Anxiety and Phobias

Anxiety is a normal human feeling. We all experience it when faced with situations we find threatening or difficult.

People often call this feeling stress but the word “stress” can be used to mean two different things – on the one hand, the things that make us anxious and on the other, our reaction to them. This makes it a confusing word.

When our anxiety is a result of a continuing problem, such as money difficulties, we call it worry. If it is a sudden response to an immediate threat, like looking over a cliff edge or being confronted with an angry dog, we call it fear.

Normally both fear and worry can be helpful, helping us to avoid dangerous situations, making us alert and giving us the motivation to deal with problems. However if the feelings become too strong or go on for too long, they can stop us from doing the things we want to and can make our lives miserable.

As parents it may be difficult for us to find out the cause of worry or stress in our children or adolescents but we can often start to work on reducing the symptoms and signs without always knowing the root cause.

A phobia, on the other hand, is a fear of particular situations or things that are not dangerous and which most people do not find troublesome.

In the mind:

• Anxiety
• Feeling worried all the time
• Feeling tired
• Unable to concentrate
• Feeling irritable
• Sleeping badly

In the body:

• Irregular heartbeats (palpitations)
• Sweating
• Muscle/tension pains
• Breathing heavily
• Dizziness
• Faintness
• Indigestion
• Diarrhoea

These symptoms are easily mistaken by anxious people for evidence of serious physical illness – their worrying about it can make the symptoms even worse. With children or young people we are not going to know about some of these symptoms unless they specifically tell us.

Sudden unexpected surges of anxiety are called panic, and usually lead to the person having to quickly get out of whatever situation they happen to be in. Anxiety and panic are often accompanied by feelings of depression, when we feel sad and see the future as bleak and hopeless.

Generalised Anxiety Disorder, or GAD, is characterised by excessive, exaggerated anxiety and worry about everyday life events. People with symptoms of GAD tend to always expect the worst. They can’t stop worrying about health, money, family, work or school. Often the worry is unrealistic or out of proportion for the situation. Daily life becomes a constant source of worry, fear and dread.

Eventually the anxiety so dominates the person’s thinking that it interferes with daily functioning, including work, school attendance and performance, social activities and relationships.

People with GAD may suffer from muscle tensions, headaches, nausea or tiredness, and may have trouble falling asleep or staying asleep.

A person with a phobia has intense symptoms of anxiety, as described above, but they only arise from time to time in the particular situations that frighten them. At other times they don’t feel anxious at all. If you have a phobia of spiders, you will feel fine if there are no spiders around; if you are scared of heights, you will be fine with your feet planted firmly at ground level and if you can’t face social situations you will feel calm when there are no crowds of people around.

A phobia will lead the sufferer to avoid situations in which they know they will be anxious, but this could actually make the phobia worse as time goes on. It can also mean that the person’s life becomes increasingly dominated by precautions they have to take to avoid the situation they fear.

Adult sufferers usually know that there is no real danger but children often believe there is. They may feel silly about their fear, but they are still unable to control it.

Children and young people at different ages may develop phobias about different things.

At ages 2-4 there’s more likely to be fear of animals, loud noises, being left alone, inconsistent discipline, toilet training, bath, bedtime, monsters and ghosts, bed wetting, disabled people, death and injury.

At ages 4-6 this may be fear of darkness and imaginary creatures. Also at this age there’s often fear of animals, bedtime, monsters and ghosts. Other fears, such as fear of strangers seem to be persistent. 'Stranger fear' would probably be called 'shyness', while fear of snakes tends not to decrease much, if at all, during this period. Children at this age may also fear loss of a parent, death, injury and divorce.

Beyond these ages, irrational fears tend to decline rapidly, though there may be further peaks to do with other situations, e.g. ages 9-11: fear of school; fear of blood and injury.

Older children tend to worry more about death and related topics such as nuclear war. Up to age 11 boys and girls tend to be equally represented in the 'fear tables'; after age 11 boys lose their fears more rapidly than girls.

Teenagers may often suffer from social phobia. They tend to be worried about how they look, what other people think of them, how they get on with people in general, but especially about how they get on with the opposite sex (or same sex dependent on their sexuality). They could find it difficult to eat in front of someone from the opposite/same sex. At the heart of this anxiety is their belief that other people will notice their anxiety and that this will make them look foolish or stupid. These worries can usually be dealt with by talking about them.

However, if the worries are too strong, other people may notice that they are doing badly at school, behaving differently, or feeling physically unwell.

If a child or teenager feels so anxious or fearful that it is spoiling their life, it’s a good thing to ask the family doctor to look into it.

Bear in mind that as a parent you will not necessarily get to find out what the problem is that your teenager is dealing with, unless they decide to tell you themselves. That doesn’t mean you can’t be supportive by letting them know you’re there for them if they need you.

OCD is when someone has recurrent and unwanted ideas and impulses (obsessions) and an urge or compulsion to relieve the discomfort caused by the obsession. If you have obsessive thoughts this means that certain words or ideas keep coming into your mind automatically. This can make you feel anxious, particularly if the thoughts are unpleasant or frightening. For example, some people have repeated thoughts about germs causing diseases. In order to cope with the anxiety they start to do things over and over again to get rid of the thoughts, like washing their hands again and again. OCD behaviours are senseless, repetitive, distressing and sometimes harmful, and they are very difficult to overcome.

For children with OCD, mornings and evenings can often be the worst times.

In the morning, they feel they must do their rituals right, or the rest of the day will not go well.

Meanwhile, they are often being rushed out of the door by parents so they will be on time for school. This combination of factors leads to them feeling pressured, stressed, and irritable. In the evenings, they feel compelled to finish all of their compulsive rituals before they go to bed. They know they must get their homework done and take care of any chores they have been given. Some children stay up late because of their OCD, and are often exhausted the following day.

Panic attacks are very scary. They often come out of the blue. Most people describe a sudden overwhelming sense of anxiety, fast breathing, racing heart and often feeling faint or thinking they are going to pass out. If your child experiences repeated panic attacks in different situations this is known as a panic disorder and you should talk to your family doctor about this.

Some of us seem to be born with a tendency to be anxious – research suggests that it can be inherited through our genes. However, even people who are not naturally anxious can become anxious if they are put under enough pressure.

Sometimes the causes of anxiety are obvious. When the problem disappears, so does the anxiety, but there are some circumstances that are so upsetting and threatening that the anxiety they cause can go on long after the event. These are usually life threatening situations like car crashes, train crashes or fires. The people involved may feel nervous and anxious for months or years after the event – even if they were physically unharmed.

This is part of what we now call post-traumatic stress disorder.

Sometimes anxiety can be caused by the use of street drugs like amphetamines, Ecstasy or by smoking marijuana. Even the caffeine in coffee can be strong enough to make some of us feel uncomfortably anxious.

Yet sometimes it may not be clear at all why a particular person feels anxious because it is due to a mixture of their personality, the things that have happened to them or life changes such as pregnancy.

If we are put under a lot of pressure, we may feel anxious and fearful much of the time. This is the same for children. We usually cope with these feelings because we know what is causing them and we know when the situation will end. For instance, most adults would feel very anxious before taking a driving test, but we can cope because we know that the feelings will disappear once the test is over.

Talking about the problem

This can help with children. For instance if your child is afraid of the dark you might use a night light to help them through this. Talk about the shapes the shadows make on the wall or how things look different at night. If they were afraid of dogs you might verbalise the fear for them “I know dogs can be scary because they can jump up and they have big teeth but this one lives right next door and he just wants to be your friend.”

For children with a fear of the dark:

• Read stories, or make up your own stories, about children bravely, or humorously, conquering their fear of the dark, or shadows, or monsters - whatever fear your child faces.
• Tuck your child's sheets around them so they're tight and snug.
• Give them something warm to drink to calm and soothe them before bed.
• Move or remove a light that your child thinks throws frightening shadows on the walls.
• Help them make a sign for the door, such as "No monsters allowed!"
• Make a thorough search of the room part of your bedtime ritual.
• Tell your child that any monsters would be more scared of them and they have the power to frighten them away.

Phobias, like other anxiety disorders, can be effectively treated. Treatment should always be based on a comprehensive evaluation of the child and family. Treatment recommendations may include individual or cognitive behavioral therapy for the child (focused on helping the child learn new ways to control anxiety and panic attacks when/if they do occur), family therapy, and consultation with the child's school.

Some children may also benefit from treatment with medication - specifically, medications to stop the occurrence of panic attacks. As parents we play a vital supportive role in any treatment process.

Listen to children’s worries, and treat their fears seriously. Don't make fun of them or treat them as unimportant, as this will stop them from telling you about them.

Young people may be embarrassed about talking about some things with parents. Instead, they may spend hours on the phone talking to friends about their clothes, social situations and the opposite sex. These discussions may seem like a waste of time to parents, but the support that they give can be of major importance to the young people.

Be available to give your children information if they ask for it. Help them look at situations and choices in a calm, thoughtful way so that they can make wise decisions. Help them gain confidence in their ability to make decisions and of finding useful ways of coping. Give encouragement for thinking for themselves – don't always provide the answers or "know better". It is best to not try and fix things for them or tell them how to do it, but rather to listen and help them learn to solve problems for themselves. If you think that your child or young person's anxieties are becoming so unreal or so strong that they are interfering with their daily life, then it could be useful to suggest that they talk with a counsellor, such as a school counsellor, or for you to discuss the situation with a professional.