What is Anxiety?
Anxiety is worry, fear, or discomfort that feels more likely or intense than what might actually happen and is frequently paired with physical signs.
While it serves as a natural response to stress, it becomes a defining feature of anxiety disorders when it occurs in excess or impacts one’s daily life.
The Many Faces of Anxiety
Separation Anxiety is an intense fear or distress about being separated from a loved one. While it's a normal part of childhood development, it becomes a concern when it’s excessive or persistent, causing significant distress or interfering with daily activities. In both children and adults, it can lead to avoidance behaviors and physical symptoms. If severe, it may be diagnosed as Separation Anxiety Disorder and treated with therapy or medication.
Social Anxiety causes an intense avoidance of social situations due to a worry over social judgement.
Selective Mutism is a specific type of social anxiety characterized by a consistent inability to speak in specific social situations despite being able to speak in setting where the child feels comfortable. It is most commonly diagnosed in young children, although symptoms can persist without treatment.
Panic disorder is an anxiety disorder characterized by recurrent, unexpected panic attacks—sudden episodes of intense fear or discomfort that reach their peak within minutes – and efforts to avoid these attacks. These attacks can occur without warning and are often accompanied by physical symptoms, such as a rapid heartbeat, sweating, chills, chest pain, difficulty breathing, dizziness, or a feeling of choking. Many people experience a sense of impending doom or feel like they are losing control or having a heart attack during a panic attack.
Phobias are an intense, persistent fear of a specific object, situation, or activity that is out of proportion to the actual threat. People with phobias typically go to great lengths to avoid the feared object or situation, which can interfere with their daily life and functioning. Some examples of phobias include agoraphobia (fear of leaving home), claustrophobia (fear of enclosed spaces), acrophobia (fear of heights), and aviophobia (fear of flying).
Obsessive Compulsive Disorder is a debilitating mental health condition characterized by persistent, intrusive thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) that the person feels driven to perform in response to the obsessions. These obsessions and compulsions interfere with daily life and can cause significant distress.
Obsessions: Recurrent and unwanted thoughts, images, or urges that cause anxiety or discomfort. People with OCD often try to suppress or ignore these thoughts, but they tend to be persistent and distressing.
Compulsions: Repetitive behaviors or mental acts that a person feels compelled to perform in response to an obsession, or according to rigid rules. These actions are meant to reduce anxiety or prevent a feared event, but they often provide only temporary relief and instead lead to an increase in anxiety.
Common obsessions in OCD include contamination, harm, just right, moral/religious, and counting.
Why is it important for a psychologist to do an assessment to diagnose Anxiety?
There are many types of anxiety and pinpointing the exact type of anxiety can direct treatment in the right direction. Anxiety can look very different in children. Some children may be shy and withdrawn while other anxious children may present as loud and chaotic. Some children may even become aggressive if their anxiety is triggered. The following example illustrates the need for a proper diagnosis.
Two children with anxiety have been invited to a birthday party at a local bowling alley. Lily, a 9-year-old girl, has always been quiet and shy, but recently, her fear of being judged in social situations has grown much worse. When it’s time for the party, Lily's mom must coax her out of her room. Lily feels a huge wave of anxiety just thinking about walking into the party where everyone will be watching her. She worries about making a fool of herself, saying the wrong thing, or that her friends might laugh at her if she messes up.
Ethan, a 10-year-old boy, has developed an obsession with germs and cleanliness. He spends a lot of time washing his hands and making sure everything around him is "clean" before touching it, even if it means avoiding social settings where he feels uncomfortable with potential contamination. He starts to feel panicked as the day of the birthday party approaches. He worries about touching the bowling balls, the shared bathroom, and the possibility of germs being everywhere. He asks his parents if he can skip the party, explaining that he might get sick if he touches something “unclean.”
At the party, Lily hesitates at the door, paralyzed by the thought of being the center of attention. Her mom tries to encourage her to join the group, but Lily stays at the edge of the room, clutching her phone for distraction, avoiding eye contact with the other kids. She doesn't participate in any of the games, and even when someone tries to include her, she quickly excuses herself, saying she feels too sick to play.
Ethan spends his time constantly checking if the bathroom is sanitized and watching for one bowling ball that he has cleaned with a towel he brought from home. He avoids playing games where he might touch shared items or interact too closely with other kids, worrying they might transfer germs to him. When one of his friends offers him a cookie, Ethan hesitates, worried it might be contaminated with something. As a result, he spends the entire party feeling anxious, disconnected from the fun, and wishing he could leave.
Both kids struggle with anxiety that impacts their ability to enjoy life. They both attempt to avoid a fun activity due to paralyzing anxiety; however, each child is driven by different internal motivations and can be helped using different treatments.
Lily’s avoidance is driven by social anxiety and an intense fear of being judged or embarrassed in front of others. Even though her friends might not even notice her actions, the anxiety of being scrutinized is overwhelming. She feels like if she engages, she’ll say or do something embarrassing, reinforcing her belief that social interactions are scary and should be avoided.
In contrast, Ethan’s avoidance is propelled by Obsessive Compulsive Disorder, causing him to feel that he must perform specific rituals (such as handwashing or avoiding certain objects or people) to reduce the anxiety caused by these intrusive thoughts and avoid harm. His rigidity and singular focus may also make it hard for him to connect with friends.
While both treatments should include elements of cognitive behavior therapy and exposure, therapy would look quite different for each child. Lily’s treatment would focus on cognitive restructuring (challenging her irrational fears of social judgement) with progressive exposure to social situations that cause her anxiety. In contrast, Ethan’s treatment would focus on diminishing his intrusive thoughts and compulsive behaviors. Exposure and Response Prevention is an evidenced based treatment of OCD, challenging one’s thoughts and gradually exposing a child to an anxiety provoking situation while helping them resist the urge to engage in compulsive behavior. Inference-Based Cognitive Behavior Therapy is another evidenced based treatment for OCD that focuses on changing the way individuals interpret and assign meaning to their intrusive thoughts, reducing the need for compulsive behaviors.
Receiving an accurate diagnosis enables a child to access essential treatment quickly and effectively, allowing them to regain functionality and rejoin the party.
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