How to know when your child is experiencing everyday stress versus an anxiety disorder?
Written by: Angela Durbin-Garfield, APRN, PMHNP-BC
Collectively, our nation is experiencing a multitude of events such as the Coronavirus (COVID-19), economic hardships, and societal changes that could invoke stress in your child or teen. As a parent, it is understandable that you could also feel overwhelmed and that you may be noticing increasing signs of stress in your young ones. So, how do you know the difference between a temporary response to stressful events versus an anxiety disorder that may require professional help? First, it is important to understand the difference between stress and anxiety.
Stress Versus Anxiety
Stress is a temporary mental state that resolves once the stressor is removed. Children and adolescents may experience temporary stress related to events such as the first day of school or an upcoming exam. This type of stress is commonly referred to as eustress and is considered beneficial because it provides the determination to study for the exam or constructively prepare for the first day of school. Stress also functions to protect us from harm by initiating the body’s fight, flight or freeze response when danger is perceived. During this physiological response, the body produces hormones that prepare your body to flee, fight or freeze, and then to relax after the danger is gone. However, when stress is prolonged, it is considered distressing and can become physiologically harmful as your body and mind attempt to deal with consistent alarm signals.
Unlike stress, anxiety relates to worry about a perceived future event that could encompass one thing or a variety of things that may or may not happen. The most common form of anxiety is generalized anxiety and you may notice this in your child if they worry frequently about anticipated events, feel tired often, have problems concentrating or focusing, have difficulty falling asleep or remaining asleep and experience irritability or seem tense. Other common types of anxiety in children and adolescents are social anxiety and separation anxiety. Social anxiety refers to worry about social situations and critical evaluation, embarrassment, or judgement. Common symptoms of social anxiety in children are crying, holding on to the parent, remaining quiet in groups or having bodily complaints such as headache or upset stomach. Adolescents may express social anxiety through avoidance behaviors related to social settings or struggle with speaking up in front of classmates or friends. The third most common type of anxiety in children is separation anxiety and this type of anxiety relates to fear of losing a parent or attachment figure. Separation anxiety manifests as a fear of leaving home or being separated from the parent, therefore your child may not want to attend sleepovers, participate in functions away from home or they may have frequent nightmares about losing a family member or attachment figure. It is normal and expected that teens and children will experience some of these behaviors as they grow and mature.
Seeking Professional Help
Anxiety can transition into a disorder if there are prolonged stressful events, a traumatic single event or if there is a genetic predisposition to anxiety disorders. When your child exhibits behaviors that consistently interfere with daily functioning or you notice a persistent change in mood it is time to seek professional help. You may want to see your family doctor first to rule out a medical condition or schedule an appointment with a provider specializing in mental health. Typically, cognitive behavioral therapy (CBT) which teaches your child to recognize automatic negative thoughts (ANTS) and reframe them in a manner that reduces stress, is a great starting place. Medication is another common form of treatment when something in addition to therapy is deemed beneficial. Psychiatrists and psychiatric mental health nurse practitioners prescribe medications for anxiety and will also teach your child coping skills to manage their worry. It is important to remember not to convey judgement to your child for their feelings and to help them recognize that there is strength in seeking help.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC.
Mayo Clinic Staff. (2020). Stress management in-depth. Retrieved from http://www.mayoclinic.org
Sadock, B.J., Sadock, V.A., and Ruiz, P. (2015). Kaplan and Sadock’s synopsis of psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.
Sperling, J. (n.d.). How to identify anxiety in adolescents and to talk to them about it. Retrieved from http://www.adaa.org