Anxiety disorders in adolescents

Anxiety disorders are the most common psychiatric disorders in childhood and adolescence worldwide, with prevalence rates of 10-20% and higher than depression and behavioral disorders (Sánchez et al, 2020). In another source in the literature, it is stated that anxiety disorders are among the most common disorders in childhood and adolescence and its prevalence is estimated to be between 7% and 12% (Canals et al., 2019; Ghandour et al., 2019). It is estimated that 75% of adult anxiety disorders begin in childhood and the mean age of onset is between 8 and 12 (Kessler et al., 2005).
Anxiety disorders have a high negative impact on personal and social areas, and it has been stated by the World Health Organization that it is among the top ten causes of death especially in girls during adolescence (World Health Organization, 2014).
Negative repercussions of anxiety disorders include lack of interpersonal relationships, poor academic performance, and personal difficulties. It has been stated that anxiety may be normal and even necessary in situations of anxiety, stress, or danger, as it allows one to protect oneself from a potentially harmful agent. If the response is extreme, it is considered pathological anxiety. It has been stated that anxiety disorders usually begin at these stages and present a progressive, persistent, and chronic or recurrent course (Sánchez et al ,2020).
Appropriate screening, diagnosis and treatment of adolescent anxiety disorders are important because early intervention can prevent or reduce the risk of other psychiatric disorders and functional impairment in adulthood. Screening should be routinely performed by mental health and primary care providers to identify adolescents with or at risk of developing an anxiety disorder. It has been stated that early diagnosis and treatment can reduce the impact of the child and adolescent in all areas of academic, social and family life, and prevent anxiety disorder from persisting in adult life (Guerrero & Ark, 2019, Riordan & Ark, 2018).
It has been stated that anxiety can be equivalent to fear, fears and worries are normal in childhood, they have an evolutionary character and prepare the child to face changes as well as to face situations that may contain danger. It has been stated that these fears vary according to age, from being alone or afraid of loud noises at an early age, as they grow up, the fear of separation from their parents, fear of darkness and strangers emerges. It has been stated that while fears about natural phenomena, monsters or diseases arise in school age, fear of being teased and ridiculed in front of their peers, academic failure, school competition and health problems predominate in adolescence. It has been stated that anxiety can arise in a situation of real or imagined danger, is adaptive in nature and is necessary for survival. Anxiety has been reported to become pathological when its intensity is excessive (generally lasting more than 6 months) or when it causes disproportionate discomfort or pain. It is also considered pathological when the trigger is an objectively neutral or innocuous stimulus. Anxiety can be triggered by external or internal factors (memories, images, thoughts, wishes for the future). It manifests itself with bodily, autonomic symptoms (psychomotor restlessness, tachycardia, piloerection, sweating…), cognitive (fear, anxiety) and behavioral symptoms. Adolescence, physical changes, academic choices, university entrance exams as stressful events, the beginning of working life, the need for acceptance and integration into the peer group, the beginning of emotional couple relationships, etc. It is stated that it is a period of evolutionary changes and difficulties. It has been stated that inhibition is the most typical response in anxiety disorders. (Sánchez, 2020).
Sometimes, these important life changes precipitate anxiety and possible pathology in vulnerable adolescents. Following the classification of mental disorders in the fifth edition of the diagnostic and statistical manual (American Psychiatric Association, DSM-5), the most common childhood anxiety disorders are classified as: separation anxiety disorder (SAD), generalized anxiety disorder (GAD), social phobia, and specific phobias. Comorbidity is common in anxiety disorders, especially in another anxiety disorder and depression. Importantly, in pediatrics, somatoform disorders, abdominal pain, headaches, and chronic pain without identifiable physical pathology are associated with an anxiety disorder in up to 20%.
Fear and anxiety can be caused by psychophysiological (palm sweating, tachycardia, hyperventilation, muscle tension, etc.), cognitive (anxiety, harm expectation, negative evaluation of personal coping skills, perceptual distortion, etc.) and motor (trembling, stuttering, escape, avoidance, etc.). .) shares a pattern of responses to potentially dangerous situations. In fears, external stimuli, current situation and motor responses are dominant, while in anxiety, internal stimuli, anticipation of the situation and cognitive responses are dominant. Thus, in fears the child easily identifies the threat, such as a dog or a storm, and reacts by avoiding the situation, and in anxiety the child may not recognize the source that provoked it, for example, his ability to work, and responds with anxiety. Specific phobia occurs at an earlier age than generalized anxiety disorder, perhaps because more weight falls on motor responses in fear and cognitive responses in anxiety.
The most frequently evaluated psychological treatment for anxiety disorders in children and adolescents is Cognitive Behavioral Therapy (CBT), and in recent years there have been numerous systematic reviews and meta-analyses examining the effectiveness of this approach (eg Roberts, Chitsabesan, Fothergill & Harrington, 2004; Compton et al., 2004; Davis, May & Whiting, 2011; In-Albon & Schneider, 2007; Ishikawa, Okajima, Matsuoka & Sakano, 2007; James, Soler & Weatherall, 2005 ; James, James, Cowdrey, Soler & Choke, 2013; Silverman, Pina & Viswesvaran, 2008).