Many adolescents worry from time to time about things like passing an exam, their weight or appearance, family problems, and whether some boy or girl really likes them. Generalized anxiety disorder, or GAD for short, causes teens to feel anxious and worry excessively about everything and anything, even when there’s no rational reason to be worried.
GAD can significantly impact teens’ ability to concentrate, sleep, and function normally. It makes it difficult – if not impossible – to relax and have fun, essentially robbing them of joy. If left untreated, it can cause academic problems, lead to substance abuse, interfere with relationships, and hinder setting and reaching goals.
Discerning what’s normal when it comes to your teen’s mood, behaviors, and overall emotional health can be a daunting task for any parent. This brief guide is designed to help you recognize the signs and know what steps to take if you believe your teen may be suffering from GAD.
Generalized Anxiety Disorder Statistics and Facts
Following are several statistics and facts pertaining to GAD:
- An estimated 8% of teens suffer from an anxiety disorder
- Of those 8%, fewer than 1 in every 5 gets the mental health treatment they need to recover
- Females are diagnosed with GAD more often than males
- Individuals with anxiety are especially vulnerable to depression, and frequently suffer from both
- A family history of GAD increases the risk for having it
Teens suffering from GAD often have another psychiatric disorder as well. The most common co-occurring disorders are:
- Substance use disorders
- Eating disorders
- Other anxiety disorders
Risk Factors for GAD
Anyone can develop an anxiety disorder. However, factors that may increase the risk of developing GAD include:
- Temperament / personality – Being prone to worry, pessimistic, timid, or reluctant to take risks
- Gender – Being female is associated with a higher risk
- Family history – A family history of anxiety disorders increases the risk
- Trauma – Experiencing trauma as a child can cause anxiety
- Stress – Highly stressful events, such as parental divorce or a sudden major move
Looking for and Recognizing the Signs of GAD
Knowing what to look for and how to spot the signs of generalized anxiety disorder in your teen will enable you to get your teen in to treatment sooner than later. One of the most important things to remember when looking for signs is this:
- Look for and pay close attention to any changes from your teen’s normal personality, mood, and behavior
Signs of GAD in teens may include:
- Constant, excessive, and / or exaggerated worry and anxiety
- Trouble concentrating
- Academic problems
- Constant sense of dread
- Depressed mood
- Frequent complaints of being tired
- Difficulties sleeping
- Inability to tolerate uncertainty, focusing on negative “what ifs”
- Trouble relaxing
- Distress about worrying all the time
- Complaints about their mind “going blank”
- Difficulty making decisions / frequent fear of making the wrong decision
- Frequently seeking reassurance
- Inability to let go of something they’re worried about
- Overanalyzing possible negative outcomes in a given situation
- Frequently feeling tense / complaints of aching muscles
- Shaking or trembling
- Digestive complaints
- Being jumpy or on edge
- Frequent trips to the bathroom
- Being highly self-critical or perfectionistic
- Feeling as if they have to worry in order to prevent something bad from happening
Suicidal thoughts and behaviors may also occur in teens with GAD, especially if they also have depression. These should never be ignored. Don’t assume your teen is just being “dramatic” or manipulative.
Knowing the First Steps to Take
If you believe your teen may be suffering from GAD, the first steps you should take are to:
1 – Talk to your teen. Let your teen know that you have some genuine concerns about things you’ve been noticing. Clarify that you want to help in any way you can and that you’re available and willing to listen.
Don’t be surprised if your teen denies having a problem, gets a bit defensive, or pushes you away and accuses you of worrying too much or being over-protective. Often, this is due to a teen’s embarrassment or shame regarding the anxiety he or she is experiencing. Avoid judgment, criticism, and shaming your teen, as those will only make things worse and close off the channels of communication.
2 – Have your teen evaluated. Since anxiety disorders aren’t uncommon in children and adolescents, your child’s pediatrician can be a good place to start. He or she can do an initial evaluation and physical exam, which can rule out any underlying medical issues that may be contributing to or exacerbating the symptoms your teen is experiencing.
It’s highly recommended to have your teen evaluated by a mental health professional, preferably a psychologist or psychiatrist who specializes in treating children and adolescents.
Your family doctor or pediatrician may be able to give you a referral or recommendation.
3 – Get your teen into treatment. Anxiety may worsen over time if left untreated, so early intervention is important. The primary approach to treating GAD is psychotherapy. Medication may also be prescribed as part of treatment in more severe cases or if progress in therapy isn’t going as hoped. A more intensive level of treatment may be required for a period of time if your teen’s anxiety is severe.
- Individual psychotherapy or “talk therapy” – Psychotherapy can help your teen understand the worry and anxiety he or she is experiencing, including the underlying issues that drive them. Cognitive Behavioral Therapy (CBT), is one of the most effective types of therapy for treating GAD in both adolescents and adults. It focuses on identifying and changing negative and irrational thought patterns and beliefs that are feeding the anxiety.
- Medication – Medication can play an important role in the treatment of GAD. It’s usually recommended that medication be used, at least initially, in combination with psychotherapy rather than as the sole or primary form of treatment. This is because therapy can help your teen learn the necessary coping skills to manage his symptoms, making him or her less likely to rely on medication in the future.
Medications for GAD may include:
- SSRIs (selective serotonin reuptake inhibitors) – these antidepressant drugs can also help reduce symptoms of anxiety. Escitalopram (Lexapro) and paroxetine (Paxil) are two medications in this category.
- SNRIs (serotonin norepinephrine reuptake inhibitors) – these medications are similar to SSRIs. Duloxetine (Cymbalta) is FDA-approved to treat GAD in children (7+ years of age) and teens.
- Benzodiazepines – These relatively fast-acting anti-anxiety drugs should be used with extreme caution because 1) they’re a controlled substance with street value, and 2) overuse can lead to dependency. They are intended only for short term use.
If your teen requires medication for GAD it is highly recommended that it be prescribed and monitored by a psychiatrist.
- Dual diagnosis treatment – This is usually necessary if your teen also has a substance use disorder – see more below
- Residential treatment – See below.
- Hospitalization – See below.
Supporting and Encouraging Your Child
There are many things you can do to support and encourage a teen struggling with anxiety. Two of the most important things to remember are that 1) GAD isn’t a sign of weakness and 2) it isn’t something your teen can just “overcome” with sheer willpower and determination. It’s a serious disorder and needs to be regarded as such.
Following are several ways you can provide support and encouragement without enabling or reinforcing your teen’s anxiety:
- Educate yourself about anxiety disorders in teens so you can have greater empathy for and understanding about what your teen is going through
- Be available and willing to listen to your teen
- Model healthy coping strategies when you’re worrying or feeling anxious
- Resist the urge to provide frequent reassurance. Not only does it not help; it often reinforces needy or avoidant behavior in your teen
- Help your teen learn to manage his or her time and prioritize obligations. This will help your teen feel empowered and less overwhelmed
- Don’t attempt to protect your teen from the things he or she is afraid of, as avoiding them only reinforces the anxiety. Instead, encourage your teen to face his or her fears. Doing so will help foster independence and self-confidence in your teen
- Don’t judge, ridicule, or criticize what your teen is experiencing
- Do your best to keep your wits about you even if you’re feeling frustrated, scared, or overwhelmed. Your teen needs you for support, strength, and guidance
- Respect your teen’s privacy and dignity; your neighbors, relatives, and friends don’t need to know that he or she is struggling with GAD
- Avoid nagging or lecturing your teen; if you have concerns, talk to your teen in an open, honest, and respectful manner
- Consider enrolling your teen in a yoga class. Doing yoga on a regular basis has been shown to reduce anxiety.
- Learn and practice relaxation techniques with your teen, such as progressive muscle relaxation and deep breathing exercises
- Help your teen stick to a regular sleep schedule and make sure his or her bedroom is conducive to restful sleep. Being sleep deprived typically makes anxiety (and depression) worse
What to Do When Things Escalate
Two of the greatest risks for teens with anxiety are 1) battling depression as well, and 2) utilizing unhealthy or blatantly self-destructive coping mechanisms. Co-morbid depression increases the risk for suicidal thoughts and behaviors. One of the most common self-destructive coping mechanisms in teens is the use of alcohol or drugs. Substances impair judgment, can cause erratic behavior, and may increase the risk of acting on suicidal thoughts. Any of these can cause things to escalate gradually or quickly, compromising your teen’s – and possibly others’ – safety. If this occurs, don’t hesitate to reach out for help. You can:
- Contact your child’s treatment provider asap
- Enlist the help of a close family member or friend for immediate support or assistance
- Call an emergency hotline
- Take your child to the nearest hospital emergency room (if you can do so safely)
- Call 911
When Individual Therapy isn’t Enough
Teens whose GAD symptoms are mild to moderate usually do well with individual therapy or a combination of therapy and medication. However, some teens will require a more intensive level of treatment than individual therapy can provide, at least temporarily. This includes teens who:
- Are also suffering from moderate to severe depression, another anxiety-related disorder (e.g. panic disorder, PTSD, or OCD), an eating disorder, or any other serious mental health condition that requires more intensive treatment
- Have symptoms that are severe enough to interfere with his or her ability to function at school or in other areas of his or her life
- Are actively suicidal – threatening or planning suicide, and / or engaging in suicide gestures or attempts
- Are actively using alcohol or drugs
- Are frequently engaging in non-suicidal self-harm, such as cutting or burning
More intensive levels of treatment include:
- Intensive outpatient treatment (IOP) / Psychiatric day treatment
- Dual Diagnosis Treatment
- Residential treatment
- Inpatient psychiatric treatment
Intensive outpatient treatment or psychiatric day treatment can vary in terms of the amount of time spent in treatment and how many times a week your teen is required to go. These programs are often the next step up from regular outpatient treatment.
Dual diagnosis treatment is often necessary if your teen has a substance use disorder in addition to the anxiety. Substance use almost always hinders progress in therapy, and can create serious problems if medication is being prescribed. A dual diagnosis program treats the anxiety and substance use issues simultaneously.
Residential treatment requires having your teen live at a non-hospital treatment facility that specializes in treating adolescents with anxiety disorders and other mental health issues. Residential treatment typically lasts between 30 to 180 days, depending on the severity of symptoms and how well your teen is progressing in treatment.
Inpatient psychiatric treatment in a hospital setting is the highest and most intensive level of treatment for teens with anxiety disorders. Inpatient treatment is most often required when safety is a primary concern (e.g. following a suicide attempt or threats of suicide) or if there is acute psychiatric distress, such as severe depression or a manic episode. Patients are monitored 24/7, and inpatient stays are typically brief.
Each of these more intensive levels of treatment typically provides daily or bi-weekly visits with a psychiatrist and a variety of therapeutic activities.
Taking Care of Yourself
Doing your best to parent an adolescent with an anxiety disorder can take quite a toll. Don’t be surprised – or get down on yourself – if you find yourself feeling overwhelmed, frustrated, or hopeless at times. If you don’t make self-care a high priority, you’ll risk becoming exhausted and burned out, in which case you won’t be emotionally or physically able to provide your teen with the encouragement, guidance, and support he or she really needs from you.
As a parent, it may seem counterintuitive or elicit feelings of guilt to pay attention to your own needs as well, but it’s really a win-win for everyone involved. A few things you can do to take care of yourself include:
- Get support from others (e.g. a support group for parents, a therapist, close friends and family, or your church family if you have one)
- Reduce your stress with regular exercise, yoga, or meditation
- Get sufficient sleep
- Set aside a few minutes each day for yourself
With proper treatment and plenty of support, your teen can learn healthy ways to manage his or her anxiety, and hopefully overcome it altogether.