Be careful: anxiety in children and adults

May is Mental Health Awareness Month, and UNMC Wellness Team Steve Wengel, MD, Sarah Fischer, PhD, and Priya Gearin, MD will discuss mental health topics weekly on UNMC Today. Dr. Gearin is an assistant professor in the UNMC Department of Psychiatry and a child psychiatrist at Nebraska Medicine.

Anxiety disorders are the most common type of mental illness in the world. They often start in childhood or adolescence, affecting 31.9% of people between 13 and 18 years old.

But how do we know when anxious thoughts and feelings turn into a disorder?

I often tell patients and families that everyone worries or feels anxious sometimes, and some worry is healthy because it can help us make decisions that promote our well-being. For example, a new driver may worry about getting into a car accident, so they will be more careful about following traffic laws.

However, when worrying thoughts become persistent and excessive, they can progress to an anxiety disorder. To be considered a disorder, anxiety symptoms must interfere with an individual’s functioning. Using the same example, if a new driver begins to worry most of the time that an accident will occur, focuses on worst-case scenarios in other situations, and begins to avoid getting in the car because of these fears, they may be experiencing anxiety. disorder

There are different anxiety disorders, including generalized anxiety disorder, social anxiety disorder, separation anxiety disorder, panic disorder, and illness anxiety disorder. Obsessive compulsive disorder is a related condition. Each has its own set of characteristics needed to make the diagnosis, including number of symptoms and duration of symptoms. Generalized anxiety disorder is the most common anxiety disorder and is diagnosed with the following criteria:

• Excessive anxiety and worry about a series of events or activities that occur most days for six months or more
• Difficulty controlling worry
• Three or more of the following (only one is required in children)
  • Restlessness or feeling on edge
  • Difficulty concentrating or the mind goes blank
• Symptoms cause clinically significant distress or impairment in functioning
• The disturbance is not better explained by another mental health condition, substance use, or other medical condition

Anxiety disorders can cause more than mental or emotional distress. Physical manifestations of anxiety can include stomach aches, headaches, and muscle tension. In children, school avoidance can be a sign of anxiety.

Part of therapy for anxiety disorders, along with other mental health conditions like depression, involves identifying automatic negative thoughts. Automatic negative thoughts are thoughts that pop into our brains without thinking and can perpetuate anxiety. For example, if someone receives an email from their boss saying that they have to meet, the individual may automatically think that they are going to fire me. In reality, there may be several other possibilities, but anxiety often makes the worst case the only case. Therapy works to identify the thinking traps, such as catastrophizing, overgeneralization, and all-or-nothing thinking, that may underlie these automatic negative thoughts.

If you’re concerned about an anxiety disorder in yourself or a loved one, start by asking your primary care doctor to screen for anxiety, as well as other common causes of anxiety, such as thyroid conditions. Along with psychotherapy, medication may be considered for both children and adults, depending on the severity of the anxiety disorder and the goals of the patient and caregivers. Primary care providers may refer to a psychiatric specialist if necessary, especially if co-occurring diagnoses exist.