January 9, 2019

Intro to Anxiety Disorders

By Mihai Simionescu MD By MS
Complexity rating Basic
Evidence High Evidence
Read time 6 minutes

Up to a point, at different times, especially of stress, all people, throughout their lives, will experience the signs and symptoms associated with Anxiety Disorders (AD). And what makes the difference between this ‘normal anxiety’ and an anxiety disorder?

In order to make a diagnosis of anxiety, a mental health specialist needs to identify that the symptoms produce significant impairment in functioning and or lead to significant subjective distress (emotional pain). This means that the symptoms of anxiety need to affect the individual’s capacity to engage in age appropriate activities, from work to enjoyment and from self-care to relationships. 



The field of psychiatry recognizes the following disorders that can be diagnosed in children and adolescents:

  • Separation anxiety disorder
  • Generalized anxiety disorder
  • Panic disorder
  • Phobias (including social phobia)
  • Selective mutism
  • Obsessive-compulsive disorder
  • Post-traumatic stress disorder
  • Anxiety disorder associated with a medical condition

Will address each of these disorders individually elsewhere. For now, let us talk about Anxiety Disorders (AD) as a group.


AD are not rare at all. Between 4 and up to 20% of all children and adolescents will be diagnosed with anxiety at some point. Girls are more likely than boys to develop one of these conditions.


The youth diagnosed with an AD are quite likely to have at least another disorder (39% of children and 14% of adolescents). The most common additional diagnoses (comorbidity) are:

  • Another anxiety disorder
  • Depression
  • ADHD / ODD.


What causes somebody to develop an AD? All mental processes are very complex with ‘many moving parts’. A lot of things could go wrong (that is, worse than average) and these are called risk factors. Likewise, a lot of things could go well (that is, average or better than average) and these are called neutral or protective factors. While it is hard to say with absolute certainty why a child developed that particular anxiety disorder, we generally think that it is a combination of having a number of risk factors present and and number of protective factors absent.

A number of important risk factors for the development of AD are:

  • Inheriting a genetic risk – family history of AD in parents and close relatives. If a child has an AD there is a 50% probability that at least one parent has an AD.


  • Having certain temperamental or personality traits. Temperament is the part of the personality that is ‘built in’, biologically determined, relatively independent of experience. Such traits that carry a risk for the development of AD are:
    • Excessive fearfulness or behavioral inhibition trait is a tendency to respond to novel situations in shy, or timid ways. These kids are harm avoiders, they will not seek novelty as much and shut down more than average when something doesn’t work. This trait is present in 10-15% of all children and can be noticed from toddlerhood. 


    • High neuroticism is a personality trait. It means that the child is more moody and has more and more intense negative emotions like anxiety, sadness or anger. This is a risk factor for anxiety and but also for depression and other conditions.



  • Exposure to stressful and negative life events (especially in early childhood)
    • History of trauma, abuse, bullying, living in unsafe circumstances are obvious, rather extreme examples of such events.


    • Also important may be a variety of parenting practices and styles. The home environment can be a ‘fear conditioning’ environment if the parent most involved in parenting is also very anxious. The anxious parent will model inevitably an anxious style of reacting to what otherwise are neutral situations, and may be over-protective and controlling. In turn this models low confidence and low autonomy in the child. For this reason, having the anxious parent receive treatment early on, becomes a significant protective role, lowering the likelihood for the development of an AD in the child.


  • Having some physical health conditions, such as thyroid problems, heart arrhythmias and others.


Like any disorders, anxiety disorders can be mild, moderate or severe in their impairment of the child or adolescent. It is generally better for parents to seek help earlier and try to get a proper diagnosis with somebody experienced. 

This is because untreated anxiety disorders are persistent over time. At 4-5 years after diagnosis up to 77% of the cases no longer had that particular, initial, anxiety disorder. A substantial number of cases continue to struggle though, often with a new disorder (for example depression or an anxiety disorder different than the first one). 


This is the first part of the anxiety disorder series. The next part will try to help you make sense of anxiety symptoms.