By Dr. Molly McVoy
Aesop wrote, “A crust eaten in peace is better than a banquet partaken in anxiety.”
Those who suffer with anxiety disorders will understand what Aesop is referring to—no matter how wonderful, magical, enjoyable, beautiful, or exciting the surroundings are, if one cannot enjoy it, it is meaningless. Anxiety disorders can cause beautiful, pleasurable, positive things to become completely unbearable and miserable.
Anxiety is the most common mental health disorder diagnosed in childhood, more common even than Attention Deficit Hyperactivity Disorder (ADHD) and depression.
Around 15 to 20 percent of youth will be diagnosed with an anxiety disorder during their childhood. In addition, anxiety is an important component of most other psychiatric illnesses, and often a component of chronic medical illness.
Anxiety, or “worry,” is often underestimated in its power. “Stop worrying about that.” “What’s the big deal?” “It’s just a worry …” These are just some of the phrases many of my patients and their families have heard before finally coming to my office for treatment.
Because anxiety is so underestimated and so common, many families struggle with it for years before they finally present to a therapist or a psychiatrist. “Worry,” “anxiety,” and “stress” are hard concepts for kids to understand and express. Consequently, over the years, I’ve learned to be on the lookout. When families and I discover that anxiety is what has been crippling their lives for years, I feel relief, and the families often feel understood for the first time in a long time.
I feel relief, because, although incredibly impairing and overwhelming, anxiety disorders are some of the most treatable disorders in all of pediatric psychiatry. Completely. Treatable. With the right combination of therapy and, in some cases, medication, children can flourish and succeed, the anxiety no longer running their lives.
First, however, they need to get the right diagnosis. Anxiety can present in all different forms—it can make adolescents irritable and angry—which can make those adolescents seem oppositional and “bad.” It can make them distracted and disorganized, a reason it’s sometimes mistaken for ADHD. Anxiety can make children fear things that aren’t real and, therefore, act in ways that seem unusual.
Typical signs of anxiety are difficulty sleeping, many unexplained physical complaints (stomach aches, headaches, etc.), and “worries”—often presented to parents in the form of unending questions about “what if,” “when,” and “why.” Avoidance of things that are stressful is also quite common in anxiety disorders.
Complicating all of this is the fact that anxiety, fear, and worry are a normal part of childhood. Nearly every child has periods in which they are more fearful—“stranger anxiety” as an infant; fear of the dark and monsters under the bed as a toddler; fear of not fitting in as a school-age child and teenager. All of these are typical.
The difference between “normal” anxiety and an anxiety disorder is the way the child and family are able to respond. If the anxiety or fear persists for months or is completely unmanageable for the child and family, then it may be more than a “phase,” and it is worth seeking help.
Therapy, particularly, cognitive behavior therapy (CBT), is the gold standard for the treatment of anxiety disorders. When done properly, CBT can give a child and a family a new understanding of the way they think and behave in response to anxiety—and, consequently, allow the child and family to run their lives, not the anxiety. If the anxiety is moderate or severe, medication can be helpful in addition to therapy. The selective serotonin reuptake inhibitors (SSRIs) are the medication most often prescribed for children with anxiety disorders—these include sertraline (Zoloft), fluoxetine (Prozac), citalopram (Celexa), and escitalopram (Lexapro), to name a few. Medications for anxiety, in general, are safe and effective.
The bottom line is anxiety disorders are common, under-diagnosed, and very impairing, while still incredibly treatable.
To finish, I will quote another author, one our teen readers may recognize, Veronica Roth, the author of Divergent: “I have to face the fear. I have to take control of the situation and find a way to make it less frightening.”
Dr. Molly McVoy is a psychiatrist and program director of the Department of Child and Adolescent Psychiatry at UH Case Medical Center.