Anxiety

Anxiety

Anxiety is a feeling of apprehension, fear and uneasiness often accompanied by nervous behaviour and is characterized by physical symptoms like sweating, palpitations etc.

Normal vs Abnormal anxiety

Anxiety with optimum level can be beneficial as it improves performance and excessive anxiety causes decline in performance.

It is considered pathological when it turns out to be strangely extreme, unavoidable, inappropriate and debilitating.

Fear vs Anxiety

Anxiety is caused by an unknown internal stimulus or exaggerated response to the external stimulus.

While fear is a sense of dread and foreboding that occurs in response to some external threatening event.

Characteristics of an anxious child

1. Harder to calm themselves
2. Usually,above-average creativity but they are unable to use this creativity in coping
3. Even with a good plan get discouraged easily and quit
4. Fail to recognise their success

Types of Anxiety

Generalized Anxiety Disorder – Children with GAD have persistent, unnecessary, extreme, outlandish and unrealistic concerns that do not revolve around a particular item or circumstance. A child may stress unnecessarily over their presentation and performance at school or in activities like games, about close to home security and that of relatives, or about catastrophic events.

Children with generalized anxiety struggle “winding down” they’re stressing, which leads to difficulty in thinking, concentrating, learning, and participating in social situations. Some children may be insecure and habitually look for consolation, while others may be self-conscious, self-doubting, or excessively worried about meeting other people’s expectations.

Obsessive-Compulsive Disorder – Children with OCD encounterrecurring, intrusive, unwanted thoughts (obsessions) and repetitive, purposeful physical and mental actions (compulsions). Children often intend for compulsive behaviours to control anxiety-provoking thoughts but end up being controlled by their OCD.They perform compulsions, or repetitive actions, rituals, or routines, to relieve the anxiety associated with those thoughts. Compulsions may involve cleaning, counting, organizing objects, or reading a text over and over.In these children, these thoughts and behaviours significantly interfere with their everyday working and can cause distress and shame.

Panic Disorder – Some children or adolescents mightencounter extreme discomfort, uneasiness or fear when in certain situations or places, resulting in a panic attack. A panic attack is a discrete period ofintense anxietynot associated with a specific circumstance or conditions.It develops abruptly, reaches the peak over 10 minutes and last for limited time (5-30 minutes). The attack manifests as a mixture of physical and psychological symptoms.

Physical symptoms –

1. Shortness of breath
2. A Pounding heart / accelerated heartbeat
3. Sweating
4. Chills or hot flushes
5. Chest pain or discomfort
6. A sense of choking
7. Dizziness

Psychological symptoms –

1. Fear of dying
2. Fear of losing control

Specific Phobias– Persistent, irrational, excessive fear of a specific object or situation like animals, heights,thunder etc. that often leads to avoidance of places where the feared object or situation could be encountered and if confronted with the object of their fear, children may react with extreme distress.

Social Phobia – Social phobia, also known as social anxiety disorder, is an extreme fear of being dismissed, embarrassed, or humiliated in front of others. Children and adolescents with social phobia stress over a wide range of situations, like speaking in front of a gathering, taking an interest in class, conversing with grown-ups or friends, beginning or participating in discussions,or eating in public. They may fear unfamiliar or new people and have difficulty making friends.

Separation Anxiety Disorder–Associated with severe distress upon detachment from a place or individual with whom a patient is emotionally connected. Youth might decline to go to spots like school or camp and frequently have fears in regards to the wellbeing and security of their folks, in any event, during brief partitions.

These children experience significant fear and distress about being away from home or their parents. This fear alters the abilities of child to function socially and academically.For instance, a child might struggle making companions or keeping up with connections since the person will not go on playdates without a parent, or rest without being close to a parent or guardian.

Selective Mutism–Children with selective mutism speak freely or unreservedly in familiar and recognizable situations but become mute in specific situations or around certain individuals. Some children with selective mutism may avoid eye to eye contact and refuse to communicate with others. Others may enjoy the company of others but remain silent or have a dear companion who represents them.

What are the signs of anxiety in children?

When young children feel anxious, they can’t generally comprehend or communicate what they feel.

• They become irritable, tearful or clingy
• Have difficulty in sleeping
• Often wake up in the night
• Start wetting the bed ( nocturnal enuresis )
• Have bad dreams
• Lack confidence to try new things
• Seem unable to face simple and everyday challenges
• Find it difficult to concentrate
• Anger outbursts
• Encounter negative thoughts

Treatment

The most effective treatment for youth is a combination of cognitive behaviouraltherapy and medications.

Pharmacotherapy–

1. SSRIs( Selective Serotonin Reuptake Inhibitors )–increases serotonin level in brain and hence elevate mood.

• fluoxetine
• fluvoxamine
• paroxetine
• sertraline

2. SNRIs ( Serotonin and Norepinephrine Reuptake Inhibitors ) – increases the level of both serotonin andnorepinephrine in the brain andimproves mood and reduce the feeling of anxiety.

• Venlafaxine
• Duloxetine

3. Benzodiazepines– enhance the action of GABA and have a calming effect on the excitable parts of the brain. Thus, helps to manage anxiety.

• Lorazepam
• Clonazepam
• Alprazolam
• Oxazepam

4. Tricyclic antidepressants

• Amitriptyline
• Amoxapine
• Doxepin

Cognitive Behavioural Therapy (CBT)

Cognitive behavioural therapy (CBT) is a type of psychotherapeutic treatment that aims to improve mental health and assists kids in figuring out how to recognize and change disturbing or destructivethought patterns that hurt conduct and feelings.