How Anxiety Affects Adolescence in Life - Literature review Example

How anxiety affects adolescence in life Anxiety disorders are a group of mental health problems that are common not only in adults but also in children and adolescents. However, in the latter group, they are not well understood. The prevalence of anxiety disorders in children and adolescents has been estimated to be 5.7% to 17.7% (Cohen et al., 1993; Costello and Angold, 1995; Costello et al., 1996; Fergusson et al., 1993; cited in Woodward and Fergusson, 2001). Thus, it can be said that anxiety disorders affect a significant portion of younger people. Anxiety disorders in childhood and adolescents have implications in not only their present life, but also in their future, and there is not much research in this regard. While some studies have shown children and adolescents with anxiety develop several mental and social health problems as they grow up, other have dismissed this fact. In this essay, effects of anxiety on a adolescent life will be discussed with reference to review of literature. The discussion will also include an overview of symptmatology, diagnosis and management. The most common type of anxiety that occurs in children and adolescents is generalized anxiety disorder in which the individual experiences excessive, persistent and unrealistic worry that is not related to a particular situation or object. Children with this condition may worry more intensely and more often than other children in similar circumstances. Common situations which may trigger worry include competence in school, performance in school or sporting events. They may worry about natural disasters, family members, personal safety and future events. The focus of anxiety may shift, but worry persists leading to other problems (Nutter et al, 2010). Anxiety in children and adolescents decreases the ability to concentrate and process information. The may lack the ability to engage in various activities. Their constant feelings of insecurity makes them seek reassurance from others, affecting their social relationships and personal growth. Some of them may be perfectionist and overly conforming. They may also be self-critical. These attributes make them redo even tasks that are not significant, several times, thus wasting lots of time and energy (Nutter et al, 2010). The world wide prevalence of anxiety in children and adolescents is unknown. In the United States, the prevalence has been estimated to be 2.9- 4.6 percent (Nutter et al, 2010). The condition is more prevalence among adolescents than in children less than 11 years of age. No predilection for a specific group, ethnicity or culture has been identified so far. The prevalence is similar in both the sexes in childhood. However, epidemiologic studies have identified increased risk of anxiety in females atleast 6 times as much in males (Nutter et al, 2010). The age of onset varies, but anxiety is more common in older children and adolescents than young children. Also, symptoms are more severe in adolescents (Nutter et al, 2010). General anxiety is classified under DSM-IV as generalised anxiety disorder. A diagnosis of generalised anxiety disorder is established if the individuals is suffering from excessive worry and anxiety for more days, for atleast 6 months over several activities and events and has difficulty in controlling worry. Worry is associated with one or more of symptoms like fatigue, restlessness, irritability, poor concentration sleep disturbance and muscle tension. Also, the focus of worry is not confined to a particular thing in generalised anxiety. If the focus of worry is about having a panic attack, then it is panic disorder, if it is about social embarrassment, it is social anxiety disorder and it is about separation from caregiver, it is separation anxiety. Similarly, if the worry is about going to public places, it is known as agarophobia (Nutter et al, 2010). Panic disorder or panic anxiety is a type of the mental illness which can cause distress not only to the individual suffering from it but also to his/her family members. The individual can suffer from this attack anywhere and at any time. Sudden and spontaneous attacks of panic with preoccupation of fear of recurring attack is known as panic disorder. Each episode of panic attack is characterized by abrupt onset of fear which is intense and reaches peak within few minutes and constitutes of atleast four of the following symptoms. The symptoms which can be manifested in a panic attack are the need to escape, a feeling of imminent danger or doom, heart palpitations, trembling, sweating, chest pain or discomfort, shortness of breath, nausea or abdominal discomfort, tingling sensation, dizziness or light-headedness, fear of losing control and chills or heat flush (ADAA, 2009). Agoraphobia causes significant psychological anguish and also many social, medical and occupational consequences like restricted role functioning, increased use of health care and social withdrawal (Daniels, 2006). Those suffering from agoraphobia are constantly on guard for the next episode of panic attack. According to DSM-IV, the symptoms of worry lead to significant distress and impairment in school, social circumstances or in other situations (Nutter et al, 2010). Some children and adolescents with anxiety suffer from physical symptoms like rapid heat beat, shortness of breath, dry mouth, nausea, diarrhoea, trouble in swallowing, frquent in urination, "lump in the throat feeling" and cold clammy hands. They often complain of headaches and abdominal pain. When these individuals are taken to the physician, no physical health problems are identified on examination. Several causes can contribute to anxiety disorders and they include biological, environmental and familial factors. Research has shown that inhibition of behaviour which is an "early temperament associated with aversion to novel situations", is associated with development of anxiety in later part of life. Infact, there is an association between anxiety disorder in parents and behaviour inhibition in children. Anxiety tends to occur in families. This may be due to genetic reasons. Environmental factors associated with development of anxiety are emotional problems in parents, stressful life events like sexual abuse, traumatic experiences and disrupted attachment. Family has an important role to play in the development of anxiety in children because young chlidren are not developmentally mature and are dependent on adults for various benefits (Nutter et al, 2010). Anxiety is often comorbid with depression and it is because of this that there is associated mortality an morbidity. However, anxiety disorder per se may not result in mortality. The course of anxiety disorders is unstable and a child who has struggled with anxiety for some duration may not continue to do so. However, for whatever period it is present, it is a serious problems for children and adolescents. It not only affects the academic functioning of the individual, but also leads to may serious long term consequences. According to a study by Woodward and Fergusson (2001), anxiety in adolescence increases the risk of development of several other problems later in life like major depression, anxiety disorder, illicit drug indulgence, alcohol addiction , nicotine dependence, suicidal behaviour, poor performance in school and employment, failure to attend university and early parenthood. Some continue to suffer anxiety intermittently through out their lives. Anxiety contributes to stress and can result in stress-related health disorders like headaches and iriitable bowel syndrome. In the long term, other gastrointestinal and cardiovascular complications can also develop (Nutter et al, 2010). Panic anxiety disorder is associated with many medical comorbid disorders, the most common of which is asthma. Felmana et al (2009) studied the association of panic disorder and asthma and the association of symptoms between the two. According to the authors,emotional disturbance and illness-related poor quality of life contributed to the association between the two. The study showed evidence of greater irritability in patients with asthma-panic anxiety disorder than in those with only asthma symptoms. Other medical conditions associated with panic disorder are cardiovascular disorders like hypertension, cardiomyopathy and mitral valve prolapsed, chronic obstructive pulmonary disease, migraine headache and irritable bowel syndrome (Daniels, 2006). No specific laboratory tests or imaging studies are essential to diagnose anxiety, including panic disorder, separation anxiety or agoraphobia. The diagnosis is mainly based on clinical symptoms. Most of the times, simple reassurance and social intervention may benefit the patient. Others may require medications ranging from oral benzodiazepines to IV Ativan. Selective serotonin reuptake inhibitors, tricyclic antidepressants and monoamine oxidase inhibitors also can be used to treat symptoms of panic disorder (Daniels, 2006). The most appropriate treatment for anxiety is cognitive behavioral therapy or CBT. Infact, CBT is very useful in the treatment of various anxiety disorders. It is now considered the first line therapy in any anxiety disorder. Currently, it is the most effective treatment for phobic disorders. CBT is a symptom oriented therapy approach combining psychoeducation and specific treatment intervention. The basic concept is in vivo exposure where in the person is gradually exposed to the actual, feared stimulus. Normally when a person is exposed to a fearful stimulus, a fear response is evoked and then maintained due to classical conditioning. In CBT, repeated exposure is provided and this conditioning is unlearned. This process of unlearning is known as extinction and habituation. When anxiety is not associated with severe co-morbid conditions like personality disorders, the therapy can be time limited. It can be done in 12 to 15 settings. Fear of spiders, a type of phobia or phobia to any such insects can be treated with in vivo exposure in one session itself (Ost, 1989). The optimal range of duration for anxiety therapy is usually 7 to 14 hours. Most people would require weekly sessions of 1-2 hours for about 4 months. Briefer CBT should be atleast 7 hours and should be supplemented with proper information and tasks (NICE guidelines, 2007). The nature of process should be determined on a case-to- case basis. The main objective of the treatment is to identify thoughts, beliefs, assumptions and behaviors that are related to debilitating, dysfunctional, inaccurate and unhelpful negative emotions and monitor them. The result expected out of such forms of therapy is to replace or transcend these emotions with more realistic and useful emotions (NICE guidelines, 2007). Behavioral therapy focuses on how a persons behavior contributes to the symptoms and difficulties. It deals with behavior modification (Kaplan, et al, 1998). There are various behavioral modification techniques used in the treatment of anxiety disorders. These include teaching self- monitoring skills, teaching relaxation skills, exposure techniques to extinguish the fears associated with certain situations like heights and public places and teaching more appropriate responses to situations. In conclusion, it can be said that anxiety occurs commonly in adolescents and children and can lead to devastating mental, physical and social outcomes in life. Hence it is important to identify anxiety in early stages and seek proper counseling and help. Parents play a major role in the development and management of the condition. References Anxiety Disorders Association of America (ADAA). (2009). Panic Disorder. Retrieved on 15th November, 2010 from http://www.adaa.org/gettingHelp/AnxietyDisorders/Panicattack.asp Daniels, C.Y. (2006). Panic disorder. Emedicine from WebMD. Retrieved on 15th November, 2010 from http://emedicine.medscape.com/article/287913-overview Fergusson, D.M., and Woodward, L.J. (2002). Mental Health, Educational, and Social Role Outcomes of Adolescents With Depression. Archives of General Psychiatry, 59(3), 225- 231. Feldmana, J.M., Siddique, M.I., Thompsana, N.S., and lehrer, P.M. (2009). The role of panic-fear in comorbid asthma and panic disorder. Journal of Anxiety Disorders, 23(2), 178-184. Kaplan, M.D, Harold, I. and Sadock, M.D, Benjamin, J. (1998). Synopsis of Psychiatry, Eighth Edition Baltimore: Williams & Wilkins. NICE Guidelines. (2007). Anxiety. Retrieved on 15th November, 2010 from http://www.nice.org.uk/Guidance/CG22/NiceGuidance/pdf/English Nutter, D.A., Larsen, L.H. , and Sylvester, C. (2010). Anxiety Disorder, Generalized Anxiety. Retrieved on 15th November, 2010 from Emedicine from WebMD. http://emedicine.medscape.com/article/916933-overview Read More