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The Tipping Point: When Stress Pushes a Teen Toward an Anxiety Disorder

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 Meet The Team >

How to Recognize Anxiety and Reduce Stress in Anxious Teens

Everyone knows about stress.

Adults, teenagers, and children experience stress.

Most of us understand that stress is an unavoidable part of life. Most of us also understand stress is not always negative. Stress can play a positive role in our lives. Stress leads to adaptation, which, in turn, can lead to growth and change. That’s true on a physical, psychological, and emotional level. In addition to creating change through adaptation, stress – in the form of anticipating potential problems in the future, a.k.a. worry – can also cause us to plan carefully to ensure our safety and survival.

We think ahead, we see potential pitfalls, we stress over them, we come up with solutions, and we use the solutions to avoid the pitfalls or mitigate their impact.

That’s how stress helps.

At the same time, we also understand that too much stress can lead to a wide range of physical, psychological, and emotional problems. We have a good idea of how that happens. And it’s something we can explain, with the help of leading experts on stress and mental health.

We can also explain how stress can push a teen – or anyone – toward an anxiety disorder. Although we don’t know the specific details, we do know the following factors contribute to the development of an anxiety disorder:

  • Genetics: A family history of anxiety or other mental health disorders
  • Environmental factors: A history of trauma, including childhood abuse or neglect, the death of a loved one, or witnessing/experiencing violence
  • Major life events: Chronic personal illness or chronic illness in a loved one, moving, changing schools, and other extremely stressful experiences

This article will focus on how the events of the past year – namely the coronavirus pandemic – may have pushed a teen past the tipping point, from typical anxiety and stress toward an anxiety disorder.

What is Stress?

 Before we explain how stress can lead to an anxiety disorder in a teenager, we need to understand exactly what stress is. Here’s a basic definition of stress from the American Psychological Association (APA) Dictionary of Psychology:

“Stress (noun): The physiological response to internal or external stressors. Stress involves changes affecting nearly every system of the body, influencing how people feel and behave. Severe stress is manifested by the general adaptation syndrome. By causing these mind–body changes, stress contributes directly to psychological and physiological disorder and disease and affects mental and physical health, reducing quality of life. See also chronic stress.”

That definition contains an explanation of how stress can lead to the physical, psychological, and emotional problems we mention above. Stress-induced pathologies are caused by mind-body changes related to the general adaptation syndrome. Click this link to read more about the general adaptation syndrome, chronic stress, and how to mitigate the effects of chronic stress in your life.

Next, we need to understand what chronic stress means. According to the 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.”

Now we’re clear on how mental health experts define both stress and chronic stress. And we have a basic idea of how stress leads to pathology. What we lack is the link between the general adaptation syndrome and a pathology such as an anxiety disorder.

That missing link is us. Or, more specifically, the link is how we respond to stress.

We’ll explain that now.

Stress Response, Mental Health, and Teen Anxiety: The Connection

Experts identify three types of the stress response: positive, tolerable, and toxic. These correlate roughly with stressful experiences classified as acute and chronic. The type of response a teenager has to acute and chronic stress – positive, tolerable, or toxic – can determine whether that teenager develops an anxiety disorder or manages the stress they experience without developing an anxiety disorder.

Experts at the Harvard Center on the Developing Child define the three types of the stress response as follows:


A positive stress response is an essential element of child and adolescent development. Positive stress response occurs in response to acute, short-term stressors. These include things like the first day at a new school, nerves about an exam, excitement about an upcoming sports event, or worrying about peer and/or romantic relationships. This type of stress response elicits a temporary increase in heart rate and stress hormones, which decrease relatively quickly in the absence of the stressor.


A tolerable stress response is a natural reaction to difficult life events. It’s basically the same as a positive stress response, but the mental and physical reactions are intense and more extreme. A tolerable stressor may cause lasting psychological, physical, and emotional problems, though, when a child or adolescent does not have a responsible adult to help them work through and process the stress in a healthy manner. This process of understanding and working through and past stress with the help of an adult is known as buffering. As a parent, it’s critical to understand that right now – as the coronavirus pandemic winds down – the presence of these protective buffering relationships can prevent potentially negative consequences of difficult life events such as the coronavirus pandemic.


A toxic stress response occurs in reaction to long-term exposure traumatic experiences. The coronavirus pandemic is a prime example. The isolation, fear, uncertainty, and loneliness related to shelter-in-place orders and virtual school – if left unaddressed – can lead to a toxic stress response. Also, the emotional hardship around missing key milestones like homecoming, sports, school trips, and graduation can cause a tolerable stress response to turn toxic. Chronic elevation of stress hormones can damage vital organs, impair psychological and emotional processes, degrade cognitive function, and cause physical and mental illness. Without the protective presence of buffering relationships with responsible adults, a teenager who experiences a toxic stress response related to the coronavirus pandemic may reach a tipping point – and develop an anxiety disorder.

The first takeaway here is that over the past year, the conditions were almost a perfect storm for a stressed-out teen to develop an anxiety disorder. The second takeaway is that if a teen has not developed an anxiety disorder, a qualified adult can help them process their stress and potentially stop an anxiety disorder from developing.

However, if a teen has passed the tipping point, and now has an anxiety disorder there are specific signs and symptoms to watch for.

Anxiety Disorders: Signs and Symptoms

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) indicates that the following anxiety disorders can occur in children and adolescents:

While the symptoms of these anxiety disorders differ, they all share common physical and emotional symptoms.

Here’s what parents should watch for:

Physical symptoms:

  • Rapid heart rate
  • Hyperventilating
  • Sleep problems: too much or too little
  • Excessive fatigue
  • Frequent headaches
  • Twitching or tremors
  • Excessive sweating
  • Frequent nausea/stomachaches
  • Frequent trips to the restroom

Emotional symptoms:

  • Excessive fear of regular daily situations
  • Excessive irritability
  • General restlessness
  • Assuming negative outcome for any future event
  • Extreme agitation
  • General nervousness

If a teen shows these signs and symptoms more days than not for at least six months, they may meet the criteria for one of the seven anxiety disorders listed above. Parents with teens whose symptoms are significantly disruptive and present more days than not for six months should arrange a full psychiatric evaluation with a mental health professional. Click here to read more about teen anxiety that meets the threshold for clinical diagnosis.

Stressed Out, But Not Clinical: How to Help a Stressed and Anxious Teen

It’s possible that a stressed-out teen has not crossed the threshold to clinical anxiety. In fact, that’s probably the case for millions of teens in the U.S. We say that because the rate of anxiety disorders in children and youth is far higher than most people realize, and for the prevalence rates to reach the levels we share below, it stands to reason there are many teens on the brink of, or at-risk of developing an anxiety disorder.

Here are the basic statistics:

Anxiety Disorders in U.S. Teens

The National Institute of Mental Health reports that:

  • 31.9% of teens have some type of anxiety disorder
  • 8.3 % of those with an anxiety disorder have severe impairment as a result.
  • 38% of female teens have an anxiety disorder.
  • 26.1% of male teens have an anxiety disorder.

In addition, the Child Mind Institute reports that:

  • 19.3% of teens have a specific phobia
  • 9.1% of teens have social anxiety disorder
  • 7.6% of teens have separation anxiety
  • 2.3% of teens have a panic disorder
  • 2.2% of teens have generalized anxiety disorder

To help a stressed-out teen avoid developing an anxiety disorder, we recommend taking the following steps:

Ten Simple Steps to Help a Stressed-Out Teen

  1. Feed them three healthy meals every day, at consistent times.
  2. Require them to exercise for at least an hour every day. Exercise can be mild, moderate, or intense – but they need to do something.
  3. If possible, make sure they spend at least two hours outdoors every day. This time will be best if spent near water or in the woods. If that’s not possible, green space like a park works just as well.
  4. Help them plan their days so they get 8-10 hours of sleep every night.
  5. Restrict caffeine consumption.
  6. Restrict sodas and sugary snacks. Sodas and sugary snacks are fine sometimes, but not all the time.
  7. Teach them basic mindfulness techniques like yoga, guided self-relaxation techniques, or simple meditation.
  8. Encourage them to engage in positive self-talk. Rather “I’m the worst swimmer on the swim team,” they can say “I’m working hard at practice and getting better every day.”
  9. Help them find positive friends. Teenagers can be a moody bunch. Which is fine, but some over-romanticize the dark and gloomy. Parents can help a teen recognize when a friend is adding to, or subtracting from, their level of stress.
  10. Step back and recalibrate. If a teen is very busy and goes from one organized activity to another every day of the week, that might contribute to their stress. Think about giving them time off. Let them chill at home and do simple things. Music, drawing, riding bikes, walking the dog, and talking to old friends are all good, all count, and can all go a long way to reducing stress.

Those are all tried, true, and effective ways to reduce stress. If they do not work, and a teenager needs professional support, it’s important to understand that evidence-based treatment for anxiety is both effective and widely available.

Treatment for Anxiety Disorders in Teens

Evidence indicates the most effective way to treat anxiety disorders in adolescents is with holistic, integrated treatment that includes is with a combination of psychotherapy (talk therapy) and medication (if needed):

Another core element of a modern approach to anxiety treatment is lifestyle adjustments and complementary therapies. Data indicates that these approaches work best in combination with, and in support of, traditional modes of treatment. They’re also most effective with the support and guidance of a licensed therapist or clinician.

Here are the most common complementary/lifestyle supports in use in anxiety treatment today:

Parents of teens with a clinical anxiety disorder should know that anxiety disorders may require long-term treatment. The symptoms of anxiety may disappear for long periods of time and then return, triggered by stress, anxiety, or challenging life circumstances. A teen who receives treatment for anxiety and learns practical skills to manage their symptoms has that knowledge for life. If their symptoms recur, they’ll be ready to handle them.

Finding Help: Resources

If you’re seeking anxiety treatment for your teen, please navigate to our page How to Find the Best Treatment Programs for Teens and download our helpful handbook, A Parent’s Guide to Mental Health Treatment for Teens.

In addition, the American Academy of Child and Adolescent Psychiatry (AACAP) is an excellent resource for locating licensed and qualified psychiatrists, therapists, and counselors in your area. Both the National Institute of Mental Health (NIMH) and the National Alliance on Mental Illness also provide and high-quality online resources, ready and waiting for you right now.

Our Behavioral Health Content Team

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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