Feeling shy or nervous in social situations can be a normal reaction to social experience, however for some teens, they find themselves so fearful and distressed when interacting with others that it causes great impairment in their life. Also referred to as Social Phobia, teenagers who suffer from this type of anxiety are extremely afraid of negative judgment and negative evaluation from others. They worry about looking foolish, giving off a bad impression, going blank mid-way in conversation, being embarrassed or being ridiculed. Physical symptoms of social anxiety can include shaking or trembling, feeling hot, feeling nauseous or faint, redness in the face, dry mouth, increased heart rate or shallow breathing. Due to the distressing nature of the anxiety, teenagers can begin to avoid social situations or reduce their social interaction quite significantly. They may avoid situations when they are required to initiate or maintain conversation, perform (such as public speaking), or when having to participate in groups (e.g. class discussion). They may even start to feel isolated and as a result, depressed. Therapy can offer teenagers the chance to overcome their social fears and feel better connected with others in their peer group.
Academic or Performance Anxiety
Some teenagers can find themselves so anxious about their academic performance that is begins to effect their mood and overall functioning. Related issues can include perfectionism, excessive worry and rumination, feeling on edge, procrastination, and sometimes avoiding submitting school work. While this can be thought of as merely part of being a “high achiever”, for some adolescents striving to achieve and the pressure to do things perfectly causes significant anxiety and stress.
Worrying persistently and excessively can be debilitating and exhausting! Excessive worry, or Generalised Anxiety Disorder, is a form of anxiety where there is a tendency to ruminate or worry excessively about bad events or negative outcomes. Common topics adolescents can worry about include: health and safety; the future; social concerns and friendships; being late; appearance; family finances; or academic performance. Other symptoms of Generalised Anxiety Disorder include difficulty with concentration and attention, sleep disturbance, appetite changes, general feeling of irritability and restlessness, finding it hard to relax or wind down and somatic symptoms such as muscle tension, stomachaches or headaches.
While more commonly experienced in younger children, teenagers too can feel fearful about being away from family, or worrying that something bad might happen them or to their loved ones while they are away. Daily expressions of this anxiety can look like excessive questioning, reassurance-seeking, distress when having to be away from home or parents (such as sleep overs, school camps).
Panic attacks can be described as the sudden onset of intense fear and discomfort. People with Panic disorder experience recurrent and unexpected episodes of intense fear which involve unpleasant physical symptoms. These symptoms can include shortness of breath and difficulty breathing, feeling nauseous, feeling faint or dizzy, heart palpitations, sweating and shaking. These symptoms can then be misinterpreted and lead to other worries including fear of losing control, fear of having a heart attack or fear of going “crazy”. Worrying about having further panic attacks and not being able to escape can lead to avoidance of certain places, situations or environments such as crowded places, public transport, driving, or some social situations.
OCD (Obsessive Compulsive Disorder)
This type of anxiety refers to two components. One component of OCD is the experience of persistent obsessions. Obsessions are recurrent thoughts, images or urges that are intrusive, unwanted and distressing. It is extremely difficult to stop or switch off from these thoughts. For example, thoughts about contamination or harming others. The other component of OCD is the compulsions – repetitive behaviours that are performed in response to obsessions. For example, repeating rituals of washing and cleaning, ordering or checking. Usually people engage in the compulsion in order to reduce anxious feelings or discomfort caused by the obsession, or in order to prevent bad things from happening. Some adolescents experience only the thought component of OCD, while others engage in the ritualistic behaviour as well. Daily life for teenagers suffering from OCD can be a struggle as it causes significant distress and life interference.
Phobias refer to an intense and persistent fear of a situation, place, animal or object. When confronted by the feared situation or object, people with phobias feel frightened, anxious or very uncomfortable. Those who experience phobias often go to great lengths to avoid their fears. Commonly reported fears in adolescence include fear of: blood, needles/injections, heights, small or confined spaces, vomiting, choking, animal or insect phobias.
Low Mood and Depression
With the ups-and-downs of mood that teenagers typically experience, adolescent Depression is fequently overlooked and often mistaken for the effects of teenage hormones. While this can contribute in some cases to mood instability, for other teens, their mood problems can develop into Depression. Symptoms of Depression in youth can include: feeling depressed most days; feeling hopeless, worthless; restlessness or alternatively feeling slowed; reduced feeling of interest or pleasure in usual activities; changes in appetite; sleep disturbance; fatigue; and difficulties with concentration, attention and memory. In severe cases of depression, some teenagers experience thoughts of suicide.
Body Image Concerns and Disordered Eating
Body image is the perception that a person has of their physical self. Poor body image is when there are negative thoughts and negative feelings associated with that perception. Teenagers can experience great distress and anxiety about their appearance, body weight or shape. Teenage boys and girls can both be affected by unhealthy body image. Sometimes unhealthy body image can lead to an unhealthy relationship with food including the development of eating problems such as binging or over-eating, under-eating, restricting food, or bulimia.
As children move into adolescent years, changes to their sleep cycle can be common. Many teens do not get adequate sleep. Reasons for this can include: changes in physiology, being consumed by fear or worry, busy schedules, academic pressures, as well as excessive use of electronic devices and screens. Sometimes sleep problems in teenagers can also be symptomatic of underlying problems with anxiety or depression.
Compulsive or Unwanted Behaviours
Teenagers can experience distress and impairment caused by various compulsive or seemingly incontrollable behaviours. Such behaviours can include skin picking and hair-pulling (trichotillomania), or compulsive patterns of behaviour around eating. These concerns are usually a result of problems with impulse control, where the teen finds it difficult to resist urges or impulses to engage in these behaviours. Therapy can help those wanting to reduce these unhelpful behaviours and respond to the urges differently or more effectively.
People who engage in self-harm deliberately hurt their bodies. The most common methods of self-harm among young people are cutting, scratching, hurting or banging body parts, and deliberately overdosing on medication. Therapy can help teens who engage in self-harming behaviours to break the cycle of self-harm by learning to recognise the factors that have led to the development of their harming behaviours as well as working on finding other more helpful strategies to cope with negative and overhwleming emotions.
Concerns with Peers & Friendships (including bullying)
In general, a teenager's ability to make friends can be impacted by a number of factors, including their communication skills, social skills, shyness, self-esteem, and attitudes towards friendships and intimacy. Initiating and maintaining friendships can be particulary challenging for those who have experienced previous interpersonal rejections including social exclusion, teasing, and bullying.