably refer you to a therapist or psychiatrist who may offer some of the following interventions:

• Therapy 

  Talk therapy is the first, and safest, line of defense against anxiety disorder. Two of the most effective types of therapy for adolescents are Dialectical Behavior Therapy (DBT) and Cognitive Behavioral Therapy (CBT). DBT’s Emotion Regulation skills teach teens how to reduce the overwhelming feelings of negativity and worry that interrupt their daily functioning, whether it’s anxiety, depression, or any other extreme emotion. In CBT, Exposure and response prevention (ERP) will teach your teen how to overcome irrational fears and how to manage the thoughts and feelings that play a role in overall anxiety.

• Medication

  Sometimes, therapy isn’t enough. In these situations, a psychiatrist may recommend specific medications to limit your anxiety. These include SSRIs, SNRIs, and benzodiazepines. For teens, the most commonly prescribed anti-anxiety drugs are SSRIs (selective serotonin reuptake inhibitors). SSRIs are antidepressants, but they are effective in anxiety disorder since they regulate the levels of serotonin in the teen’s body, which help enhance mood. For example, paroxetine (Paxil) and citalopram (Celexa) are commonly prescribed SSRIs for adolescents. SNRIs (serotonin norepinephrine reuptake inhibitors) are also medications, similar to SSRIs, that also treat anxiety. Duloxetine (Cymbalta) is approved by the FDA to treat anxiety disorder in adolescents starting from age 8.

  On the other hand, benzos are minor tranquilizers and are in a class of their own. They are usually prescribed for as-needed/short-term treatment, for example, to help prevent panic attacks. One needs to use extreme caution when taking benzos, as they can lead to dependence and addiction fairly quickly. A teen must always use them as directed and never use them unprescribed. Ativan, Valium, Xanax, and Klonopin are some examples of benzos you might be familiar with. (Their generic versions, respectively, are Lorazepam, Diazepam, Alprazolam, and Clonazepam).

• Complementary therapies 

  Before, or in addition to, prescribing medication, some psychiatrists will recommend complementary therapies like meditation, yoga, mindfulness exercises, and physical fitness. For example, your psychiatrist or psychologist may teach you certain breathing or mindfulness-based stress reductation exercises (like guided imagery). They may instruct you to practice these techniques every day. They may also give you some techniques on what to do if you’re having an acute panic attack.

• Teen Anxiety Treatment Center 

  if your anxiety is severe, frequent, and debilitating, your doctor may recommend a more intensive treatment than just therapy or medication alone. You may benefit from an adolescent mental health treatment center that specializes in anxiety. Depending on the level of your clinical acuity, you may need outpatient programs (intensive outpatient or partial hospitalization) or full-time residential care.