Types of Anxiety: Understanding Anxiety Disorders in Children and Teens

In order for routine anxiety to be elevated to an anxiety disorder, this emotion must be prolonged (usually lasting at least six months) and impact everyday activities and responsibilities. Even then, it’s relatively common. Anxiety disorders affect up to 15% of children at some point during their development.¹ If you suspect that your child is suffering from an anxiety disorder, it’s important to seek professional help. But what exactly is an anxiety disorder? Anxiety disorders are typically divided into six categories that each include a number of criteria to assist in diagnosis.

Each anxiety disorder listed below is accompanied by its own specific symptoms, but note that symptoms across all categories tend to focus on excessive, irrational fear and dread.² Additionally, keep in mind that your child may be experiencing more than one type of anxiety disorder—so you may recognize symptoms in more than one category listed below.

Anxiety disorders affect up to 15% of children at some point during their development.

Note: These descriptions are meant to serve as an overview for what to look for if you suspect your child is experiencing anxiety. It is important to get a proper diagnosis from a vetted, licensed psychologist.

Recognizing Anxiety Disorders in Children

Separation Anxiety Disorder:

Definition: Separation Anxiety Disorder (SAD) occurs when a child experiences intense stress when separated from parents or caregivers (even temporarily for a common occurrence like school). SAD typically first occurs among school-age children, but can be a problem in younger children who attend daycare or spend time with a babysitter. Separation Anxiety Disorder is the most common anxiety disorder in childhood and is found in about 10% of all children. Among older children and teens, SAD can cause a fear of new situations, such as the transition from middle school to high school. Some may exhibit dramatic behavior, such as threatening suicide or self-harm, although those impulses are rarely acted upon.

Diagnostic Criterion: A psychologist will look for three or more of these symptoms:

• Excessive anguish when separated (or anticipating separation) from parent or caregiver; may be clingy when with parents
• Irrational fears that something bad may happen to a parent (ex. scared a parent will get sick or die)
• Irrational fears that something bad could lead to separation (ex. scared of kidnapping)
• Reluctance or refusal to attend school
• Difficulty falling asleep without being near a parent; may insist on sleeping in bed with parents
• Repeated nightmares about separation
• Frequent complaints of physical symptoms (such as headache or stomachache) when separated or anticipating separation

Generalized Anxiety Disorder:

Definition: Children suffering from Generalized Anxiety Disorder (GAD) may be described with the more gentle term “worry wart,” but that doesn’t mean it’s any less stressful. Children with Generalized Anxiety Disorder will excessively worry about an array of topics (as opposed to just one specific fear). This could include everything from their family’s health to monsters under the bed to riding the school bus to the possibility of an earthquake. For young children, verbalizing these worries may present as a child asking for constant reassurance (but not finding relief when it’s offered).  For older children and teens, the negative outcomes associated with GAD may be more pronounced, as it often presents with other mental health issues, such as depression or substance abuse.

Diagnostic Criterion: A psychologist will look for the hallmark sign of GAD, which is excessive and uncontrollable worry, along with  one or more of these physical symptoms.

• Pounding heart
• Restlessness
• Trouble concentrating or sleeping
• Irritability
• Stomachaches
• Headaches

Specific Phobia:

Definition: Nearly everyone is afraid of something (spider, snakes, elevators, etc.), but a specific phobia is more extreme than a typical fear. It’s an irrational and intense fear that impacts one’s quality of life and may cause a child to avoid certain situations. There is not always an obvious cause for a phobia, though some researchers have posited they can be triggered by a previous experience (getting stuck in an elevator leads to an elevator phobia, for example) or a parent may inadvertently model a fear of their own.

Diagnostic Criterion: A psychologist will look for the following symptoms –

• An irrational, persistent, excessive fear that is triggered by an object or situation
• Experiencing panic attacks when faced with a phobia. A panic attack in a child can include a tantrum, crying, clinging to a parent, or running away.
• Doing almost anything to avoid the situation

Obsessive-Compulsive Disorder:

Definition: There are two parts to OCD. A child may experience just one, but it will often be a combination of the two. Obsessions are defined as thoughts that can’t be stopped, are unwanted, and repetitive. Compulsions are repetitive actions. Both obsessions and compulsions are excessively time-consuming and interfere with normal routines and relationships. The most common obsession among children and teens is excessive worry about germs, while the most common compulsion is excessive hand washing, showering, and grooming.

Diagnostic Criterion:

To qualify as an obsession, the thoughts must –

• Cause anxiety or distress
• Go beyond legitimate worries (i.e. if a child’s parent is gravely ill, thinking about this excessively does not qualify as OCD)
• Be generated from the child’s own mind (vs. being told to worry about something)
• Be something that the child attempts to suppress or ignore

To qualify as a compulsion, the repetitive actions must be –

• Something the child can’t stop him or herself from performing
• An action a child is undertaking in an unrealistic attempt to prevent stress (for example, a child may wash his hands compulsively in an attempt to avoid getting sick)

Social Anxiety:

Definition: Also known as social phobia, this anxiety disorder tends to impact older children and teens as social interactions become an increasingly important part of life. Social anxiety involves an irrational fear of being around and interacting with other people, oftentimes peers. With the advent of social media, teens are exposed to more social interactions than ever before, which can expand the impact of social anxiety among this group. As older children and teens develop heightened self-awareness and evaluative abilities, they may understand their symptoms and feel ashamed of them, further compounding the issue.

Diagnostic Criterion: To qualify as social anxiety, it must negatively impact a child or teen’s ability to take part in certain social interactions. This includes common social interactions like speaking in class, eating lunch with friends, participating in after-school activities, or socializing outside of school.

Post-Traumatic Stress Disorder:

Definition: Commonly referred to as PTSD, this anxiety disorder is triggered by exposure to a traumatic event, including everything from a car crash to family violence to sexual abuse. It is characterized by frightening thoughts, flashbacks and/or nightmares, mood disturbances, and elevated physical and emotional distress.

Diagnostic Criterion: A psychologist will look for at least two of the following symptoms:

• Trouble sleeping
• Irritability or angry outbursts
• Trouble concentrating
• Hypervigilant behavior
• A tendency to startle easily over seemingly small things

There are a number of treatments for anxiety disorders. If you suspect your child or teen is suffering from one or more of these anxiety disorders, there are many places to get help. You may want to start with our Psychologist Locator and explore additional articles on this site, including the APA-approved resources on the Bookstore page.

This article was adapted from How to Find Mental Health Care for Your Child, by Ellen B. Braaten, PhD