Conditions & Treatments
- A to Z Guide

Anxiety Disorders

Disease Information

In-Depth

What causes anxiety disorders?
All of us are born with the instinctive “fight or flight” response that helped our ancestors escape predators and other threats. When we are afraid, concerned or stressed, the part of our brain responsible for the fight or flight response will generate the nervous, fearful sensation we call anxiety.

While everyone experiences anxiety at times, people with anxiety disorders feel excessive worry that does not subside the way normal anxiety does.

Anxiety disorders are linked to:

biological factors

The brain has special chemicals, called neurotransmitters, that send messages back and forth to control the way a person feels. Serotonin and dopamine are two important neurotransmitters that, when “out of whack,” can cause feelings of anxiety.

family factors
Anxiety and fear can be inherited. Just as a child can inherit a parent’s brown hair, green eyes and nearsightedness, a child can also inherit that parent’s tendency toward excessive anxiety. In addition, anxiety may be learned from family members and others who are noticeably stressed or anxious around a child. For example, a child whose parent displays perfectionist tendencies may become a perfectionist, too.

environmental factors

A traumatic experience (such as a divorce, illness or death in the family) may also trigger the onset of an anxiety disorder.

What do kids with anxiety disorders worry about?
The exact subject of the anxiety depends on the type of anxiety disorder the child has:

Children with generalized anxiety disorder (GAD) may worry about anything (and often worry about more than one topic at once).
Children with separation anxiety disorder worry about being physically separated from loved ones.
Children with social anxiety disorder worry about experiencing humiliation in front of others.
Children with obsessive-compulsive disorder worry about something bad happening if they do not perform a certain mental or physical ritual.Children with phobias experience intense fear that centers on a particular person, type of person (for example, doctors), animal or event.

Don’t all kids worry about things, sometimes unreasonably?
Children with anxiety disorders might worry about the same subjects as children who do not have an anxiety disorder. The difference is that for the child with an anxiety disorder, there is no “on-off” switch for the worry: it is ever-present and so extreme that it interferes with the child’s ability to relax, concentrate and enjoy activities.

What are the symptoms of a possible anxiety disorder?

Unlike adults, children usually don’t realize how intense or abnormal their feelings of anxiety have become. It can be difficult for a child to determine that something is “wrong.”

If your child has an anxiety disorder, she may need frequent reassurance from you or other family members, or from teachers or classmates at school.

Other symptoms can include:

worrying about things before they happen
a need for everything to be “perfect”
ongoing worries about friends, school or activities
constant thoughts and fears about safety (of self or of others, such as parents and siblings)
reluctance or refusal to go to school
frequent stomachaches, headaches or other physical complaints
frequent muscle aches or tension
trouble sleeping at home and away
"clingy” behavior with parents
feeling the sensation of a “lump in the throat”
fatigue
inability to concentrate
becoming easily startled
irritability
inability to relax

Your child may be diagnosed with an anxiety disorder if these symptoms:

are present for at least six months
cause significant distress for the child
do not subside, no matter how much the child tries to relax or stop worrying
impair functioning at home, at school or with peers

What are the treatments for an anxiety disorder?

Here at Children’s Hospital Boston, our expert team of psychiatrists, psychologists and social workers can help you, your child and your family by:

tailoring therapy plans according to your child’s age, specific symptoms, family and school situation and overall medical history
using psychotherapy (which is also referred to as “talk therapy”), or a combination of medication and therapy, to help your child feel and function better

Psychotherapy

The traditionally accepted best treatment for all anxiety disorders is psychotherapy (“talk therapy”). Therapy is designed to help your child understand why and how feelings of anxiety emerge. It will also teach her important new skills for overcoming those feelings and replacing them with healthier, more constructive behaviors.

Your child may receive individual therapy, or may participate in group sessions with other kids who are also working to overcome an anxiety disorder. We also offer family counseling, which allows parents, siblings and other family members to take part in a child's therapy sessions and learn new strategies as a team.

Coping strategies learned in therapy may include:

identifying and talking about worries and other feelings
stopping recurring negative thoughts as soon as they start
relaxing the mind and body during times of stress

Anti-anxiety medications

If your child’s anxiety disorder does not adequately respond to psychotherapy, your clinician may recommend adding an anti-anxiety medication to his treatment plan. These medications can help your child feel more relaxed and comfortable while he is working on learning and practicing coping skills in therapy.

Here at the Children's Department of Psychiatry, we never prescribe mental health medication as a standalone treatment. Instead, we always consider medication as part of a two-pronged approach, with psychotherapy as a necessary component. Our Psychopharmacology Clinic can help determine whether medication might be a useful addition to your child's talk therapy.

Commonly prescribed anti-anxiety medications include: