Have a child who is a nervous Ned or a Fearful Fran? Here is the segment of a course I taught to parents caring for what I called Challenging Children. The parents had been charged with abuse by NYCity’s Child Welfare Authorities.
Anxiety disorders, being controlled by fear or stress are among the most commonplace mental health disorders. The lifetime prevalence for anxiety disorders as a whole in adults is about 25%; the frequency in children is unknown, but felt to be significantly underreported and under-diagnosed.
Fear is part of being human. Fears warn of the need to take care. Intense fear leads to fleeing from the source of the fear—something the experts call “the flight response.” Sometimes fear causes fainting which is the way the human body forces us to play dead. It is the way many animals and birds respond when trapped by a larger predator. If the larger animal is not hungry, but only playing or establishing dominance, playing dead is life-saving. Birds often escape a cat’s claws this way.
The younger the child, the more likely s/he will not easily know which fears to take seriously and which to ignore. During the early years, children easily believe in Santa Claus, the Big Bad Wolf, the Boogie Man, Wicked Witches and other creatures that the rest of us know are imaginary. The fears, worries, and nerves that are part of an anxiety disorder are not tied to reality. One way to generally define an anxiety disorders is to think it is when the word FEAR means False Expectations Appearing Real.
This session reviews the major anxiety disorders including trauma reactions, generalized anxiety disorder, social anxiety, phobias, and Obsessive Compulsive Disorder.
This session will:
- Discuss fear as a normal part of being human
- Review the causes of an anxiety disorder
- Introduce the major anxiety disorders
- Define trauma
- Review how trauma changes the brain
- Discuss the various trauma disorders
- Define phobia, compulsion, and obsession;
- Review the two treatments most commonly recommended for reducing anxiety
- Review the with medications used to treat anxiety disorders
- Examine how parents/caregivers can help a child who worries too much
WHAT IS AN ANXIETY DISORDERThe simplest definition of an anxiety disorder remains this one:F = False E = Expectations A = Appearing R = Real
In other words worrying to much about things that will mostly likely never happen. As with all mental health disorders, the difference between normal fears and those leading to an anxiety disorder is the amount of disruption to the child’s ability to function. A child or person who would rather walk up twenty flights of stairs then get on an elevator has a phobia; the fear interferes with normal functioning.
WHAT CAUSES ANXIETY DISORDERS
Normal fears get out of hand. We are all genetically programmed to fear the unknown—very young children are often frightened by clowns because they look so different from known human faces. Normal fears that get out of hand might originally start with a real event such as being bitten by a dog.
Others teach us to be afraid. Parents teach children to fear certain things and this can be carried too far. For example, some parents teach children to be afraid of germs and a sensitive child might overly worried about dirt and getting sick.
Our genes play a part. Some children and some adults are born more nervous or fearful then others. Shy children are one example.
Traumatic events are often a cause. Pain or fear that overwhelms combined with feeling powerless create what the mental health experts call trauma reactions. Research is rapidly uncovering the role traumatic experiences play in anxiety disorders as well as a number of other mental health disorders.
mental health labels related to fear and worry
Generalized Anxiety Disorder: Constant unrealistic worrying about anything and everything. Extremely self conscious, tense, and may complain of physical discomforts related to tension such as head aches and stomach aches. Seen by others as worrier, lacking in confidence, too sensitive.
Separation Anxiety Disorder: Need parents to be present in order to feel safe. Protest having to leave parents or have parents leave them. Normal for babies to develop separation anxiety by eight months, not normal by the age of five or six although one in 25 children at that age has difficulty being apart from parents. This may include problems falling asleep unless parents are in the room, clinging behaviors, and expressed fears a family member may die or something bad will happen to loved ones or self. Usually reluctant to try new things. Seen by others as shy, scaredy cats, or insecure.
Phobias: Excessive fears attached to specific situations or objects usually animals, dirt, heights, being closed in somewhere, fear others are judging them harshly, fear of school. See Handouts for a list of the many phobias and the names they have been given by the mental health professionals.
Panic Disorder: A “panic attack” is caused by a fear that leads to a pounding heart beat, hyper-ventilation, dizziness, nausea, faintness and feeling that you are about to die.
Obsessive-Compulsive Disorder (OCD): Obsessions are unwanted and repetitive and senseless thoughts; compulsions are unwanted behaviors such as excessive hand washing, counting behaviors, perfectionism. Such children may take forever to complete a school assignment.
Trauma reactions: A trauma is defined as any event that causes pain, leaves you feeling powerless, and overwhelmed with fear. A more general definition is an unpleasant event that changes you forever. Sexual and physical abuse, witnessing violence, being in an accident, or being involved in a disaster such as 911 or a hurricane are examples of traumatic events. Often left out when considering traumatic events are life threatening diseases that include the need for emergency hospitalization. Asthma can be particularly traumatizing to a child as can various forms of epilepsy. Being challenged by a mental disorder in which one is subject to angry voices yelling at you inside your head that you think can traumatize.
Traumatic events change you forever.Traumatic events become life markers. Some become chapters that stand out from the other events of our lives. “When the house burned down.” “When I almost died in the car accident.” Some traumas divide our lives in half. Think of 9/11. People traumatized by 9/11 think of their lives as before and after 9/11. The larger and more painful the trauma, the more powerless the person feels to take any action, the more likely it is to divide your life into a before and after.
Trauma changes your brain. The experts know this by studies of the startle response. When someone frightens you, you jump. After a trauma, you jump more often and your jumpiness is more intense. That is a sure sign that what happened was traumatic. Most of the changes have to do with the release of chemicals in the brain.
Some chemicals make you more aware and more sensitive.
- This means you are always on guard. Because you are always aware of danger, you are also always ready to protect yourself by fleeing or fighting.
- You flee by trying to avoid anything that might reawaken the pain of the trauma. You don’t want to talk about it, think about, go to places that will remind you of it.
- You also flee by shutting down.
- You fight by yelling, hitting, attacking others.
Other chemicals strengthen you. You need a burst of energy so you can fight or run.
Still more chemicals numb you. The numbing makes it possible to stand pain. Both fighting and running can cause pain. Numbing chemicals are essential to survival and cause the following:
- A reaction called dissociation which means you go into a kind of trance state and feeling what is happening is not real. You feel outside of your body as if you are looking at someone else.
- The numbing can shut down your memory, so you don’t remember everything that happened. You may remember nothing or just parts of what happened.
- Numbing chemicals can also make you feel emotionally numb and dead. This can lead to such behaviors as cutting, head banging, other self injurious behaviors and risk taken behaviors.
- The numbing chemicals may make what is happening seem unreal. In fact, just as there may be no conscious memory of the trauma, there may be no memory of the triggered behavior related to the trauma. This leads to trance like states that make the person seem spaced out or creates the appearance of someone with two personalities.
These chemical changes in brain’s chemical cause the brain splits. Part of brain is ready to pounce on anything that might create hurt or pain, while another part of it is totally numb to that possibility. This makes victims of trauma, particularly traumas such as rape or physical assault more likely to be re-traumatized.
The changes cause triggering. The brain operates on memory. Memories get stored according to the senses. Parts of any memory is stored visually, other part be sound, another by smell and another by touch. Each sense seems to have a different file. When enough memories come together, the complete memory is recalled. In the case of trauma, when enough of the memories come together to bring back the memory, the person feels and reacts as if the trauma was happening again.
To make matters worse, in terms of trauma, the complete memory need not be unlocked. A certain smell may cause a triggered reaction, but not bring back the full memory. This means the person may not know what caused the reaction. This is crazy making for the person who experiences trauma triggering. It also makes those who witness such behavior, think the person is crazy. Not helpful.
Finally, The release of chemicals can cause an addiction like process. The chemicals released These are also “feel good” chemicals. The traumatized person, may find that engaging in some risk taking behaviors, other behaviors such as head banging or cutting; even scary movies can trigger a rush of feel good chemicals. Such rushes are called “adrenaline rushes.”
Because the body can produce only so many feel good chemicals at one time, when the body’s chemical supply becomes depleted, the person suffers a withdrawal similar to coming down off crack. This explains the mood swings of many traumatized people. At those times the person may uses substances or the stress of the chemical depletion can set off triggered behaviors. Domestic or child abuse can be another result.
Trauma also changes beliefs: According to James Garbarino an expert on the impact of trauma in children and author of numerous books including “Raising Children in A Toxic Society” or “Lost Boys.”
- The belief your body is invulnerable and that you will not ever be seriously hurt or die.
- The belief your family, others who care for you, and the forces of society will keep you from harm.
- The belief good people don’t do violence to those they love and you are one of those good people.
These are beliefs that help us survive life’s struggles. Children, in particular, need such beliefs to develop normally. Trauma destroys those beliefs and combined with the chemical impact of trauma can lead to what the experts are calling Complex or Developmental Trauma Disorders.
Complex Trauma Reaction or Developmental Trauma Reaction: Not yet a DSM diagnosis, one or both of these will most likely be included in the next edition of the Diagnostic Statistical Manuel. (DSM). These are reactions tied to on-going trauma. Severe child abuse and neglect, severe asthma, painful medical conditions, or living in a “war-zone” neighborhood can all give rise to this disorder. In children, ongoing trauma interferes with normal development. Children who have experienced on going trauma show these symptoms:
- Hyper-arousal which means a greater sensitivity to stress or threat
- Confusion or spacing out (dissociative symptoms) when stressed
- Inability to regulate emotions—numbed out reactions alternate with out of control emotions
- Under-controlled or over-controlled behaviors
- Self hatred, self blaming, self punishing, filled with shame
- May be clinging, overly dependent or risk taking
- Poor boundaries and a weak sense of what is appropriate behavior in terms of relationships are common and might lead to the child’s engaging in inappropriate sexual behaviors.
General treatment for fears and worry
Children and adolescents with anxiety disorders can benefit from a variety of treatments and services. Following an accurate diagnosis, possible treatments include:
- Cognitive-behavioral treatment, in which young people learn to deal with fears by modifying the ways they think and behave;
- Desensitization and relaxation techniques;
- Biofeedback (to control stress and muscle tension)
- Parent training
- Medication- Medications do not cure anxiety disorders, but can help lessen the symptoms. See Handouts for more detailed discussion of medication.
- Alternative treatments such as EMDR, exorcisms, hypnosis.
The most effective treatments seem to combine a number of approaches.
Traumas reactions require a more intensive approach. It used to be thought “getting it all out” by talking about what happened was the treatment of choice. This is now known “getting it out not to be particularly helpful particularly for children and teens. What seems to work are the following interventions:
- Establishing safety
- Make safety plans
- Teach personal safety skills— those that promote self defense and teach meditation is best.
- Develop self soothing skills
- Teach emotional regulation skills
- Provide information about trauma reactions including treatment practices
- Talk about traumatic events as not being normal and that it is normal to have difficulty coping with such events.
- Help find a useful and life affirming explanation for why people do bad things, why bad things happen.
- Medication is sometimes useful in a number of ways.
WHAT CAN PARENTS DO TO HELP?
- Get an accurate diagnosis.
- Find a treating clinician working with children and adolescents, who has used cognitive-behavioral, relaxation and behavioral approaches.
- Learn the skills being taught your child, practice them yourself and help your child practice them. Most often these will include:
- Use of rating scales or feeling thermometers
- Calming self talk.
- Relaxation skills such as Calming Breath; Centering; Scan, Tense, and Release; visualizing a safe place; using calming self talk.
- Having reminders of safety—pictures of parents helped a child with separation anxiety stay calm.
- Never belittle or shame your child for being fearful or anxious at the same time do not allow the fear to control the child.
- Encourage the child to face the fear, when child is fearful suggest various cognitive behavioral coping strategies noted above.
- Consider medication or alternative treatments if a trial of cognitive-behavioral treatment does not help. Be wary, however of alternative treatments that promise a quick cure or cost lots of money.
- Find support for self.
Quotes for dealing better with fear and worryI am not afraid for I am learning to sail my ship. Louisa Mae Alcott, Author Many of our fears are tissue-paper-thin, and a single courageous step would carry us clear through them. Brendan Francis, Poet Fear has a large shadow, but he himself is small. Ruth Gendler, Author Fear makes strangers of people who would be friends. Shirley Maclaine, Actress To conquer fear is the beginning of wisdom. Bertrand Russell, Philosopher I’ve had a lot of worries in my life, most of which never happened. Mark Twain, Humorist
Are you good at using meditation to help you stay calm? The calmer you are the more you help calm a child’s fears. Try learning EFTI’s One Minute Meditation.
Most EFTI posters posted on my blog can be obtained at the EFTI Store Many are free. Poster Coaches are printed up in color on letter size card stock and used to inspire, teach, remind you to practice #emotional_fitness exercises.
You might also be helped by the exercises found in my book Self-soothing, Create Calm in your Life. It costs less than a happy meal and has more benefits for you and your child.
Thank you for all you do, your support, please continue to like, comment, or share these posts.
If you were one part human, two parts something else — another animal, a plant, an inanimate object — what would the other two parts be? My answer? I would like the skin of a Rhinoceros so small hurts would not reach my heart.