CINAPS 

        Cambridge Independent Neuroscience and Psychiatry Services
Anxiety Disorders
Why do we get anxious?

Everyone gets anxious at times and the symptoms of anxiety, such as breathing faster or feeling your heart beating faster, are designed with a purpose.  

Imagine yourself swinging above a river or lake and then seeing a crocodile in the water.
You are likely to feel anxious with physical changes (symptoms) such as feeling your heart race or a dry mouth.  These symptoms of anxiety that you feel, will be because your heart and lungs are making changes to enable you to perform and get to a place of safety.  These physical changes and what you experience as anxiety symptoms are designed to save your life in certain circumstances. 
ANXIETY DISORDERS

In some cases, individuals feel anxious constantly or have severe episodes of anxiety, without there being any real danger or risk, and these symptoms interfere with general daily functioning; these presentations can sometimes be referred to as anxiety disorders.  Research indicates that the prevalence for different anxiety disorders in children vary between 1-8%, some say 15-20%.  As with Depression, most children and young people do not ask for help. 

It is important to treat anxiety disorders early, because it is likely to become more difficult to treat, the longer you wait and the prognosis deteriorates.  Anxiety disorders usually do not resolve on their own. 

What are some of the signs of anxiety disorders?

Physical (health/medical) symptoms
Presentation usually relate to autonomic symptoms and motor tension, for example:

Increased respiration, heart rate, palpitations (awareness of heart beating), shortness of breath, dizziness
Epigastric (stomach) and chest pain, sweating, blushing, dry mouth, feeling of being 'choked'
Frequency (urinating often), urgency (feeling you 'have to go' urgently)
Nausea, diarrhoea, constipation, lack of appetite, insomnia, poor concentration, impulsive behaviour
Muscle tightening, fidgeting, hyperactivity, headaches and tremors (shaking)

Psychological symptoms
Avoiding the situation that causes stress or rapidly exiting rapidly from a scary situation
Anticipatory anxiety or constant worry / apprehension or heightened startle response
Feeling you are going 'crazy', 'mad' or going to die or that you, your life or 'things' are unreal
Fear of losing control or feeling you are losing control
Daydreams of scary memories, nightmares and flashbacks - reliving past events as if real
Detachment, emotional numbness or no interest in social interaction, relationships or previous interests
Not enjoying things you previously found enjoyable

What causes anxiety disorders or excessive anxiety?

The causes are often complex and a direct cause is not always clear.  It is often helpful to consider predisposing, precipitating and maintaining risk factors as well as protective factors. 

Protective factors:  
This list will not prevent anxiety disorders completely, but will lower the risk and improve prognosis. 

Engagement in enjoyable and regular group activities with friends or adults with similar interests
Many interests that are enjoyed regularly such as horse riding, swimming, boxing or cooking
Positive and supportive relationships with other children or young people, adults and family
Positive and supportive environment at home, at school and/or in the community
Certain personality traits (not taking life too seriously, not being too hard on yourself)
Good coping or defense mechanisms (sports, humour, friends)

This list is not comprehensive. 

Risk factors:
Genetic factors (family history of mental illness or anxiety)
Certain personality traits (sensitive, anxious, needing to get things 'just right', hard on oneself) 
Medical problems, illness or disorders
Social environment at home, at school and/or in the community
Major life events and trauma including traumatic events during early childhood and early adulthood
Stressors - chronic (such as bulling at school) and acute (death in the family or sudden change) 
Other existing mental health difficulties e.g. Depression or neurodevelopmental problems e.g. ADHD

This list is not comprehensive.  

Medical problems and medications that can cause anxiety symptoms:
Trauma, toxins (such as mercury) or nutrition deficiencies (such as Vit B12)
Infections especially chronic infections
Inflammatory disease (such as related to Lupus Erythematosus)
Neurological causes such as migraine or epilepsy (remember not all epilepsy presents with convulsions)
Cardiovascular or cardiopulmonary causes
Endocrine causes (such as related to adrenal or pituitary gland, thyroid, or parathyroid hormone)
Biochemical and haematological causes (such as relating to glucose levels and anaemia) 
Neoplasms (some tumours produce adrenaline)
Medications (such as some antibiotics, sympathomimetics and vasopressors)

This list is not comprehensive.

Many medical disorders or side effects of medications can cause anxiety symptoms and look like anxiety disorders in children and young people where no anxiety disorders exist (differential diagnoses).  Child Psychiatrists are medical doctors, so should be able to advise you and liaise with your GP to ensure that medical causes are excluded, before mental health causes are considered.  

How are anxiety disorders diagnosed?

Child Psychiatrists meet with children with various degrees of anxiety every day.  Many children present with anxiety, but no anxiety disorder.  Many medical disorders and mental illness or neurodevelopmental disorders can present similar to anxiety disorders.  Through a detailed assessment, including a p