Anxiety & OCD In
Teens And Adolescents

Feelings of anxiety are normal for teens at some point in their life. It is a natural and important emotion for us to experience and can be helpful when signaling to us through stirrings of worry, fearfulness, and alarm that danger or a sudden, threatening change is near. Yet sometimes anxiety becomes an exaggerated, unhealthy response.

Given the array of changes and uncertainties facing a normal teenager, anxiety often hums along like background noise. For some teenagers, anxiety becomes a chronic, high pitched state, interfering with their ability to attend school and to perform up to their academic potential.

Participating in extracurricular activities, making and keeping friends, and maintaining a supportive, flexible relationship within the family becomes difficult. Sometimes anxiety is limited to generalized, free-floating feelings of uneasiness. At other times, it develops into panic attacks and phobias. Other times, the anxiety is the outflow from Obsessive Compulsive Disorder. 

Our Experience With Anxiety & OCD In Teens

At NPS, we have been working with teens in general with many different types of struggles for over 4 decades. We have multiple therapists who specialize and have experience in dealing with adolescents who struggle with anxiety or OCD.

Dr. Douglas Neal has decades of experience of diagnosing and teasing out the various reasons why a teen is struggling with anxiety or OCD.  

Zach Neal, MA is seasoned and passionate about working with teens.  

Zachary Schmidt, LPC is passionate and also brings a specialty of working with teens who struggle with anxiety as it relates to performance stress associated with sports, academics or as a musician. 

What Is Anxiety 

Identifying the Signs of Anxiety

Anxiety disorders vary from teenager to teenager. Symptoms generally include excessive fears and worries, feelings of inner restlessness, and a tendency to be excessively wary and vigilant. Even in the absence of an actual threat, some teenagers describe feelings of continual nervousness, restlessness, or extreme stress.

Teenagers who suffer from excessive anxiety regularly experience a range of physical symptoms as well. They may complain about muscle tension and cramps, stomachaches, headaches, pain in the limbs and back, fatigue, or discomforts associated with pubertal changes. They may blotch, flush, sweat, hyperventilate, tremble and startle easily.

Anxiety during adolescence typically centers on changes in the way the adolescent's body looks and feels, social acceptance, and conflicts about independence. When flooded with anxiety, adolescents may appear extremely shy. They may avoid their usual activities or refuse to engage in new experiences. They may protest whenever they are apart from friends. Or in an attempt to diminish or deny their fears and worries, they may engage in risky behaviors, drug experimentation, or impulsive sexual behavior.

Anxiety In Teen Girls

Studies have shown that anxiety has skyrocketed in girls. One study found that the number of girls who often felt nervous, worried or fearful jumped by 55 percent over a five-year period. What factors are behind rising stress and anxiety in girls and what can we do about it?

Dr. Lisa Damour is a clinical psychologist and executive director of Laurel School’s Center for Research on Girls. She has a new book out called "Under Pressure: Confronting the Epidemic of Stress and Anxiety in Girls."

Anxiety Rates In Teens

Anxiety among teens and young adults is rising. 31.9% of teens have some type of anxiety disorder. 8.3% of those with an anxiety disorder have severe impairment as a result. 38% of female teens have an anxiety disorder. 26.1% of male teens have an anxiety disorder.

Types Of Anxiety In Teens

Social Anxiety In Teens

In a social setting, anxious teenagers may appear dependent, withdrawn or uneasy. They seem either overly restrained or overly emotional. Some teens are naturally more timid than others, as their bodies, voices, and emotions change during adolescence, they may feel even more self-conscious.

Despite initial feelings of uncertainty, most teens are able to join in if given time to observe and warm up. In extreme cases, called social phobia, the adolescent becomes very withdrawn, and though they want to take part in social activities, they are unable to overcome intense self-doubt and worry.

Gripped by excessive or unreasonable anxiety when faced with entering a new or unfamiliar social situation, the adolescent with social phobia becomes captive to unrelenting fears of other people's judgment or expectations. They may deal with their social discomfort by fretting about their health, appearance, or overall competence.

Alternatively, they may behave in a clowning or boisterous fashion or consume alcohol to deal with the anxiety.

If you notice your teenager is struggling socially, there is a chance they may be suffering from social anxiety disorder. Knowing the signs and symptoms of this mental health disorder is the first step in helping your teen get the necessary help.

• Anxiety about being with other people (especially people they do not know)
• Difficulty talking to and/or having “normal” conversations with others
• Feeling uncomfortable or self-conscious around other people
• Experiencing embarrassment while interacting with others
• Fear of being embarrassed
• Self-judgment and criticism after social interactions
• Fear of being judged by others
• Worry for days or weeks before a public event
• Avoidance of public places and/or social situations
• Difficulty making friends and maintaining relationships
• Blushing, sweating, shaking, or rapid heart beat when in social situations
• Stomach aches and nausea as a result of being around other people (other physical symptoms may include – confusion, diarrhea, muscle tension)

Every teen with social anxiety disorder will experience the same symptoms (or same severity).  And while the symptoms can be quite significant and impair functioning in a variety of ways, social anxiety disorder is treatable.

Separation Anxiety In Teens

Separation anxiety is seen in younger children as a normal developmental stage. The older kids get, the less common Separation Anxiety Disorder seems to be. Historically, little children have needed to stay in close proximity to their parents in order to survive. Feeling anxious about being far away from a parent makes sense.

The older children get, the less common Separation Anxiety Disorder seems to be. About 3.9% of young teenagers (12-14) are dealing with separation anxiety symptoms. The numbers go down even further for older teenagers, to about 1.3% for teenagers ages 14-16. Although it used to be considered a children’s condition, some research suggests that a small percentage of adults continue to struggle with Separation Anxiety Disorder into adulthood. 

Panic Disorder In Teens

More common in girls than boys, panic disorder emerges in adolescence usually between the ages of fifteen and nineteen. Feelings of intense panic may arise without any noticeable cause or they may be triggered by specific situations, in which case they are called panic attacks. A panic attack is an abrupt episode of severe anxiety with accompanying emotional and physical symptoms.

During a panic attack, the teen may feel overwhelmed by an intense fear or discomfort, a sense of impending doom, the fear he or she is going crazy, or sensations of unreality. Accompanying the emotional symptoms may be shortness of breath, sweating, choking, chest pains, nausea, dizziness, and numbness or tingling in his/her extremities. During an attack, some teens may feel they're dying or can't think.

Following a panic attack, many youngsters worry that they will have other attacks and try to avoid situations that they believe may trigger them. Because of this fearful anticipation, the teen may begin to avoid normal activities and routines.

Phobias In Teens

Many fears of younger children are mild, passing, and considered within the range of normal development. Though some teenagers develop exaggerated and usually inexplicable fears called phobias that center on specific objects or situations. These intense fears can limit a teenager's activities.

The fear generated by a phobia is excessive and not a rational response to a situation. The objects of a phobia usually change as a child gets older. While very young children may be preoccupied with the dark, monsters, or actual dangers, adolescents' phobic fears tend to involve school and social performance. 

Several studies have revealed an increase in school avoidance in middle-school or junior-high years. With school avoidance, excessive worries about performance or social pressures at school may be at the root of the reluctance to attend school regularly. This leads to a cycle of anxiety, physical complaints, and school avoidance. The cycle escalates with the worsening of physical complaints such as stomachaches, headaches, and menstrual cramps.

Visits to the doctor generally fail to uncover general medical explanations. The longer a teenager stays out of school, the harder it becomes for them to overcome their fear and anxiety and return to school. They feel increasingly isolated from school activities and different from other kids.

OCD In Teens

Identifying the Signs of OCD

• Fear of dirt or germs
• Fear of contamination
• A need for symmetry, order, and precision
• Religious obsessions
• Preoccupation with body wastes
• Lucky and unlucky numbers
• Sexual or aggressive thoughts
• Fear of illness or harm coming to oneself or relatives
• Intrusive negative or fearful thoughts
• Continual need for reassurance from a parent

How To Help Your Teen With Anxiety And OCD

Do your homework to learn as much as you can about anxiety and OCD. There are many good resources online to learn how to bring anxiety relief and help with OCD. At NPS our therapists are trained and experienced in using natural, alternative methods to help treat anxiety and OCD.

While anxiety medication and OCD medication may need to be used, we assess for the best approach and work closely with our parents and teens to arrive at a collaborative decision on what is the best approach. Many times, using both mindfulness techniques in addition to medication or natural supplements together is the most effective approach for relief. 

7 Reasons Teens Have So Much Anxiety

1. High Expectations

Today’s teenagers are under a lot of stress and tend to place high expectations on themselves. Most teens want to do well in school and might expect to go to prestigious universities. Many participate in after school sports and part-time jobs.

Today’s teens also volunteer, participate in community events, have chores at home, and want to maintain active social lives. These expectations not only make teens feel stress, but they also leave little time for decompressing, having quiet time, and even sleeping. Sleep deprivation adds to anxiety and anxiety makes it harder to sleep, creating a vicious cycle.

2. Hormones

Your teen’s hormone production ebbs and flows during adolescence. Sometimes your teen might feel anxious, upset, depressed, and angry for no reason at all. Some of this is likely caused by hormonal fluctuations. Teenage boys are dealing with testosterone surges, and teenage girls are dealing with hormonal shifts due to menstruation. Combined with a lack of experience in dealing with these feelings and general immaturity, hormones are a recipe for stress and teenage anxiety.

3. Brain Development

Teenagers don’t have fully developed brains until they are in their early- to mid-twenties or even later. Your teen is expected to take on adult responsibilities, but they don’t have the skills or the brain development necessary to really care for themselves. Your son or daughter has probably had many moments where they didn’t know what they were doing. Frustration mixed with a lack of ability when it comes to “adulting” raises teenage anxiety levels.

4. Parental Disapproval

Teens are at an awkward stage where they want the approval of their parents but also want to do things that push up against parental authority and society. This is frustrating for both teens and parents. When they are met with parental disapproval, it’s natural that they feel stressed and anxious. At the same time, they continue with actions that are not what their parents would have them do. This is a necessary and natural stage of development, but it is stressful for everyone involved.

5. Peer Pressure and Social Media

Kids today are under a lot of pressure from their peers. Peer pressure can be positive or negative, but both types raise stress levels. For example, being pressured to shoplift or commit some other crime is stressful and an example of negative peer pressure. If your teen’s peers are all getting excellent grades, applying to good universities, and dating the captain of the football or cheerleading team, this puts a lot of pressure on your own teen to conform and keep up. Social media is also a significant source of stress because it can appear as if their peers are living the perfect life or your teen is being left out. 

6. Drinking and Drug Use

Many teens experiment with alcohol and, in some cases, drugs. They know they shouldn’t be doing this and that their parents will disapprove. Peer pressure might also be involved. All of these factors can lead to teenage anxiety before, during, and after the experimentation. Worse, some teens will go on to become addicted to these substances, which raises anxiety levels even higher. Finally, some teens who are anxious already will turn to these substances as a form of self-medication. It rarely works; instead, anxiety levels go up, which leads to more self-medication.

7. Depression

Some teens have depression, which can present at the same time as teenage anxiety. The symptoms of depression can overlap with the symptoms of anxiety, so sometimes it’s difficult for parents to know which mental health concern is responsible for which symptoms. Our NPS counselors are trained and experienced in how to tease out the difference. 

FAQs On Anxiety And OCD In Teens & Adolescents

How To Talk To Teens With Anxiety or OCD?

If your teen is acting differently than usual or you notice some signs of anxiety, the first step is to talk to them about it. Even if there isn’t anything going on, an open and non-judgemental conversation won’t do any harm and will only improve your relationship with your teen.

Be specific about what you’ve noticed and why you’re worried. For example, you might say: ‘You haven’t been seeing your friends recently. Is everything okay?’ Or: ‘I’ve noticed that you don’t seem to be sleeping well recently. Is there anything you want to chat about?’ or ‘I notice that you are excessively worried’ or ‘I notice that there are routines or habits that you must do.’

When talking to your teenager, try to:

• Empathise and acknowledge their feelings. Teens often don’t speak out about their worries because they’re afraid that people won’t take them seriously. For a teenager experiencing anxiety, it’s especially important that they feel you’re taking them seriously and are there to support them. It’s normal for a young person to be focused on social relationships. Some worries may sound minor or illogical to adults; however, it’s important to show that you ‘get’ them, by acknowledging their concerns. You could say: ‘It sounds like you’re feeling really worried about this.’
• Listen and relate. If your child wants advice, they’ll ask for it. Otherwise, they just want to know that you’re there for them. Listen to what they’re saying and share your own experiences to show that what they’re going through isn’t anything to be ashamed of.
• Check in regularly. Keeping the communication lines open, even if your teenager doesn’t want to chat right now, tells them that if anything happens and they need you, you’ll be there for them.

Good Jobs For Teens With Anxiety?

This can be tricky waters to navigate because a teen with anxiety may avoid conversation about your desire for them to start working. It is important to understand that if your teen has more than just the normal anxiety associated with stepping out to try something new, then perhaps a conversation with a counselor trained in the more serious nature of an anxiety disorder may be warranted.

Your teen may seem lazy or defiant when refusing to look for a job when underneath they feel overwhelmed by the prospect of getting a job. 

Easy Coping Skills For Teens With Anxiety?

If your teen has anxiety, there are some lifestyle changes that you can recommend that might help. If they don’t help or if the anxiety is affecting your child’s daily life, it’s time to see a mental health specialist. Start with your pediatrician or family doctor, who can run some tests; sometimes vitamin deficiencies or hormonal imbalances can cause symptoms that mimic anxiety. If nothing physical is found, then your teen will be referred to a mental health provider.

In the meantime, try some of these tips:

• Encourage your teen to get daily exercise. Evidence shows that exercise can reduce the symptoms of anxiety. If your teen isn’t involved in a sport, try inviting them to walk or run with you before or after dinner or suggest a game of soccer in the backyard. If you have a dog, ask your teen to take responsibility for walking it each day.
• Encourage your teen to eat a healthy diet. Too much sugar, a high-fat diet, and other poor eating habits can exacerbate anxiety. Have your teen focus on eating more vegetables, whole grains, fruits, dairy products, and lean sources of protein.
• Help your teen evaluate his or her schedule. It could be that they’re overextended. You might have to ask them to drop one or two activities if they’re too stressed out by their obligations. Time management techniques can help, too.
• Teach your adolescent about relaxation techniques. Visualization, progressive muscle relaxation, mindfulness meditation, yoga, and breathing exercises can all help your teen take charge of his or her anxiety.

Working with your teen to help them get through this period of transitioning from childhood to adulthood can help minimize teenage anxiety and set the stage for a lifetime of good mental health.

Links Between Teen Anxiety And Depression

Often we see a teen who has both anxiety and depression. It is important to tease out which came first because long term depression can lead to a teen presenting with anxiety. Their depression has undermined their ability to perform at school academically, or navigate the social waters in the hallway or classroom or they can no longer engage in after school activities.

This can lead to them feeling overwhelmed which will present as anxiety. It’s the chicken or the egg scenario, as which is causing which? Which came first? The same is true for long term anxiety, as it too prevents a teen from doing the normal things their peers or friends are doing.

After many months, it can become depressing for a teen to even consider stepping out and doing a normal adolescent life. A skilled therapist can determine what is primary and what is secondary and how to proceed with an effective counseling plan of treatment.