In last week’s column, we looked at anxiety and what the different
anxiety disorders are. Today, I will cover the causes of anxiety and how
to recognize it in your children.
What Causes Anxiety?
Anxiety can be caused by biological sensitivities, genetics, stressful
life events or learned behaviors. In the film Angst (an independent film
addressing teenage anxiety – strongly recommend seeing it if available),
one of the experts always asks a child “who in your family has anxiety?”
Whether passed on genetically, or through modeling and instilling feelings
of anxiety, the problem tends to run in families. When a family member,
particularly a parent, experiences anxiety, they often transmit those
fears indirectly to their children. The children become conditioned to
have similar anxious feelings to events in their lives. This can be done
through avoidance of activities and actions, and possessing an extreme
sense of worry and danger.
Children also develop anxiety from frightening or traumatic events. I have
found that dysfunctional inconsistent parenting, and poor limits and boundaries
can lead to anxiety, as children do not feel secure and are constantly
worried about what will occur, and try and develop ways to control everything
around them. Since this is not possible, the result is a feeling of fear
When anxiety begins, it often generalizes to other areas as well. For example,
someone may initially be fearful of crowds, then develop fear of going
outside where crowds are, and then generalize to being fearful of open
spaces (agoraphobia). As has been stated earlier, some anxiety in unfamiliar
situations is a normal, healthy response. It is when it becomes exaggerated
and interferes with day to day functioning, or causes one to avoid situations
they should be able to engage in, that it becomes an anxiety disorder.
The signs and symptoms of anxiety can be physical, emotional, or behavioral.
Anxiety is often experienced in the body, in the form of headaches, stomach
aches or pain with no apparent medical cause for the discomfort. Children
may change their eating patterns, feel nauseous or refuse to eat in public
spaces like the school cafeteria. They may show signs of nervousness,
like tics, fidgeting, sweating, extreme blushing or shaking. They may
avoid public places like restrooms. They may complain of chest pain or
muscle pain, and may constantly try to relax themselves. Sleep disturbance
is common, both in terms of falling asleep and staying asleep, as well
as nightmares and feelings of fatigue despite having slept.
Children with anxiety feel on edge frequently, and are easily irritated,
frustrated and act out verbally. They may appear timid and fearful of
making any mistakes. Criticism of any kind is experienced as very painful,
even when gentle and constructive. They can be labile and cry frequently.
Their minds are always active, particularly in worrying about the future.
We call that catastrophizing, which is a fundamental characteristic of anxiety.
When one catastrophizes, he/she projects into the future, often thinking
about the worst that can happen. For example, your child may do poorly
on a test, then think they will fail the class, then fear they will not
get into college, then project they will never get a job and that no one
will ever want to marry them, and so on. You get the picture. Fear of
being judged is a component of anxiety, and fear of failure goes with
it. Test anxiety and avoidance of school to relieve that anxiety are common.
As stated above, much of anxiety is experienced in the school setting,
and children with anxiety disorders are likely to avoid school. They may
feign illness or just state they cannot go. They will likely avoid activities
and avoid being around others. They withdraw, isolate and keep to themselves.
Those with OCD type of anxiety may engage in excessive hand washing, arranging
of items, hand tapping, mentally counting, behavioral rituals and other
compulsive behaviors. They may experience separation anxiety when away
from parents or home. Their anxiety may result in explosive outbursts
or expressions of anger.
It is important to recognize the signs of anxiety and not to minimize your
child’s feelings. Telling them not to worry or that it will go away
on its own may seem like it helps, but can actually make them feel worse.
In the next column, I will review some coping skills and some of the things
parents can do. In the meantime, remember that anxiety is extremely common,
and more importantly, very treatable.
Remember, if you have issues you would like to see addressed, please email me at
Moe Gelbart, Ph.D.
Executive Director, Thelma McMillen Center