Anxiety Disorders:
Signs and Symptoms in Children, Adolescents and Adults

What is an Anxiety Disorder?

Anxiety disorders are a group of diagnoses characterized by either cognitive (thinking) worry, or by panic which has more physical symptoms, or by both in combination.  In all cases, the symptoms of worry and negative thinking, or of physical panic interfere significantly with a person's ability to function.

Anxiety Disorders Include:

  • Panic Attacks
  • Agoraphobia
  • Panic Disorder without Agoraphobia
  • Panic Disorder with Agoraphobia
  • Agoraphobia with history of Panic Disorder
  • Specific Phobia
  • Social Phobia
  • Separation Anxiety Disorder
  • Obsessive-Compulsive Disorder (OCD) - characterized by obsessions, which cause distress, and/or by compulsions which reduce worry
  • Post Traumatic Stress Disorder (PTSD) - characterized by re-experiencing an extremely traumatic event accompanied by symptoms of increased arousal and by avoidance of stimuli associated with the trauma
  • Acute Stress Disorder - similar to PTSD but symptoms occur immediately after the traumatic event
  • Generalized Anxiety Disorder - characterized by at least 6 months of persistent and excessive anxiety and worry
  • Anxiety Disorder due to a General Medical Condition
  • Substance-Induced Anxiety Disorder

Panic Attack

A Panic Attack is a specific reaction with physical symptoms such as shortness of breath, rapid heart beats, chest pain or discomfort, choking or smothering sensations, and fear of going crazy or losing control.  This is coupled with a sudden onset of intense thoughts of apprehension, fearfulness or terror, often coupled with fears of impending doom.  Panic Attacks occur with several different disorders.  An attack happens suddenly, and can build to a peak (usually in 10 minutes or less).

A Panic Attack requires 4 of 13 of the following somatic or cognitive symptoms:

  • Palpitations, pounding heart, accelerated heart rate
  • Sweating
  • Trembling or shaking
  • sensations of shortness of breath or smothering
  • feeling of choking
  • Chest pain or discomfort
  • Nausea or abdominal distress
  • Feeling dizzy, unsteady, lightheaded or faint
  • Derealization (feelings that things are unreal) or depersonalization (being detached from your body)
  • Fear of losing control or going crazy
  • Fear of dying
  • Parasthesias (numbing or tingling sensations)
  • Chills or hot flashes

These criteria are the signs and symptoms currently designated by the American Psychiatric Association for this disorder.  They are published in the Diagnostic and Statistical Manual of Mental Disorders (fourth edition, 1994), and available in the public domain.  Diagnoses for mental health remain dominated by the medical model in this country.

People having an unexpected Panic Attack will usually describe having intense fear, and report that they thought they were going to die, lose control, have a stroke, or go crazy.  They also often report an urgent desrie to run away from wherever the attack is happening.  When attacks are recurring, some of the intense fearfulness can lessen.  Blushing is common in situationally caused attacks related to social or performance anxiety.  The symptoms characteristic of panic attacks are different from a more generalized type as they are intermittent and typically more severe.

Panic Attacks are associated with the secretion of natural hormones, such as adrenaline or epinephrine.  Our pituitary and thyroid gland injects these hormones into our blood streams in situations of emergency.  Most people experience this sensation when having to jam on their brakes when a car stops suddenly in front of them in traffic, or when suddenly threatened with physical harm.  It is probably a survival instinct, producing "fight or flight" which can lead to handling a life threatining situation.  Usual thinking is temporarily suspended to respond more immediately to the threat.  Panic Attacks occur without life threats, usually unexpectedly, and can be associated with the situation where they occur.  Worry or negative thinking can trigger an attack.  Trying to stop an attack usually results in prolonging the symptoms, whereas relaxing and letting the symptoms pass leads to minimizing the attacks.  Many people seek help in an emergency room when they first experience a Panic Attack, since the symptoms are physical and so overwhelming.  It may be helpful to know that these attacks are rarely associated with causing death or even fainting.  Though the symptoms are intense subjectively, others around the individual usually are unaware the panic is occuring.

Panic Attacks can occur in a Panic Disorder, a Social Phobia, a Post Traumatic Stress Disorder, or an Acute Stress Disorder.  There are three types of Panic Attacks, with differing relationships between the onset of the attack and the presence or absence of situational triggers.  These are Unexpected or Uncued, Situationally Bound or Cued (which occur immediately on exposure to, or in anticipation of, a situation or trigger), or Situationally Predisposed (which are likely but not invariably associated with the situation or trigger).  Unexpected attacks are required for a Panic Disorder.  Situationally Bound attacks are characteristic of Social and Specific Phobias.


Agoraphobia is defined as anxiety about being in places or situations from which escape might be difficult or embarrasing.  Or it may be about a situation where help may not be available in the event of having a Panic Attack or panic like symptoms (like being suddenly dizzy or a sudden attack of diarrhea).  The anxiety usually leads to a persistent avoidance of a variety of situations that may include being alone outside home or being home alone; being in a crowd; specific types of travel (car, train, plane, or bus); or being in an elevator or on a bridge.  Some people with Agoraphobia can be in these situations, but experience considerable dread.  They can often deal more successfully with such a situation with a companion.  The avoidance of situations interferes with their ability to travel to work or carry out homemaking tasks.  They often have clusters of situations they fear or avoid.

Separation Anxiety Disorder

A Separation Anxiety Disorder is characterized by symptoms related to the separation from parents.  It usually develops in childhood.  Some separation problems naturally occur around age 6 months, when infants first realize that people other than their parents actually exist.  More natural separation distress also occurs when first encountering significant time away from parents (such as first school experience, going to overnight camp, or leaving for college).

If you think that your child or adolescent might have anxiety, you should talk to a professional about what to do and how to get help.  Talking to your child's pediatrician is often a good way to get a referral to a competent psychologist, social worker or child psychiatrist.  If you live in southeast Massachusetts, in Plymouth county, Cranberry Counseling, P.C. in Marshfield would be more than happy to answer your questions and to make an appointment to help diagnose and start a treatment plan for your child or adolescent and your family.  See the Cranberry Counseling, P.C. page of this web site for more information, or use the Contact Us form.  Psychotherapy can help to reduce problems related to anxiety.