Signs of Anxiety in Teens

Anxiety is one of the most common mental health challenges that teens face. In fact, approximately 1 in 5 adolescents report experiencing symptoms of anxiety or depression, according to the Kaiser Family Foundation.

While the signs of anxiety in teens may seem like typical teenage rebellion or moodiness, they are often reflective of deeper internal struggles that can affect almost every area of a teen’s life. In order to provide your teen with the support they need, it’s essential to gain a better understanding of what they’re going through.

What is Anxiety?

Anxiety is a persistent feeling of unease or worry that is tied to what might happen rather than what’s happening right now. It prepares the mind and body for situations that may never occur; however, this constant fight or flight response can be difficult to manage as anxiety tends to be lasting.

According to the DSM-5, anxiety disorders last for at least six months and can interfere with daily routines and relationships. Some of the most common anxiety disorders outlined include:

Separation anxiety disorder in which being away from family or close relationships causes extreme distress
Selective mutism, which makes it hard to speak in certain social settings
Specific phobias, or an intense fear of certain objects or situations
Social anxiety disorder, where social interactions feel intimidating or unbearable
Panic disorder that involves sudden and intense episodes of fear or panic
Agoraphobia, which makes some spaces or situations feel impossible to face
Generalized anxiety disorder, which involves constant worry about everyday things

What Can Cause Anxiety in Teens?

Academic pressure is one of the most common sources of stress for teens. Research shows that 61% of teens feel immense pressure to get good grades. Other things, like maintaining appearances, fitting in socially, and excelling in sports or extracurricular activities, also weigh heavily on many teenagers. These expectations can create an overwhelming environment where teens struggle to balance their responsibilities, thus leading to feelings of anxiety.

Biological changes during adolescence are another contributor to anxiety. The hormonal shifts that occur during puberty affect brain development, emotional processing, and social dynamics. As teens go through these changes, they may feel more emotionally vulnerable and reactive.

How Anxiety is Diagnosed in Teenagers

When diagnosing a teen with anxiety, a healthcare provider will often begin with a physical examination to rule out any underlying conditions that may be contributing to symptoms. From there, the provider will conduct a mental health exam that evaluates the teen’s symptoms, behaviors, and overall functioning to determine if their concerns meet the criteria for a clinical anxiety disorder.

Symptoms are considered clinically significant when they:

Are unexpected for the teen’s developmental stage
Persist even when reassurance or support is provided
Cause noticeable distress or interfere with daily activities, including school, relationships, and extracurriculars

Mental health professionals may use standardized questionnaires, interviews, or observation to determine the severity of the anxiety. Parents or guardians will often be questioned as well so that the provider can have a fuller picture of the teen’s behavior and experiences.

Anxiety Symptoms in Teens

Anxiety can present differently in teens than it does in adults. Symptoms are typically divided into three categories: psychological, behavioral, and physical.

Psychological Symptoms

Teens with anxiety may feel overwhelmed by emotions that seem out of proportion to their situations. These symptoms often include:

Intense feelings of panic, fear, or uneasiness without clear triggers
Persistent worry about future events or worst-case scenarios
Feeling constantly on edge, irritable, or unable to relax
Uncontrollable or obsessive thoughts
Difficulty concentrating or making decisions
Feeling a sense of impending doom or dread that’s hard to explain
Intrusive thoughts or a hyperfocus on personal flaws or fears

Behavioral Symptoms

Anxiety can also change how teens behave as they attempt to manage or avoid what they perceive as a threat. Common behavioral symptoms of teen anxiety include:

Avoiding activities, people, or places that provoke anxiety
Reluctance or refusal to go to school, participate in extracurriculars, or try new things
Becoming overly dependent on caregivers or peers for reassurance
Withdrawing from social situations or hobbies they once enjoyed
Engaging in repetitive behaviors, like pacing or fidgeting, to soothe their anxiety
Excessive procrastination or difficulty completing tasks due to fear of failure
Outbursts or emotional meltdowns when faced with anxiety-inducing scenarios

Physical Symptoms

Aside from the mind, anxiety can also affect the body. Teens with anxiety may experience physical symptoms such as:

Racing heart or palpitations, which can feel like a heart attack
Tightness in the chest or difficulty breathing
Nausea, stomachaches, or other digestive issues
Sweating, chills, or feeling faint without an obvious cause
Muscle tension, especially in the shoulders, neck, or jaw
Headaches or migraines triggered by stress
Trouble falling asleep, staying asleep, or waking up feeling unrested
Fatigue or low energy levels, even after getting enough rest

Anxiety Treatment for Teens

Teen anxiety can be treated with therapy, medication, or a combination of both. The choice of treatment often depends on the severity of the symptoms and how much they affect the teen’s ability to function.

Therapy

Cognitive Behavioral Therapy (CBT) is often recommended as the first choice for treating anxiety and has been shown to work well for mild to moderate symptoms. CBT focuses on two areas: helping teenagers recognize and reframe negative thought patterns and encouraging changes in behaviors that reinforce anxiety. It uses techniques like social skills training, relaxation exercises, and gradual exposure to fears.

Other therapies that may be beneficial for teens with anxiety include:

Supportive child-centered therapy
Mindfulness-based practices
Acceptance and commitment therapy (ACT)

Medications

While therapy is the first line of treatment, medications may be necessary for teens with more severe anxiety or when therapy alone is not effective. Medications may be recommended in cases where anxiety causes panic attacks, refusal to attend school, or extreme distress.

Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed medications for anxiety in teens. These include fluoxetine (Prozac), sertraline (Zoloft), and escitalopram (Lexapro), all of which are generally well-tolerated and effective. For some cases, serotonin-norepinephrine reuptake inhibitors (SNRIs), like duloxetine (Cymbalta), may also be used. Duloxetine is FDA-approved for treating generalized anxiety disorder in children and adolescents in the United States.

When Teens Should See a Doctor

While some anxiety is a normal part of growing up, there are times when it may not be just a passing phase. Teens should see a doctor if their anxiety begins to interfere with their ability to function at school, maintain friendships, or participate in activities they once enjoyed. Persistent symptoms, like uncontrollable worry, headaches, stomachaches, or trouble sleeping may indicate that professional help is needed.

You may also want to consult a doctor if your child’s anxiety leads to avoidance behaviors, like refusing to go to school or engage in social situations. Sudden changes in mood, outbursts of anger, or withdrawal from family and friends can also be a sign that the anxiety is reaching a level that requires intervention.

If you’re concerned about your teen’s anxiety, Mission Harbor Behavioral Health is here to help. Our experienced team provides specialized care that provides teens with the tools and support they need to thrive. Contact us today to learn more about our services or schedule a consultation.