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The Long-Term Effects of Untreated Anxiety in Teens From Low Self-Esteem to Substance Abuse

Written by Evolve's Behavioral Health Content Team​:

Alyson Orcena, LMFT, Melissa Vallas, MD, Shikha Verma, MD, Ellen Bloch, LCSW, Lianne Tendler, LMFT, Megan Johnston, LMFT
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Untreated Anxiety and Chronic Stress: Negative Emotional, Psychological, and Physical Consequences

The challenges of parenting are endless.

[seriesbox]Little Ways to Help an Anxious Teen
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What Is Resilience and How Can It Help with Teen Anxiety and OCD?[/seriesbox]If you have kids, you know this already.

If you have a teen or teenagers, you really know this.

You look back on the days when your child was an infant and a toddler and wish you could go back. You forget about the messy diapers, the countless stained bibs, the adventures of feeding – bottle, breast, or baby food – and you conveniently gloss over all the nights you got up in the wee hours to attend to your crying child.


Because back then, it was relatively simple to figure out what was going on with them. They cried – and that was your signal to start parenting. Most often, they were hungry, thirsty, needed a diaper change, or just needed to feel the comfort and safety of your love and affection.

That you could do. Easy. You fed them, changed the diaper, and held them in your arms. You baby-talked or sang your special lullabies. And most of the time it worked. Through the magic of being mom or dad, you made it all go away.

You fixed it.

Fast-forward to the teenage years, and things are not as simple. Your teen is now a complex human. Sure, they have the same essential needs. And sure, you can fix a lot of their problems by attending to those needs. You provide a safe space and healthy food. You provide love and affection. And rides: you provide rides to school, extracurricular activities, and social events.

But since they’re now complex almost-adults, with complex emotions, psychological quirks, and a rapidly developing and changing personality, you can’t fix everything like you used to.

If your teen has an anxiety disorder, your teen needs more than you: they need professional support.

Parenting a Teen with Anxiety

When your teen reaches puberty – as you know – things start to change. And if you don’t know already, one of the changes you need to watch for is the development of a mental health disorder. While some disorders appear during early adulthood or later, the first signs of disorders like depression and anxiety can appear as early as childhood.

In fact, they symptoms of most clinical anxiety disorders appear before the age of 18.

You might not be ready for something like that. You see signs your kid is more anxious or irritable than they used to be. They might withdraw from their siblings and you. They may stop socializing or stop doing things they used to love doing.

You see them struggle and try your best to help. You search for the adolescent equivalent of a hug and a warm glass of milk, but you can’t find it. It’s hard. You don’t want to admit to yourself that your teen has an anxiety disorder. Therefore, you don’t consider seeking treatment, because that would be acknowledging a bigger problem than you can fix, yourself.

But there’s something you should know: if your child has an anxiety disorder, putting off treatment is the worst thing you can do. Brushing off the problem, ignoring what you see, and telling yourself, “I just have a nervous kid, that’s all,” can backfire in a major way.


Because untreated anxiety has significant, negative long-term emotional, psychological, and physical consequences.

Long-Term Anxiety and Chronic Stress

To understand how untreated anxiety can cause long-term problems, there are three important things to learn:

  1. The clinical definition of anxiety
  2. The relationship between untreated anxiety and chronic stress
  3. The effect of chronic stress on the mind and body

We’ll start with a clinical definition of anxiety. The National Association on Mental Illness (NAMI) indicates that all the various anxiety disorders recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) have one thing in common:

“A persistent, excessive fear or worry in situations that are not objectively or inherently dangerous.”

When a teenager shows the signs of anxiety more days than not for a month or more, it’s critical to realize that they may have an anxiety disorder – and as you’ll learn as you read the rest of this article, it’s critical to get them treatment for their disorder as soon as possible.

The DSM-5 indicates the following anxiety disorders may appear during adolescence:

  • Generalized anxiety disorder (GAD)
  • Separation anxiety
  • Social anxiety disorder (SAD)
  • Panic disorder
  • Agoraphobia
  • Specific phobia
  • Selective mutism

While each anxiety disorder has a specific subset of symptoms to watch for, the following symptoms are common to almost all the disorders listed above:

Physical Symptoms

  • High heart rate
  • Stomachaches or nausea
  • Headaches
  • Sleep issues
  • Breathing problems
  • Shaking or tremors
  • Tense muscles
  • Sweaty palms

Behavioral Symptoms

  • Impulse control problems
  • Need for reassurance about everything
  • Fast and excessive talking
  • Repetitive actions/behaviors
  • Withdrawal from family and friends
  • Extreme shyness

Emotional Symptoms

  • Large reactions to small things
  • Extreme fear of inadequacy, failure, or loss of control
  • Irritability/anger
  • Difficulty solving problems
  • Drop in grades
  • Issues with memory
  • Rigid/disruptive patterns of thought

Those are the signs and symptoms to watch for. If you see these signs in your teen, do not ignore them. And if they persist more days than not for a month or more, it’s essential to seek professional help. If you don’t, the result – in addition to the ongoing disruptive symptoms – is chronic stress. Which brings us to item #2 on our list above: understanding the relationship between untreated anxiety and chronic stress.

What is Chronic Stress?

According to the dictionary of the American Psychological Association (APA), chronic stress is:

“The physiological or psychological response to a prolonged internal or external event. The stressor need not remain physically present to have its effects. Recollections of it can substitute for its presence an sustain chronic stress.”

Let’s connect the dots between anxiety and chronic stress.

When someone with anxiety has a panic attack or experiences the symptoms above, such as anger, irritability, or fear, it triggers an internal chemical cascade that’s identical to the fight-or-flight reflex. When this reflex kicks in, the brain signals the endocrine system to flood the body with the stress hormone, cortisol. Cortisol has a positive role in our brain, but that role is limited to short doses when necessary. Our bodies and brains aren’t designed to handle a flood of cortisol more days than not, and certainly not for months on end – which is what happens when someone with a clinical anxiety disorder does not learn to manage the symptoms of anxiety.

Those are the dots, connected.

Now we can move on to the third item on our list above: the effect of chronic stress on the mind and body. With the dots connected, you know that the problem with chronic stress is over-exposure – a.k.a chronic or long-term exposure – to the stress hormone, cortisol.

Chronic exposure to cortisol can cause, contribute to, or exacerbate the following physical problems:

  • High blood pressure
  • Decreased immune function
  • Heart Disease
  • Obesity
  • Fatigue

In addition, chronic exposure to cortisol can cause, contribute to, or exacerbate the following emotional issues:

  • Depression
  • Irritability
  • Feeling overwhelmed
  • Negative/pessimistic thoughts
  • Anxiety

Let’s back up for a moment and clarify something: untreated anxiety leads to chronic exposure to cortisol, which leads to the problems we list above. Cortisol and anxiety are linked, to be sure. However, there are additional emotional problems related to untreated anxiety that peripherally related to chronic exposure to cortisol, and directly related to persistent, untreated anxiety symptoms.

Anxiety, Self-Esteem, Substance Use Disorder (SUD), and Suicidal Behavior

The symptoms of an anxiety disorder can be extremely disruptive in the life of a teen. According to the Anxiety Disorders Association of America (ADAA), an anxiety disorder can prevent a teenager from:

  • Making new friends
  • Participating in school, e.g. raising their hand in class
  • Engaging in activities, e.g. sports, band, or clubs

When they don’t get treatment to learn to manage their symptoms, behavioral problems can become emotional problems. Symptoms of anxiety can make a teen feel:

  • Alone
  • Afraid
  • Embarrassed

All those feelings are amplified if a parent or caregiver minimizes them or ignores them. This means their subjective experience – i.e. their anxiety and all its related symptoms – is not validated by the person from whom they need validation the most. This can lead to a downward emotional spiral. For a teen with anxiety, a downward spiral can lead to:

  • Decreased self-esteem
  • Depression
  • Self-medication, i.e. using alcohol or drugs to soothe negative emotions. Self-medicating can lead to:
    • Alcohol use disorder (AUD)
    • Substance use disorder (SUD)
  • Self-harming behavior
  • Suicidal ideation
  • Suicide attempts

Those last two bullet points may seem like an exaggeration or a scare tactic, but they’re not. Research shows that anxiety – especially when untreated – significantly increases risk of both suicidal ideation (thinking/talking about suicide) and suicide attempts.

When you think about that possibility – suicidal ideation and suicide attempts – combined with the negative consequences of untreated anxiety we list above, it’s plain to see that ignoring the symptoms of an anxiety disorder in your teen is a significant mistake. It’s important to take it seriously, and seek professional help.

Professional Support for Teen Anxiety

If you think your teen has an anxiety disorder, the best thing to do is arrange a full biopsychosocial evaluation administered by a licensed psychiatrist who specializes in working with adolescents. If they determine presence of an anxiety disorder, they may recommend professional treatment and support. Teens with mild anxiety may need outpatient treatment once or twice a week, while teens with moderate or severe anxiety may require an intensive outpatient program (IOP), a partial hospitalization program (IOP), or a immersive support at a residential treatment center (RTC).

The latest research indicates the best treatment for teen anxiety is the integrated treatment model. The integrated model, for teen anxiety, typically means mix of psychotherapy and, in some cases, medication.

The most common, evidence-based psychotherapeutic modes of treatment for teen anxiety include:

The most common medications for teen anxiety include:

  • Anxiolytics (anti-anxiety medications)
  • Anti-depressants

During treatment, a teen with anxiety can learn practical tools to manage their symptoms. When they learn to manage their symptoms, they can reduce or eliminate the consequences of untreated anxiety: first, because they’re getting treatment, and second, because you, as the parent, validate their very real experience of a mental health disorder.

In the meantime – while you seek treatment for your teen with the help of our  please navigate to our Parent’s Guide to Mental Health Treatment located on our page How to Find the Best Treatment Programs for Teens, here are five things you can do every day to help your teen manage their anxiety:

Five Steps to Help an Anxious Teen

  1. Provide three healthy meals every day, at consistent times. Healthy means plenty of whole grains, fresh fruit, and vegetables.
  2. Encourage them – or require them – to exercise for an hour a day. They don’t have to become a fitness fanatic, but they need to do something to get their body moving.
  3. Encourage them – or require them – to spend a good chunk of time outdoors every day. Two hours is best, an hour will work, and a half an hour will do – if that’s all they can manage. If they can spend time in nature – near water or in a park with plenty of greenspace – that’s best.
  4. Get them to bed early enough to get 8-10 hours of sleep every night.
  5. Limit their intake of caffeine, processed foods, and sugar. We’re not saying they can’t have dessert or snacks when appropriate: simply help them cut down by saving the sweet treats for special occasions.

You can create the foundation for positive mental health by taking those five steps, every day. They can build on that foundation when they learn to manage their anxiety in collaboration with the mental health professional you choose after their full psychiatric evaluation. If their evaluation does not indicate the presence of an anxiety disorder, then you should still take those five steps: they’re guaranteed to improve their overall wellbeing – and yours, too.

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We are an expert team of behavioral health professionals who are united in our commitment to adolescent recovery and well-being.

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