The listener who came to me with this question specifically asked, “Should I tell my teen that he has an Anxiety Disorder? Will it help him?”
First let me share the arguments I’ve heard against sharing an anxiety disorder diagnosis with a child or teen, namely that doing so can influence how a person sees themselves and their functioning. Especially for teens who are working on issues of identity — figuring out who they are and what that means — being told they have a specific diagnosis may become a very important aspects of who they are in ways that can be limiting.
In my clinical practice I’ve met with teens who are extremely attached to their diagnosis and the limits it brings that moving on through it — learning to manage it — feels like giving up a part of themselves.
If their anxiety diagnosis has made them feel special and unique, if it’s been something that’s had a number of accommodations, such as people who are extra careful with that person. Like if a friend says, “Oh I’ll go and ask the teacher for the assignment because I know you have anxiety” then that’s a lot to lose.
Part of our work in therapy is helping kids who are having this experience to see that they are more than their anxious functioning and that learning to live with it will expand their lives so it’s ok to lose some of the protection and safety of identifying with an anxiety disorder.
Now when families are targeting the pitfalls in parenting an anxious child, they are already doing this work because they are helping their child see that they may be anxious but they are also brave. Things may be more difficult sometimes but they have the strength to overcome those difficulties.
In other words, when we are learning to support our anxious child, we don’t need to worry about them becoming too attached to the idea that they are unable to function due to their anxiety. There is no danger of letting them know that they have an anxiety disorder or — if they don’t have an official diagnosis — they they struggle with anxiety.
In fact, I would argue that telling them this truth can be empowering.
Letting a child or teen know that there are words for what they’re dealing with and that the feelings they have are real is one of the first steps in learning to manage anxiety. This is part of cognitive behavioral therapy where we learn about anxiety — how it works, how it limits us, what we can do about it. In my experience, most kids feel relief to find out that there is a name for what’s happening to them. Helping them understand that anxiety is a part of is — not the full sum of us — is important. It validates and normalizes their experience.
Lots of people have anxiety. And lots of people have wonderful lives in spite of it. That’s because we can learn to run anxiety so it doesn’t run us.
So how do we tell our kids?
We tell them by explaining that anxiety is normal, everyone has it, but some of us are more sensitive to it than others. Some of us are highly tuned in to things that seem threatening. When those feelings get too big for us to handle and begin limiting us from doing the things we need and want to do, that’s called an anxiety disorder.
What that means is that the anxiety is getting out of hand.
I always tell kids that having a little anxiety is a good thing because it’s what reminds us to look both ways before we cross the street. But having too much anxiety may make us not even want to try crossing the street; that just feels way too scary. We need to learn how to talk back to our anxiety so we’re not always stuck staying on one side of the street.
For teens, obviously the explanation can and should be more sophisticated. The teen years are an anxious time anyway. It’s hard to go from child to adult — the social stressors are so much worse, the expectations can feel over demanding, worries about an adulthood in a world that seems to be coming undone is a lot. I’ve said before that anxiety is an existential crisis and that’s especially true for teens who are already in an existential crisis. That means they’re trying to figure out how to be a person and the anxious teen is also learning how to tolerate the intense discomfort of worrying that they’re not capable of figuring out how to be a person.
As parents, we may unintentionally contribute to this existential crisis by getting on board with their worries about grades or friends or getting into college. Doing this is an accommodation. It’s saying to them, “You should be freaked out about all of this. Your anxiety and angst about it is warranted.”
That’s incredibly tricky for parents but I think for teens especially we need to focus more on coping, we need to focus more on anti-anxiety skills, and we need to let the future work itself out. This might means letting go of specific college plans and remember that there is no expiration date on getting a degree. It might mean being open to a child who misses out on some opportunities while we focus on baby steps to access others.
And that can mean prioritizing learning the anti-anxiety coping skills including education about what it means to have an anxiety disorder and building an identity that is inclusive of this without being exclusive of all the other aspects of who they are. Ironically when we work on becoming an anti-anxiety family, even though our focus on anxiety becomes more explicit, it will actually be less central to our family functioning. That’s because the family will no longer be consumed by accommodations and will instead be creating a family culture of facing and managing difficult feelings.
If you have told your child that they have anxiety and if you’ve noticed them saying things like, “I can’t, it’s my anxiety.” Or explaining that their anxiety is preventing them from doing something or you find yourself doing this, then that’s a pitfall. Anxiety as a shut door — a one and done excuse — is a pitfall. However if you notice your child saying, “I need a minute; I’m feeling anxious” or is using tools and explaining that they’re deep breathing or fiddling with their shirt buttons because they’re anxious, then that’s coping. Anxiety as an acknowledged bump in the road is a reason. That’s not a pitfall even if it feels sticky. Anxiety may slow us down but it doesn’t have to stop us.
None of this — learning to cope, wrestling with the reality of it, accepting our anxious feelings and understanding we must cope with them — can happen if we’re not explicit about what we’re dealing with.