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Anxiety Health Article

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Causes and symptoms

A child's genetics, biochemistry, environment, history, and psychological profile all seem to contribute to the development of anxiety disorders. Most children with these disorders seem to have a biological vulnerability to stress, making them more susceptible to environmental stimuli than the rest of the population.

Emotional and behavioral symptoms of anxiety disorders include tension; self-consciousness; new or recurring fears (such as fear of the dark, fear of being alone, or fear of strangers); self-doubt and questioning; crying and whining; worries; constant need for reassurance (clinging to parent and unwilling to let the parent out of sight); distractibility; decreased appetite or other changes in eating habits; inability to control emotions; feeling as if one is about to have a heart attack, die, or go insane; nightmares; irritability, stubbornness, and anger; regression to behaviors that are typical of an earlier developmental stage; and unwillingness to participate in family and school activities. Physical symptoms include rapid heartbeat; sweating; trembling; muscle aches (from tension); dry mouth; headache; stomach distress; diarrhea; constipation; frequent urination; new or recurrent bedwetting; stuttering; hot flashes or chills; throat constriction (lump in the throat); sleep disturbances; and fatigue. Many of these anxiety symptoms are very similar to those of depression, and as many as 50 percent of children with anxiety also suffer from depression. Generally, physiological hyperarousal (excitedness, shortness of breath, the fight or flight response) characterizes anxiety disorders, whereas underarousal (lack of pleasure and feelings of guilt) characterizes depression. Other signs of anxiety problems are poor school performance, loss of interest in previously enjoyed activities, obsession about appearance or weight, social phobias (e.g., fear of walking into a room full of people), and the persistence of imaginary fears after ages six to eight. Children with anxiety disorders are often perfectionists and are concerned about "getting everything right," but rarely feel that their work is satisfactory.

Shyness does not necessarily indicate a disorder, unless it interferes with normal activities and occurs with other symptoms. A small proportion of children do experience social anxiety, incapacitating shyness that persists for months or more, which should be treated. Similarly, performance anxiety experienced before athletic, academic, or theatrical events does not indicate a disorder, unless it significantly interferes with the activity.

Separation anxiety disorder (SAD) is the most common anxiety disorder among children, affecting 2 to 3 percent of school-aged children. SAD involves extreme and disproportionate distress over day-to-day separation from parents or home and unrealistic fears of harm to self or loved ones. Approximately 75 to 85 percent of children who refuse to go to school have separation anxiety. Normal separation fears are outgrown by children by the ages of five or six, but SAD usually starts between the ages of seven and 11.

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