Clinical
Anxiety Disorders

What are the Different Types of Anxiety Disorders and Their Symptoms?

Separation Anxiety Disorder (SAD)
Children with SAD experience extreme fear and distress concerning separation from home or primary caregivers. They may have tantrums, cling, and cry when asked to separate from home or parents. They often worry excessively about their parents’ health and safety, have difficulty sleeping without parents, complain of stomachaches and headaches, and may refuse to go to school.

Generalized Anxiety Disorder (GAD)
GAD is characterized by chronic, excessive, uncontrollable worry that may relate to school, making friends, health and safety of self and family, and future events. In addition, one of the following symptoms are present with the worry: restlessness or feeling on edge, muscle tension, get tired out easily, difficulty with sleep, irritability, or poor concentration. Children with GAD often are perfectionists. These children may suffer with their anxiety without others being aware of it. Physical complaints such as headaches, stomachaches, aches and pains are common.

Social Phobia
Children with social phobia experience extreme fear or discomfort in social or performance situations. They fear negative evaluations and worry about doing something embarrassing or dumb in social settings such as classrooms, restaurants, or sports activities. In school, they may have difficulty raising their hand, participating in class discussions, working in groups, attending gym class, using public restrooms, eating in front of others, having their picture taken for yearbook, attending school activities or dances.

Specific Phobia
Specific phobia is fear of a particular object or situation, and may be associated with avoiding that object or situation. Common phobias include a fear of small spaces, certain animals, insects, or heights to name a few. Specific fears are common; however, when it interferes with normal life, treatment may be warranted.

Panic Disorder
Panic disorder involves recurrent and spontaneous attacks of intense fear. They are not just associated with a specific situation or stressor, but seem to occur “out of the blue”. These episodes must be accompanied by at least four symptoms such as pounding or racing heart, sweating, shaking, difficulty breathing, chest pain, feeling of choking, nausea or upset stomach, chills or hot flushes, numbing or tingling in hands or feet, dizziness, fear of dying or going crazy. Once a child has experienced a panic attack, they may be very fearful of having another one and what might happen if do have another panic attack.

Agoraphobia
Children with agoraphobia avoid or are cautious in places where they fear they will be unable to get help or escape if necessary. Agoraphobia may present on its own or with panic disorder. Common problematic situations for children with agoraphobia include crowds, standing in line, shopping malls, traveling (especially by public transportation), enclosed places such as elevators, open spaces such as large parks, and trips or camps away from home.

Obsessive Compulsive Disorder
Obsessions are uncontrollable thoughts or images that occur over and over in the child’s mind that do not make sense. Children and adolescents with OCD are usually aware that their behavior is unnecessary or extreme, but they feel they are unable to stop or control their actions or thoughts. Some children and adolescents try to cope with severe anxiety by repeatedly doing something that may calm their fears. The child may feel anxious or uncomfortable if he/she cannot do the same thing over and over in a special way or order. These are called compulsions or rituals.
Children obsessively worried about contamination, for example, may wash their hands repeatedly. People who fear causing unintentional harm may check something—like whether the gas is turned off or whether the doors are locked—over and over again. Other signs of obsessive compulsive disorder (OCD) include excessive collecting or hoarding, compulsive counting, doing things in an unnaturally slow or ritualistic manner, replacing "bad" thoughts with "good" ones, and fears related to religious beliefs.
OCD frequently co-occurs with other disorders, including ADHD, tic disorders, or Tourette’s syndrome. In addition, OCD has been found to co-occur with bipolar disorder.

Post-Traumatic Stress Disorder
Post-traumatic stress disorder (PTSD) may follow a traumatic event such as an accident, fire, shooting, rape, assault, or natural or man-made disaster. The trauma may be a one-time event or repeated trauma such as abuse, neglect, or repeated serious medical procedures/surgeries. The child may experience the trauma, witness the trauma, or be confronted by the trauma. The child’s response to the trauma includes intense fear, helplessness, horror, disorganization, or agitated behavior.
Often, children and adolescents with PTSD will have frightening thoughts, nightmares, and memories about the traumatic event that interferes with their daily routine. This is called re-experiencing the trauma. Youth with PTSD may avoid things that remind them of the trauma (avoidance), have a hard time expressing their feelings or enjoying things (psychic numbing) and think that the future will not work out for them. Hyperarousal symptoms include difficulty sleeping and restlessness, feeling angry and easily upset, difficulty paying attention, being on the lookout for danger all the time (hypervigilance) and getting startled easily.
Depression often co-occurs with PTSD.

Selective Mutism
Selective mutism is characterized by a persistent inability to speak in certain situations (e.g., school) despite the ability to speak in other settings (e.g., home). Children with selective mutism often have difficulty laughing, speaking, reading, or singing aloud in front of people outside their family or home environment. Although selective mutism is not officially categorized as an anxiety disorder, most children with selective mutism also have social phobia.

Co-occurring Conditions
Anxiety disorders commonly occur with other anxiety disorders as well as with other psychiatric disorders. Most children with an anxiety disorder meet criteria for at least one other anxiety disorder. Other common co-occurring conditions include Major Depressive Disorder or Attention Deficit Hyperactivity Disorder (ADHD). The rate of co-occurring anxiety and major depressive disorder increases with the age of the child. In addition, some young people with anxiety disorders also suffer from Trichotillomania, which refers to a tendency to pull one’s hair out (scalp, eyebrows, eyelashes, and other body hair) resulting in noticeable hair loss. When a child experiences co-occurring disorders, all should be considered in developing treatment interventions.

Contact Information
For more information or to schedule an evaluation, please call the Pediatric Stress and Anxiety Disorders Clinic at 312-355-0194.