Anxiety Disorders

Anxiety is a normal human emotion. Many people feel nervousness or worry, especially when faced with a problem, before taking a test, or while making an important decision. But for some the worry and distress caused by the anxiety is persistent and crippling, interferes with daily life, and requires medical treatment by a doctor. A child or adult psychiatrist can often diagnose, prescribe medications, and make referrals to appropriate specialists or local psychologists. Dr. Kothari, who practices in the Boca Raton, Delray Beach, Parkland, Coral Springs, and South Florida area refers patients as needed to psychologists who are experienced in providing individual counseling for anxiety disorders.

Generalized Anxiety Disorder

Generalized anxiety disorder, or excessive or exaggerated worry about everyday life events without cause for worry, can develop in children as well as adults. Roughly 4 million American suffer with GAD each year, with women being affected more often than men. Symptoms must persist for 6 months or longer to qualify for the diagnosis.

Symptoms include:

• persistent worrying or obsession, often unrealistic or out of proportion
• unrealistic view of problems
• inability to relax or restlessness
• difficulty concentrating
• worrying about excessively worrying
• distress about making decisions for fear of making the wrong decision
• difficulty handling uncertainty or indecisiveness
• fatigue
• irritability
• muscle aches or tension
• trembling, feeling twitchy
• easily startled
• difficulty sleeping
• sweating
• nausea, diarrhea, GI difficulties
• headaches

In children and teens, generalized anxiety disorder can also present as:

• excessive worries about school or sports performance
• worry about punctuality
• earthquakes, natural disasters, war, or catastrophic events
• anxiety to fit in
• may appear as a perfectionist
• redoing tasks that weren’t done perfectly the first time
• excessive time spent doing homework
• lack of confidence

While many worries will go away with time, generalized anxiety disorder may actually get worse if not treated. Generalized anxiety disorder is most effectively treated with a combination of medication and cognitive-behavioral therapy although relaxation techniques, lifestyle changes, and coping skills can also help. Treatment for generalized anxiety disorder can also help alleviate depression, insomnia, heart related issues, and bowel or digestive issues which may also be present. Dr. Kothari, M.D., can complete an initial evaluation and continued treatment for children and adults in the Boca Raton, Coral Springs, and Delray Beach area who may be suffering from generalized anxiety disorder.

Separation Anxiety

Separation anxiety, or fearfulness or nervousness of being away from home or a loved one, can be normal for young children, but when a child over the age of 6 experiences excessive fear lasting longer than 4 weeks, they may have separation anxiety disorder. It can affect 4-5% of American children ages 7-11. Common symptoms include:

• an unrealistic and persistent worry that something bad will happen to the child or parent when separated
• refusal to go to school
• refusal to go to sleep without the loved one nearby
• fear of being alone
• nightmares about being separated
• bedwetting
• complaints of physical symptoms on school days, including headache or stomachache
• repeated temper tantrums or pleading

Most mild cases do not need mental health treatment, but in more severe cases where the child refusals to attend school, evaluation by a doctor or psychiatrist may be necessary. A child psychiatrist may treat with psychotherapy and/or medications, and may make referrals to local specialists if needed, including a child or adolescent psychologist.

School Phobia

Going to school is usually an exciting and enjoyable experience for children, but for about 1-5% of school aged children it cause intense fear or panic. School phobia is when children refuse to go to school on a regular basis or refuse to stay in school and is usually seen in children between 5-7 and 11-14, but may occur at any time. Children may feign a sore throat or stomach ache to stay home from school only for the illness to subside at home and reappear the next school day, or they may present with actual physical symptoms such as diarrhea, vomiting, or diaphoresis. Children with school phobia may exhibit behaviors such as: feeling unsafe when in a room by themselves, clingy behavior, excessive worry and fear for their parents, have difficulty sleeping, have nightmares, have unrealistic fears about monsters, burglars, or animals, and have severe tantrums when forced to go to school and may also be suffering from comorbid anxiety and depression. Children may develop serious educational and social problems if their fear of school or anxiety related to school keeps them away from school and friends for an extended period of time. Parents or caregivers should seek a mental health evaluation for the child with school phobia or school refusal. This evaluation can be performed by a child and adolescent psychiatrist and may reveal the reasons behind the refusal to attend school and determine the best modality of treatment. Without treatment, the continued refusal to attend school may further reinforce the phobia or anxiety. Coordination with the school system is also vitally important.

Social Anxiety

In contrast to normal shyness or nervousness, social anxiety presents as persistent fear, anxiety, or avoidance that disrupts social, home, or work or school life. Symptoms may include:

• fear of situations in which you may be judged
• worrying about humiliating or embarrassing yourself
• concern for offending someone
• intense fear of talking to strangers
• fear of physical symptoms that may cause you embarrassments, such as blushing, sweating, or trembling
• avoiding situations where you might be the center of attention
• avoiding doing things or speaking to people out of fear of embarrassment
• spending time after a situation analyzing your performance and assessing the flaws in your interactions
• expecting the worst from a social situation

For children, social anxiety may present as clinginess, crying, refusal to speak in social situations, or throwing tantrums. Physical symptoms, such as fast heartbeat, nausea, dizziness, confusion, or diarrhea may also present in those with social anxiety disorder.

When social anxiety persistently disrupts your life, a doctor or psychiatrist should be consulted. When your social fear or anxiety prevents you from making eye contact, interacting with strangers, eating in front of others, entering a room in which people are already seated, using a public restroom, dating, attending parties or social gatherings, or missing work or school, a child or adult psychiatrist can help you address these problems. Without treatment, social anxiety may lead to low self esteem, poor social skills, isolation, hypersensitivity, poor school or work performance, substance abuse, or suicide. A psychiatrist can help identify other disorders that may accompany social anxiety disorder, including depression, other anxiety disorders, or substance abuse problems, and offer a variety of modalities of treatment.

Panic Disorder

Panic disorder is a common and treatable anxiety disorder that affects up to 3 million Americans, and often begins in childhood as well as late adolescence. Children, adolescents and adults with panic disorder can experience unexpected and repeated periods of intense fear or discomfort, both emotional and physical, including a pounding heartbeat, intense feeling that something bad is going to happen, dizziness, shortness of breath or feeling of being smothered, shaking or trembling, and fear of dying, losing control, or losing one’s mind. These “panic attacks” can last minutes or hours and can happen without warning. If the disorder is not recognized and treated, it can have crippling effects. Panic attacks can interfere with schoolwork or employment, social activities, and relationships. Children and adults who suffer with panic attacks may begin to feel anxiety even when not experiencing an attack, and may avoid social situations for fear of having an attack. Diagnosing and treating panic disorder early is crucial, as sufferers may develop major depression or suicidal thoughts, and some may seek drugs and alcohol to in an attempt to decrease their anxiety.

Agoraphobia

Agoraphobia is the result of severe panic attacks and subsequent anxiety about these attacks that leads to an avoidance of places or situations that may trigger an attack. Triggers may include wide open places, airports, bridges, shopping malls, or places situations where sufferers don’t have control. Sufferers may go to great lengths to avoid these places or situations, including avoiding leaving the house even for medical emergencies. Early treatment of panic disorder may prevent agoraphobia. Psychiatrists employ a number of treatment modalities for those who suffer from agoraphobia, including cognitive and behavioral treatment and medication management.

Selective Mutism

Selective mutism is usually seen in children, often beginning before the age of five. Selective mutism occurs when a child does not speak in certain situations (like in school or in public), but chooses to speak in other situations (like at home or with friends). Symptoms of selective mutism are the consistent failure to speak in situations where there is an expectation to speak, is not due to a speech delay communication disorder, interferes with work, school, or social situations, and persists for longer than one month. That being said some children with selective mutism may have an overlap with speech/language disorders. A child psychiatrist can be a valued member of the treatment team for selective mutism. Dr. Kothari, who practices in the Boca Raton, Delray Beach, Parkland areas of South Florida, frequently reviews reports from pediatricians and school counselors to make the best recommendations for further treatment.

Reactive Attachment Disorder

Reactive attachment disorder can occur in children who fail to develop a healthy attachment to parents or caregivers. This condition usually begins in infancy, and most symptoms are seen in children under the age of 5. They may appear unhappy, irritable, scared, or withdrawn during normal interactions with their caregiver, and may not seek comfort from their caregivers when stressed or upset. may fail to ask for assistance when it’s needed, do not reach out when picked up, and can have no interest in playing interactive games. Children with reactive attachment disorder should receive a comprehensive psychiatric evaluation and individualized treatment plan. Treatment should involve the child as well as the primary caregiver, with a focus on understanding and strengthening the relationship between them. Dr. Kothari, who practices in the Boca Raton, Delray Beach, and Coral Springs areas evaluates and treats children with reactive attachment disorder.

Grief

Grief is a natural response to loss or death. It has physical, emotional, cognitive, social, and philosophical facets that may vary from person to person. While it is often associated with the death of a loved one, grief can also be associated with a significant loss, such as the loss of a job, end of a relationship, or illness. Grief may change forms as the person moves through the grieving process, and each person grieves on a different time table. There may be a point at which normal grief can evolve into a more complicated form of grief, which may include mental and physical impairments and render the person incapacitated. A psychiatrist can help those experiencing symptoms of depression and sleep disorders associated with grief.

Children may experience grief differently from adults. Many children can not grasp the concept of death yet and believe the person will return, or they believe they were the cause of the death. Children may exhibit behaviors such as displaying younger or infantile behavior, demanding attention, and baby talk. Children may need professional help when their depression causes them to lose interest in activities and events, inability to sleep, loss of appetite, withdrawal from friends or family, repeated statements of wanting to join the deceased, or a sharp drop in school grades or refusal to attend school. A child or adolescent psychiatrist may help the child through the grieving process, and may refer to a child or adolescent psychologist as needed.

Trauma

Psychological trauma is the emotional response to a terrible or life-threatening event, such as an accident, sexual assault, or natural disaster. At first, the person may be in denial or shock. They may then begin to feel the longer lasting effects of the trauma, which may include unpredictable emotions, flashbacks, anger, guilt, difficulty sleeping, anxiety, strained relationships, and even physical symptoms such as inability to concentrate, headache, or nausea. Consulting with a psychiatrist or psychologist can be crucial to emotional and physical recovery. Children who experience trauma should be treated professionally by a child psychiatrist and/or a child psychologist in order to prevent the fear and sense of helplessness carrying over into adulthood.