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Signs of anxiety in teens


How Anxiety Affects Teenagers - Child Mind Institute

There is substantial evidence that the pandemic has increased the number of adolescents (and even some pre-adolescents) who are anxious. It’s no wonder, given that Covid lockdowns and distancing robbed teenagers of many of the activities they care about most, disrupted their education, and isolated them from their friends.

We’re all hoping that as life returns to something like normal, adolescents will rebound. But anxiety in adolescents was already on the rise before the pandemic. Why? Experts cite increased pressure to succeed in school, a world that feels scarier and the toll social media can take on self-esteem. But nobody really understands it. It’s important to recognize the signs of anxiety, and get kids who are struggling help.

How is anxiety different in teenagers?

Anxious teenagers are different from anxious children. At each stage of development, kids have different worries and vulnerabilities.

Younger children are prone to be anxious about external things — like animals or insects, the dark, monsters under the bed, or something bad happening to mom and dad. But teenagers are more likely to be worried about themselves — their performance in school or sports, how they are perceived by others, the changes in their bodies.

Some anxious teenagers have been anxious for many years by the time they reach adolescence. Maybe parents have been aware of it, but the child functioned well despite their distress, so nothing was done about it. Or the child was treated, and things got better. But as more is expected of them, in middle and high school, and as they develop more focus on their peers, the anxiety can resurface and become more severe. And some teens who weren’t anxious children develop adolescent-onset kinds of anxiety, including social anxiety and panic attacks.

What are teenagers anxious about?

Their performance. “We see a lot of fear of not doing well,” explains Jerry Bubrick, PhD, a clinical psychologist at the Child Mind Institute who specializes in anxiety and OCD. “A lot of anxiety is geared towards perfectionism, or needing to do their absolute best in school, beyond an intense work ethic.” Even when parents report that they urge kids not to stress over college admissions, teenagers say they feel intense pressure to get those straight A’s.

How they’re perceived.  “Every teenager is going to have an awareness of and a certain vigilance about how they’re being perceived,” Dr. Bubrick notes. “That’s just part of the adolescent process, but some kids have that on steroids.” The result can be debilitating social anxiety. “They’re going to be really excessively worrying about whether they might be seen as incompetent or stupid, or they’re really worried about doing something embarrassing.”

Their bodies. Physical changes of adolescence are a cause of discomfort for many teenagers. Developing either before most of your peers, or after them, can make kids feel different and out of step.   “For girls if you’re on the early side in development, it’s going to affect you more negatively than if you were on time with development or even late,” notes Dr. Bubrick. Boys, he adds, are especially sensitive to height. “So if a 15-year-old hasn’t gone through puberty yet, and they’re looking like they’re 12 and their peers are looking like they’re 19, that can have a pretty profound impact on self-esteem and confidence.” Some kids develop a form of extreme anxiety called body dysmorphic disorder, becoming so obsessed with a perceived physical flaw (real or imagined) that it causes great distress and interferes with their functioning.

Symptoms of anxiety in teenagers

Symptoms of anxiety vary widely, from withdrawal and avoidance to irritability and lashing out. Anxiety is often overlooked because teenagers are good at hiding their thoughts and feelings. But these are some of the behaviors that might be a sign that a teenager is anxious.

  • Recurring fears and worries about routine parts of everyday life
  • Irritability
  • Trouble concentrating
  • Extreme self-consciousness or sensitivity to criticism
  • Withdrawal from social activity
  • Avoidance of difficult or new situations
  • Chronic complaints about stomachaches or headaches
  • Drop in grades or school refusal
  • Repeated reassurance-seeking
  • Sleep problems
  • Substance use

Anxiety and school refusal

Since so much of what adolescents are focused on is connected with school — think academics, sports, other activities and social life — school can be the setting of a lot of things a teenager might be anxious about. Hence when kids resist going to school, it’s not necessarily about school itself.

Dr. Bubrick notes that what we call school refusal used to be called school phobia, but that implied that school is the source of their anxiety. Instead, in dealing with kids who find frequent excuses to stay home, or flat-out refuse to go, the focus isn’t on that decision to not go to school. “We’re more focused on why they’re making that decision to not go to school.”

The problem could be worry about being called on randomly by a teacher and making a mistake. Or having a panic attack in class. Or worry that they look wrong, and people will make fun of them. “You could interview a hundred kids refusing to go to school,” adds Dr. Bubrick, “and get a hundred different reasons why.”

Anxiety and substance use

Teenagers who are anxious (not unlike adults who are anxious) may use recreational drugs, especially marijuana, as a way of coping with their discomfort. It’s self-medication, notes Dr. Bubrick, and the reality is, in the short term, it works. “It does alleviate anxiety and stress. It numbs it. It does shut off the worry part of your brain.” But it’s a poor coping mechanism in the longer term, because the anxiety persists and the teenager becomes dependent on the substance.

Dr. Bubrick says what he hears about most from teenagers is that marijuana is healthier than alcohol. And now that marijuana is legal in many places (for those over 21) and vaping is an option, it’s easier than ever to smoke — on the street, at home or at school — without adults being aware of it.

But he notes that neither is a healthy way to manage anxiety, and he urges kids not to use recreational drugs as medicine. “If you have a joint in your pocket all the time and you’re smoking during the day, to get through your day at school, that’s no different from having a bottle of vodka in your desk drawer at work.” You’re still relying on a substance to get through the day — and the more you use it, the more dependent on it you’ll be.

Anxiety and depression

It’s common in teenagers to find that they are depressed as well as anxious. That is in part because an anxious lifestyle can be so distressing, or so limiting, that it leads to depression.

Dr. Bubrick recalls treating a young woman whose move to a new high school triggered intense social anxiety. She was so worried about failing in a more competitive atmosphere that she began to withdraw from activities. Then she had a panic attack, and began to withdraw from friends because she was afraid of having another panic attack in front of them. Eventually she was so isolated she became severely depressed.

This kind of layering of anxiety and depression is both common and commonly missed, Dr. Bubrick notes. If a clinician just treats the presenting symptoms of depression, and misses the anxiety, the result won’t be effective.

But it’s also possible that anxiety and depression are two separate co-occurring disorders.

Dr. Bubrick explains: “The question I ask kids is ‘If I was able to go into your brain and just remove your anxiety, would you still be depressed?’ If they say ‘Yes, I would still be depressed,’ that would suggest it might be a co-occurring depression. If the answer is, ‘No, I would feel amazing if you took the anxiety away,’ then I would think the anxiety is causing the depression.”

Dr. Bubrick notes that among the various kinds of anxiety, generalized anxiety disorder, commonly called GAD, is particularly linked to depression later in life — so much so that it’s also thought of as a precursor for depression. GAD is anxiety that’s not triggered by a particular thing (that’s called specific phobia) but by persistent and excessive worry about a variety of everyday things.

What’s the link between anxiety and depression? Dr. Bubrick thinks anxiety undermines well-being. If you can’t trust yourself and you can’t trust that you’re going to make good decisions and you live defensively, then you’re especially at risk for depression.

“If you’re walking around always worrying and always doubting, and everything in life is ‘what if?’ that’s going to start to have a pretty profound effect on how you see yourself and your confidence and your self-esteem,” he explains. It’s not surprising, he adds, that if you’ve been living defensively, with a steady diet of fear, it could lead to depression.

Treatment for anxiety

The most effective treatment for anxiety in teenagers is cognitive behavioral therapy (CBT), combined, if needed, with antidepressant medication. And the good news is that it’s very effective.

CBT teaches anxious kids strategies for thinking differently about anxiety and responding to it differently when it occurs. By tolerating anxiety rather than avoiding things that trigger it, they learn that it diminishes over time. And by gradually increasing exposure to feared objects or activities (a type of CBT called exposure therapy), the anxious response itself is reduced or eliminated.

Antidepressants called SSRIs (selective serotonin reuptake inhibitors) ― are the medications recommended for treating anxiety disorders in children. They are combined with CBT in kids whose anxiety is too great to enable them to participate in CBT alone.

Frequently Asked Questions

How can I help my teenager manage anxiety?

The most effective treatment for anxiety in teenagers is cognitive behavioral therapy (CBT), combined, if needed, with antidepressant medication. CBT teaches kids strategies for reshaping how they think about anxiety.  

What do teenagers worry about?

Teens are under a lot of pressure. The anxiety they experience often centers on perfectionism around grades, college, and extracurriculars. They also have anxiety from the heightened awareness of where they stand socially compared to their peers. Adults tend to care less about how they are perceived, but teens are still building confidence and figuring out who they are. The physical changes in the teenage years are another source of discomfort, especially for kids who develop early or late.   

What causes anxiety in teens?

Stress and overthinking are all common causes of anxiety in teens. These worries often center around school, social life, or body image. 

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6 Hidden Signs of Teen Anxiety

All teens experience some amount of anxiety at times. Anxiety is actually a normal reaction to stress, and sometimes it helps teens deal with tense or overwhelming situations. For many teens, things like public speaking, final exams, important athletic competitions, or even going out on a date can cause feelings of apprehension and uneasiness. They may also experience an increase in heartbeat or excessive sweating. That’s how the brain responds to anxious feelings.

For some teens, however, anxiety can go beyond these typical symptoms to negatively affect friendships and family relationships, participation in extracurricular activities, and even their schoolwork. When feelings of anxiety interfere with normal daily living, the presence of an anxiety disorder should be considered. According to the National Institute of Mental Health, approximately 25% of 13- to 18-year-olds have an anxiety disorder, and just under 6% have a severe anxiety disorder.

Given that teens experience a wide variety of physical and emotional changes as they grow, an anxiety disorder can be difficult to spot. Many red flags may seem like usual teens struggles or be chalked up to hormones. Watch for these hidden signs of anxiety in your teens:

#1. Emotional Changes to Watch Out For in Teens

While some anxious teens express feelings of pervasive worry, others experience subtle emotional changes such as:

  • Feeling “keyed up”

  • Feeling on edge

  • Irritability

  • Difficulty concentrating

  • Restlessness

  • Unexplained outbursts

Anxiety can negatively affect friendships. If your once social teen suddenly avoids his favorite activities or stops making plans with friends, think twice. You might notice your child:

  • Avoiding social interactions with usual friends

  • Avoiding extracurricular activities

  • Isolating from peer group

  • Spending increased time alone

#3. Physical Changes

Many of the physical complaints that can occur with an anxiety disorder mimic average teen complaints, which tend to increase as they get older. Pay attention to patterns. A couple of headaches here and there shouldn’t be a cause for concern, for example, but frequent headaches are a red flag. Watch for these common psychosomatic complaints:

  • Frequent headaches, including migraines

  • Gastrointestinal problems

  • Unexplained aches and pains

  • Excessive fatigue

  • Complaints of not feeling well with no obvious medical cause

  • Changes in eating habits.

#4. Sleep Disturbances

The American Academy of Pediatrics recommends that teens aged 13 to 18 get 8 to 10 hours of sleep on a regular basis to promote optimal health. Pediatricians also recommend shutting down screens 30 minutes prior to bedtime, and removing all electronics from the bedroom.

It’s no big secret that homework demands, changing brain structure, extracurricular activities, and screen time can all cut into the sleep habits of teens. Therefore, it can be difficult to know whether fatigue is a product of anxiety or of a busy schedule. Watch for these red flags:

  • Difficulty falling asleep

  • Difficulty staying asleep

  • Frequent nightmares

  • Not feeling refreshed after sleep

#5. Poor School Performance

Given that anxiety can affect everything from sleep habits to eating habits to missing school due to physical issues, it should come as no surprise that poor academic performance can also result from untreated anxiety. School avoidance, missed days due to anxiety-related illness, and persistent worry can make it difficult for anxious teens to keep up with their workload. Watch for these changes in your teen:

  • Significant jump in grades (usually downward)

  • Frequently missed assignments

  • Describes feeling overwhelmed by workload

  • Procrastinates on, or has difficulty concentrating on, homework assignments more than usual

#6. Panic Attacks: Know the Symptoms

Not all anxious teens experience panic attacks, and some experience mild symptoms of panic without enduring a full panic attack. The following symptoms are common among people with anxiety disorders:

  • Rapid heartbeat

  • Sweating and trembling

  • Dizziness

  • Upset stomach

  • Difficulty breathing

  • Chest pain

  • Feeling like they’re dying

  • Feeling like they’re “going crazy”

  • Numbness or tingling in arms and legs

  • Derealization.

If your teen appears to be struggling with anxiety that interferes with school, friendships, family relationships, or other areas of daily functioning, it’s important to get an evaluation from a licensed mental health practitioner. Anxiety is treatable, and most teens can learn to cope with and manage their anxiety independently.

  1. National Institute of Mental Health, “Any Anxiety Disorder Among Children,” retrieved from https://www.nimh.nih.gov/health/statistics/prevalence/any-anxiety-disorder-among-children.shtml.
  2. American Academy of Pediatrics. American Academy of Pediatrics Supports Childhood Sleep Guidelines. Published June 13, 2016. Retrieved from https://healthychildren.org/English/news/Pages/AAP-Supports-Childhood-Sleep-Guidelines.aspx. Accessed November 24, 2020.

Notes: This article was originally published November 20, 2017 and most recently updated February 25, 2021.

How to help a teenager cope with anxiety?

Useful materials

How can I help my teen cope with anxiety?

04. 05.2022

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According to Russian research data, 30% of schoolchildren aged 13 to 17 have a significantly higher level of anxiety and depression than the average for this age. According to adolescents themselves, one of the main reasons for their psycho-emotional distress is the lack of understanding on the part of parents and teachers.

How increased anxiety manifests itself in children and how to stabilize their emotional state, the staff of ANO "CISM" was told by a teacher-psychologist of the state regional budgetary institution of the Murmansk region "Center for Psychological, Pedagogical, Medical and Social Assistance", a participant in a seminar-meeting on improving interdepartmental interaction in the system of education and prevention of neglect and juvenile delinquency Svetlana Kolesnik .

- What causes anxiety and obsessive thoughts in adolescents? Is this the norm?

Everyone experiences feelings of worry and anxiety from time to time. The same event in two people can cause different emotional states. For example, someone will not attach much importance to the loss of the phone, and the other person will be upset for many months, thinking that he is a loser. Anxiety is necessary in order to see the threat, mobilize your forces and deal with it. This feeling as a stable personality trait is formed in adolescence. The appearance of latent anxiety depends on individual characteristics and the presence of the following components in the child's experience : improper upbringing and dysfunctional parent-child relationships, unfavorable relationships with peers, low self-esteem, success at school.

One of the options for anxiety is obsessive thoughts. These are images or impulses that uncontrollably, against the will of a person, invade consciousness. Obsessive thoughts often appear when there is someone's evaluative attitude to our actions and deeds. In adolescence, the social environment and external evaluation are especially significant. Peers can influence the appearance of certain obsessive thoughts, constant looping . If a teenager constantly returns to a certain thought, cannot switch to something else, then this is no longer the norm. Also important is the intensity and form of manifestation of obsessive thoughts. In one case, if there is a pathology, you need to contact psychiatrists and clinical psychologists, and in the other case, a psychologist's consultation will be enough to understand the causes of the child's anxiety.

– What most often provokes the emergence of such emotional states?

- In adolescence, the child gains new experience, knowledge about himself and others. In this period of growing up, there is a clash of internal conflicts that have to be resolved independently and for the first time. Each teenager has his own significant events that cause feelings. An exam, first love, a quarrel with a friend can lead to various disturbing manifestations. The leading need of this age is communication with peers, so the most significant events will be associated with the immediate social environment. In some situations, the effect of contagion may occur, when the occurrence of anxiety is provoked by others. For example, if family members are very worried and worried about moving, then the child picks up similar feelings. In my opinion a frequent cause of fear and anxiety is the lack or inaccuracy of information . Qualitative, open and objective information makes it possible to prepare and prevent various troubles and, as a result, automatically reduce anxiety.

- What are the symptoms of increased anxiety?

The symptoms of anxiety can be divided into several categories. One of them is emotional changes : irritability, difficulty concentrating, disinhibition, outbursts of anger. The next category is physiological changes when the child complains about his physical condition. In this case, it is necessary to pay attention to frequent headaches, digestive disorders, changes in eating habits, excessive fatigue.

Separately, symptoms associated with sleep disturbance can be distinguished: the child often wakes up at night, it is difficult to fall asleep, he often has nightmares, after a good sleep there is no feeling of cheerfulness. Increased anxiety in a teenager often affects academic performance in school and in meaningful activities. Adolescents and adults may present with symptoms of panic attacks that occur against the background of stressful events and already signal a possible anxiety disorder. In such cases, there is a rapid heartbeat, fever or trembling, dizziness, difficulty breathing, numbness, chest pain. If we consider the symptoms in the context of pathology, then this is already a section of medicine, and not psychology. Then the intervention of medical professionals is required to provide assistance.

- How to help a teenager sort out his emotions?

In psychology, there is such a thing as emotional intelligence. This is the ability to recognize the feelings of other people and manage their own states. This ability is laid in infancy, when the child reads the different emotions of an adult who cares for him, copies them and then applies them in his life. To help a teenager sort out his or her conditions, adults need to voice their own feelings and let the child do it . The ability to express emotions is important - pronunciation allows you to realize them. If a parent forbids a child to feel (“do not be angry”, “do not cry”), then this can lead to psychosomatic disorders. It is often difficult for children to tell what emotions they are experiencing. Therefore, psychologists in their work use stimulus materials, explain what this or that feeling means. If a child does not have a clear example of how to understand emotions, then it is difficult for him to realize his own states.

- Is it possible to solve the problem of increased anxiety on my own?

– There are various methods of self-help in stressful situations. They include breathing exercises, muscle relaxation practices, switching from one thought to another . Teenagers need to be taught these techniques. However, due to age characteristics (mood swings), children often cannot cope on their own. In this case, should be nearby an attentive and sensitive adult who will record the emotional states of the child and take care of his feelings. The task of an adult is to accept what causes anxiety. It is extremely important for a child to feel support, then he is not left alone with his experiences.

If adults note a large number of different signs of an anxiety state, then consultation with a teacher-psychologist is necessary. Based on the results of the meeting, a decision can be made to contact a child psychiatrist. Unfortunately, in some cases, parents do not see any need for specialist help. As a result, the child's condition is aggravated and begins to be expressed in deviant behavior, which may include cases of self-harm.

- How to avoid anxiety and fears in a teenager?

- It is impossible to protect the child from all the external and internal conflicts that he has to face daily. Therefore, there will be worries and fears. A teenager learns to overcome life's difficulties and manage his condition. The task of an adult is to guide and accompany the child in new and disturbing situations , to accept his feelings, to pass on his knowledge and experience. It is important to take into account the symptoms that are in a state of anxiety. To avoid negative consequences, it is necessary to take into account areas of life that are significant for the child and treat them with care. If an adult denies the importance of something, then a teenager will carefully hide his experiences, emotions and feelings. Then it will be more difficult for the parent to provide timely assistance and support.


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6 hidden signs of teenage anxiety — Phoenix Center

All teenagers experience some anxiety from time to time.

Anxiety is actually a normal reaction to stress and sometimes helps teenagers cope with stressful or “pressing” situations. For many teens, things like public speaking, final exams, an important sporting event, or even a date can cause feelings of anxiety and anxiety. They may also experience palpitations or excessive sweating. This is how the brain reacts to the manifestation of feelings of anxiety.

However, for some adolescents, anxiety can go beyond these typical symptoms and negatively affect friendships and family relationships, participation in extracurricular activities, and even schoolwork. When anxiety interferes with normal daily life, the presence of an anxiety disorder should be considered. According to the National Institute of Mental Health, approximately 25% of adolescents aged 13 to 18 have an anxiety disorder, and just under 6% have a severe anxiety disorder .

Given that adolescents experience a wide range of physical and emotional changes as they grow older, an anxiety disorder can be difficult to detect.

Watch for these hidden signs of anxiety in adolescence:

Emotional change

While some anxious adolescents express feelings of pervasive anxiety , others experience subtle emotional changes such as:

  • feeling "wound up"
  • a feeling of being on the edge
  • irritability
  • difficulty concentrating
  • restlessness
  • inexplicable outbursts of anger

Changes in communication

Anxiety can negatively affect friendships. If the once outgoing teenager suddenly avoids his favorite activities or stops making plans with friends, think twice.
You may notice that your child:

  • avoids social interactions with friends
  • avoids extracurricular activities
  • isolates from peer group
  • spends more time alone

Physical changes

Many of the physical complaints that can occur with an anxiety disorder - infrequent headaches (1-2 times a week) should not be a cause for concern, but frequent headaches (every day or most of the week) - this is a significant reason.
Pay attention to common psychosomatic complaints such as:

  • frequent headaches, including migraines
  • gastrointestinal problems
  • unexplained pain, general weakness
  • excessive fatigue
  • complaints of feeling unwell without an obvious medical reason
  • changes in eating habits

Sleep disorder

The American Academy of Pediatrics recommends that adolescents aged 13 to 18 get 8 to 10 hours of regular sleep to maintain optimal health.
Pediatricians also recommend not using gadgets 30 minutes before bedtime.
Watch for the following signs:

  • difficulty falling asleep
  • frequent nightmares
  • child does not feel rested after sleep

Poor academic performance

Considering that anxiety can affect everything from sleep habits to eating habits to skipping school due to physical problems, it's not surprising that poor academic performance can also be the result of unrecognized anxiety. Absence from school, missed days due to anxiety-related illness, and constant worry can make it difficult for anxious teens to resolve workload tasks. Watch for these changes in a teenager:

  • big jump in grades (usually down)
  • frequently missed tasks
  • feeling overworked
  • difficulty concentrating on homework more than usual

Panic attack symptoms

Not all anxious teens experience panic attacks, and some experience mild panic symptoms that do not progress to a full-blown panic attack.
The following symptoms are common in people with anxiety disorders:

  • rapid heartbeat
  • fever, shivering, chills
  • dizziness
  • indigestion
  • shortness of breath
  • chest pain
  • sense of impending death
  • the feeling that they are "going crazy"
  • numbness or tingling in hands and feet
  • derealization

If a teenager is struggling with anxiety that is interfering with school, friendships, family relationships, or other areas of daily activities, it is important to contact a child/adolescent psychiatrist .

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