The Anxiety Umbrella
THERE IS A VAST SPECTRUM of mental health conditions nestled within an anxiety diagnosis. Generalized anxiety disorder, panic disorder, separation anxiety disorder, social anxiety disorder, selective mutism and specific phobias are the main syndromes. Obsessive-compulsive disorder, once considered an anxiety disorder, is now its own category, explains Ryan Glode, a licensed mental health counselor and founder and vice president of OCD Rhode Island.
“ People with OCD often have a secondary anxiety disorder, and … the likeliness of having a third increases,” Glode says.“ Anxiety is a big component of OCD, because usually it’ s based on some type of feared outcome. Children worry that something bad is going to happen, and the mind tricks them into thinking they have to engage in some type of repetitive behavior in order to prevent the feared outcome from occurring, or to reduce their distress.”
Many kids with OCD have a specific phobia in childhood or separation anxiety that doesn’ t interfere in their functioning or isn’ t diagnosed or treated, he adds. Many others also have social anxiety or general worries. A common phobia experienced in childhood is emetophobia, or a fear of vomiting, which can result in fears of germs and certain illnesses, and can build into OCD if the child engages in compulsions or reassurance-seeking to prevent themselves from getting sick.
“ But they’ re two separate conditions that are highly comorbid,” he says.“ Children can also feel guilt, shame and an uncomfortable feeling of incompleteness if things aren’ t performed the right way. So, some just need things to be organized or arranged in a particular way, otherwise their brain doesn’ t shut off.”
Other disorders often accompany anxiety too, which can complicate diagnosis and treatment, like attention deficit hyperactivity disorder or post-traumatic stress disorder. Zara’ s * journey with anxiety and PTSD started with a trauma that led to self-harm. She was hospitalized before coming into the temporary foster care of Shariyah and Daniel Rhone * in North Kingstown. Now working through her emotions and finding stability, she remains sensitive to even the slightest change, like a delay in a scheduled pickup time or place. She fears her peers will taunt her or that she’ ll experience the trauma again, Shariyah says.
“ She typically goes into her room and is quiet, and she will talk to her mom, which is very helpful. Mom is one of her coping skills,” Shariyah says.“ We go on walks and let her know that she can come to us. Talking about what happened helps, but she is very closed off because of what she’ s been through.”
* Names changed to protect privacy.
Anxiety vs. Anxiety Disorder
ANXIETY IN ITSELF IS ACTUALLY NOT A BAD THING, explains Marcy Shyllon, interim executive director for Boys Town New England in Portsmouth. We all have it and need it to a certain extent so we can function in our daily lives. For example, your child has a big test coming up and they need to prepare. If they weren’ t nervous about it, they wouldn’ t study and would score poorly or fail, Shyllon hypothesizes. Additionally, if they’ re joining a new school, playing a new sport or flying for the first time, it’ s natural to feel some trepidation. Those without anxiety push through that initial fear and move on, and in doing so, learn they can face the hard thing that frightened them.
Anxiety disorder, however, is an excessive, persistent and often uncontrollable apprehension that interferes with normal functioning. Those with anxiety disorder are unable to mentally forge ahead and often talk themselves out of whatever scares them because not doing it is easier than facing it and failing. The fear dominates their thoughts and actions, paralyzing them in the moment and making them think they can’ t persevere.
“ When anxiety becomes debilitating and starts to prevent us from engaging in life in a way that we thrive,” Shyllon says,“ that’ s when anxiety is a problem and needs to be labeled, diagnosed, acknowledged and treated.”
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