# data[].attributes.attachment_link.provider_name
Washington University School of Medicine in St. Louis

# data[].attributes.attachment_link.readable_text
Visit the News Hub

Clinic services provided free of charge
Matt Miller
The first signs of mental illness involving psychosis - the experience of having hallucinations, delusions or intrusive, disturbing thoughts - often appear during the teen years. There is emerging evidence, however, that early intervention can help such adolescents avoid the extremely serious problems that can derail their educations and disrupt family relationships.

With this goal in mind, Washington University School of Medicine in St. Louis has opened a clinic to provide treatment free of charge to adolescents and young adults who may be in the early stages of psychosis. Mental health professionals at the new clinic will treat people ages 13 to 25 at high risk for developing psychosis, as well as those who have been diagnosed with a psychotic illness within the prior three years.

Psychosis is a symptom of psychiatric illnesses such as schizophrenia and some forms of bipolar disorder. Such illnesses affect an estimated 3% of the U.S. population, according to Daniel Mamah, MD, director of the new clinic, called the Washington Early Recognition Center (WERC).

The new clinic began seeing its first such patients earlier this year. Mamah, an associate professor of psychiatry, has directed a research effort with the same name for the last few years. Those treated at the clinic will be offered the opportunity to participate in research studies, but the new clinic is primarily aimed at providing early treatment to adolescents and young adults experiencing psychosis.

"There is a real need to help young patients and their families because psychotic disorders tend to get worse over time, especially if untreated," Mamah said. "The aim of this clinic is to get patients into treatment as early as possible, providing them with interventions such as individual psychotherapy, family therapy and medication. Like most other illnesses, the earlier you intervene with psychosis, the better the long-term outcomes tend to be."

Similar clinics that attempt to treat young people with psychosis before or when most symptoms appear have opened in larger cities, mainly on the East and West coasts, but this new clinic is the only one of its kind in the St. Louis region. Mamah and a staff of psychotherapists and social workers will counsel and treat affected youth at 4444 Forest Park Ave. Patients also will undergo detailed behavioral and cognitive assessments using structured interviews and questionnaires. During the current COVID-19 outbreak, visits are being conducted using telemedicine to assess and serve patients.

Mamah said that early treatment makes it possible to delay or perhaps even prevent the onset of some of the most serious problems associated with psychotic disorders, such as hearing voices and seeing things that aren't there. The earlier treatment also may help young people avoid extended hospitalizations that can be necessary to get severe psychosis under control.

"There are a number of signs that someone is at risk of developing psychosis, but those signs can be dismissed as typical teenage behavior," he said. "Perhaps your child used to be very outgoing but is now withdrawn. Or he or she is not doing as well in school as in the past. Sometimes a person will seem to respond to voices that no one else hears or will become more suspicious. These kinds of behavioral changes may be chalked up to adolescent changes, but they usually are fairly apparent to family members."

When psychosis goes untreated, those affected by the condition not only may suffer from symptoms such as hallucinations and delusions, they may struggle to stay in school or succeed in careers.

In Missouri alone, the total economic burden for individuals with schizophrenia is about $2 billion annually, according to the Missouri Department of Mental Health. That estimate factors in lost wages, criminal justice system-related costs, and hospitalizations. The average hospital stay for a patient with schizophrenia is seven days, longer than average stays for those who have kidney transplants, heart attacks or hip-replacement surgeries.

"It's a serious public health issue," Mamah said. "But because of stigmas that remain attached to psychiatric illness, many patients go months or even years without receiving treatment that could help them."

Cost won't be an issue at the clinic. With grant support from the St. Louis County Children's Service Fund, The Foundation for Barnes-Jewish Hospital and the St. Louis Children's Hospital Foundation, patients ages 13 to 25 will be able to receive psychiatric treatment free of charge, regardless of whether they have insurance. If medications are needed, however, there will be costs associated with those.

Individuals who might need help may be referred to the clinic by parents, guardians, pediatricians or other adults in their lives. The team at the clinic then will do a screening by phone to see whether a patient is actually exhibiting signs of the risky behavior connected to psychosis, such as hallucinations, delusions and disordered thinking.

The clinic team then may recommend a more detailed evaluation to see whether the individual is eligible to be treated at the clinic. Teens with significant intellectual disability, for example, would not be candidates for treatment.

"When people contact us, we'll ask them some questions and, if needed, ask them to come to the clinic for a more detailed assessment," Mamah said.

Because of funding limitations, people over age 25 aren't eligible for treatment at the clinic. However, Mamah and his colleagues are pursuing further grants in hopes of being able to offer treatment to more young people in the St. Louis area.

For more information, call 314-362-6952 or check the website at werc.wustl.edu.

Washington University School of Medicine's 1,500 faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children's hospitals. The School of Medicine is a leader in medical research, teaching and patient care, ranking among the top 10 medical schools in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children's hospitals, the School of Medicine is linked to BJC HealthCare.

# data[].attributes.attachment_link.title
Schizophrenia, other psychotic disorders focus of new clinic for teens, young adults | Washington University School of Medicine in St. Louis

# data[].attributes.attachment_link.description
Visit the News Hub Clinic services provided free of charge Matt Miller The first signs of mental illness involving psychosis - the experience of having hallucinations, delusions or intrusive, disturbing thoughts - often appear during the teen years.

# data[].attributes.attachment_link.readable_text
Schizophrenia, and other mental disorders, should only be diagnosed by a medical doctor, clinical psychologist, or trained health professional who has spent time with the person and has conducted a proper mental health assessment. Diagnoses are complicated with many nuances. Please do not attempt to diagnose someone based on the symptoms you read in magazines or on the internet. If you are concerned, speak to a trained health professional.

Many young people with Schizophrenia will demonstrate a slow and gradual onset of the illness (often over the period of 6-9 months or more). This is called a prodrome.

It can sometimes be difficult to distinguish the onset of Schizophrenia from other mental disorders, such as Depression, Obsessive-Compulsive Disorder, or Social Anxiety Disorder. To be diagnosed with Schizophrenia, the person must have experienced symptoms for at least 6 months (e.g., delusions, hallucinations, disorganized speech, abnormal motor behaviour, or negative symptoms), including at least one month of delusions, hallucinations, or disorganized speech. These problems cause severe dysfunction in one or more areas of their daily life (social, family, interpersonal, school/work) and are not the result of using a substance (i.e., getting high) or of another medical condition.

It's important to note that believing or sensing something that other people do not is not always a sign of Schizophrenia. We can all believe things that other people do not - whether it's that a higher power exists, that an old house is haunted, that the government is monitoring our internet use, or something else entirely. Age-appropriate or culturally-appropriate beliefs are not considered delusions. The same is true for hallucinations. If you can hear your neighbour's conversation on the other side of the wall but someone standing on the other side of the room cannot - you are not "hearing voices" (e.g., a hallucination). A child's imaginary friend is also not a hallucination. Age-appropriate displays of imagination are not hallucinations. A hallucination is when something is experienced through your senses (sound, sight, smell) that is not there. Delusions and hallucinations are diagnosed when people believe or sense something despite many other people giving evidence that the belief or sensory perception does not exist.

*In accordance with the Diagnostic and Statistical Manual of Mental Disorders, 5 th Edition

Remember, you cannot diagnose someone with Schizophrenia without a proper mental health assessment conducted by a properly trained health provider.

# data[].attributes.attachment_link.description
Schizophrenia, and other mental disorders, should only be diagnosed by a medical doctor, clinical psychologist, or trained health professional who has spent time with the person and has conducted a proper mental health assessment. Diagnoses are complicated with many nuances. Please do not attempt to diagnose someone based on the symptoms you read in magazines or on the internet.

# data[].attributes.attachment_link.readable_text
MedlinePlus links to health information from the National Institutes of Health and other federal government agencies. MedlinePlus also links to health information from non-government Web sites. See our disclaimer about external links and our quality guidelines.

# data[].attributes.attachment_link.description
MedlinePlus links to health information from the National Institutes of Health and other federal government agencies. MedlinePlus also links to health information from non-government Web sites. See our disclaimer about external links and our quality guidelines.

# data[].attributes.attachment_link.readable_text
Are obsessive thoughts and compulsive behaviors interfering with your daily life? Explore the symptoms, treatment, and self-help for OCD.

What is obsessive-compulsive disorder (OCD)?

It's normal, on occasion, to go back and double-check that the iron is unplugged or worry that you might be contaminated by germs, or even have an occasional unpleasant, violent thought. But if you suffer from obsessive-compulsive disorder (OCD), obsessive thoughts and compulsive behaviors become so consuming they interfere with your daily life. OCD is an anxiety disorder characterized by uncontrollable, unwanted thoughts and ritualized, repetitive behaviors you feel compelled to perform. If you have OCD, you probably recognize that your obsessive thoughts and compulsive behaviors are irrational-but even so, you feel unable to resist them and break free.

Like a needle getting stuck on an old record, OCD causes the brain to get stuck on a particular thought or urge. For example, you may check the stove 20 times to make sure it's really turned off because you're terrified of burning down your house, or wash your hands until they're scrubbed raw for fear of germs. While you don't derive any sense of pleasure from performing these repetitive behaviors, they may offer some passing relief for the anxiety generated by the obsessive thoughts.

You may try to avoid situations that trigger or worsen your symptoms or self-medicate with alcohol or drugs. But while it can seem like there's no escaping your obsessions and compulsions, there are plenty of things you can do to break free of unwanted thoughts and irrational urges and regain control of your thoughts and actions.

OCD obsessions and compulsions

Obsessions are involuntary thoughts, images, or impulses that occur over and over again in your mind. You don't want to have these ideas, but you can't stop them. Unfortunately, these obsessive thoughts are often disturbing and distracting.

Compulsions are behaviors or rituals that you feel driven to act out again and again. Usually, compulsions are performed in an attempt to make obsessions go away. For example, if you're afraid of contamination, you might develop elaborate cleaning rituals. However, the relief never lasts. In fact, the obsessive thoughts usually come back stronger. And the compulsive rituals and behaviors often end up causing anxiety themselves as they become more demanding and time-consuming. This is the vicious cycle of OCD.

Most people with OCD fall into one of the following categories:

Washers are afraid of contamination. They usually have cleaning or hand-washing compulsions.

Checkers repeatedly check things (oven turned off, door locked, etc.) that they associate with harm or danger.

Doubters and sinners are afraid that if everything isn't perfect or done just right something terrible will happen, or they will be punished.

Counters and arrangers are obsessed with order and symmetry. They may have superstitions about certain numbers, colors, or arrangements.

OCD and hoarding

Hoarding used to be considered a category of OCD. While estimates suggest that up to 25 percent of people with OCD experience compulsive hoarding, it can also be a sign of a separate condition, hoarding disorder.

Hoarders fear that something bad will happen if they throw anything away and hoard things that they don't need or use. However, there are distinctions between OCD-related hoarding and hoarding disorder.

OCD-related hoarders tend not to accumulate so many possessions that their homes become unmanageable. Hoarding for them is usually unwelcome and distressing-a way to manage intrusive thoughts

Someone with hoarding disorder, on the other hand, experiences both positive and negative emotions. Acquiring possessions provides pleasure rather than simply satisfying a compulsion and they being surrounded by their things provides comfort. The distress in hoarding disorder stems more from the consequences of hoarding-the clutter and unsafe environment-along with the anxiety of having to discard possessions .

Read: Hoarding Disorder: Help for Hoarders

OCD signs and symptoms

Just because you have obsessive thoughts or perform compulsive behaviors does NOT mean that you have obsessive-compulsive disorder. With OCD, these thoughts and behaviors cause tremendous distress, take up a lot of time (at least one hour per day), and interfere with your daily life and relationships.

Most people with obsessive-compulsive disorder have both obsessions and compulsions, but some people experience just one or the other.
Common obsessive thoughts in OCD include:

Fear of being contaminated by germs or dirt or contaminating others.

Fear of losing control and harming yourself or others.

Intrusive sexually explicit or violent thoughts and images.

Excessive focus on religious or moral ideas.

Fear of losing or not having things you might need.

Order and symmetry: the idea that everything must line up "just right".

Superstitions; excessive attention to something considered lucky or unlucky.

Common compulsive behaviors in OCD include:

Excessive double-checking of things, such as locks, appliances, and switches.

Repeatedly checking in on loved ones to make sure they're safe.

Counting, tapping, repeating certain words, or doing other senseless things to reduce anxiety.

Spending a lot of time washing or cleaning.

Ordering or arranging things "just so".

Praying excessively or engaging in rituals triggered by religious fear.

Accumulating "junk" such as old newspapers or empty food containers.

OCD symptoms in children

While the onset of obsessive-compulsive disorder usually occurs during adolescence or young adulthood, younger children sometimes have symptoms that look like OCD. However, the symptoms of other disorders, such as ADHD, autism, and Tourette's syndrome, can also look like obsessive-compulsive disorder, so a thorough medical and psychological exam is essential before any diagnosis is made.

OCD self-help tip 1: Identify your triggers

The first step to managing your OCD symptoms is to recognize the triggers-the thoughts or situations-that bring on your obsessions and compulsions. Record a list of the triggers you experience each day and the obsessions they provoke. Rate the intensity of the fear or anxiety you experienced in each situation and then the compulsions or mental strategies you used to ease your anxiety. For example, if you have a fear of being contaminated by germs, touching a railing at the mall might generate a fear intensity of 3, whereas touching the restroom floor in the mall might generate a 10 and require 15 minutes of hand washing to ease your anxiety.

Keeping track of your triggers can help you anticipate your urges. And by anticipating your compulsive urges before they arise, you can help to ease them. For example, if your compulsive behavior involves checking that doors are locked, windows closed, or appliances turned off, try to lock the door or turn off the appliance with extra attention the first time.

Create a solid mental picture and then make a mental note. Tell yourself, "The window is now closed," or "I can see that the oven is turned off."

When the urge to check arises later, you will find it easier to re-label it as "just an obsessive thought."

Identifying and recording your triggers also provides an important tool for learning to resist your OCD compulsions.

Tip 2: Learn to resist OCD compulsions

It might seem smart to avoid the situations that trigger your obsessive thoughts, but the more you avoid them, the scarier they feel. Conversely, by repeatedly exposing yourself to your OCD triggers, you can learn to resist the urge to complete your compulsive rituals. This is known as exposure and response prevention (ERP) and is a mainstay of professional therapy for OCD.

ERP requires you to repeatedly expose yourself to the source of your obsession-and then refrain from the compulsive behavior you'd usually perform to reduce your anxiety. If you are a compulsive hand washer, for example, that could mean touching the door handle in a public restroom and then not allowing yourself to wash your hands. As you sit with the anxiety, the urge to wash your hands will gradually begin to go away on its own. In this way, you'll learn that you don't need the ritual to get rid of your anxiety and that you have some control over your obsessive thoughts and compulsive behaviors.

Tackling your biggest fears straight off might be too extreme, so ERP exercises start with you confronting lesser fears and then working your way up the "fear ladder." Confront those situations that generate a low fear intensity and once you're able to tolerate the anxiety you can move on to the next, more difficult exposure challenge.

Building your fear ladder

Think about your end goal (to be able to use a public restroom without fear of contamination, for example, or to drive to work without stopping to check if you've hit something) and then break down the steps needed to reach that goal. Using the information you recorded in identifying your triggers, make a list of situations from the least scary to the most scary. The first step should make you slightly anxious, but not so frightened that you're too intimidated to try it.

Here's a sample fear ladder:

Goal: To drive to work without stopping to check if you've hit something

Fear intensity

Situation

10

Drive all the way to work without stopping to check if you've hit something

8

Don't phone your spouse to check they got to work safely

6

Leave the house, lock the front door and walk away without checking

4

Turn off the stove and leave the room without checking

2

Put milk in the refrigerator without checking the top is secure

Using your fear ladder

Work your way up the ladder. Start with the first step and don't move on until you start to feel more comfortable doing it. If possible, stay in the situation long enough for your anxiety to decrease. The longer you expose yourself to your OCD trigger, the more you'll get used to it and the less anxious you'll feel when you face it the next time. Once you've done a step on several separate occasions without feeling too much anxiety, you can move on to the next step. If a step is too hard, break it down into smaller steps or go slower.

As you're resisting your compulsions, focus on the feelings of anxiety. Instead of trying to distract yourself, allow yourself to feel anxious as you resist the urge to engage in your compulsive behavior. You may believe that the discomfort you're feeling will continue until you engage in the compulsion. But if you stick with it, the anxiety will fade. And you'll realize that you're not going to "lose control" or have some kind of breakdown if you don't perform the ritual.

Practice. The more often you practice, the quicker your progress will be. But don't rush. Go at a pace that you can manage without feeling overwhelmed. And remember: you will feel uncomfortable and anxious as you face your fears, but the feelings are only temporary. Each time you expose yourself to your trigger, your anxiety should lessen and you'll start to realize that you have more control (and less to fear) than you thought.

Tip 3: Challenge obsessive thoughts

Everyone has troubling thoughts or worries from time to time. But obsessive-compulsive disorder causes the brain to get stuck on a particular anxiety-provoking thought, causing it to play over and over in your head. The more unpleasant or distressing the thought, the more likely you are to try to repress it. But repressing thoughts is almost impossible and trying usually has the opposite effect, causing the unpleasant thought to resurface more frequently and become more bothersome.

As with resisting compulsions, you can overcome disturbing, obsessive thoughts by learning to tolerate them through exposure and response prevention exercises. It's also important to remind yourself that just because you have an unpleasant thought, that doesn't make you a bad person. Your thoughts are just thoughts. Even unwanted, intrusive, or violent thoughts are normal-it's only the importance you attach to them that turns them into damaging obsessions.

The following strategies can help you see your thoughts for what they are and regain a sense of control over your anxious mind.

Write down your obsessive thoughts. Keep a pad and pencil on you, or type on a smartphone. When you begin to obsess, write down all your thoughts or compulsions.

Keep writing as the OCD urges continue, aiming to record exactly what you're thinking, even if you're repeating the same phrases or the same urges over and over.

Writing it all down will help you see just how repetitive your obsessions are.

Writing down the same phrase or urge hundreds of times will help it lose its power.

Writing thoughts down is much harder work than simply thinking them, so your obsessive thoughts are likely to disappear sooner.

Create an OCD worry period. Rather than trying to suppress obsessions or compulsions, develop the habit of rescheduling them.

Choose one or two 10-minute "worry periods" each day, time you can devote to obsessing.

During your worry period, focus only on negative thoughts or urges. Don't try to correct them. At the end of the worry period, take a few calming breaths, let the obsessive thoughts go, and return to your normal activities. The rest of the day, however, is to be designated free of obsessions.

When thoughts come into your head during the day, write them down and "postpone" them to your worry period.

Challenge your obsessive thoughts. Use your worry period to challenge negative or intrusive thoughts by asking yourself:

What's the evidence that the thought is true? That it's not true? Have I confused a thought with a fact?

Is there a more positive, realistic way of looking at the situation?

What's the probability that what I'm scared of will actually happen? If the probability is low, what are some more likely outcomes?

Is the thought helpful? How will obsessing about it help me and how will it hurt me?

What would I say to a friend who had this thought?

Create a tape of your OCD obsessions or intrusive thoughts. Focus on one specific thought or obsession and record it to a tape recorder or smartphone.

Recount the obsessive phrase, sentence, or story exactly as it comes into your mind.

Play the tape back to yourself, over and over for a 45-minute period each day, until listening to the obsession no longer causes you to feel highly distressed.

By continuously confronting your worry or obsession you will gradually become less anxious. You can then repeat the exercise for a different obsession.

Tip 4: Reach out for support

OCD can get worse when you feel powerless and alone, so it's important to build a strong support system. The more connected you are to other people, the less vulnerable you'll feel. And just talking to an understanding person about your worries and urges can make them seem less threatening.

Stay connected to family and friends. Obsessions and compulsions can consume your life to the point of social isolation. In turn, social isolation will aggravate your OCD symptoms. It's important to invest in relating to family and friends. Talking face-to-face about your worries and urges can make them feel less real and less threatening.

Join an OCD support group. You're not alone in your struggle with OCD, and participating in a support group can be an effective reminder of that. OCD support groups enable you to both share your own experiences and learn from others who are facing the same problems.

Tip 5: Manage stress

While stress doesn't cause OCD, it can trigger symptoms or make them worse. Physical exercise and connecting with another person face-to-face are two very effective ways to calm your nervous system. You can also:

Quickly self-soothe and relieve anxiety symptoms by making use of one or more of your physical senses -sight, smell, hearing, touch, taste-or movement. You might try listening to a favorite piece of music, looking at a treasured photo, savoring a cup of tea, or stroking a pet.

Practice relaxation techniques. Mindful meditation, yoga, deep breathing, and other relaxation techniques can help lower your overall stress and tension levels and help you manage your urges. For best results, try practicing a relaxation technique regularly.

Tip 6: Make lifestyle changes to ease OCD

A healthy, balanced lifestyle plays a big role in easing anxiety and keeping OCD compulsions, fears, and worry at bay.

Exercise regularly. Exercise is a natural and effective anti-anxiety treatment that helps to control OCD symptoms by refocusing your mind when obsessive thoughts and compulsions arise. For maximum benefit, try to get 30 minutes or more of aerobic activity on most days. Ten minutes several times a day can be as effective as one longer period especially if you pay mindful attention to the movement process.

Get enough sleep. Not only can anxiety and worry cause insomnia, but a lack of sleep can also exacerbate anxious thoughts and feelings. When you're well rested, it's much easier to keep your emotional balance, a key factor in coping with anxiety disorders such as OCD.

Avoid alcohol and nicotine. Alcohol temporarily reduces anxiety and worry, but it actually causes anxiety symptoms as it wears off. Similarly, while it may seem that cigarettes are calming, nicotine is actually a powerful stimulant. Smoking leads to higher, not lower, levels of anxiety and OCD symptoms.

Treatment for OCD

Cognitive-behavioral therapy is the most effective treatment for obsessive-compulsive disorder and generally involves two components:

1. Exposure and response prevention, which requires repeated exposure to the source of your obsession, as explained above.

2. Cognitive therapy, which focuses on the catastrophic thoughts and exaggerated sense of responsibility you feel. A big part of cognitive therapy for OCD is teaching you healthy and effective ways of responding to obsessive thoughts, without resorting to compulsive behavior.

Other OCD treatments

In addition to cognitive-behavioral therapy, the following treatments are also used for OCD:

Medication. Antidepressants are sometimes used in conjunction with therapy for the treatment of obsessive-compulsive disorder. However, medication alone is rarely effective in relieving the symptoms.

Family Therapy. Since OCD often causes problems in family life and social adjustment, family therapy can help promote understanding of the disorder and reduce family conflicts. It can also motivate family members and teach them how to help their loved one with OCD.

Group Therapy. Through interaction with fellow OCD sufferers, group therapy provides support and encouragement and decreases feelings of isolation.

Is unresolved trauma playing a role in your OCD?

In some people, OCD symptoms such as compulsive washing or hoarding are ways of coping with trauma. If you have post-traumatic OCD, cognitive approaches may not be effective until underlying traumatic issues are resolved.

How to help someone with OCD

The way you react to your loved one's OCD symptoms can have a big impact on their outlook and recovery. Negative comments or criticism can make OCD worse, while a calm, supportive environment can help improve the outcome of treatment.

Avoid making personal criticisms. Remember, your loved one's OCD behaviors are symptoms, not character flaws.

Don't scold someone with OCD or tell them to stop performing rituals. They can't comply, and the pressure to stop will only make the behaviors worse.

Be as kind and patient as possible. Each sufferer needs to overcome problems at their own pace. Praise any successful attempt to resist OCD, and focus attention on positive elements in the person's life.

Do not play along with your loved one's rituals. Going along with your loved one's OCD "rules," or helping with their compulsions or rituals will only reinforce the behavior. Support the person, not their compulsions.

Keep communication positive and clear. Communication is important so you can find a balance between supporting your loved one and standing up to the OCD symptoms and not further distressing your loved one.

Find the humor. Laughing together over the funny side and absurdity of some OCD symptoms can help your loved one become more detached from the disorder. Just make sure your loved one feels respected and in on the joke.

Don't let OCD take over family life. Sit down as a family and decide how you will work together to tackle your loved one's symptoms. Try to keep family life as normal as possible and the home a low-stress environment.

# data[].attributes.attachment_link.description
It's normal, on occasion, to go back and double-check that the iron is unplugged or worry that you might be contaminated by germs, or even have an occasional unpleasant, violent thought. But if you suffer from obsessive-compulsive disorder (OCD), obsessive thoughts and compulsive behaviors become so consuming they interfere with your daily life.

# data[].attributes.attachment_link.readable_text
What Happens in OCD?

OCD causes the brain to create repetitive worries and fears. These worries, fears and "bad thoughts" can pop up in the brain and might be hard to get rid of.

People who have OCD feel they can't stop thinking about worries like these:

someone might get sick, hurt, or die

things might be germy or dirty

something isn't straight, even, or exactly right

something is lucky or unlucky, bad or good, safe or harmful

bad thoughts might come true

OCD also can cause people to feel they have to do behaviors to feel safe from worries and fears. For example, someone with OCD might feel like they have to:

wash and clean too much

erase, rewrite, or re-do things

repeat a word, phrase, or a question more often than necessary

check and re-check if something is closed or locked

touch, tap, or step in an unusual way

put things in just the right order

These behaviors are called rituals. People with OCD may repeat rituals over and over. Doing a ritual temporarily interrupts the bad thoughts.

The brain learns that doing a ritual brings relief. Pretty soon, people with OCD do a ritual automatically. They may feel like they can't stop. But doing rituals causes OCD to continue.

The name OCD is short for obsessive-compulsive disorder. "Disorder" is a medical way of saying that something in the body isn't working properly. "Obsessive" is the unwanted thoughts and worries. "Compulsive" is a medical word used to describe the behaviors that people feel they must do to fix the worries.

What Causes OCD?

OCD happens because of a problem in the brain's message system. The problem causes worry and fear messages to form by mistake. It also causes the strong feeling of having to do a ritual to make things safe.

Scientists don't yet know what causes this problem to happen. OCD tends to run in families. People may get OCD because it's in their genes or they might have had an infection. There may be differences in the brain that cause OCD to start. OCD is not caused by anything a person (or parent) did.

What's it Like for People With OCD?

Teens with OCD might have it for a while before a parent or doctor realizes it. They may know that their worries and rituals don't make sense. They may want to stop, but feel they can't.

OCD worries and rituals can multiply and begin taking more time and energy. This makes it hard to concentrate, do schoolwork, or enjoy fun and friends. OCD can leave people feeling stressed, tired, and sad.

People who have OCD don't have to go through it alone. The best thing to do is tell a parent or other adult so you can go to a doctor.

How Is OCD Diagnosed and Treated?

To diagnose OCD, doctors who know the signs of OCD will ask questions and talk about what's happening. They also will do a health checkup.

If a doctor decides that you have OCD, it can be a relief to know what's causing the trouble. Now you can move forward and learn how to overcome it.

OCD can get better with therapy. Doctors sometimes also give medicines to treat OCD. But not everyone needs medicine to get well.

Therapists and doctors use a talk-and-do therapy for OCD. During this treatment, you will learn more about OCD and how it works. You will learn that doing rituals keeps OCD going strong and not doing rituals weakens OCD. You will learn and practice ways to face fears and ignore worry messages caused by OCD. You will learn to resist doing rituals.

You'll spend time talking and practicing your new skills. This can take time - how long depends on the person. But learning and practicing these skills stops the cycle of OCD and allows the brain's message system to work better again.

How Can Parents Help?

If you're going through OCD, parents or other adults can be a big part of helping you get better.

Your therapist can teach your parent the best ways to help you through OCD. Family members can help you practice the things you learn in therapy, like dealing with fears and rituals. They can help you with schoolwork if you have trouble getting it done. They can talk with your teacher if you need extra help while you're going through OCD.

Parents and adults in your life can be there to give you love and support. They can take your mind off OCD by doing fun or relaxing things with you. And they can remind you that OCD can get better with time, practice, and patience.

# data[].attributes.attachment_link.description
OCD causes the brain to create repetitive worries and fears. These worries, fears and "bad thoughts" can pop up in the brain and might be hard to get rid of.

# data[].attributes.attachment_link.title
Symptoms and Strategies for Generalized Anxiety Disorder (GAD) in Children and Teens

# data[].attributes.attachment_link.readable_text
Does your child go through extreme changes in mood and behavior? Does your child get much more excited or much more irritable than other kids? Do you notice that your child goes through cycles of extreme highs and lows more often than other children? Do these mood changes affect how your child acts at school or at home?

Some children and teens with these symptoms may have bipolar disorder, a brain disorder that causes unusual shifts in mood, energy, activity levels, and day-to-day functioning. With treatment, children and teens with bipolar disorder can get better over time.

What is bipolar disorder?

Bipolar disorder is a mental disorder that causes people to experience noticeable, sometimes extreme, changes in mood and behavior. Sometimes children with bipolar disorder feel very happy or "up" and are much more energetic and active than usual. This is called a manic episode. Sometimes children with bipolar disorder feel very sad or "down" and are much less active than usual. This is called a depressive episode.

Bipolar disorder, which used to be called manic-depressive illness or manic depression, is not the same as the normal ups and downs every child goes through. The mood changes in bipolar disorder are more extreme, often unprovoked, and accompanied by changes in sleep, energy level, and the ability to think clearly. Bipolar symptoms can make it hard for young people to perform well in school or to get along with friends and family members. Some children and teens with bipolar disorder may try to hurt themselves or attempt suicide.

Most people are diagnosed with bipolar disorder in adolescence or adulthood, but the symptoms can appear earlier in childhood. Bipolar disorder is often episodic, but it usually lasts a lifetime.

Signs and symptoms of bipolar disorder may overlap with symptoms of other disorders that are common in young people, such as attention-deficit/hyperactivity disorder (ADHD), conduct problems, major depression, and anxiety disorders. Diagnosing bipolar disorder can be complicated and requires a careful and thorough evaluation by a trained, experienced mental health professional.

With treatment, children and teens with bipolar disorder can manage their symptoms and lead successful lives.

What causes bipolar disorder?

The exact causes of bipolar disorder are unknown, but several factors may contribute to the illness.

For example, researchers are beginning to uncover genetic mechanisms that are linked to bipolar disorder and other mental disorders. Research shows that people's chance of having bipolar disorder is higher if they have a close family member with the illness, which may be because they have the same genetic variations. However, just because one family member has bipolar disorder, it does not mean that other members of the family will have it. Many genes are involved in the disorder, and no single gene causes it.

Research also suggests that adversity, trauma, and stressful life events may increase the chances of developing bipolar disorder in people with a genetic risk of having the illness.

Some research studies have found differences in brain structure and function between people who have bipolar disorder and those who do not. Researchers are studying the disorder to learn more about its causes and effective treatments.

What are the symptoms of bipolar disorder?

Mood episodes in bipolar disorder include intense emotions along with significant changes in sleep habits, activity levels, thoughts, or behaviors. A person with bipolar disorder may have manic episodes, depressive episodes, or "mixed" episodes. A mixed episode has both manic and depressive symptoms. These mood episodes cause symptoms that often last for several days or weeks. During an episode, the symptoms last every day for most of the day.

These mood and activity changes are very different from the child's usual behavior and from the behavior of healthy children and teens.

Children and teens having a manic episode may:

Show intense happiness or silliness for long periods of time.

Have a very short temper or seem extremely irritable.

Talk fast about a lot of different things.

Have trouble sleeping but not feel tired.

Have trouble staying focused, and experience racing thoughts.

Seem overly interested or involved in pleasurable but risky activities.

Do risky or reckless things that show poor judgment.

Children and teens having a depressive episode may:

Feel frequent and unprovoked sadness.

Show increased irritability, anger, or hostility.

Complain a lot about pain, such as stomachaches and headaches.

Have a noticeable increase in amount of sleep.

Have difficulty concentrating.

Feel hopeless and worthless.

Have difficulty communicating or maintaining relationships.

Eat too much or too little.

Have little energy and no interest in activities they usually enjoy.

Think about death, or have thoughts of suicide.

Can children and teens with bipolar disorder have other problems?

Young people with bipolar disorder can have several problems at the same time. These include:

Misuse of alcohol and drugs. Young people with bipolar disorder are at risk of misusing alcohol or drugs.

Attention-deficit/hyperactivity disorder (ADHD). Children and teens who have both bipolar disorder and ADHD may have trouble staying focused.

Anxiety disorders. Children and teens with bipolar disorder also may have an anxiety disorder.

Sometimes extreme behaviors go along with mood episodes. During manic episodes, young people with bipolar disorder may take extreme risks that they wouldn't usually take or that could cause them harm or injury. During depressive episodes, some young people with bipolar disorder may think about running away from home or have thoughts of suicide.

If your child shows signs of suicidal thinking, take these signs seriously and call your child's health care provider.
If you think your child is in crisis and needs immediate help, call 911. You also can call the National Suicide Prevention Lifeline (Lifeline) at 1‑800‑273‑TALK (8255), or text the Crisis Text Line (text HELLO to 741741). The deaf and hard of hearing can contact the Lifeline via TTY at 1-800-799-4889. These services are confidential, free, and available 24/7.

How is bipolar disorder diagnosed?

A health care provider will ask questions about your child's mood, sleeping patterns, energy levels, and behavior. There are no blood tests or brain scans that can diagnose bipolar disorder. However, the health care provider may use tests to see if something other than bipolar disorder is causing your child's symptoms. Sometimes health care providers need to know about medical conditions in the family, such as depression or substance use.

Other disorders have symptoms like those of bipolar disorder, including ADHD, disruptive mood regulation disorder, oppositional defiant disorder, conduct disorder, and anxiety disorders. It also can be challenging to distinguish bipolar disorder from depression that occurs without mania, which is referred to as "major depression." A health care provider who specializes in working with children and teens can make a careful and complete evaluation of your child's symptoms to provide the right diagnosis.

How is bipolar disorder treated?

Children and teens can work with their health care provider to develop a treatment plan that will help them manage their symptoms and improve their quality of life. It is important to follow the treatment plan, even when your child is not currently experiencing a mood episode. Steady, dependable treatment works better than treatment that starts and stops.

Treatment options include:

Medication. Several types of medication can help treat symptoms of bipolar disorder. Children respond to medications in different ways, so the right type of medication depends on the child. This means children may need to try different types of medication to see which one works best for them. Some children may need more than one type of medication because their symptoms are complex. Children should take the fewest number of medications and the smallest doses possible to help their symptoms. A good way to remember this is "start low, go slow." Medications can cause side effects. Always tell your child's health care provider about any problems with side effects. Do not stop giving your child medication without speaking to a health care provider. Stopping medication suddenly can be dangerous and can make bipolar symptoms worse.

Psychosocial Therapy. Different kinds of psychosocial therapy can help children and their families manage the symptoms of bipolar disorder. Therapies that are based on scientific research-including cognitive behavioral approaches and family-focused therapy-can provide support, education, and guidance to youth and their families. These therapies teach skills that can help people manage bipolar disorder, including skills for maintaining routines, enhancing emotion regulation, and improving social interactions.

What can children and teens expect from treatment?

With treatment, children and teens with bipolar disorder can get better over time. Treatment is more effective when health care providers, parents, and young people work together.

Sometimes a child's symptoms may change, or disappear and then come back. When this happens, your child's health care provider may recommend changes to the treatment plan. Treatment can take time, but sticking with the treatment plan can help young people manage their symptoms and reduce the likelihood of future episodes.

Your child's health care provider may recommend keeping a daily life chart or mood chart to track your child's moods, behaviors, and sleep patterns. This may make it easier to track the illness and see whether treatment is working.

How can I help my child or teen?

Help begins with the right diagnosis and treatment. Talk to your family health care provider about any symptoms you notice.

If your child has bipolar disorder, here are some basic things you can do:

Be patient.

Encourage your child to talk, and listen to your child carefully.

Pay attention to your child's moods, and be alert to any major changes.

Understand triggers, and learn strategies for managing intense emotions and irritability.

Help your child have fun.

Remember that treatment takes time: sticking with the treatment plan can help your child get better and stay better.

Help your child understand that treatment can make life better.

How does bipolar disorder affect caregivers and families?

Caring for a child or teenager with bipolar disorder can be stressful for parents and families. Coping with a child's mood episodes and other problems-such as short tempers and risky behaviors-can challenge any caregiver.

It is important that caregivers take care of themselves, too. Find someone you can talk to or consult your health care provider about support groups. Finding support and strategies for managing stress can help you and your child.

Where do I go for help?

If you're not sure where to get help, your doctor, pediatrician, or other family health care provider is a good place to start. A health care provider can refer you to a qualified mental health professional, such as a psychiatrist or psychologist, who has experience treating bipolar disorder and can evaluate your child's symptoms.

You can learn more about getting help and finding a health care provider on the National Institute of Mental Health website. Hospital health care providers can help in an emergency. The Substance Abuse and Mental Health Services Administration (SAMHSA) has an online tool to help you find mental health services in your area.

I know someone who is in crisis. What do I do?

If you know someone who might be thinking about hurting themselves or someone else, get help quickly.

Do not leave the person alone.

Call 911 or go to the nearest hospital emergency room.

Call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or the toll-free TTY number at 1-800-799-4TTY (4889). You also can text the Crisis Text Line (text HELLO to 741741) or go to the National Suicide Prevention Lifeline website.

What should I know about clinical trials?

Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and conditions. Although individuals may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future.

Researchers at NIMH and around the country conduct clinical trials with patients and healthy volunteers. Talk to your health care provider about clinical trials, their benefits and risks, and whether one is right for you. For more information, visit the NIMH Clinical Trials webpage.

Reprints

This publication is in the public domain and may be reproduced or copied without permission from NIMH. Citation of NIMH as a source is appreciated. To learn more about using NIMH publications, please contact the NIMH Information Resource Center at 1-866‑615‑6464, email nimhinfo@nih.gov, or refer to our reprint guidelines.

For More Information

MedlinePlus (National Library of Medicine) ( En español)

ClinicalTrials.gov ( En español)

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Institutes of Health
NIH Publication No. 20-MH-8081
Revised 2020

# data[].attributes.attachment_link.description
Does your child go through extreme changes in mood and behavior? Does your child get much more excited or much more irritable than other kids? Do you notice that your child goes through cycles of extreme highs and lows more often than other children?

# data[].attributes.attachment_link.readable_text
Children with intermittent explosive disorder (IED) exhibit short episodes of intense, uncontrollable anger or aggression with very little or no apparent cause. Our guide outlines how to recognize the symptoms of IED, and how it is diagnosed and treated.

IED: What Is It?

Intermittent explosive disorder (IED) is a behavior disorder characterized by brief episodes of disproportionate anger and aggression. Onset is in late childhood or adolescence. A child or adolescent with IED can't control his anger and will impulsively explode into rage with little or no apparent provocation. The pattern is often one of frequent, less severe outbursts (tantrums, tirades, arguments or fights) that don't do physical damage, punctuated by less frequent, more severe episodes that do cause injury to people or animals or damage to property. IED greatly interferes with a child's family life as well as his social relationships and academic achievement.

IED: What to Look For

Adolescents with IED have low frustration tolerance and are disproportionately enraged by small annoyances, often becoming verbally and physically aggressive, sometimes causing property damage or even physical injury. Road rage, breaking furniture and getting into fights are all common behaviors for people with the disorder. They describe feeling overcome with anger and "out of control." Some experience a sensation of building tension in the head or chest that is finally released when they react aggressively. The explosions are typically brief, less than 30 minutes, and are not premeditated, or aimed at some tangible objective. Adolescents and young adults with IED are at a higher risk of intentionally harming themselves or committing suicide.

IED: Risk Factors

Children who have experienced physical and emotional trauma are more likely to develop intermittent explosive disorder, as are those with first-degree relatives who have the disorder.

IED: Diagnosis

To be diagnosed with intermittent explosive disorder, one must exhibit a pattern of being unable to resist angry impulses, resulting in explosions of rage that are disproportionate to the situation and sometimes quite dangerous or destructive. Since aggressive behavior can occur in the context of many mental disorders, a doctor must first rule out other reasons for these symptoms, such as substance abuse, another psychiatric disorder, or a physical explanation like head trauma.

IED: Treatment

Treatment for intermittent explosive disorder generally involves a psychotherapeutic and a psychopharmacological component.

Psychotherapeutic: Cognitive behavioral therapy (CBT) is commonly used to help people with IED learn which situations trigger their rage episodes. Through CBT they can learn to recognize and manage their anger in a healthy, non-disruptive way. A therapist will work with the patient and family (and, when appropriate, teachers) to manage and prevent explosive episodes.

Pharmacological: There are no medications specifically for IED, but a variety of medications have been used to help people with IED, including antidepressants and anti-anxiety medications, nas well as anticonvulsants and other mood regulators. After a careful evaluation, a psychiatrist will prescribe the appropriate type of medication for an individual case.

IED: Risk For Other Disorders

Someone diagnosed with intermittent explosive disorder is more likely to also develop an anxiety, depressive, or substance use disorder.

# data[].attributes.attachment_link.description
Children with intermittent explosive disorder (IED) exhibit short episodes of intense, uncontrollable anger or aggression with very little or no apparent cause. Our guide outlines how to recognize the symptoms of IED, and how it is diagnosed and treated. Intermittent explosive disorder (IED) is a behavior disorder characterized by brief episodes of disproportionate anger and aggression.

# data[].attributes.attachment_link.readable_text
Oppositional Defiant Disorder

No. 72; Reviewed January 2019

All children are oppositional from time to time, particularly when tired, hungry, stressed, or upset. They may argue, talk back, disobey, and defy parents, teachers, and other adults. Oppositional behavior is a normal part of development for two to three year olds and early adolescents. However, openly uncooperative and hostile behavior becomes a serious concern when it is so frequent and consistent that it stands out when compared with other children of the same age and developmental level and when it affects the child's social, family, and academic life.

In children with Oppositional Defiant Disorder (ODD), there is an ongoing pattern of uncooperative, defiant, and hostile behavior toward authority figures that seriously interferes with the child's day to day functioning.

Symptoms of ODD may include:

Frequent temper tantrums

Excessive arguing with adults

Often questioning rules

Active defiance and refusal to comply with adult requests and rules

Deliberate attempts to annoy or upset people

Blaming others for his or her mistakes or misbehavior

Often being touchy or easily annoyed by others

Frequent anger and resentment

Mean and hateful talking when upset

Spiteful attitude and revenge seeking

The symptoms are usually seen in multiple settings but may be more noticeable at home or at school. One to sixteen percent of all school-age children and adolescents have ODD. The causes of ODD are unknown, but many parents report that their child with ODD was more rigid and demanding than the child's siblings from an early age. Biological, psychological, and social factors may have a role.

A child presenting with ODD symptoms should have a comprehensive evaluation. It is important to look for other disorders which may be present, such as attention-deficit hyperactivity disorder (ADHD), learning disabilities, mood disorders (depression, bipolar disorder), and anxiety disorders. It may be difficult to improve the symptoms of ODD without treating the coexisting disorder. Some children with ODD may go on to develop conduct disorder.

Treatment of ODD may include:

Parent Management Training to help parents and others manage the child's behavior

Individual Psychotherapy to develop more effective anger management

Family Psychotherapy to improve communication and mutual understanding

Cognitive Problem-Solving Skills Training and Therapies to decrease negativity

Social Skills Training to increase flexibility and improve social skills and frustration tolerance with peers

Medications may be helpful in controlling some of the more distressing symptoms of ODD as well as the symptoms related to coexistent conditions such as ADHD, anxiety, and mood disorders.

A child with ODD can be very difficult for parents. These parents need support and understanding. Parents can help their child with ODD in the following ways:

Always build on the positives, give the child praise and positive reinforcement when s/he shows flexibility or cooperation.

Take a time-out or break if you are about to make the conflict with your child worse, not better. This is good modeling for your child. Support your child if s/he decides to take a time-out to prevent overreacting.

Pick your battles. Since the child with ODD has trouble avoiding power struggles, prioritize the things you want your child to do. If you give your child a time-out in his room for misbehavior, don't add time for arguing. Say "your time will start when you go to your room."

Set reasonable, age appropriate limits with consequences that can be enforced consistently.

Maintain interests other than your child with ODD, so that managing your child doesn't take all your time and energy. Try to work with and obtain support from the other adults (teachers, coaches, and spouse) dealing with your child.

Manage your own stress with healthy life choices such as exercise and relaxation. Use respite care and other breaks as needed.

Many children with ODD will respond to the positive parenting techniques. Parents may ask their pediatrician or family physician to refer them to a child and adolescent psychiatrist or other qualified mental health professional who can help diagnose and treat ODD and any coexisting psychiatric condition.

# data[].attributes.attachment_link.description
Oppositional Defiant Disorder No. 72; Reviewed January 2019 All children are oppositional from time to time, particularly when tired, hungry, stressed, or upset. They may argue, talk back, disobey, and defy parents, teachers, and other adults. Oppositional behavior is a normal part of development for two to three year olds and early adolescents.

# data[].attributes.attachment_link.readable_text
By: Michael Puskar

Updated June 04, 2020

Behavioral disorders, although they are commonly associated with children, they can also affect adults, especially if one was left untreated since a person's youth. This article will discuss what behavioral disorders are, what conditions are considered one, as well as what treatment methods are available to those who have one.
Don't Wait - Connect With A Licensed Therapist Today
Source: pxhere.com

What Is A Behavioral Disorder?

Despite sounding like a very generic term, since all mental disorders will affect a person's behavior to some degree, behavioral disorders refer to a specific group of distinct mental conditions.

Behavioral disorders can be impulsive and disruptive to everyone around them; there used to be only a few different conditions within this category, but as of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), it has expanded this category by adding new ones. These are behavioral disorders currently identified by the American Psychiatric Association and the DSM-5:

Attention-Deficit Hyperactivity Disorder (ADHD)

Oppositional Defiant Disorder (ODD)

Conduct Disorder

Intermittent Explosive Disorder (IED)

Disruptive Mood Dysregulation Disorder (DMDD)

Typically, for a diagnosis of one of these disorders to occur, symptoms will need to have lasted for six months or longer and cause issues in school, at home, social situations, and for adults, at work. [1]

This list of behavioral disorders will be elaborated on more in-depth throughout this article where you can learn about the signs and symptoms of each of them.

Each of them might have similar traits such as aggression, impulsivity, disruption, and appearing at very young ages; however, they are all unique and should be discussed individually.

Source: learningsuccessblog.com
Attention-Deficit Hyperactivity Disorder (ADHD)
Attention-Deficit Hyperactivity Disorder is one of the most common behavioral disorders that affect children. It is estimated that around 8.4 percent of kids in the United States have ADHD, whereas 2.5 percent of adults have it as well. In fact, many adults are unaware that they have the disorder and will show signs of it for many years before getting diagnosed and receiving treatment. [2]

ADHD has three different categories, also known as presentations: inattentive type, hyperactive/impulsive type, and a combined type if they meet the minimum criteria for the first two types. Some people might be dominant one category over another; however, hyperactivity symptoms typically appear around the age of 3, whereas ones related to inattention will be more apparent around 5 to 8 years old. [3]

The condition is progressive, and symptoms may evolve, meaning that some may come and go, which can lead to a new diagnosis with a different presentation. In children, six symptoms must be observed to be diagnosed with a specific presentation, whereas only five need to be apparent for adults (those who are 17 and older).

For example, a boy has six symptoms of hyperactivity - he is very fidgety, cannot sit still, is always talking and interrupting others, and refuses to wait his turn. On the other hand, he only had four symptoms of inattention, primarily related to listening, paying attention, following directions, and staying focused. Because of this, he will then be diagnosed with Predominantly Hyperactive/Impulsive, but this might change with time.

No matter the age, ADHD can cause people to struggle in their daily lives, especially at school, work, and ordinary social interactions. Despite the challenges that people with ADHD face, the condition is treatable, and people can live more productive lives with medication, skill-building, and therapy.
Oppositional Defiant Disorder (ODD)
ODD is another mental condition that is often seen during childhood and adolescence and can coexist with other ones such as ADHD and anxiety.

This condition is typically described as being disobedient towards authority figures such as parents and teachers and some symptoms of ODD include: [4]
Don't Wait - Connect With A Licensed Therapist Today
Source: pxhere.com

Anger, speaking harshly and having frequent temper tantrums

Being defiant, arguing with adults, refusing to do what they say, and questioning rules

Being easily irritated by other people

Vindictive behaviors, such as revenge and deliberately annoying others

These symptoms in ODD may resemble other mental health conditions, and in ADHD specifically, they can coincide with issues with self-control. Additionally, those with ODD function best when they can exert authority onto others. Like ADHD, they also must be present for at least six months. [3]

It is currently unknown as to what causes ODD, but there are two theories - the developmental theory and the learning theory.

The developmental theory believes that ODD occurs when people are toddlers, and it stems from difficulties of learning how to be independent of their parent or guardian. The learning theory suggests that these attitudes are learned behaviors through negative reinforcement, and ODD behaviors essentially help the individual get what they want, such as attention, so he or she will continue to do it. [4]

Early diagnosis is critical for ODD because it can persist and create even more serious problems, such as committing crimes and disobeying police officers, which are all traits sometimes seen in conduct disorder.
Conduct Disorder
Conduct disorder is a condition that is much more severe than ODD, and although some people might consider it a continuum of it, conduct disorder is considered a separate condition, according to the American Psychiatric Association. [3] [5]

This disorder is considered more serious because it tends to be more aggressive, often purposely, in how rules are broken, sometimes leading to criminal activity.

Some signs of conduct disorder include: [5]

Bullying and fights

Carrying and using weapons

Destroying property, either public or private

Lying and stealing

Running away from home

Skipping school (truancy)

Source: pxhere.com

These aspects of conduct disorder can have grave consequences for people, and can especially school, social, and family life. Certain activities can get an individual expelled from school, or worse, sent to juvenile hall, if a crime has been committed.

It is essential to note that conduct disorder can only be diagnosed in people who are 18 years old or younger. Adults who have the same symptoms are typically diagnosed with the antisocial personality disorder, which belongs to a separate class of mental conditions, appropriately known as personality disorders, which contains illnesses such as borderline, narcissistic, avoidant, and several others. [5]

While conduct disorder can be dangerous for the individual and to others, it can be treated through a variety of means such as family therapy which promote positive parenting skills and building relationships, and in turn, helps kids control their angry feelings. This is essential to preventing problems from continuing into adulthood and potentially becoming a personality disorder. [5]
Intermittent Explosive Disorder (IED)
Similar to ODD and conduct disorder, IED is also another aggressive type of behavioral disorder that manifests during childhood but can be very persistent.

In fact, some of the signs can be just as destructive; however, the difference between all of these is that the symptoms are impulsive. Typically, these will be unplanned angry outbursts that do not require much provocation, if any, and they are completely out of proportion. [5]

Source: pxhere.com

Failure to control anger can lead to recurring temper-tantrums and arguments, and this rage can potentially hurt people, animals, and property in the form of verbal or physical aggression.

Another crucial part of getting diagnosed with IED is that it must cause significant distress to the individual, and it has to cause impairment at school or work. It can affect kids and adults and is not diagnosed in those who are under six years old and to receive one, it cannot be explained better by a separate mental disorder. [5]

Unfortunately, a risk factor for IED is being exposed to physical and emotional trauma during one's youth, which can also lead other conditions like PTSD, anxiety, depression, and more. Therefore, in addition to changing their aggressive thoughts and teaching coping skills, therapy and counseling may be necessary to address their past trauma. In some cases, medication can also be useful to help calm a person and keep outbursts under control.
Disruptive Mood Dysregulation Disorder (DMDD)
Disruptive Mood Dysregulation Disorder is one of the most recent conditions to enter the DSM-5 and therefore, make this list of behavioral disorders. Although it is one of the newest additions to the psychiatric literature, it does carry many similarities with other conditions.

For instance, DMDD is characterized by extreme irritability, anger, and frequent outbursts, which are all traits seen in IED. Despite the potential for someone to meet most of the criteria for both conditions, one of the key differences between DMDD and IED is how persistent the anger is.

In IED, the anger is considered to be relatively brief, and people can return to normal shortly after an impulsive outburst. However, in DMDD, these feelings can linger around much longer, and kids with this condition are irritable for most of the day and can have verbal or physical outbursts three or more times per week. [6] [7]

Source: pexels.com

Like IED, DMDD can also be extremely disruptive and cause problems at school and home, but it can be managed with similar treatments.

To get diagnosed with DMDD, a patient must be over six years old but under 18 and have displayed symptoms for more than 12 months, especially the persistent anger. Psychotherapy and parent training is often the first course of treatment for DMDD, but in many cases, medication might be necessary for managing the symptoms of it. [7]
Conclusion
As you can tell, behavioral disorders are a diverse group, yet, they still have plenty in common with one another.

Not only do many of these have similarities in regards to symptoms, but they can also share treatment methods. One of the most consistent ways to address any behavioral disorder is through therapy, and millions of kids and adults have seen a lot of success by using techniques, such as cognitive behavioral therapy (CBT), with the help of a professional.

At BetterHelp, licensed therapists are available online to help treat a variety of mental conditions, including the ones discussed here. It is also an affordable and convenient option, and making an appointment is easy and flexible and allows you to find sessions that can be suited to school or work schedules.

Hopefully, this list of behavioral disorders has been informative, and if you suspect that your child has one of these, make an appointment with your family doctor so that a formal diagnosis can be made. Receiving the right one can make a difference in terms of medication, and by receiving the proper prescription and dosage for their condition, people can have higher success rates and live better lives.
References

U.S. Department of Health & Human Services. (2017, August 23). Behavioral Disorders. Retrieved June 24, 2019, from https://www.mentalhealth.gov/what-to-look-for/behavioral-disorders

American Psychiatric Association. (2017, July). What Is ADHD? Retrieved June 24, 2019, from https://www.psychiatry.org/patients-families/adhd/what-is-adhd

Austerman, J. (2015). ADHD and behavioral disorders: Assessment, management, and an update from DSM-5. Cleveland Clinic Journal of Medicine, 82(Suppl 1).doi:10.3949/ccjm.82.s1.01

John Hopkins Medicine. (n.d.). Oppositional Defiant Disorder (ODD) in Children. Retrieved June 24, 2019, from https://www.hopkinsmedicine.org/health/conditions-and-diseases/oppositional-defiant-disorder

1. American Psychiatric Association. (2018, January). What Are Disruptive, Impulse-Control, and Conduct Disorders? Retrieved June 24, 2019, from https://www.psychiatry.org/patients-families/disruptive-impulse-control-and-conduct-disorders/what-are-disruptive-impulse-control-and-conduct-disorder

2. Coccaro, E. F. (2018). DSM-5 intermittent explosive disorder: Relationship with Disruptive Mood Dysregulation Disorder. Comprehensive Psychiatry, 84, 118-121.doi:10.1016/j.comppsych.2018.04.011

National Institute of Mental Health. (2017, January). Disruptive Mood Dysregulation Disorder. Retrieved June 24, 2019, from https://www.nimh.nih.gov/health/topics/disruptive-mood-dysregulation-disorder-dmdd/disruptive-mood-dysregulation-disorder.shtml

# data[].attributes.attachment_link.title
A List Of Behavioral Disorders | Betterhelp

# data[].attributes.attachment_link.description
By: Michael Puskar Updated June 04, 2020 Behavioral disorders, although they are commonly associated with children, they can also affect adults, especially if one was left untreated since a person's youth. This article will discuss what behavioral disorders are, what conditions are considered one, as well as what treatment methods are available to those who have one.

# data[].attributes.attachment_link.readable_text
Defining Mood Disorders

Mood disorders, also call affective disorders, may be defined as 'a variety of conditions characterized by a disturbance in mood as the main feature. If mild and occasional, the feelings may be normal. If more severe, they may be a sign of a major depressive disorder or dysthymic reaction or be symptomatic of a bipolar disorder. Other mood disorders may be caused by a general medical condition. Mood disorder is a DSM-IV term.'

We're all familiar with the way moods come and go. What makes a mood disorder different is the fact that they last a long time and they affect people's lives. The key emotions in the list of mood disorders are depression and mania. Depression is roughly ten times more common than mania. it is estimated that at any one time around five percent of the adult female population suffers from it, compared with just over two percent of males.

Extremes of Mood

Depression and mania are two extremes of mood. The World Health Organization defines depression as, 'a common mental disorder that presents with depressed mood, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, low energy, and poor concentration. These problems can become chronic or recurrent and lead to substantial impairments in an individual's ability to take care of his or her everyday responsibilities. At its worst, depression can lead to suicide, a tragic fatality associated with the loss of about 850 000 lives every year.'

Mania

Mania, by contrast, may be defined as, 'an abnormally elevated mood state characterized by such symptoms as inappropriate elation, increased irritability, severe insomnia, grandiose notions, increased speed and/or volume of speech, disconnected and racing thoughts, increased sexual desire, markedly increased energy and activity level, poor judgment, and inappropriate social behavior. A mild form in mania that does not require hospitalization is termed hypomania.'

Major Depressive Disorders

Major depressive disorder (often referred to as unipolar depression) contrasts with bipolar disorder, which is characterized by the occurrence of one or more manic or hypomanic episodes. The diagnosis of either will then fall into a category and a subcategory. What follows is a list of Common Mood Disorders:

Depressive Disorders

Major depressive disorders are on our list of mood disorders and are subcategorized into a single episode or recurrent episodes, in which two or more depressive episodes occur. The core symptoms of depression include:

Sadness, apathy, unhappiness, apathy, anxiety.

Pessimism, guilt, negative thinking, low motivation, poor concentration, suicidal thoughts.

Lack of interest in personal appearance and hygiene, agitation, sluggish movements.

Changes in appetite, constipation, loss of sex drive, sleep disturbances, menstrual cycle disruption.

Manic Disorders

The core symptoms of mania include:

Elation, grandiosity, irritability.

Pressure of thoughts, easily distractible with flighty ideas and poor judgement.

Overactive speech.

High levels of arousal and decreased need for sleep.

Dysthymic Disorder

Another sub-category of depression is dysthymic disorder. This is characterized by a chronic and relatively continual set of symptoms that are similar to major depressive disorder but which do not quite meet the full diagnostic criteria.

Bipolar Disorders

Subcategories include Bipolar I and Bipolar II disorders. A further subcategory is cyclothymic disorder which, like dysthymic disorder, is a chronic and relatively continual set of symptoms, in which the person is never free from symptoms for more than two months.

Bipolar I Disorders

Bipolar I disorders include:

Single manic episode, in which the presence of one manic episode and no past major depressive episodes.

Most recent episode hypomanic, in which currently (or most recently) a hypomanic episode has occurred, with at least one previous manic episode.

Most recent episode manic, in which currently (or most recently) a manic episode has occurred, with at least one previous hypomanic episode.

Most recent episode mixed, in which symptoms of major depression and manic episode have both been met.

Most recent episode depressed, in which currently (or most recently) a major depressive episode has occurred, with at least one previous manic episode.

Most recent episode unspecified, in which symptoms meet the criteria for depression and/or mania but not the duration required.

Bipolar II Disorder

Bipolar II disorder includes recurrent major depressive episodes with hypomania.

report this ad

Other Mood Disorders

The list of mood disorders also covers disturbances in mood brought about by a medical condition. Moreover, substance-induced mood disorder is characterized by a persistent disturbance in mood, attributable to substance misuse

References

Benazzi, F. (2007) Bipolar disorder-focus on bipolar II disorder and mixed depression. Lancet, 369, 935-45.

"Depression." Mental Health. World Health Organization, n.d. Web. 18 Nov 2010. https://www.who.int/mental\_health/management/depression/definition/en/index.html.

Mosby's Medical Dictionary, 8th edition. © 2009, Elsevier.

Sue, D., Sue, D.W., Sue, S. (2000) Understanding Abnormal Behavior (6th Ed) Houghton Mifflin.

# data[].attributes.attachment_link.description
The list of mood disorders include mental illness disorders which involve symptoms such as depression and mania. While some mood disorders may seem similar, they all have their differences. All mood disorders discussed are found on the DSM which is the Diagnostic tool for mental health professionals.

# data[].attributes.attachment_link.readable_text
Mental health problems ranging from depression to bipolar disorder are known as mood disorders, or affective disorders. In any of these disorders, a serious change in mood shapes your child's emotional state. Unlike a normal bad mood a child feels occasionally, a mood disorder involves thoughts and feelings that are intense, difficult to manage, and persistent. A mood disorder is a real medical condition, not something a child will likely just "get over" on his own.

Today, clinicians and researchers believe that mood disorders in children remain one of the most underdiagnosed health problems. Mood disorders that go undiagnosed can put kids at risk for other conditions, like disruptive behavior and substance use disorders, that remain after the mood disorder is treated. Children and teens with a mood disorder don't always show the same symptoms as adults. So it can be difficult for parents to recognize a problem in their child, especially since he or she may not easily express his or her thoughts or feelings.

The most common mood disorders in children and adolescents include:

Major depression. A depressed or irritable mood, lasting at least two weeks.

Persistent depressive disorder (dysthymia). A chronic, low-grade, depressed or irritable mood for at least 1 year.

Bipolar disorder. Periods of persistently elevated mood followed by periods of depressed or flat emotional response.

Disruptive mood dysregulation disorder. A persistent irritability and extreme inability to control behavior.

Premenstrual dysmorphic disorder. This includes depressive symptoms, irritability, and tension before menstruation.

Mood disorder due to a general medical condition. Many medical illnesses, including cancer, injuries, and chronic medical illnesses, can trigger symptoms of depression.

Substance-induced mood disorder. Symptoms of depression due to drug use, the effects of a medication, or exposure to toxins.

Girls are at least twice as likely as boys to develop depression. Boys and girls are equally likely to develop bipolar disorder and obsessive-compulsive disorder.

The causes of mood disorders are not well understood. Imbalances in brain chemicals play a role. Environmental factors, such as unexpected life events and/or chronic stress, can also contribute to a mood disorder.

Mood disorders often run in families, so there is a genetic component, too. Children who have relatives with depression are at increased risk for depression. In addition, a family history of bipolar disorder may predispose a child to have bipolar disorder or other mood disorder.

Sometimes, extreme stress or a life event can "turn on" a gene, causing the disorder to develop. This can happen especially with depression.

Children show symptoms differently, according to their age and biological makeup. Symptoms also vary according to the type of mood disorder. Overall signs of a mood disorder may include:

Sad, depressed, irritable, angry, or elevated mood that appears more intense than the child usually feels, lasts for a longer period of time, or occurs more frequently

Trouble with family, including difficult behavior

Lack of motivation or pleasure in previously enjoyed activities

Changes in sleep or eating patterns or weight

Frequent physical complaints, such as headaches, stomachaches, or fatigue

Loss of energy or fatigue

Difficulty achieving in school

Worthlessness, guilt, or low self-esteem

Severe recurrent temper outbursts

Increased energy or bursts of energy with racing thoughts or fast speech

Rebellious or high risk behavior

Running away or threats of running away from home

Difficulty with friends and peers

Expressions of suicidal thoughts, which should be evaluated immediately

If you believe your child is struggling with a mood disorder, you can ask your pediatrician for a referral to a therapist or child psychiatrist. An accurate diagnosis of the mood disorder, as well as any other conditions, is a crucial first step in managing the disorder effectively. At The Children's Hospital of Philadelphia, a specialist will perform a comprehensive evaluation. The evaluation may assess:

Your child's overall health and medical history

Your child's symptoms

Your child's behavior at home, at school, and with peers

Environmental factors that might be stressors in your child's life

Input from teachers or guidance counselor about issues at school

Your child's past experiences with specific medications or therapies

Your opinion or preference for treatment options

Mood disorders can be treated with evidence-based treatments, especially with early recognition of the problem. Treatment can help manage the episode, reduce the severity of symptoms, and help to prevent future episodes. It can also enhance your child's normal growth and development and improve his or her quality of life and relationships.

A CHOP specialist will design a personalized treatment plan based on your child's symptoms and other factors unique to her situation. The plan may include:
Individual therapy

The specialist will identify key problems in your child's life and help your child learn how to manage these stressors. The specialist may also use a variety of techniques to help your child manage the symptoms of the mood disorder, including

Cognitive-behavioral. This approach involves changing problematic thoughts, feelings, and behaviors that your child may be experiencing.

Interpersonal therapy. This technique focuses on building social skills and helping children with difficult relationships in their lives.

Family therapy
Families play a vital supportive role in any mood disorder. Families, including parents or guardians, can learn methods to help their child manage mood and behavior problems. The specialist may also explore potential stressors in a child's life and patterns of interaction within the family. A consultation with your child's teachers or guidance counselor may also be advised.
Medications
A variety of medications are very effective in treating mood disorders by altering the brain chemicals involved. Depending on the mood disorder and your child's symptoms, medications may reduce the severity or frequency of symptoms, decrease problematic behaviors, improve functioning, and prevent future episodes.

Many children who receive early and adequate treatment for their mood disorder may improve significantly and keep their condition managed with ongoing intervention or support . If the episodes recur, they can usually be managed with therapeutic support, including medications, therapy, and additional resources. Despite the mood disorder, children and adolescents are able to grow, develop, and have meaningful life experiences, especially when their mood disorder is managed appropriately and adequately.

Depending on your child's personalized treatment plan, your child and family may continue to meet with the specialist for a number of weeks or months. The focus of individual and family therapy may change over time, depending on your child's age, progress, and needs. Medication needs may also change over time depending on a number of factors. At CHOP, a specialist will monitor and manage your child's condition closely.

Children with mood disorders have a complexity to their condition that includes biology, genetics, factors like stress and physical health, family and peer dynamics, behavior and thought patterns, and sometimes other conditions operating alongside the mood disorder. This complexity means the accuracy of the diagnosis and assessment of your child is crucial and shapes the treatment approach. The right treatment then determines how effectively the mood disorder is managed-and how well your child flourishes in every domain: home, school, and among peers. The team at CHOP is specially trained to recognize, diagnose, and treat the full range of mood disorders in children. They design a personalized plan for your child based on the latest thinking and approaches to care. Their skill set leads your child to long-term success.

# data[].attributes.attachment_link.title
Mood Disorders in Children and Adolescents

# data[].attributes.attachment_link.description
Mood disorders in teens remain one of the most under-diagnosed mental health problems. These disorders also put teens at risk for other conditions that may persist long after the initial episodes of depression are resolved.

# data[].attributes.attachment_link.authors[].name
National Institute of Mental Health (NIMH)

# data[].attributes.attachment_link.title
What can I do as a teacher or school to encourage healthy eating habits and to be active? | SA Health

# data[].attributes.attachment_link.description
How primary school teachers and schools can help children and teens to develop healthy eating habits and to be active.

# data[].attributes.attachment_link.readable_text
Affiliations

¹ Bury College, Bury, United Kingdom.

² Department of Education and Psychology, University of Bolton, Bolton, United Kingdom.

Free PMC article

Steven Barnes et al. JMIR Serious Games.

Free PMC article Show details

Affiliations

¹ Bury College, Bury, United Kingdom.

² Department of Education and Psychology, University of Bolton, Bolton, United Kingdom.

Abstract

Background: Extant evidence suggests that the proportion of adolescents suffering from anxiety disorders (ADs) has increased by up to 70% since the mid-1980s, with experience of anxiety at this stage associated with significant negative short- and long-term life outcomes. The existing therapeutic interventions (eg, cognitive behavioral therapy, CBT; attention bias modification, ABM) have proven to have clinically measurable benefits in reducing anxiety, but their efficacy is often compromised by social and practical barriers. The growing discrepancy between demand for, and access to, clinical interventions for anxiety has led to the development of a range of eHealth (health care practice supported by electronic processes and communication) and mHealth (versions of eHealth using mobile devices) interventions. One such protocol is therapeutic games, which aim to provide clinical frameworks in dynamic, adaptable, and personalized virtual environments. Although some evidence exists to suggest therapeutic games are associated with reductions in subjective anxiety and observed stress reactivity, there is currently, to our knowledge, no systematic review of the adherence to, and effectiveness of, therapeutic games for adolescent anxiety.

Objective: The aim of this review was to establish the effectiveness of therapeutic games in making clinically measurable reductions in anxiety symptoms in adolescent samples.

Methods: A systematic search of the existing academic literature published between 1990 and July 2017 was conducted using the databases Journal of Medical Internet Research, Journal Storage, Psychology Articles, Psychology Info, ScienceDIRECT, and Scopus. Records linked to empirical papers on therapeutic games for anxiety using adolescent samples were evaluated.

Results: A total of 5 studies (N=410 participants) met the inclusion criteria, and 3 gamified anxiety interventions for adolescents were identified. The papers included a mixture of randomized controlled trials, quasi-experimental studies, and usability studies comprising quantitative and qualitative measures, with varying degrees of mixed methods. Extant evidence shows potential for therapeutic games to create clinically measurable reductions in symptoms of anxiety in adolescent samples, though findings are complicated in some cases by a low sample size, and in other cases by research design and methodological complications, including anxiety reductions in control groups caused by a control-game selection.

Conclusions: Although research in this field appears to be extremely limited, as demonstrated by the small number of papers meeting the inclusion criteria for this review, early findings suggest that therapeutic games have potential in helping to engage adolescents with anxiety and lead to clinically measurable reductions in symptoms.

Keywords: CBT; adolescent; anxiety disorder; eHealth; mental health; mobile health; video games.

Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Similar articles

eHealth Interventions for Anxiety Management Targeting Young Children and Adolescents: Exploratory Review.

Tozzi F, Nicolaidou I, Galani A, Antoniades A. Tozzi F, et al. JMIR Pediatr Parent. 2018 May 10;1(1):e5. doi: 10.2196/pediatrics.7248. JMIR Pediatr Parent. 2018. PMID: 31518330 Free PMC article. Review.

Screening and Interventions for Childhood Overweight [Internet].

Whitlock EP, Williams SB, Gold R, Smith P, Shipman S. Whitlock EP, et al. Rockville (MD): Agency for Healthcare Research and Quality (US); 2005 Jul. Agency for Healthcare Research and Quality (US). 2005. PMID: 20722132 Free Books & Documents. Review.

Serious Games for Mental Health: Are They Accessible, Feasible, and Effective? A Systematic Review and Meta-analysis.

Lau HM, Smit JH, Fleming TM, Riper H. Lau HM, et al. Front Psychiatry. 2017 Jan 18;7:209. doi: 10.3389/fpsyt.2016.00209. eCollection 2016. Front Psychiatry. 2017. PMID: 28149281 Free PMC article. Review.

Digital Game Interventions for Youth Mental Health Services (Gaming My Way to Recovery): Protocol for a Scoping Review.

Ferrari M, McIlwaine SV, Reynolds JA, Archie S, Boydell K, Lal S, Shah JL, Henderson J, Alvarez-Jimenez M, Andersson N, Boruff J, Nielsen RKL, Iyer SN. Ferrari M, et al. JMIR Res Protoc. 2020 Jun 24;9(6):e13834. doi: 10.2196/13834. JMIR Res Protoc. 2020. PMID: 32579117

References

American Psychiatric Association . Diagnostic and statistical manual of mental disorders (5th ed) Washington: American Psychiatric Publishing; 2013.

Gelder M, Mayou R, Geddes J. Psychiatry. New York: Oxford University Press; 2005.

Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005 Jun;62(6):593-602. doi: 10.1001/archpsyc.62.6.593. - DOI - PubMed

Baxter AJ, Vos T, Scott KM, Ferrari AJ, Whiteford HA. The global burden of anxiety disorders in 2010. Psychol Med. 2014 Aug;44(11):2363-74. doi: 10.1017/S0033291713003243. - DOI - PubMed

Hagell A. Changing Adolescence: Social Trends and Mental Health. Bristol: Policy Press; 2012.

# data[].attributes.attachment_link.keywords[]
national center for biotechnology information

# data[].attributes.attachment_link.title
Empirical Evidence for the Outcomes of Therapeutic Video Games for Adolescents With Anxiety Disorders: Systematic Review - PubMed

# data[].attributes.attachment_link.description
Although research in this field appears to be extremely limited, as demonstrated by the small number of papers meeting the inclusion criteria for this review, early findings suggest that therapeutic games have potential in helping to engage adolescents with anxiety and lead to clinically measurable ...

# data[].attributes.attachment_link.readable_text
Everyone experiences anxiety. It is a natural and important emotion, signaling through stirrings of worry, fearfulness, and alarm that danger or a sudden, threatening change is near. Yet sometimes anxiety becomes an exaggerated, unhealthy response.

Given the array of changes and uncertainties facing a normal teenager, anxiety often hums along like background noise. For some teenagers, anxiety becomes a chronic, highpitched state, interfering with their ability to attend school and to perform up to their academic potential. Participating in extracurricular activities, making and keeping friends, and maintaining a supportive, flexible relationship within the family become difficult. Sometimes anxiety is limited to generalized, free-floating feelings of uneasiness. At other times, it develops into panic attacks and phobias.

Identifying the Signs
Anxiety disorders vary from teenager to teenager. Symptoms generally include excessive fears and worries, feelings of inner restlessness, and a tendency to be excessively wary and vigilant. Even in the absence of an actual threat, some teenagers describe feelings of continual nervousness, restlessness, or extreme stress.

In a social setting, anxious teenagers may appear dependent, withdrawn, or uneasy. They seem either overly restrained or overly emotional. They may be preoccupied with worries about losing control or unrealistic concerns about social competence.

Teenagers who suffer from excessive anxiety regularly experience a range of physical symptoms as well. They may complain about muscle tension and cramps, stomachaches, headaches, pain in the limbs and back, fatigue, or discomforts associated with pubertal changes. They may blotch, flush, sweat, hyperventilate, tremble, and startle easily.

Anxiety during adolescence typically centers on changes in the way the adolescent's body looks and feels, social acceptance, and conflicts about independence. When flooded with anxiety, adolescents may appear extremely shy. They may avoid their usual activities or refuse to engage in new experiences. They may protest whenever they are apart from friends. Or in an attempt to diminish or deny their fears and worries, they may engage in risky behaviors, drug experimentation, or impulsive sexual behavior.

Panic Disorder More common in girls than boys, panic disorder emerges in adolescence usually between the ages of fifteen and nineteen. Feelings of intense panic may arise without any noticeable cause or they may be triggered by specific situations, in which case they are called panic attacks. A panic attack is an abrupt episode of severe anxiety with accompanying emotional and physical symptoms.

During a panic attack, the youngster may feel overwhelmed by an intense fear or discomfort, a sense of impending doom, the fear he's going crazy, or sensations of unreality. Accompanying the emotional symptoms may be shortness of breath, sweating, choking, chest pains, nausea, dizziness, and numbness or tingling in his extremities. During an attack, some teens may feel they're dying or can't think. Following a panic attack, many youngsters worry that they will have other attacks and try to avoid situations that they believe may trigger them. Because of this fearful anticipation, the teen may begin to avoid normal activities and routines.

Phobias Many fears of younger children are mild, passing, and considered within the range of normal development. Some teenagers develop exaggerated and usually inexplicable fears called phobias that center on specific objects or situations. These intense fears can limit a teenager's activities. The fear generated by a phobia is excessive and not a rational response to a situation. The objects of a phobia usually change as a child gets older. While very young children may be preoccupied with the dark, monsters, or actual dangers, adolescents' phobic fears tend to involve school and social performance.

Several studies have revealed an increase in school avoidance in middle-school or junior-high years. With school avoidance, excessive worries about performance or social pressures at school may be at the root of the reluctance to attend school regularly. This leads to a cycle of anxiety, physical complaints, and school avoidance. The cycle escalates with the worsening of physical complaints such as stomachaches, headaches, and menstrual cramps. Visits to the doctor generally fail to uncover general medical explanations. The longer a teenager stays out of school, the harder it becomes for him to overcome his fear and anxiety and return to school. He feels increasingly isolated from school activities and different from other kids.

Some youngsters are naturally more timid than others, As their bodies, voices, and emotions change during adolescence, they may feel even more self-conscious. Despite initial feelings of uncertainty, most teens are able to join in if given time to observe and warm up. In extreme cases, called social phobia, the adolescent becomes very withdrawn, and though he wants to take part in social activities, he's unable to overcome intense self-doubt and worry. Gripped by excessive or unreasonable anxiety when faced with entering a new or unfamiliar social situation, the adolescent with social phobia becomes captive to unrelenting fears of other people's judgment or expectations. He may deal with his social discomfort by fretting about his health, appearance, or overall competence. Alternatively, he may behave in a clowning or boisterous fashion or consume alcohol to deal with the anxiety.

Because so much of a teenager's social life gets played out in school, social phobia may overlap with and be hard to distinguish from school avoidance. Some teens with social phobia may try to sidestep their anxious feelings altogether by refusing to attend or participate in school, Classroom and academic performance falls off, involvement in social and extracurricular activities dwindles, and, as a consequence, self-esteem declines.

Some teens may experience such a high level of anxiety that they cannot leave the house. This disorder, agoraphobia, seems to stem from feelings about being away from parents and fears of being away from home rather than fear of the world. In fact, a number of children who demonstrate severe separation anxiety in early childhood go on to develop agoraphobia as adolescents and adults.

Causes and Consequences
Most researchers believe that a predisposition towards timidity and nervousness is inborn. If one parent is naturally anxious, there's a good chance that their child will also have anxious tendencies. At the same time, a parent's own uneasiness is often communicated to the child, compounding the child's natural sensitivity. A cycle of increasing uneasiness may then be established. By the time this child reaches adolescence, his characteristic way of experiencing and relating to his world is tinged with anxiety. Some research suggests that children who are easily agitated or upset never learned to soothe themselves earlier in life.

In many cases, adolescent anxiety disorders may have begun earlier as separation anxiety, the tendency to become flooded with fearfulness whenever separated from home or from those to whom the child is attached, usually a parent. Adolescents can also have separation disorders. These teens may deny anxiety about separation, yet it may be reflected in their reluctance to leave home and resistance to being drawn into independent activity. Separation anxiety is often behind a teen's refusal to attend or remain at school.

School avoidance can follow a significant change at school, such as the transition into middle school or junior high. It may also be triggered by something unrelated to school, such as a divorce, illness, or a death in the family. Some youngsters become fearful about gang activities or the lack of safety in school.

A worried teenager performs less well in school, sports, and social interactions. Too much worry can also result in a teenager's failing to achieve to his potential. A teen who experiences a great deal of anxiety may be overly conforming, perfectionistic, and unsure of himself. In attempting to gain approval or avoid disapproval, he may redo tasks or procrastinate. The anxious youngster often seeks excessive reassurance about his identity and whether be is good enough.

Some teenagers with anxiety disorders can also develop mood disorders or eating disorders. Some teenagers who experience persistent anxiety may also develop suicidal feelings or engage in self-destructive behaviors; these situations require immediate attention and treatment. Anxious teens may also use alcohol and drugs to self-medicate or self-sootheor develop rituals in an effort to reduce or prevent anxiety.

How to Respond
If your teenager is willing to talk about his fears and anxieties, listen carefully and respectfully. Without discounting his feelings, help him understand that increased feelings of uneasiness about his body, performance, and peer acceptance and a general uncertainty are all natural parts of adolescence.

By helping him trace his anxiety to specific situations and experiences, you may help him reduce the overwhelming nature of his feelings. Reassure him that, although his concerns are real, in all likelihood he will be able to handle them and that as he gets older, he will develop different techniques to be better able to deal with stress and anxiety.

Remind him of other times when he was initially afraid but still managed to enter into new situations, such as junior high school or camp. Praise him when he takes part in spite of his uneasiness. Point out that you are proud of his ability to act in the face of considerable anxiety. Remember, your teenager may not always be comfortable talking about feelings that he views as signs of weakness. While it may seem at the moment as though he's not listening, later he may be soothed by your attempts to help.

If fearfulness begins to take over your teenager's life and limit his activities, or if the anxiety lasts over six months, seek professional advice. His doctor or teacher will be able to recommend a child and adolescent psychiatrist or other professional specializing in treating adolescents.

Managing anxiety disorders - as with any adolescent emotional disturbance - usually requires a combination of treatment interventions. The most effective plan must be individualized to the teenager and his family. While these disorders can cause considerable distress and disruption to the teen's life, the overall prognosis is good.

Treatment for an anxiety disorder begins with an evaluation of symptoms, family and social context, and the extent of interference or impairment to the teen. Parents, as well as the teenager, should be included in this process. School records and personnel may be consulted to identify how the teen's performance and function in school has been affected by the disorder.

The evaluating clinician will also consider any underlying physical illnesses or diseases, such as diabetes, that could be causing the anxiety symptoms. Medications that might cause anxiety (such as some drugs used in treating asthma) will be reviewed. Since large amounts of caffeine, in coffee or soft drinks, can cause agitation, a clinician might look at the youngster's diet as well. Other biological, psychological, family, and social factors that might predispose the youngster to undue anxiety will also be considered.

If a teenager refuses to go to school, a clinician will explore other possible explanations before labeling it school avoidance. Perhaps the teen is being threatened or harassed, is depressed, or has an unrecognized learning disability. He may also be skipping school in order to be with friends, not from anxiety about performance or separation.

If the teenager has engaged in suicidal or self-endangering behavior, is trying to self medicate through alcohol or drug use, or is seriously depressed, these problems should be addressed immediately. In such cases, hospitalization may be recommended to protect the youngster.

In most cases, treatment of anxiety disorders focuses on reducing the symptoms of anxiety, relieving distress, preventing complications associated with the disorder, and minimizing the effects on the teen's social, school, and developmental progress. If the problem manifests in school avoidance, the initial goal will be to get the youngster back to school as soon as possible.

Cognitive-Behavioral Therapy In many cases, cognitive-behavioral psychotherapy techniques are effective in addressing adolescent anxiety disorders. Such approaches help the teenager examine his anxiety, anticipate situations in which it is likely to occur, and understand its effects. This can help a youngster recognize the exaggerated nature of his fears and develop a corrective approach to the problem. Moreover, cognitive-behavioral therapy tends to be specific to the anxiety problem, and the teen actively participates, which usually enhances the youngster's understanding.

Other Therapies In some instances, long-term psychotherapy, and family therapy may also be recommended.

Medications When symptoms are severe, a combination of therapy and medication may be used. Antidepressant medications, such as nortriptyline (Pamelor), imipramine (Tofranil), doxepin (Sinequan), paroxetine (Paxil), sertraline (Zoloft), or fluoxetine (Prozac), or anxiety-reducing drugs, such as alprazolam (Xanax), clonazepam (Klonopin), or lorazepam (Ativan) may be prescribed in combination with cognitive or other psychotherapy. When tricyclic antidepressant medications such as imipramine are pre-scribed, your teen's physician may want to monitor for potential side effects by conducting periodic physical exams and occasional electrocardiograms (EKGs).
Click here to order Your Adolescent from Harper Collins
See also;
Anxiety Disorders Resource Center
Facts for Families #47, The Anxious Child
Glossary of Symptoms and Illnesses; Anxiety
AACAP's Practice Parameter for the Assessment and Treatment of Children and Adolescents with Anxiety Disorders

# data[].attributes.attachment_link.title
Your Adolescent - Anxiety and Avoidant Disorders

# data[].attributes.attachment_link.description
Everyone experiences anxiety. It is a natural and important emotion, signaling through stirrings of worry, fearfulness, and alarm that danger or a sudden, threatening change is near. Yet sometimes anxiety becomes an exaggerated, unhealthy response. Given the array of changes and uncertainties facing a normal teenager, anxiety often hums along like background noise.