Does your teenager have temper tantrums that rival those of a 2-year-old? Can they be insanely rude, disrespectful, angry, and oppositional? Are they often horribly uncooperative—defiant even? Or maybe they refuse to go to school, argue with teachers, or explode into major crying or screaming episodes without warning?

This may not be “bad behavior”—it could indicate an anxiety disorder.

Anxiety in teens has been on the rise for a while and experts blame everything from the pressure to succeed academically and social media to global warming and divisive politics.

As a matter of fact, anxiety disorders are the most commonly diagnosed mental health disorder in children and adolescents affecting almost 1 in 12 children and 1 in 4 adolescents.

With so many of our teens impacted by this issue, it’s extremely important for you to be able to recognize it for what it is so you don’t mistakenly treat their anxiety symptoms as a simple behavior problem (and just make it worse).

This is the first episode in a series on teen anxiety so stay right there and let’s start by addressing how anxiety manifests in teens and tweens. In later episodes I’ll address diagnosis, treatment options and even what you can do at home to help them through it.

PODCAST INTRO

Living with a child, adolescent or adult with any sort of anxiety disorder can be anything from slightly stressful to a nightmare, depending on the situation. But I can personally attest to the fact that having anxiety is certainly no picknick either.

I’ve had anxiety my entire life. Some of my earliest memories involve me walking the floors crying and telling my parents I didn’t know why I was upset. Middle school was absolute hell. I argued with teachers, and friends, dreaded those parties with spin the bottle as the main feature, and cried all the time. And my parents were clueless as to how to help. And I realize now, they both had anxiety disorders.

It turns out, that’s how it often happens. I also raised an anxious child, who became an even more anxious adolescent.

The risk of your child or teen developing an anxiety disorder increases if you have an anxiety disorder. It’s both genetic and environmental.

I’ve talked many times on this podcast about how our fear and anxiety makes us more controlling parents. It’s human nature to control what we fear. If we can control it, it’s not as scary. Fears are often based on a lack of control. So, if you’re afraid your teen is getting in trouble with a group of friends, for example, you’ll tend to try and keep them from those friends any way you can. This threatens your teen’s autonomy and causes animosity between you, disconnection, and likely, even rebellion. Having a real anxiety disorder will also mean you’ll feel more out of control, you may yell more, punish more frequently, say things you don’t mean, act rashly and cause even more conflict.

Not only does our anxiety interfere with our parenting skills, but our kids look to us as models for their behavior. The way we handle life’s stressors rubs off on them. If we fly into a rage because we can’t find the car keys or we curse the driver who pulls out in front of us, or regularly exhibit a lack of emotional regulation, that has a profound effect on our kids—on both their nervous system and just in the way they think it’s okay to act. They’re influenced by their environment and we are the biggest part of their environment.

Of course, there are other environmental risk factors for anxiety—any sort of stressful life circumstances or events, trauma, a chaotic or high conflict home environment, negative peer relationships, bullying, discrimination—all of this factors into whether or not your teen may develop an anxiety disorder.

 

What it is and how it happens:

But now what’s the difference between being nervous or anxious about something and having an anxiety disorder?

The psychological and physiological state of being nervous or anxious falls into the category of fear as an emotion. The fear family of emotion encompasses everything from being a bit apprehensive to being jittery, distraught, panicked or horrified. There are all sorts of emotional nuances in the fear family.

And each one of these states of fear, like all other emotions, serves a purpose. If we feel anxious about something it tells us this thing is important, possibly urgently important, and forces us to focus our attention on it. That’s a good thing. We have to have a little bit of fear to motivate us to do what we need to do, to keep us safe, and healthy and happy.

For example, even after I’d been practicing law for years, I’d still get a little nervous before a hearing or trial. That feeling always prompted me to over prepare, have meticulous notes, have all the evidence ready to go and in order of the testimony I was pulling out of the witnesses, anticipate objections from opposing counsel and have case law ready for them. It’s the same thing when a teen prepares for a test, drives on a highway for the first time, goes on their first date with someone. It helps them pay attention (study harder, be more vigilant of their surroundings, spend more time on hair and makeup).

So, anxiety is a good thing when recognized and optimized for personal performance.

But too much of a good thing can be really bad—especially when it comes to fear in adolescents.

The emotional part of the brain—the amygdala—is the area that helps create the fear emotion—all versions of it. The amygdala is the brain’s threat detector and when it senses any sort of threat it automatically sends the brain and body into the fight or flight response, which can cause a form of fear or anger, a rapid heartbeat, feeling flush and so on—and you’ll usually react in fear (like get out of the way of something, run, jump, scream, cower), or react in anger (lash out physically or verbally).

The fight or flight response happens when, for example, someone jumps out and scares you or throws something at you. But during adolescence the amygdala is much more threat-aware and sensitive and makes lots and lots of mistakes (thinking something’s a threat when it actually isn’t). Your teen is in fight or flight response a lot of the time.

This is why you see them get really frustrated, annoyed, or apprehensive about things that you may think are irrational or really overreactions.

And you know what makes their amygdala even more reactive? Stress of any kind. And boy are they stressed.

Their brain is wired to pay more attention to friends and romantic relationships, to be obsessed with what their peers think of them, of being accepted, and they’re super self-conscious and really easily embarrassed.

They worry about the selfie they post, they worry about whether they’ll be invited to the big event, they worry about college and their future, and your relationship with their other parent, and just how they fit into society as a whole.

They think about all of this stuff all the time. They get stressed about things we cannot relate to.

Remember that when you start thinking, “what could they possibly have to be stressed about? They don’t know stress”. No, they don’t know what it’s like to work a full time job, pay household bills, take care of kids, the home, a spouse.

But teens only know they life they’ve had over these past 12, 15, 18 years…they don’t have an adult’s life to compare it to—only their own. The reality is, if they perceive something as stressful, it is stressful—period. So, never doubt that what they’re experiencing is very real and should be taken very seriously.

And the more stressed they are, the more emotionally reactive they’ll be…because not only does all this stress make the amygdala more reactive but it also makes it more difficult for them to engage the part of the brain that helps calm the amygdala’s fight or flight response—the prefrontal cortex.

So, it’s like teens are walking around with gasoline and kindling in their brain, stress is the match, and they have no access to a water hose.

And the more their amygdala is triggered by these mistaken threats, the more they go into fight or flight mode, without much help from the prefrontal cortex to calm it down, the more vigilant (or reactive) the amygdala becomes—meaning it makes even more mistakes. Your teen starts thinking about and anticipating bad things. They start making up stories in their head. They imagine the worst-case scenarios, and anxiety becomes their natural state.

This is how anxiety disorders manifest so easily in teens and can turn them into this overly sensitive, fragile, or explosive, emotional mess.

But here’s the thing…your kid may not recognize what they’re experiencing or feeling, as anxiety. They may feel something’s not quite right, or that they don’t feel good, or feel nervous often, but unable or unwilling to articulate it to you or anyone else. So, it could be totally up to you to watch out for signs and symptoms that could indicate an anxiety disorder.

Outward behaviors

I started this episode by asking if your teen has temper tantrums, are terribly disrespectful or defiant, or explodes into major crying episodes. All of this and so much more can be an indication of an anxiety disorder (although certainly not always, which is why a diagnosis is necessary).

The problem is that anxiety often doesn’t look like what we’d assume it would, and it doesn’t always look the same in teens as it does in adults or even other teens.

Your teen’s anxiety may show up as a constant case of mild irritability (which can cause a lot of arguments, rude and disrespectful behavior, refusal to cooperate). They might seem angry all the time for no discernable reason, difficult to talk to without feeling like you’ll accidentally provoke their wrath. You may even see explosive or violent rages (including aggressive or destructive behavior). The emotional dysregulation can be really scary sometimes.

This type of behavior gets old for parents. Even if you understand that it’s anxiety, empathy can wain when they’re constantly being rude, yelling at you, calling you names, refusing to do anything you ask, or destroying the house. You may have a hard time regulating your own emotions about this part of their anxiety. We’ll talk about that in another episode.

If they have anxiety attacks as part of their disorder, they may say they suddenly feel like they’re dying, overtaken by an impending sense of doom, that the world is ending, or that something horrible is about to happen. It can be really terrifying for them

But at times, or in certain kids, an anxiety disorder can also look like being completely zoned out and unable to focus. This happens because again, the amygdala puts them in fight or flight, their prefrontal cortex shuts down, and can’t help them think. It feels a bit like being in a fog or in limbo where you just can’t move forward.

Of course, what does that sound like? ADHD. This is why anxiety and ADHD are commonly misdiagnosed for the other. But ADHD and anxiety also often occur at the same time in a kid, which is why getting the right professional diagnosis is so important (again, another episode).

Certain types of anxiety disorders (like social and generalized) can cause your teen to avoid activities, situations or certain people or places—even school, friends, and extracurriculars. Anxiety is the most common cause of school refusal or avoidance. If your kid is begging out of school, skipping classes, walking out and going home and you can’t figure out what’s going on, anxiety is likely a big part of it. Anxiety and probably ADHD and/or a learning issue, which may not have even been diagnosed.

Anxiety can also manifest as restlessness, an inability to handle boredom, and, never wanting to be without friends nearby. All teens obsess over friends, but an anxious teen may never seem to be able to be alone or without something to do or someone to hang out with. Friendship issues can be much more complex for these kids—especially younger adolescents.

If you have a teen who’s a major procrastinator, anxiety could be the culprit. Lots of times when kids get behind in school because of some learning issue or because they’ve missed due to school refusal, they get even more anxious because they don’t see a way to ever get caught up, so they just bury their head and put it off and put it off.

On the other hand, over-the-top perfectionistic tendencies or a need for constant reassurance may also be signs of anxiety. That’s one reason it can take us a lot longer to do something than most people. Those last-minute projects, working on something forever, second guessing themselves constantly, all of these things could be an indication they have anxiety.

Anxious kids and teens can also be very bossy in an attempt to control situations, so they’ll feel less anxious. Remember fear (the root of anxiety) breads controlling behavior—if we can control it, we won’t be so afraid anymore, right?

Unfortunately, anxiety also commonly leads to other maladaptive behaviors – especially if it goes untreated. Teens are already prone to risky behaviors because of how their brain works, but those with anxiety are even more likely to go to the extreme.

With substances for example, they’re more likely to use them to self-medicate to try and find some relief (it could be alcohol, weed, Xanex, or anything they can get their hands on). If you think about it, this makes sense for them—especially if their anxiety is going untreated, they’re looking for anything that may help them feel less anxious. The bad thing is, many of these substances can actually make their anxiety worse in the long-term. But again, this is why spotting anxiety symptoms, getting a diagnosis and the proper treatment is so very important.

Some teens with anxiety disorders may also self-harm as an emotional release. Self-harm is almost always associated with emotional dysregulation of some sort (and anxiety is certainly that).

Another byproduct of teen anxiety is lots of relationship issues with friends or romantic partners…because of their inability to control their emotions or possibly their neediness, bossiness, or controlling behavior.

Physical symptoms

Anxiety also very often shows up as physical symptoms or illnesses.

The fight or flight response is felt in the body—cortisol is released, blood rushes to the extremities, heartrate speeds up, as does breathing—it’s the body’s way of readying itself to fight or flee the scene.

But with anxiety, remember, we’re talking about a prolonged state of being in fight or flight, hypervigilance, the body and brain on constant alert. This can breed all sorts of very real physical symptoms that neither you nor your teenager may even associate with anxiety. Leg cramps, headaches, nausea, vomiting, stomachaches, diarrhea, faintness, chills, sweating, trembling, muscle tightness, feeling jittery inside, difficulty breathing, dizziness, weakness, or lethargy – even dissociation (a feeling of not being one’s self or being outside of one’s body). Somatic symptoms vary person to person and just because someone has one of these symptoms doesn’t necessarily indicate they have an anxiety disorder.

Unfortunately, these physical manifestations can also make your kid even more anxious—fearing there’s something terribly wrong with them—which in turn can make the symptoms and the anxiety even worse. It can be really scary for everyone involved. Parents often spend a lot of time with doctors trying to figure out the cause of these physical symptoms without ever being told that it could be anxiety—it’s simply not what most medical doctors recognize.

One very frightening (but relatively harmless) potential symptom of an anxiety disorder is dissociation. This can manifest both physiologically and psychologically.

Your teen might say they feel like they’re “not in their body” or may feel “like nothing is real” or that “they don’t feel real” and it might even be something vague like, “I don’t feel like me”.

It’s a feeling of being disconnected or detached from your surroundings, your memory, or even from your own body – they may even describe looking at themselves from the outside – things in the environment may appear distorted or foggy.

Although this sounds like a complete mental break, it will pass and is generally nothing to panic about. It’s really just the brain’s way of checking out when things get too difficult. It can happen to someone with really bad anxiety or during a panic attack but it can also happen with trauma or post-traumatic stress.

Experiencing dissociation doesn’t mean you have a “dissociative disorder”. About half of us will experience dissociation at some point during our lifetimes, but very few people are actually diagnosed with the disorder (which is longer lasting and more pervasive).

I just wanted to point that out because my son experienced dissociation and it was very scary for us.

……………………

 

So, just remember if your teen complains of physical random symptoms that may come and go with no rhyme or reason (or that even seem to happen at just the right time to prevent them from participating in something they may have been dreading)—that doesn’t mean they’re faking it. This is real and it can’t be helped.

You have to know what to look for and who to go to for help. The first thing you’ll want to do is rule out true medical causes for the symptoms. When my son was growing up, we went to allergists, gastroenterologists, internists, ophthalmologists, just trying to find a medical reason for my son’s stomach and upper GI symptoms and never found anything that explained it.

The brain and the body are so interconnected that anxiety spills over like this all the time. But once medical issues are ruled out and the anxiety is diagnosed, treated properly, and brought under control, the somatic symptoms should dissipate.

The same is true with the behavior issues that stem from an anxiety disorder—proper treatment will improve them. Usually, the most optimal treatment involves a combination of therapy and medication.

But your teen’s anxiety can persist despite proper treatment if you don’t understand the disorder and learn to parent them properly.

Parenting a kid or teen with anxiety can be an enormous challenge. It takes patience, empathy, compassion, and lots of emotional regulation. And even with all of that, you’ll still falter now and then. I’ve said before that teens with anxiety or ADHD – any sort of developmental or mental health challenge or maladaptive behavior are like typical teens squared. All the issues one has with a typical teen are magnified exponentially in a teen with one of these additional challenges. And it can be extremely difficult to remember, in the middle of their 3^rd meltdown of the week, that they’re not doing it on purpose. It can sure seem purposeful sometimes.

But anxiety is not something they’ve chosen, it’s not something they enjoy, and it’s certainly not something that can be disciplined out of them. On top of that, quite often your teen doesn’t even realize why they feel the way they do. I had anxiety my whole life and couldn’t articulate it until I was well into my 30s. Unless someone notices the symptoms and digs a little deeper and explains to a kid what’s happening to them, they’re more likely to simply think they’re weak, weird, stupid, or overly sensitive.

It sucks to feel that way about yourself—to be so confused about how you feel inside and why you act the way you do on the outside. Don’t forget, they need your help with this. They need your patience and your diligence in helping to find a solution. They need validation that what they’re going through is rough, and they need to hear that you’ll get through it together as a team.

You can’t control the anxiety out of them. Extra rules and more consequences won’t help. We’ll get to what will help in a later episode. But next week, I think I’ll dive more into the diagnosis and treatment side of things.

In the meantime, you can download my free Parenting guide called Your Teen and Anxiety. I’ve included everything from signs and symptoms to how to explain anxiety to your teen and tools that will help them. I’ll have the link in the show notes.

That’s wraps up another episode of Speaking of Teens. I’ll be back next week and probably the next with more on adolescent anxiety. Thank you so much for being here with me – both if you’re new here or an SOT OG – I appreciate you. Please remember, we have over 200 episodes to dive into, many worth listening to more than once (so I’m told).

Alright, until next time, remember to connect with your teen in at least some small way, each and every day.