Anxiety Disorders Ireland: Symptoms, Types, Causes, Treatment and Help for Adults, Children and Teenagers

A comprehensive Irish clinical guide to anxiety symptoms, panic attacks, social anxiety, health anxiety, phobias, school anxiety, separation anxiety, exam anxiety, emetophobia, OCD-related fears, trauma, childhood anxiety, teenage anxiety and treatment.

Written by Claire Russell, Registered Nutritionist, Counsellor and Psychotherapist, Couples and Marriage Counsellor, Clinical Hypnotherapist, Clinical Medical Hypnotherapist, RTT therapist and Advanced Rapid Transformational Therapist (RTT®), with more than 20 years’ clinical experience working with Adults, Couples, Teenagers and Children in person in Ireland, UK, Europe, USA, UAE, Australia and internationally ONLINE.

Originally published: 8 August 2026
Substantively reviewed and rewritten: 27 August 2026

If anxiety is controlling where you go, what you eat, whether you drive, how you sleep, how you work, whether your child can separate from you, or whether your teenager can face school, exams, friendships and ordinary life, it deserves to be properly understood.

Anxiety is not one single problem.

One person may worry constantly about almost everything.

Another may experience sudden panic attacks.

A child may complain of tummy aches every Sunday evening.

A teenager may procrastinate for hours because they are terrified of getting something wrong.

Someone else may avoid driving, flying, eating in restaurants, having blood tests, speaking in public or going anywhere where a toilet or quick exit is not immediately available.

The most useful question is therefore not simply:

“Do you have anxiety?”

It is:

“What is your anxiety predicting, what happens when that fear appears, what do you do to feel safe, and how much of your life has gradually become organised around preventing the feared outcome?”

Understanding that pattern can make the problem much clearer.

This resource is educational and non-diagnostic. It cannot determine which condition you or your child has and does not replace appropriate individual medical, psychological or psychiatric assessment.

Summary

Anxiety is part of the normal human threat-protection system.

It can influence your:

thoughts
emotions
heart rate
breathing
digestion
muscles
sleep
attention
appetite
energy
behaviour
relationships
confidence
independence

Anxiety becomes more concerning when it is persistent, excessive, difficult to control or substantially interferes with everyday life.

Recognised anxiety disorders include:

generalised anxiety disorder
panic disorder
social anxiety disorder
agoraphobia
specific phobias
separation anxiety disorder
selective mutism

There are also many important anxiety presentations that are not necessarily separate psychiatric diagnoses, including:

school anxiety
exam anxiety
anticipatory anxiety
health anxiety
performance anxiety
driving anxiety
medical anxiety
bedtime anxiety
toilet anxiety
vomiting anxiety
choking anxiety
relationship anxiety
perfectionism-related anxiety

Other conditions, including obsessive-compulsive disorder, post-traumatic stress disorder, eating disorders, depression, ADHD and autism, can involve substantial anxiety while needing their own clinical consideration.

Anxiety may also look very different according to age.

A five-year-old, a ten-year-old, a sixteen-year-old and a forty-year-old may all experience anxiety without behaving remotely alike.

That is why developmental context matters.

The strongest broad treatment evidence across many anxiety disorders supports cognitive behavioural therapy, usually called CBT, and appropriately designed exposure-based interventions. However, treatment should be matched to the actual problem. OCD, PTSD, panic disorder, social anxiety, specific phobias and school refusal should not simply be treated as interchangeable forms of worry. [1,10-15]

If you or your child needs urgent help

Most anxiety is not an emergency.

However, anxiety can occur alongside severe depression, suicidal thoughts, self-harm, substance dependence, dangerous eating restriction or other problems requiring urgent care.

In Ireland:

Phone 112 or 999 or attend your nearest emergency department if you or somebody else is at immediate risk of harm.
Contact your GP or GP out-of-hours service if urgent mental-health support is needed.
Samaritans can be contacted free on 116 123, 24 hours a day.
Text HELLO to 50808 for Text About It.
Children and teenagers can contact Childline on 1800 66 66 66 or use Childline’s online services. [7]

Seek appropriate medical assessment if anxiety-like symptoms occur with severe chest pain, fainting, significant breathing difficulty, acute confusion, neurological symptoms, major food or fluid restriction, severe dehydration, swallowing difficulty or another concerning physical change.

If you are physically dependent on alcohol, suddenly stopping can cause serious withdrawal, including seizures and delirium tremens. Speak to your GP or an appropriate alcohol service rather than attempting unsupported withdrawal. [9]

Anxiety Disorders at a Glance

Question	Answer
Is anxiety normal?	Yes. Anxiety is part of the normal human threat and protection system.
Is all anxiety an anxiety disorder?	No. Anxiety exists on a continuum and may occur without meeting diagnostic criteria for an anxiety disorder.
Can children have anxiety disorders?	Yes. Anxiety disorders often begin during childhood or adolescence.
Can anxiety look like anger in children?	Yes. Some anxious children become irritable, controlling, tearful or explosive rather than visibly frightened.
Can teenagers hide significant anxiety?	Yes. Anxiety may appear as withdrawal, procrastination, perfectionism, overachievement, anger or school avoidance.
Can anxiety cause physical symptoms?	Yes. Palpitations, breathlessness, nausea, diarrhoea, dizziness, shaking and muscle tension can occur.
Should physical symptoms automatically be called anxiety?	No. New, severe or unexplained symptoms require appropriate medical assessment.
What treatments have the strongest broad evidence?	CBT and appropriately designed exposure-based approaches have strong evidence across several anxiety disorders.
Is OCD simply an anxiety disorder?	No. OCD is classified separately, although anxiety is often central to its obsession-compulsion cycle.
Is PTSD simply anxiety?	No. PTSD is trauma-related and requires trauma-informed, disorder-specific assessment and treatment.
Can Clinical Hypnotherapy help?	Research suggests hypnosis can reduce anxiety symptoms for some people, particularly alongside other psychological interventions, although evidence varies by presentation.
Can nutrition cure anxiety?	No. Nutrition may be relevant when eating patterns, deficiencies, caffeine, digestive symptoms or other physical factors contribute, but it is not a universal treatment for anxiety disorders.
When should you seek help?	When anxiety is persistent, worsening or limiting school, work, eating, sleep, travel, relationships, healthcare, independence or quality of life.

The World Health Organization estimated that anxiety disorders affected approximately 359 million people worldwide in 2021 and notes that these conditions commonly begin during childhood or adolescence. [1]

The important point is not simply that anxiety is common.

It is that anxiety can become life-shaping.

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What Is Anxiety?

Anxiety is your mind and body’s response to perceived threat, danger or uncertainty.

Your nervous system constantly processes information about what is happening around you and inside your body.

When danger seems possible, protective systems can rapidly prepare you to respond.

Your:

heartbeat may accelerate
breathing may change
muscles may tighten
attention may narrow
digestion may alter
alertness may increase

This response can be extremely useful.

If a car suddenly moves towards you as you cross a road, rapid threat detection helps you move before you have time for a detailed analysis.

The problem arises when your alarm system repeatedly responds to situations that are not immediately dangerous, substantially exaggerates the likelihood of harm, underestimates your ability to cope, or continues responding after the threat has passed.

You may logically understand:

“I am probably safe.”

Yet another part of your system is responding:

“Do not risk it. Check again. Get out. Stay home. Ask somebody. Make certain.”

That gap between what you know intellectually and what you feel physiologically is one reason anxiety can be so frustrating.

For some people, Psychotherapy and Counselling can provide a structured space to understand these thought, emotional and behavioural patterns and identify what is maintaining them.

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When Does Normal Anxiety Become a Problem?

Feeling anxious before something important does not automatically mean you have an anxiety disorder.

It is understandable to feel nervous before:

an examination
an interview
public speaking
medical results
surgery
a difficult conversation
beginning secondary school
leaving home for college
flying
meeting unfamiliar people
starting a new job
a major life transition

Some anxiety can encourage preparation.

The important distinction is what happens next.

More proportionate anxiety	Anxiety that may need assessment
Has an understandable trigger	Occurs frequently or spreads across many situations
Reduces after the event	Continues long after the immediate situation has passed
Helps you prepare	Prevents you preparing effectively
Feels uncomfortable but manageable	Feels overwhelming or uncontrollable
Does not substantially restrict life	Begins determining where you go and what you do
Requires occasional reassurance	Produces repeated reassurance-seeking
You can face the situation despite nerves	Avoidance progressively expands
Fear broadly matches the actual level of danger	Fear substantially exceeds the objective risk

One of the most useful questions I ask clinically is:

“How much smaller has your life become because of anxiety?”

Anxiety may deserve attention when it is deciding:

which roads you drive
whether you leave home
what foods you eat
whether you attend school
whether you travel
who you speak to
whether you attend medical appointments
whether you sleep alone
whether you apply for opportunities
whether you can tolerate uncertainty without checking

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What Does Anxiety Feel Like?

Anxiety can affect your thoughts, emotions, behaviour and physical functioning simultaneously.

Emotional symptoms

You may feel:

frightened
tense
restless
irritable
overwhelmed
unsafe
emotionally exhausted
constantly on edge
unable to relax
afraid of losing control
convinced something bad is approaching

Thinking symptoms

You may experience:

constant worry
catastrophic thinking
repeated “what if?” thoughts
difficulty concentrating
indecision
intrusive thoughts
mental rehearsal
perfectionism
difficulty tolerating uncertainty
repeated checking
reassurance-seeking
replaying conversations
researching symptoms
monitoring other people’s reactions
doubting decisions you have already made
difficulty disengaging from possible threats

Behavioural symptoms

You may:

cancel plans
avoid travelling
avoid being alone
arrive excessively early
leave situations early
procrastinate
check repeatedly
overprepare
seek reassurance
avoid eating before journeys
stay close to exits
take another person everywhere
carry “just in case” items
avoid exercise because an increased heart rate frightens you
use alcohol, nicotine, food or another behaviour to reduce distress

Physical symptoms

Anxiety can involve:

palpitations
racing heartbeat
chest tightness
rapid breathing
breathlessness
dizziness
light-headedness
trembling
sweating
tingling
nausea
abdominal discomfort
bowel urgency
diarrhoea
constipation
reflux
dry mouth
difficulty swallowing
headaches
jaw tension
neck and shoulder tension
urinary frequency
fatigue
poor sleep
feeling detached from yourself
feeling that your surroundings are unreal

These symptoms are genuine.

They should not be dismissed as imaginary.

However, physical symptoms being compatible with anxiety does not prove that anxiety is their cause.

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Recognised Anxiety Disorders and Other Anxiety Presentations

Language matters.

You can experience significant anxiety without every fear having its own formal psychiatric diagnosis.

Recognised anxiety disorders

Major contemporary classifications include conditions such as:

generalised anxiety disorder
panic disorder
social anxiety disorder
agoraphobia
specific phobia
separation anxiety disorder
selective mutism [1]

Common anxiety presentations that are not necessarily separate diagnoses

These include:

anticipatory anxiety
school anxiety
exam anxiety
performance anxiety
public-speaking anxiety
medical anxiety
dental anxiety
driving anxiety
motorway anxiety
relationship anxiety
bedtime anxiety
toilet anxiety
fear of vomiting
fear of choking
perfectionism-related anxiety

They may occur within a diagnosed anxiety disorder, alongside another condition, or as a significant problem without fitting neatly into one diagnostic category.

Related conditions where anxiety can be prominent

These include:

obsessive-compulsive disorder
post-traumatic stress disorder
body dysmorphic disorder
eating disorders
depression
ADHD
autism and other neurodevelopmental differences

This distinction matters because appropriate treatment depends on what is actually happening.

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The Main Anxiety Disorders Explained

Generalised Anxiety Disorder

Generalised anxiety disorder, usually abbreviated to GAD, involves excessive and difficult-to-control worry across several areas of life.

You may worry about:

family
health
finances
work
relationships
school
mistakes
safety
future events
whether you are coping
events that have not happened

One problem may be resolved and another immediately takes its place.

It can feel as though your mind is permanently scanning for the next threat.

Sleep disturbance, fatigue, muscle tension, restlessness, irritability and concentration difficulties may accompany the worrying. [4,10]

Panic Disorder

Panic disorder involves recurring panic attacks together with ongoing fear about further attacks or significant changes in behaviour because of them.

The original problem may be:

“I had a terrifying panic attack.”

The longer-term problem becomes:

“I must make absolutely sure that never happens again.”

That can lead to increasingly elaborate avoidance.

Social Anxiety Disorder

Social anxiety is more than introversion or ordinary shyness.

It involves pronounced fear of being negatively evaluated, judged, embarrassed or humiliated.

You may fear:

speaking
eating in front of people
entering a room
meeting unfamiliar people
being observed
making telephone calls
presentations
parties
asking questions
disagreeing
dating
appearing visibly anxious

The fear is often not simply:

“I don’t like people.”

It is:

“What if people see something unacceptable about me?”

Agoraphobia

Agoraphobia involves fear or avoidance of circumstances where escape may feel difficult or help may not be readily available.

Triggers may include:

public transport
crowds
queues
open spaces
enclosed spaces
shopping centres
motorways
being far from home
leaving home alone

The feared event may be panic, fainting, vomiting, bowel urgency, losing control or being unable to escape.

Specific Phobia

Specific phobias involve marked fear associated with a particular object or situation.

You may fully understand that the statistical danger is low while your body still produces an overwhelming alarm response.

Separation Anxiety Disorder

Separation anxiety involves excessive fear associated with separation from an important attachment figure.

Although particularly associated with childhood, clinically significant separation anxiety can also occur later in life.

Selective Mutism

Selective mutism usually begins during childhood.

A child may speak normally and comfortably in one setting, such as home, while consistently finding themselves unable to speak in another setting, such as school.

It should not be interpreted as deliberate stubbornness.

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The Complete Anxiety Map

There are many ways anxiety can organise itself.

The categories below are a clinical map, not a list of separate diagnoses.

Health and safety fears

These can include:

health anxiety
illness anxiety
fear of cancer or another serious illness
fear about heart health
death anxiety
fear that a loved one will die
medical anxiety
hospital anxiety
test-result anxiety
MRI or scan anxiety
dental anxiety
needle anxiety
blood and injury fear
fear of allergic reactions
contamination fear
germ anxiety
fear of medication side effects
fear of fainting

Anxiety about bodily sensations

You may experience:

panic-related fear
palpitations anxiety
breathing anxiety
dizziness anxiety
fear of trembling
fear of sweating
fear of blushing
nausea anxiety
emetophobia
choking anxiety
swallowing anxiety
bowel-urgency anxiety
toilet anxiety
bladder anxiety
fear of losing bodily control

Social and relationship anxiety

This can include:

social anxiety
friendship anxiety
rejection anxiety
fear of criticism
fear of embarrassment
fear of conflict
relationship anxiety
attachment-related anxiety
dating anxiety
fear of abandonment
people-pleasing driven by fear
phone-call anxiety
video-call anxiety
social-media anxiety
group-chat anxiety
fear of eating publicly
fear of being photographed
fear of speaking in groups

Achievement and performance anxiety

This may involve:

exam anxiety
Leaving Cert anxiety
Junior Cycle anxiety
test anxiety
school-performance anxiety
presentation anxiety
public-speaking anxiety
interview anxiety
work anxiety
sports-performance anxiety
music-performance anxiety
dance-performance anxiety
stage anxiety
creative-performance anxiety
perfectionism-related anxiety
fear of failure
fear of disappointing others
fear of success and increased expectations

Travel and place-related anxiety

This can include:

driving anxiety
motorway anxiety
passenger anxiety
flying anxiety
public-transport anxiety
travel anxiety
fear of unfamiliar places
claustrophobic fear
lift anxiety
tunnel anxiety
crowd anxiety
queue anxiety
fear of being far from home
fear of staying in hotels
fear of being unable to escape

Childhood and developmental anxiety

Children may experience:

separation anxiety
preschool anxiety
school-entry anxiety
school anxiety
school refusal
bedtime anxiety
fear of sleeping alone
sleepover anxiety
toilet anxiety
fear of teachers
friendship anxiety
bullying-related anxiety
fear of making mistakes
reading-aloud anxiety
sports anxiety
food anxiety
medical and dental fears
animal fears
weather fears
death anxiety
transition anxiety
sensory-related anxiety

Change and uncertainty anxiety

This may involve:

anticipatory anxiety
uncertainty anxiety
decision anxiety
moving-house anxiety
new-school anxiety
college-transition anxiety
career anxiety
parenting anxiety
pregnancy-related anxiety
childbirth fear
perimenopause-related anxiety
world-event anxiety
climate-related anxiety

These categories frequently overlap.

A teenager with social anxiety may also develop school avoidance, presentation anxiety and fear of eating publicly.

Someone who experiences panic while driving may subsequently develop motorway anxiety and agoraphobic avoidance.

A child with emetophobia may begin avoiding school, restaurants, travel and particular foods.

The label rarely tells the whole story.

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What Is Your Anxiety Actually Predicting?

One of the most clinically useful ways to understand anxiety is to identify the predicted catastrophe.

Anxiety pattern	What the fear may be predicting
Panic	“I am going to collapse, die or lose control.”
Social anxiety	“People will notice something wrong with me and reject me.”
Health anxiety	“This symptom means I have a serious illness.”
Emetophobia	“I will vomit and I will not be able to cope.”
Separation anxiety	“Something terrible will happen while we are apart.”
School anxiety	“Something at school will be unbearable.”
Perfectionism	“If I make a mistake, I will fail or disappoint people.”
OCD	“Unless I perform this action, I cannot be certain something bad won’t happen.”
Driving anxiety	“I will panic, crash or be unable to escape.”
Toilet anxiety	“I won’t reach a toilet and I will be humiliated.”
Medical anxiety	“The procedure, result or bodily sensation will be intolerable.”
Relationship anxiety	“If I am not constantly vigilant, I will be rejected or abandoned.”
Public-speaking anxiety	“I will freeze and everybody will see me fail.”
Bedtime anxiety	“If I cannot sleep, tomorrow will be disastrous.”

This can reveal much more than asking only:

“How anxious are you from 1 to 10?”

Intensity matters.

But meaning matters too.

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The Anxiety, Avoidance and Reassurance Cycle

Anxiety often becomes persistent because of what happens immediately after fear appears.

Imagine that you have to give a presentation.

Your prediction is:

“I will freeze and everybody will think I am incompetent.”

Your heart races.

You feel nauseous.

You call in sick.

Your anxiety drops immediately.

That relief feels helpful.

However, it can also teach your brain:

“Escaping kept me safe.”

The next presentation can then feel even more dangerous.

This is the paradox of avoidance.

It often works extremely well in the short term.

That is precisely why it can become so powerful.

The same process may occur with reassurance.

You notice a symptom.

You fear serious illness.

You ask somebody whether you look unwell.

They reassure you.

Anxiety falls.

Twenty minutes later another doubt appears.

You seek reassurance again.

Or with checking:

“Did I lock the door?”

You check.

Relief.

A new doubt appears.

You check again.

Not all checking, reassurance or avoidance is unhealthy.

Locking your door once is sensible.

Avoiding a genuinely dangerous person is sensible.

Making appropriate sensory accommodations is sensible.

The important question is:

“Is this behaviour solving a real problem, or has it become something anxiety requires before it allows me to feel safe?”

For a deeper explanation of fear that starts before the event itself, read Anticipatory Anxiety: Symptoms, Causes, Brain Science and How to Stop Fear Taking Over Before an Event.

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Panic Attacks and Fear of Bodily Sensations

A panic attack can feel intensely physical.

Symptoms may include:

pounding heart
chest discomfort
rapid breathing
breathlessness
shaking
sweating
dizziness
tingling
nausea
feeling hot or cold
feeling detached
fear of dying
fear of fainting
fear of losing control

HSE guidance notes that panic attacks commonly last approximately 5 to 30 minutes, although anxiety before and after an attack can last considerably longer. [5]

One of the most important aspects of panic is what happens after the first frightening episode.

Imagine experiencing a panic attack in a supermarket.

You begin thinking:

“What if it happens again?”

Next time, you stand near the exit.

Then you avoid busy times.

Then you stop going alone.

Eventually you stop going.

The difficulty has moved from one panic attack into a widening system of restrictions.

Some people also begin fearing normal physical sensations.

Exercise raises your heart rate.

A warm room makes you light-headed.

Coffee makes you jittery.

Instead of being interpreted as ordinary physiological changes, those sensations become evidence that panic is beginning.

Treatment for panic disorder commonly includes learning to reinterpret feared bodily sensations and reduce avoidance and safety behaviours. [10]

New, severe or unexplained chest pain, fainting, breathing difficulty or other concerning physical symptoms still require medical assessment.

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Health Anxiety

Health anxiety can trap you between two difficult experiences:

“What if something is seriously wrong?”

and:

“What if doctors have missed it?”

You may:

inspect your body repeatedly
check your pulse
monitor your breathing
examine your skin
search symptoms online
ask family members for reassurance
seek repeated medical investigations
avoid appointments because you fear bad news
become hyperaware of ordinary bodily sensations

Appropriate medical assessment is essential when symptoms warrant it.

The difficulty arises when reassurance repeatedly provides only short-lived relief.

A normal investigation may calm you today.

Tomorrow another sensation appears.

You are back at the beginning.

The therapeutic challenge is therefore not:

“Ignore your health.”

It is learning to distinguish sensible healthcare from an escalating cycle of threat monitoring and certainty-seeking.

For a much deeper explanation, read my dedicated Health Anxiety resource.

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Specific Phobias and Powerful Fears

A phobia may appear to concern one relatively narrow object or situation.

Its consequences can become enormous.

Fear of needles may prevent blood tests.

Fear of dental treatment may prevent essential healthcare.

Fear of vomiting may restrict food, travel and social life.

Fear of dogs may determine where you walk.

Fear of flying may prevent you visiting family.

Driving anxiety may affect work and independence.

Common specific fears include:

dogs
spiders
insects
birds
rodents
needles
blood
injuries
vomiting
choking
heights
storms
enclosed spaces
flying
driving
lifts
medical procedures

For many specific phobias, appropriately structured exposure is an important evidence-based intervention.

Exposure does not mean suddenly forcing somebody into their worst fear.

Good exposure is purposeful, planned and designed to support new learning.

The person gradually discovers:

“I expected something unbearable. I experienced anxiety, and I remained safe enough to learn that I could cope.”

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Anticipatory Anxiety

For some people, the actual event is not the worst part.

The days before it are.

You may begin worrying about:

Monday morning
a dental appointment
a hospital scan
a flight
an examination
a presentation
a social event
school
a difficult conversation

The appointment may last 20 minutes.

The anticipation may last six days.

During those six days you:

rehearse
search
check
ask questions
imagine disasters
sleep poorly
monitor your body

By the time the event arrives, you are already exhausted.

Anticipatory anxiety involves repeatedly responding to an event that has not yet happened.

If this pattern sounds familiar, read the detailed Anticipatory Anxiety clinical resource.

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Anxiety in Children and Teenagers

Children are not simply small adults.

Neither are teenagers.

How anxiety appears changes according to:

development
language
independence
relationships
school demands
puberty
neurodevelopment
family circumstances
ability to describe internal experiences

A younger child might not say:

“I am experiencing anticipatory anxiety about separation.”

They may say:

“My tummy hurts.”

A ten-year-old might repeatedly ask:

“Are you definitely collecting me?”

A fifteen-year-old may simply say:

“I’m not going.”

HSE guidance identifies worrying, sleep difficulties, eating changes, irritability, angry outbursts, fidgeting, frequent toilet use, crying, clinginess and tummy aches among possible childhood anxiety signs. [2]

For young people, HSE guidance also identifies persistent worry, reassurance-seeking, distress around mistakes or changes, perfectionism, irritability, restlessness, concentration difficulties and physical symptoms. [3]

Anxiety can therefore be missed when adults expect it always to look like visible fear.

If your child or teenager’s anxiety is affecting school, eating, sleep, friendships or independence, Psychotherapy and Counselling for adults, teenagers and children is one of the service pathways available through Claire Russell Therapy.

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What Anxiety Can Look Like at Different Ages

The following table illustrates possible patterns. It is not a diagnostic tool.

What you notice	Younger child	Primary-school child	Teenager
School anxiety	Crying, clinging, tummy ache	Headaches, repeated questions, school avoidance	Staying in bed, panic, missing classes, refusing school
Social anxiety	Hiding behind parent, not speaking	Avoiding parties, groups or answering in class	Avoiding presentations, groups, eating publicly, parties or dating
Separation anxiety	Refusing to leave parent	Avoiding sleepovers or repeatedly checking collection plans	Extreme distress away from home or repeated checking on family
Perfectionism	Starting work again after small mistakes	Erasing repeatedly, refusing unfamiliar tasks	Procrastination, overstudying, severe self-criticism
Physical anxiety	Tummy aches, toilet frequency	Headaches, nausea, dizziness	Palpitations, dizziness, gastrointestinal symptoms, panic sensations
Reassurance-seeking	“Are you coming back?”	“Are you sure everything is OK?”	Repeated checking of health, grades, friendships or relationships
Anxiety expressed as behaviour	Crying, tantrums, controlling behaviour	Anger, refusal, irritability	Withdrawal, anger, procrastination or apparent disengagement
Fear of failure	Refuses to try	Avoids tasks where mistakes are possible	Delays starting, gives up or works excessively
Sleep anxiety	Refuses to sleep alone	Worries at bedtime	Fears not sleeping and being unable to function tomorrow

One behaviour can have several explanations.

A teenager refusing school may be experiencing anxiety, bullying, depression, autistic burnout, learning difficulties, sleep problems, trauma, ADHD-related difficulties or several factors simultaneously.

Assessment should not start with an assumption.

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Anxiety in Younger Children

The age groups used here are developmental guideposts rather than rigid boundaries.

Among younger children, anxiety often centres on security, separation, unfamiliar situations and bodily safety.

Separation fears

You may notice:

crying when you leave
refusal to attend preschool or school
needing to know where you are
fear that you will die
fear that you will have an accident
difficulty sleeping alone

School-entry anxiety

Starting preschool or primary school introduces:

unfamiliar adults
new routines
separation
toilets
eating away from home
other children
rules
unfamiliar sensory environments

The apparent fear of “school” may therefore have several components.

Bedtime and nighttime anxiety

A child may fear:

darkness
nightmares
intruders
illness
death
being alone
separation from parents

Toileting anxiety

Some children become frightened of:

unfamiliar toilets
loud flushing
becoming locked in
using toilets away from home
bowel movements after pain or constipation
having an accident

Vomiting and choking fears

A powerful fear may develop after:

vomiting
seeing someone vomit
choking
watching someone choke
hearing that somebody is ill

If eating or drinking becomes significantly restricted, medical and nutritional assessment may be needed.

Medical and dental anxiety

Children may fear:

doctors
dentists
blood tests
injections
hospitals
pain
unfamiliar equipment
loss of control

Anxiety expressed as tantrums

Sometimes a frightened child becomes:

controlling
argumentative
explosive
rigid
distressed when plans change

That does not mean all difficult behaviour is anxiety.

It means that one useful question is:

“What is this child expecting will happen?”

rather than immediately assuming:

“They are simply being difficult.”

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Anxiety in Primary-School Children

As children get older, social evaluation, performance and friendships may become increasingly important.

School anxiety

Potential fears include:

answering incorrectly
being told off
reading aloud
PE
changing clothes
toilets
eating at school
vomiting
bullying
noise
sensory overload
separation
particular teachers
academic difficulties

Friendship anxiety

The child may repeatedly ask:

“Are they still my friend?”

“Why wasn’t I invited?”

“Did I do something wrong?”

Bullying-related anxiety

A child who suddenly becomes frightened of school may be responding to something that is actually happening.

Treating the child’s anxiety without investigating possible bullying can miss the central problem.

Perfectionism

You may see:

repeatedly erased work
distress over small mistakes
refusal to answer unless certain
excessive time spent on homework
avoidance of unfamiliar tasks

The behaviour may look conscientious from the outside.

Internally, the child may believe:

“Getting this wrong would be unbearable.”

Performance anxiety

This can develop around:

sport
music
dance
school plays
competitions
presentations
reading aloud

Sleepover anxiety

A child may want to attend a sleepover yet fear:

separation
vomiting
unfamiliar food
toilets
not sleeping
embarrassment

Health and death anxiety

Children can become worried about illness and death, particularly after illness, loss or bereavement.

OCD-related fears

A child may experience intrusive fears involving:

germs
harm
mistakes
morality
something happening to family members

They may develop visible or mental rituals intended to neutralise those fears.

Transition anxiety

Changing class, teacher, school or home can increase uncertainty.

For children whose eating becomes restricted by fear, sensory factors or worry about vomiting or choking, the dedicated Picky Eating in Children and Food Anxiety resource explores these issues in much greater depth.

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Anxiety in Teenagers

Adolescence adds another set of pressures.

Teenagers are navigating:

growing independence
puberty
school expectations
examinations
friendships
romantic relationships
body image
online life
identity
decisions about the future
employment
college
driving
caffeine, nicotine, alcohol and other substances

Teenage anxiety does not always look frightened.

Anxiety may look like procrastination

A teenager may appear unmotivated while privately thinking:

“If I start and it is terrible, I will prove that I can’t do it.”

Avoiding the assignment reduces anxiety temporarily.

Tomorrow the assignment is more urgent.

Anxiety rises.

The teenager avoids it again.

The mechanism needs to be understood.

Anxiety may look like overachievement

The opposite can also happen.

An anxious teenager may:

study continuously
sleep too little
rewrite work repeatedly
become devastated by small grade reductions
stop hobbies
withdraw socially
believe anything below perfection is failure

High achievement does not rule out significant distress.

Teenage social anxiety

Teenagers may fear:

entering a group
being watched
eating publicly
changing for PE
photographs
answering in class
presentations
parties
dating
saying something awkward

Group-chat and social-media anxiety

An unanswered message can become:

“They’re deliberately ignoring me.”

A photograph becomes:

“Everyone looks better than me.”

An event they were not invited to becomes:

“Nobody wants me around.”

The clinical issue is not simply possession of a phone.

It is the meaning the teenager attaches to online interactions and how checking, comparison and uncertainty affect them.

Body-image anxiety

Adolescence can intensify worries involving:

weight
shape
skin
attractiveness
height
perceived physical defects

Severe preoccupation deserves careful assessment because body dysmorphic disorder and eating disorders require their own pathways.

Health anxiety and panic

Teenagers can become frightened by:

palpitations
dizziness
nausea
breathing changes
headaches
unfamiliar bodily sensations

Driving and passenger anxiety

Learning to drive introduces:

responsibility
uncertainty
fear of accidents
fear of mistakes
fear of other drivers

Passenger anxiety may also emerge when friends begin driving.

Future anxiety

Teenagers are repeatedly asked:

“What are you going to do?”

Someone who struggles with uncertainty may hear:

“Make a decision now that determines the rest of your life.”

Relationship and dating anxiety

Fears can involve:

rejection
embarrassment
abandonment
intimacy
not being attractive enough
losing a relationship

Anxiety and substances

Some teenagers use:

nicotine
vaping
alcohol
cannabis
other substances

to reduce social discomfort, quiet thoughts or help themselves sleep.

Temporary relief can hide a developing substance problem.

If alcohol, nicotine, drugs or compulsive behaviour have become part of how anxiety is managed, the Addiction Help Ireland resource explains addiction, treatment pathways and situations where medical or specialist addiction care is needed.

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School Anxiety and School Refusal

School refusal is a description of a difficulty, not a psychiatric diagnosis.

That distinction matters.

A child or teenager may struggle to attend school because of:

separation anxiety
social anxiety
panic
emetophobia
bullying
academic difficulty
learning differences
autism
ADHD
sensory overload
depression
trauma
sleep problems
family difficulties
physical illness
fear associated with a particular class or teacher

A systematic scoping review found anxiety to be an important factor associated with school refusal, including social anxiety, separation anxiety and school anxiety, while also identifying broader family and contextual factors. [16]

Ask what “school” actually means to the child

Instead of:

“Why won’t you go?”

try to identify which part feels impossible.

The answer may be:

“The bus.”

“The toilet.”

“Lunch.”

“Maths.”

“The corridor.”

“Being sick.”

“People looking at me.”

“Leaving Mam.”

“Being asked a question.”

“My teacher.”

“A group of students.”

These are very different problems.

Do not assume avoidance is the entire story

Avoidance can maintain anxiety.

But sometimes an environment genuinely needs to change.

If a child is being bullied, the answer is not simply greater exposure to bullying.

If a sensory environment is repeatedly overwhelming an autistic teenager, appropriate adjustments may be required.

If educational demands do not match a child’s learning needs, those needs matter.

A good assessment asks both:

“How is avoidance maintaining fear?”

and:

“Is there something harmful, inaccessible or unsuitable that actually needs addressing?”

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Exam Anxiety, Junior Cycle and Leaving Cert Anxiety

Some nervousness before examinations is understandable.

Exam anxiety becomes problematic when fear begins interfering with:

preparation
sleep
concentration
eating
attendance
memory retrieval
the ability to sit the examination

A student may know the material at home yet experience:

blanking
racing thoughts
nausea
shaking
diarrhoea
panic
sleeplessness

The underlying thought may be:

“If I do badly in this examination, my entire future is ruined.”

The body then responds as though the exam is an immediate threat.

Perfectionism can make this worse.

A student may study for ten hours yet remain convinced:

“I haven’t done enough.”

Social Anxiety, Friendship Anxiety and Fear of Rejection

Social anxiety can quietly remove important developmental experiences.

A child or teenager may stop:

answering questions
joining clubs
attending parties
eating with others
speaking on the telephone
meeting unfamiliar people
applying for jobs
dating
travelling independently

Inside, they may be thinking:

“Where should I look?”

“Am I talking too much?”

“Do they think I’m weird?”

“Why did I say that?”

“Can they see I’m anxious?”

After the event, another process may begin.

They replay the conversation.

They analyse facial expressions.

They search for evidence that they embarrassed themselves.

This post-event analysis can increase anxiety before the next social interaction.

NICE guidance for children and young people with social anxiety recommends CBT specifically focused on social anxiety, including developmentally appropriate exposure to feared social situations, with parent or carer involvement where useful. [11]

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Emetophobia, Choking Anxiety and Food-Related Fear

Emetophobia

Emetophobia is an intense fear of vomiting or vomit-related stimuli.

The fear may involve:

vomiting yourself
seeing somebody vomit
hearing that somebody is ill
school stomach bugs
food poisoning
restaurants
public transport
flights
pregnancy
alcohol
unfamiliar food

The fear can progressively alter everyday life.

You may:

check food dates repeatedly
avoid restaurants
stop eating particular foods
avoid people who might be ill
sit near exits
avoid travel
monitor every stomach sensation

A 2026 scoping review identified 37 treatment studies and found that CBT was the most frequently studied intervention, but most published work consisted of single-case studies and only two randomised controlled trials were identified. [18]

The evidence is therefore emerging, not settled.

Choking and swallowing anxiety

A frightening swallowing experience may lead somebody to:

chew excessively
avoid textured foods
eat only soft foods
repeatedly monitor swallowing
fear eating alone

Because restricted food intake or genuine swallowing difficulties can have medical consequences, appropriate medical and nutritional assessment matters.

Food anxiety in children

Food restriction can have many possible explanations, including:

fear of vomiting
choking
allergy fear
gastrointestinal symptoms
sensory differences
contamination concerns
eating disorders
avoidant/restrictive food intake disorder
medical conditions

It should not automatically be treated as ordinary picky eating or assumed to be anxiety.

Read the detailed Picky Eating in Children and Food Anxiety resource if food fear or restriction is part of your child’s presentation.

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Separation Anxiety

Some separation anxiety is developmentally understandable.

Concern increases when fear is disproportionate, persistent and substantially restricts development or everyday life.

A child may fear:

a parent dying
a parent having an accident
being forgotten
becoming ill away from home
sleeping away from home

This can affect:

school
hobbies
sleepovers
sleeping independently
age-appropriate independence

The aim is not to shame attachment.

It is to help the child gradually develop confidence that separation can be safe and manageable.

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Selective Mutism

Selective mutism can be profoundly misunderstood.

A child who speaks confidently at home may become unable to speak at school.

Adults may assume:

“They are refusing.”

“They are stubborn.”

“They just need to speak.”

The child’s experience may be much closer to:

“I know the words, but I cannot make myself speak here.”

NICE recognises the need to adapt assessment and communication for children who may be unable to speak in particular settings. [11]

A 2023 systematic review and meta-analysis found promising findings for some behavioural and systems-based interventions but highlighted the small evidence base and limited number of randomised controlled trials. [17]

The evidence is therefore promising but limited.

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OCD, Intrusive Thoughts and Compulsions

OCD often involves intense anxiety, but it should not simply be described as severe ordinary worry.

An obsession is an unwanted intrusive thought, image, urge or doubt.

A compulsion is a behaviour or mental act intended to reduce distress or obtain certainty.

For example:

Intrusion:
“What if I harmed somebody?”

Anxiety:
“What kind of person would think that?”

Compulsion:
Review memories, seek reassurance, avoid sharp objects.

Temporary relief:
Anxiety drops.

New doubt:
“But what if I really am dangerous?”

The cycle begins again.

Other OCD themes may involve:

contamination
checking
responsibility
morality
religion
relationships
sexuality
symmetry
harm

Compulsions may also be invisible.

A child may silently repeat phrases, mentally review events or repeatedly ask for reassurance.

For children and teenagers with moderate to severe OCD, NICE recommends CBT incorporating exposure and response prevention, usually abbreviated to ERP, adapted to developmental age and involving family or carers. [12]

Read the dedicated OCD, Intrusive Thoughts, Compulsions and the Anxiety Loop resource for a much more detailed explanation.

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Trauma, PTSD and Hypervigilance

Trauma-related fear can resemble anxiety while requiring a different clinical formulation.

Someone may feel:

chronically unsafe
easily startled
unable to relax
watchful
frightened of reminders
emotionally detached
avoidant

They may experience:

intrusive memories
nightmares
flashbacks
strong physiological responses to reminders

A child may become irritable or clingy.

A teenager may withdraw or become intensely watchful.

An adult may describe:

“I know nothing is happening now, but my body doesn’t believe it.”

This is not simply future-oriented worry.

Something happened, and present cues may now activate a learned threat response.

NICE recommends trauma-focused CBT for children and young people with clinically important PTSD symptoms in appropriate circumstances. EMDR may also be considered for some children and teenagers according to age, time since trauma and previous treatment response. [13]

For a wider trauma formulation, read Trauma Therapy Ireland.

If the experience is more specifically one of constantly scanning for danger, the Hypervigilance Therapy resource explores why the nervous system can remain on alert after threat.

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ADHD, Autism, Sensory Overload and Anxiety

Neurodivergence and anxiety can interact.

They are not the same thing.

ADHD and anxiety

A child, teenager or adult with ADHD may repeatedly experience:

forgetting
losing belongings
lateness
missed deadlines
unfinished tasks
criticism
uncertainty about whether something has been remembered

Anxiety can become an attempt to compensate.

“If I keep worrying about it, maybe I won’t forget.”

A 2025 systematic review and meta-analysis involving 121 studies and 39,894 children and adolescents diagnosed with ADHD found anxiety disorders among the more commonly co-occurring psychiatric conditions. [22]

This does not mean ADHD causes every anxiety problem.

It means both deserve consideration.

Autism and anxiety

For an autistic person, anxiety may occur around:

unpredictable change
social uncertainty
unclear expectations
unfamiliar environments
sensory overload
masking
previous misunderstanding or rejection

A systematic review and meta-analysis of 19 randomised trials found that adapted CBT reduced anxiety symptoms in autistic children and young people in the short term, although effect sizes differed according to whether symptoms were rated by clinicians, parents or the young people themselves. Longer-term evidence was more limited. [21]

Sensory overload is not simply irrational fear

If an environment is genuinely:

deafening
painfully bright
physically uncomfortable
overwhelmingly crowded

the answer is not automatically:

“You need more exposure.”

Appropriate sensory accommodation may be entirely reasonable.

The distinction between therapeutic exposure and legitimate accessibility or sensory adjustment is very important.

For more detail, read Overstimulation and Sensory Overload: Signs, Causes and How to Reduce an Overloaded Nervous System.

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When Anxiety-Like Symptoms May Have Another Explanation

One of the most important principles in this resource is:

Do not automatically attribute every physical or behavioural symptom to anxiety.

HSE guidance notes that GP assessment for generalised anxiety may involve physical examination or blood tests and specifically mentions conditions such as anaemia and an overactive thyroid as possible alternative explanations for overlapping symptoms. [4]

Symptom or presentation	Anxiety can contribute	Other possibilities may also need consideration
Racing heart	Yes	Heart-rhythm problems, thyroid dysfunction, medication, stimulants, caffeine
Dizziness	Yes	Anaemia, dehydration, vestibular problems, medication, other medical causes
Trembling	Yes	Caffeine, medication, thyroid problems, substance effects
Breathlessness	Yes	Respiratory or cardiovascular conditions and other medical causes
Tummy aches in a child	Yes	Constipation, gastrointestinal problems, infection, food-related difficulties
Food restriction	Fear may contribute	Eating disorder, ARFID, swallowing problem, allergy, gastrointestinal disease, sensory needs
School refusal	Anxiety may contribute	Bullying, autism, ADHD, learning difficulty, depression, trauma, physical illness
Poor concentration	Yes	ADHD, sleep deprivation, depression, learning needs, physical problems
Palpitations during midlife	Anxiety can contribute	Perimenopause or menopause, thyroid, cardiac or medication factors
Shaking and anxiety after reducing alcohol	Yes	Alcohol withdrawal may be medically dangerous

The message is not:

“Anxiety isn’t real.”

It is:

“Good assessment keeps more than one explanation in mind.”

Where eating, gastrointestinal symptoms, deficiencies, significant dietary restriction or nutritional adequacy are relevant, you can read more about Registered Nutritionist Services.

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Sleep, Hormones, Nutrition, Caffeine, Alcohol and Anxiety

Sleep

Anxiety can disrupt sleep.

Poor sleep can make emotional regulation and coping more difficult the next day.

A difficult cycle can develop:

Worry about sleep → heightened arousal → poorer sleep → fatigue → reduced coping capacity → greater anxiety about the next night.

A 2026 meta-analysis encompassing 129 independent samples and more than 416,000 adolescents found meaningful cross-sectional and longitudinal relationships between sleep-related factors and anxiety. The randomised-trial component also suggested that sleep interventions may reduce anxiety symptoms. [19]

This does not mean poor sleep explains every anxiety disorder.

It means sleep deserves proper attention.

Perimenopause and menopause

HSE guidance lists anxiety, mood changes, irritability, sleep difficulty, brain fog and palpitations among possible symptoms of perimenopause and menopause. [8]

For someone who develops new anxiety, palpitations and sleep disturbance in midlife, it can therefore be important to consider the wider hormonal and medical picture rather than assuming the problem is purely psychological.

Caffeine and energy drinks

Caffeine can produce:

increased alertness
palpitations
jitteriness
restlessness

For somebody already frightened of physical sensations, those effects may amplify anxiety.

Teenagers using energy drinks alongside chronic sleep deprivation deserve particular consideration.

Alcohol

Alcohol may temporarily reduce anxiety.

That short-term effect can make it attractive as a coping strategy.

But relying on alcohol to socialise, sleep or switch off can create additional problems.

Alcohol withdrawal can itself cause:

anxiety
trembling
sweating
nausea
poor sleep

Severe withdrawal can involve seizures, hallucinations and delirium tremens and can be life-threatening. [9]

If alcohol or another addictive pattern is part of your anxiety picture, see Addiction Help Ireland.

Nutrition

Nutrition should neither be ignored nor exaggerated.

Anxiety disorders are not simply nutritional deficiencies.

However, nutritional assessment may be relevant when anxiety occurs alongside:

restricted eating
poor appetite
irregular meals
gastrointestinal symptoms
significant weight change
high caffeine intake
known deficiencies
eating difficulties
chronic illness

As a Registered Nutritionist, I may incorporate evidence-informed Functional Medicine principles where clinically relevant to consider the wider physiological picture.

This does not mean claiming that supplements, a particular diet or Functional Medicine can cure an anxiety disorder.

The purpose is to consider clinically relevant contributors, support nutritional adequacy and identify circumstances where GP investigation or other clinical care is needed.

You can read more about my approach through Registered Nutritionist Services.

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The Claire Russell Five-Layer Anxiety Assessment Framework

An original clinical reasoning framework developed by Claire Russell Therapy

Over more than 20 years of clinical work, I have found it useful to consider anxiety through several interacting layers rather than immediately treating every presentation as though it were the same problem.

This framework is educational and non-diagnostic.

It is not a scientifically validated diagnostic instrument.

Layer 1: What is the anxiety pattern?

Is the dominant difficulty:

generalised worry
panic
social anxiety
health anxiety
phobia
separation
anticipatory anxiety
school-related anxiety
another pattern?

Key question:
What exactly is the person predicting?

Layer 2: What psychological processes are maintaining it?

Consider:

avoidance
reassurance-seeking
checking
perfectionism
intrusive thoughts
trauma
grief
low self-worth
relationship patterns

Key question:
What happens immediately after anxiety appears?

Layer 3: What developmental or neurodivergent factors matter?

Consider:

age
developmental stage
ADHD
autism
communication
sensory processing
executive functioning
learning needs

Key question:
Is anxiety the whole explanation?

Layer 4: What physical or nutritional factors matter?

Consider:

sleep
thyroid function
anaemia
eating
gastrointestinal symptoms
medication
caffeine
alcohol
hormonal changes
nutritional status

Key question:
Could physical factors be creating, amplifying or mimicking some of these symptoms?

Layer 5: What is happening in the person’s environment?

Consider:

school
bullying
work
finances
relationships
caregiving
unsafe circumstances
sensory demands
major life changes

Key question:
Is the nervous system responding to something that actually needs to change?

This prevents us reducing every difficulty to:

“You need to calm down.”

Sometimes anxiety itself needs treating.

Sometimes a physical problem needs investigating.

Sometimes trauma needs addressing.

Sometimes the environment needs changing.

Sometimes several of these are true simultaneously.

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What More Than 20 Years of Clinical Work Has Taught Me About Anxiety

The observations in this section come from my professional clinical experience and are deliberately presented separately from published research.

Clinical Insight 1: The exact fear is often more informative than the word “anxiety”

Two people can both tell me:

“I have terrible anxiety.”

One fears having a heart attack.

One fears humiliation.

One fears vomiting.

One fears being abandoned.

One fears losing control.

One has trauma-related hypervigilance.

Their symptoms may overlap.

Their clinical formulation may not.

Clinical Insight 2: The loudest symptom is not always the central problem

Someone may present because of panic attacks.

Further exploration may reveal longstanding trauma.

Another person may describe “anxiety”, but the symptoms predominantly occur around alcohol withdrawal.

A teenager may appear socially anxious when sensory overload is playing a substantial role.

Good assessment asks what is beneath the presenting symptom.

Clinical Insight 3: Children do not always have language for anxiety

When a child repeatedly says:

“My tummy hurts.”

I want to understand:

Is there a physical problem?
Does it happen before school?
Is there bullying?
Are toilets a problem?
Is the child frightened of vomiting?
Is sensory overload involved?
Is separation difficult?
Does the discomfort reduce quickly when school is cancelled?

That is more useful than choosing too early between:

“It’s medical”

and:

“It’s psychological.”

Clinical Insight 4: Teenage procrastination may be fear in disguise

Some teenagers delay because they are distracted.

Some are exhausted.

Some have ADHD.

Some do not understand the task.

Others are paralysed by:

“If I cannot do this perfectly, I would rather not discover that I can’t do it.”

The behaviour can look identical from the doorway.

The underlying difficulty is not.

Clinical Insight 5: Reassurance can become a ritual

Families naturally reassure frightened children.

That is not wrong.

But when reassurance must be repeated dozens of times, the family’s role can gradually shift from providing support to participating in the anxiety cycle.

A more useful question becomes:

“How can I remain supportive without pretending I can provide absolute certainty?”

Clinical Insight 6: Anxiety can shrink life almost invisibly

Most people do not decide:

“I am going to stop living my life.”

They make one understandable adjustment.

Then another.

“I won’t use the motorway.”

“I’ll only go if somebody comes.”

“I won’t eat before the journey.”

“I’ll stay close to home.”

“I won’t go at all.”

Months later, the map of ordinary life has become dramatically smaller.

Clinical Insight 7: Sometimes the environment is part of the problem

If a child is being bullied, we need to address the bullying.

If an autistic teenager is repeatedly overwhelmed by avoidable sensory demands, we need to consider those demands.

If an adult is living in a genuinely unsafe relationship, breathing techniques alone are not enough.

Therapy should not be used to teach people to tolerate conditions that are genuinely harmful.

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Clinical Illustrations

The following are educational composite illustrations based on recurring types of presentation that may arise in clinical work.

They are not descriptions of identifiable clients and are not treatment-outcome claims.

Composite illustration 1: The child with Sunday-night tummy aches

A ten-year-old develops abdominal discomfort every Sunday evening.

Appropriate medical assessment has not identified a dangerous gastrointestinal condition.

Further discussion reveals that Monday includes a class where the child is expected to read aloud.

The child is terrified of making a mistake.

Staying home makes the stomach discomfort settle quickly.

The useful formulation is not:

“The tummy ache is fake.”

The discomfort is real.

Nor should all abdominal pain automatically be interpreted as anxiety.

The important insight in this illustration is that physical sensations, social fear and school avoidance have become interconnected.

Composite illustration 2: The teenager who “doesn’t care”

A sixteen-year-old repeatedly delays revision.

Family members interpret this as lack of motivation.

The teenager privately believes:

“If I try my hardest and still do badly, that proves I’m not good enough.”

Not trying feels safer.

The procrastination temporarily protects against feared failure while making the examination more threatening.

Composite illustration 3: The adult whose world contracts after panic

An adult experiences one frightening panic attack while driving.

They stop using motorways.

Then dual carriageways.

Then unfamiliar roads.

Eventually they drive only within a small distance from home.

The original panic attack lasted minutes.

The avoidance system changed years of behaviour.

Composite illustration 4: The child frightened of vomiting

After a stomach bug, a child becomes highly watchful of nausea.

They stop eating foods associated with the illness.

Then restaurants.

Then school lunches.

They repeatedly ask whether other children are unwell.

The clinical priority involves understanding the emetophobia while also monitoring nutritional adequacy and ensuring significant restriction receives appropriate medical and nutritional attention.

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What Actually Helps Anxiety?

There is no single treatment that is correct for every person who uses the word anxiety.

Treatment should take account of:

diagnosis or presentation
age
severity
duration
functional impairment
developmental stage
neurodivergence
physical health
trauma history
other mental-health difficulties
medication
substance use
personal preferences

The strongest broad evidence across anxiety disorders supports CBT-based psychological approaches, with exposure playing an important role for several anxiety presentations. [1,10,11,14]

However, the exact treatment matters.

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Treatment Matched to the Anxiety Pattern

Presentation	Treatment emphasis supported by current evidence and guidance
Generalised anxiety disorder	CBT-based treatment, including work with worry, uncertainty and avoidance
Panic disorder	Panic-focused CBT, including work with catastrophic interpretations and feared bodily sensations
Specific phobia	Carefully designed graded exposure
Social anxiety	Social-anxiety-specific CBT, behavioural experiments and graded exposure
OCD	CBT including exposure and response prevention
PTSD	Trauma-focused psychological treatment appropriate to age and circumstances
Childhood anxiety disorders	Developmentally adapted CBT-based treatment, with parental involvement where appropriate
Selective mutism	Developmentally appropriate behavioural and psychological intervention, with evidence promising but still limited
School refusal	Identify and address the underlying causes while coordinating family, school and relevant professionals
Emetophobia	Evidence remains emerging, with CBT and exposure-based approaches most studied
Autistic young person with anxiety	Adapted psychological treatment where appropriate, alongside genuine sensory, communication and accessibility needs
Anxiety with significant physical contributors	Psychological care alongside appropriate medical or nutritional assessment

Cognitive Behavioural Therapy

CBT examines the relationship between thoughts, feelings, bodily responses and behaviour.

WHO identifies CBT-based psychological interventions, including exposure approaches, as having the strongest broad evidence across anxiety disorders. [1]

A Cochrane review of 87 studies involving 5,964 children and adolescents concluded that CBT is probably more effective in the short term than waiting-list or no-treatment controls. Evidence was less certain for some comparisons with other active treatments and some longer-term outcomes. [14]

Evidence-based does not mean guaranteed.

Exposure-based treatment

Exposure involves gradually approaching feared situations while reducing behaviours that prevent new learning.

It may be particularly relevant for:

phobias
panic-related fears
social anxiety
OCD
some vomiting fears
other avoidance-based anxiety presentations

The objective is not to prove that uncomfortable things can never happen.

It is to learn:

“Anxiety can rise and fall without me needing to escape every time.”

Exposure and Response Prevention for OCD

Exposure and response prevention, or ERP, is a specific CBT intervention used for OCD.

The person approaches a feared trigger while reducing compulsive responses.

NICE recommends developmentally adapted CBT including ERP as the treatment of choice for children and young people with moderate to severe OCD, with family or carer involvement. [12]

Trauma-focused psychological treatment

Where anxiety forms part of PTSD, treatment needs to address trauma-related memories, meanings, avoidance and arousal rather than treating the presentation as generic worry.

Trauma-focused CBT has substantial guideline support. [13]

Counselling and Psychotherapy

Counselling and Psychotherapy may be particularly relevant when anxiety is occurring within:

grief
difficult relationships
family problems
life transitions
shame
low self-worth
trauma-related difficulties
emotional conflict

Treatment should still be matched appropriately to the specific presentation.

You can read more about Counselling and Psychotherapy services.

Clinical Hypnotherapy and Clinical Medical Hypnotherapy

Clinical Hypnotherapy may be incorporated into an individualised treatment plan to work with:

focused attention
imagery
physiological arousal
anticipatory fear
confidence
conditioned responses
some behavioural patterns

A meta-analysis of 15 studies incorporating 17 hypnosis trials found favourable effects on anxiety symptoms, with stronger results when hypnosis was combined with other psychological interventions than when it was used alone. [20]

This evidence is encouraging.

It does not establish that hypnosis is universally equivalent to disorder-specific first-line interventions such as ERP for OCD, trauma-focused treatment for PTSD or disorder-specific CBT.

I therefore use Clinical Hypnotherapy proportionately according to the individual’s presentation.

You can explore Clinical Hypnotherapy services or read the detailed scientific resource Clinical Hypnotherapy: History, Science and Evidence-Based Help for Trauma, Addictions, Anxiety, IBS and Stress.

RTT and Advanced Rapid Transformational Therapy

RTT® and Advanced Rapid Transformational Therapy may be used selectively within my broader therapeutic work to explore:

beliefs
meanings
emotional associations
learned responses

The disorder-specific evidence base for RTT is considerably less developed than the evidence for established CBT-based interventions.

I therefore do not present RTT as a replacement for treatments with stronger disorder-specific evidence when those treatments are indicated.

Medication

Medication can be appropriate for some people.

NICE includes medication among treatment options for adults with GAD or panic disorder in appropriate circumstances. [10]

A clinical practice guideline from the American Academy of Child and Adolescent Psychiatry identified substantial short-term empirical support for CBT and selective serotonin reuptake inhibitors, or SSRIs, for childhood and adolescent anxiety disorders, with some evidence for serotonin-norepinephrine reuptake inhibitors, or SNRIs. [15]

Medication decisions should be made with an appropriately qualified prescriber.

Do not start, stop or alter psychiatric medication without medical advice.

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How Strong Is the Evidence?

This is a practical evidence summary rather than a formal GRADE assessment.

Area	Evidence position	Important qualification
CBT across anxiety disorders	Strong overall	Treatment should be disorder-specific where possible
CBT for children and teenagers	Strong to moderate	Strong short-term evidence versus no treatment or waiting list; some comparative and longer-term uncertainty remains
Exposure for specific phobias and several anxiety disorders	Strong	Exposure should be appropriately designed and matched to the problem
Social-anxiety-specific CBT	Strong guideline support	Generic anxiety management may not be sufficient
ERP for OCD	Strong guideline support	OCD should not be treated as ordinary worry
Trauma-focused CBT for PTSD	Strong guideline support	PTSD requires trauma-specific assessment
SSRIs for selected anxiety disorders	Established	Requires appropriate prescribing and monitoring
Adapted CBT for autistic young people	Moderate and encouraging	Effects vary by reporter and longer-term evidence remains less certain
Selective-mutism interventions	Promising but limited	More high-quality trials are needed
Emetophobia treatment	Emerging	CBT is most studied, but the evidence base remains relatively small
Sleep interventions and adolescent anxiety	Moderate and growing	Sleep is an important modifiable factor, not a universal explanation
Clinical Hypnotherapy for anxiety symptoms	Promising to moderate, with heterogeneous evidence	Potentially useful as an adjunct rather than a universal first-line replacement
Nutrition	Supportive where clinically relevant	Not a standalone cure for anxiety disorders
RTT	Limited disorder-specific evidence	Should not displace treatment with stronger evidence where indicated

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Helping an Anxious Child or Teenager

Parents naturally want to stop their child’s distress.

Sometimes the response that removes anxiety fastest is not the response that helps most over time.

Listen before solving

Instead of:

“There’s nothing to worry about.”

try:

“Tell me what you are frightened might happen.”

You may discover that the feared issue is completely different from what you assumed.

Validate the feeling without confirming catastrophe

You can say:

“I can see this feels really frightening.”

without saying:

“Yes, this situation is dangerous.”

Those are different messages.

Avoid shame

Statements such as:

“You are being ridiculous.”

“You are too old for this.”

“Everybody else can do it.”

may increase shame without reducing fear.

Avoid overwhelming forced exposure

Well-planned exposure can be highly effective.

Suddenly forcing a frightened child into their worst situation is not the same as therapeutic exposure.

Avoid unlimited avoidance

The opposite extreme can also be unhelpful.

If every feared situation is permanently removed, the child’s world may gradually become smaller.

Professional guidance can be particularly useful when anxiety is affecting:

school
eating
sleep
independence
friendships
healthcare

For anxiety affecting school or exams specifically, you may also find the Exam Anxiety resource useful.

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Support or Anxiety Accommodation?

Family accommodation describes ways family members may change their own behaviour to reduce a child’s anxiety, such as repeatedly providing reassurance, participating in rituals or enabling avoidance.

A meta-analysis found an association between greater family accommodation and paediatric anxiety severity, although the strength of the association varied depending on who reported the symptoms and accommodation. [23]

This is not about blaming parents.

Parents accommodate anxiety because they love their child and want the distress to stop.

Support and anxiety accommodation are not the same thing

Anxiety asks the parent to…	A potentially more helpful direction may be…
Answer the same reassurance question repeatedly	Acknowledge the fear while gradually reducing repeated certainty-seeking
Promise that nothing bad can happen	Help the child build tolerance for uncertainty
Permit permanent avoidance of every feared situation	Develop an appropriately supported return where safe
Speak for the child in every social interaction	Gradually support age-appropriate participation
Participate in repeated checking rituals	Seek appropriate OCD assessment and reduce ritual participation carefully
Reorganise the entire family around the fear	Preserve support while gradually reducing anxiety-driven restrictions

An important qualification

Not every accommodation is an anxiety accommodation.

Reasonable adjustments may be necessary for:

autism
ADHD
sensory differences
disability
learning needs
medical conditions
trauma
genuinely unsafe environments

A child who needs sensory protection in an intolerably noisy environment should not automatically have it removed in the name of exposure.

A bullied child should not simply be told to tolerate bullying.

Clinical judgement matters.

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A Parent Decision Pathway for School Anxiety

Step 1: Is there an immediate safety or medical concern?

Consider:

suicidal thoughts
self-harm
abuse
severe bullying
dangerous food or fluid restriction
severe depression
major physical illness
substance problems

Seek appropriate urgent or medical help when needed.

Step 2: What exactly is your child frightened of?

Ask about:

leaving you
travelling to school
other students
bullying
vomiting
toilets
eating
answering questions
academic difficulty
a teacher
PE
sensory overload
panic
making mistakes

Do not settle for:

“School.”

Find the part of school that has become threatening.

Step 3: What happens when school is cancelled?

Does the child’s distress reduce rapidly?

If so, avoidance may be reinforcing at least part of the fear.

That is useful information.

It does not mean the child is pretending.

Step 4: What else may be contributing?

Consider:

ADHD
autism
dyslexia or other learning differences
sleep
bullying
trauma
depression
family stress
physical illness
sensory needs
academic mismatch

Step 5: What needs to happen in the environment?

Ask whether the school needs to address:

bullying
learning support
transitions
sensory demands
communication
timetable difficulties
another identifiable problem

Step 6: Who needs to be involved?

Depending on severity and circumstances, support may involve:

parents or carers
school
GP
therapist
Primary Care Psychology
CAMHS
another relevant medical or educational professional

HSE advises contacting a GP when a child’s anxiety persists or substantially affects school, family life or friendships. Primary Care Psychology may be appropriate for some mild-to-moderate difficulties, while CAMHS may be relevant to more severe difficulties or where earlier intervention has not been sufficient. [2]

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When Should You Speak to Your GP?

Speak to your GP if anxiety:

is persistent
is worsening
substantially affects daily life
interferes with school
prevents you working
damages relationships
restricts eating
causes severe sleep problems
leads to repeated panic attacks
prevents ordinary travel or independence
occurs alongside depression
occurs alongside problematic alcohol or drug use
is accompanied by concerning physical symptoms

For a child or teenager, seek additional assessment where anxiety is significantly affecting:

school attendance
eating
growth
sleep
friendships
development
family functioning
independence

HSE guidance for both children and young people recommends seeking professional support when anxiety persists or significantly affects everyday functioning. [2,3]

Urgent help is required where there is an immediate safety risk.

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Myths and Facts About Anxiety

Myth: Anxiety is just overthinking

Fact: Anxiety involves thoughts, emotions, physiology and behaviour.

You can intellectually know you are probably safe while your body remains in a powerful threat response.

Myth: Anxiety means something is wrong with your personality

Fact: Anxiety is not a character flaw.

Anxiety disorders involve patterns of threat perception, learning, avoidance and physiological arousal that can be understood and treated.

Myth: If medical tests are normal, the symptoms are imaginary

Fact: Anxiety can produce genuine physical symptoms.

Normal investigations do not make symptoms imaginary.

At the same time, concerning physical symptoms should not automatically be attributed to anxiety without appropriate assessment.

Myth: Children with anxiety always look frightened

Fact: Anxiety may look like:

anger
clinginess
controlling behaviour
perfectionism
school refusal
tummy aches
headaches
irritability

Myth: A teenager refusing school is simply lazy

Fact: School refusal may involve anxiety, bullying, depression, ADHD, autism, learning difficulties, trauma, sleep problems, physical illness or several interacting factors.

Myth: High-achieving teenagers cannot have serious anxiety

Fact: High performance can sometimes conceal perfectionism, fear of failure and relentless self-pressure.

Myth: If reassurance helps, you should keep providing more reassurance

Fact: Ordinary reassurance is part of caring.

Repeated reassurance can sometimes become part of a cycle in which relief lasts only briefly and the person increasingly depends on somebody else to supply certainty.

Myth: Avoidance keeps anxiety under control

Fact: Avoidance usually reduces anxiety immediately.

That is exactly why it can reinforce fear over time.

Myth: Exposure means throwing someone into their worst fear

Fact: Good exposure is purposeful, graded and based on appropriate clinical understanding.

Myth: Social anxiety is simply introversion

Fact: Introversion is a personality characteristic.

Social anxiety involves distress and fear of negative evaluation that may significantly restrict functioning.

Myth: Autistic children simply need greater exposure to uncomfortable sensory environments

Fact: Sensory differences are not automatically anxiety.

Reasonable environmental and sensory accommodation may be appropriate.

Myth: School refusal should always be solved by simply making the child attend

Fact: Re-engagement may be important, but first the underlying causes need to be understood and genuine problems in the environment addressed.

Myth: Every anxious child’s stomach ache is psychological

Fact: No.

Anxiety can contribute to gastrointestinal symptoms, but persistent or concerning symptoms require appropriate medical consideration.

Myth: OCD is simply very severe worrying

Fact: OCD involves intrusive obsessions and compulsive behaviours or mental rituals and often requires disorder-specific treatment such as ERP.

Myth: PTSD is just anxiety after something bad happens

Fact: PTSD is a trauma-related disorder with characteristic symptoms and specific treatment recommendations.

Myth: Nutrition can cure anxiety disorders

Fact: Nutritional and physical factors may contribute to symptom burden in some people, but nutrition should not be presented as a universal cure for anxiety disorders.

Myth: Hypnotherapy either cures anxiety instantly or has no evidence

Fact: Neither extreme accurately represents the research.

A meta-analysis supports hypnosis as potentially helpful for anxiety symptoms, particularly alongside other psychological interventions, while the evidence does not establish it as a universal substitute for disorder-specific first-line treatment. [20]

Myth: Anxiety must disappear completely before you can live normally

Fact: Treatment often involves learning that anxiety does not need to make every decision.

The objective is not necessarily zero anxiety.

It is greater freedom, functioning and confidence in your ability to respond.

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Frequently Asked Questions

What are the main anxiety disorders?

Recognised anxiety disorders include generalised anxiety disorder, panic disorder, social anxiety disorder, agoraphobia, specific phobias, separation anxiety disorder and selective mutism.

What is the most common anxiety symptom?

There is no single symptom experienced by everybody.

Worry, physical tension, restlessness, poor sleep, avoidance, repeated checking and gastrointestinal symptoms are all common.

Can anxiety cause physical symptoms?

Yes.

Anxiety can affect heart rate, breathing, digestion, muscle tension, sleep and other bodily functions.

New or concerning symptoms still require appropriate medical assessment.

Can anxiety cause nausea and diarrhoea?

Yes.

Anxiety can influence gastrointestinal function and may contribute to nausea, abdominal discomfort and bowel urgency.

Persistent gastrointestinal symptoms should not automatically be attributed to anxiety.

Why does anxiety make my heart race?

Perceived threat can activate autonomic nervous-system responses that increase cardiovascular arousal.

Unexplained or concerning palpitations should still be medically assessed.

Can anxiety make you dizzy?

Yes, particularly where panic, breathing changes or physiological arousal are involved.

Dizziness also has many possible medical causes.

Why does my child complain of tummy aches before school?

Anxiety is one possibility, particularly when symptoms repeatedly cluster around feared situations.

However, gastrointestinal and other physical causes also need appropriate consideration.

Can a child’s anger actually be anxiety?

Sometimes.

Fear can contribute to irritability, controlling behaviour and emotional outbursts.

Not every episode of anger is anxiety.

Is school refusal an anxiety disorder?

No.

School refusal describes difficulty attending or remaining at school.

Anxiety can be one underlying contributor among several.

Can bullying cause anxiety?

Yes.

Bullying can contribute to fear, hypervigilance and avoidance.

The bullying itself also needs to be addressed.

Is perfectionism anxiety?

Perfectionism is not itself an anxiety disorder.

Fear of failure, criticism or mistakes can nevertheless contribute substantially to anxiety.

Can teenagers have panic attacks?

Yes.

As with adults, new or concerning physical symptoms should receive appropriate assessment.

Can teenagers have health anxiety?

Yes.

Young people can become highly preoccupied with bodily symptoms and serious illness.

What is emetophobia?

Emetophobia is a severe fear of vomiting or vomit-related stimuli.

It can affect eating, school, travel and social life.

Is OCD an anxiety disorder?

OCD is classified separately from anxiety disorders in contemporary diagnostic systems, although anxiety frequently plays a central role in the obsession-compulsion cycle.

Is PTSD an anxiety disorder?

PTSD is also classified separately and requires trauma-specific assessment.

Can ADHD and anxiety happen together?

Yes.

A 2025 systematic review and meta-analysis confirmed that anxiety disorders commonly co-occur among children and adolescents with ADHD. [22]

Can autistic children experience anxiety?

Yes.

However, sensory needs, communication differences, uncertainty and environmental demands should not automatically be labelled anxiety.

Can poor sleep worsen anxiety?

Sleep and anxiety can influence one another.

Anxiety may make sleep difficult, while poor sleep can increase vulnerability to emotional distress.

Can caffeine worsen anxiety?

Yes, particularly in people who are sensitive to palpitations, shaking and physiological arousal.

Can alcohol help anxiety?

Alcohol may temporarily reduce anxiety.

Reliance on alcohol as a coping strategy carries risks, and withdrawal from alcohol dependence can be medically dangerous.

Can menopause affect anxiety?

Anxiety and mood changes can occur during perimenopause and menopause, alongside symptoms including sleep disturbance and palpitations. [8]

New or significant symptoms deserve appropriate assessment.

Does CBT work for anxiety?

CBT has strong evidence across several anxiety disorders.

The exact CBT intervention should be matched to the particular condition or presentation.

Does hypnotherapy work for anxiety?

Research suggests hypnosis can reduce anxiety symptoms for some people.

Evidence is encouraging, particularly when hypnosis is combined with other psychological interventions, but it varies according to the problem and should not be presented as a universal replacement for established disorder-specific treatments. [20]

Does anxiety ever completely disappear?

Anxiety is a normal human emotion.

A more useful therapeutic goal is often that anxiety no longer controls your choices, independence and quality of life.

When is anxiety serious?

Anxiety deserves assessment when it persistently affects:

work
education
eating
sleep
relationships
travel
healthcare
independence
quality of life

Immediate help is required when there is a serious safety risk.

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Working with Claire Russell

When I work with anxiety, I begin by understanding your particular pattern, or your child’s particular pattern, rather than assuming every anxious person needs exactly the same intervention.

Depending on your individual needs and clinical appropriateness, my work may include:

Counselling
Psychotherapy
Clinical Hypnotherapy
Clinical Medical Hypnotherapy
Hypnosis
RTT®
Advanced Rapid Transformational Therapy
Registered Nutritionist Services incorporating evidence-informed Functional Medicine principles
Couples and Marriage Counselling when anxiety is significantly affecting a relationship

For children and teenagers, I also consider developmental stage, family context, school, eating, sleep, ADHD, autism, sensory needs and physical health where relevant.

The objective is to develop an integrated, individualised care plan, not to force everybody into one treatment model.

No intervention is presented as a guaranteed cure.

Where GP, psychological, psychiatric, CAMHS, medical, educational or other specialist input is indicated, that support should form part of an appropriate care pathway.

Relevant service pathways

You can explore:

Counselling and Psychotherapy

Clinical Hypnotherapy, Clinical Medical Hypnotherapy, Hypnosis and RTT

Registered Nutritionist Services

If anxiety is reducing your world

You may benefit from an individual assessment if you are increasingly:

avoiding
cancelling
checking
seeking reassurance
restricting food
avoiding travel
avoiding social situations
organising family life around fear
finding that anxiety is controlling school, work or relationships

If you are concerned about your child or teenager, you do not need to know the diagnostic label before seeking help.

A useful first step is often understanding:

“What are they frightened of, what happens when that fear appears, and what is anxiety now preventing them from doing?”

Appointments are available ONLINE across Ireland and internationally, with in-person appointments also available in Adare, Newcastle West, Limerick, Abbeyfeale, Charleville, Kanturk, Midleton, Youghal, East Cork, Cork, Lismore, Dungarvan and Dublin.

Claire works with adults, teenagers, children and couples.

You can visit Claire Russell Therapy to explore services and current appointment options.

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About Claire Russell

Claire Russell is a Registered Nutritionist, Counsellor and Psychotherapist, Couples and Marriage Counsellor, Clinical Hypnotherapist, Clinical Medical Hypnotherapist, RTT therapist and Advanced Rapid Transformational Therapist (RTT®).

She has more than 20 years’ clinical experience and has worked with clients across Ireland, the UK, Europe, the UAE, Australia and the USA.

Her clinical work includes anxiety and related difficulties, trauma and PTSD/C-PTSD, addictions, ADHD, autism and wider neurodivergence, eating difficulties, digestive health, sleep, hormonal health and relationship difficulties.

Her work as a Registered Nutritionist may incorporate evidence-informed Functional Medicine principles where clinically relevant. This does not represent a separate Functional Medicine consultation.

Clinical and editorial transparency

Author: Claire Russell
Substantive evidence and editorial review: Claire Russell
Original publication date: 8 August 2026
Latest substantive review: 27 August 2026

This is an educational clinical resource, and is not an individual diagnosis or treatment plan.

Claire Russell is both the author and substantive reviewer of this resource. It should not be interpreted as having received independent medical review.

The resource should be reviewed sooner if major HSE, NICE, WHO or other relevant clinical guidance changes materially.

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Clinical and Scientific References

World Health Organization. Anxiety disorders. WHO Fact Sheet. Updated 8 September 2025.
https://www.who.int/news-room/fact-sheets/detail/anxiety-disorders
Health Service Executive. Anxiety in children. HSE. Reviewed 13 June 2025.
https://www2.hse.ie/conditions/anxiety-children/
Health Service Executive. Anxiety in young people. HSE. Reviewed 29 July 2025.
https://www2.hse.ie/mental-health/issues/anxiety-young-people/
Health Service Executive. Diagnosis: Generalised anxiety disorder. HSE.
https://www.hse.ie/mental-health/issues/generalised-anxiety-disorder/general-anxiety-disorder-in-adults-diagnosis/
Health Service Executive. Panic attacks: signs, causes, diagnosis and treatments. HSE.
https://www2.hse.ie/conditions/panic-attacks/
Health Service Executive. Social anxiety (social phobia). HSE.
https://www2.hse.ie/conditions/social-anxiety/
Health Service Executive. Get urgent help for a mental health crisis. HSE. Reviewed 28 May 2025.
https://www2.hse.ie/mental-health/services-support/get-urgent-help/
Health Service Executive. Symptoms: Menopause. HSE. Reviewed 28 July 2025.
https://www2.hse.ie/conditions/menopause/symptoms/
Health Service Executive. Alcohol withdrawal symptoms. HSE. Reviewed 10 July 2025.
https://www2.hse.ie/living-well/alcohol/dependence/withdrawal-symptoms/
National Institute for Health and Care Excellence. Generalised anxiety disorder and panic disorder in adults: management. Clinical guideline CG113. Published 26 January 2011, last updated 15 June 2020.
https://www.nice.org.uk/guidance/cg113/chapter/recommendations
National Institute for Health and Care Excellence. Social anxiety disorder: recognition, assessment and treatment. Clinical guideline CG159.
https://www.nice.org.uk/guidance/cg159/chapter/recommendations
National Institute for Health and Care Excellence. Obsessive-compulsive disorder and body dysmorphic disorder: treatment. Clinical guideline CG31.
https://www.nice.org.uk/guidance/cg31/chapter/Recommendations
National Institute for Health and Care Excellence. Post-traumatic stress disorder. NICE guideline NG116.
https://www.nice.org.uk/guidance/ng116/chapter/recommendations
James AC, Reardon T, Soler A, James G, Creswell C. Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database of Systematic Reviews. 2020;11(11):CD013162. DOI: 10.1002/14651858.CD013162.pub2.
https://pubmed.ncbi.nlm.nih.gov/33196111/
Walter HJ, Bukstein OG, Abright AR, Keable H, Ramtekkar U, Ripperger-Suhler J, Rockhill C. Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents With Anxiety Disorders. Journal of the American Academy of Child & Adolescent Psychiatry. 2020;59(10):1107-1124. DOI: 10.1016/j.jaac.2020.05.005.
https://pubmed.ncbi.nlm.nih.gov/32439401/
Tekin I, Aydin S. School refusal and anxiety among children and adolescents: A systematic scoping review. New Directions for Child and Adolescent Development. 2022;2022(185-186):43-65. DOI: 10.1002/cad.20484.
https://pubmed.ncbi.nlm.nih.gov/36161758/
Hipolito G, Pagnamenta E, Stacey H, Wright E, Joffe V, Murayama K, Creswell C. A systematic review and meta-analysis of nonpharmacological interventions for children and adolescents with selective mutism. JCPP Advances. 2023;3(3):e12166. DOI: 10.1002/jcv2.12166.
https://pubmed.ncbi.nlm.nih.gov/37720585/
Harbor MS, Harvey K, Jenkins PE. Treatment interventions for emetophobia: An extensive scoping review. Journal of Psychiatric Research. 2026;198:151-164. DOI: 10.1016/j.jpsychires.2026.03.033.
https://pubmed.ncbi.nlm.nih.gov/41905115/
Zhang J, Wan J, Wang Y, Li H, Lei Y. Explore the impact of sleep-related factors on anxiety in adolescents: A meta-analysis of cross-sectional, longitudinal and RCT studies. Journal of Affective Disorders. 2026;404:121320. DOI: 10.1016/j.jad.2026.121320.
https://pubmed.ncbi.nlm.nih.gov/41713614/
Valentine KE, Milling LS, Clark LJ, Moriarty CL. The efficacy of hypnosis as a treatment for anxiety: a meta-analysis. International Journal of Clinical and Experimental Hypnosis. 2019;67(3):336-363. DOI: 10.1080/00207144.2019.1613863.
https://pubmed.ncbi.nlm.nih.gov/31251710/
Sharma S, Hucker A, Matthews T, Grohmann D, Laws KR. Cognitive behavioural therapy for anxiety in children and young people on the autism spectrum: a systematic review and meta-analysis. BMC Psychology. 2021;9(1):151. DOI: 10.1186/s40359-021-00658-8.
https://pubmed.ncbi.nlm.nih.gov/34598734/
Njardvik U, Wergeland GJ, Riise EN, Hannesdottir DK, Öst LG. Psychiatric comorbidity in children and adolescents with ADHD: A systematic review and meta-analysis. Clinical Psychology Review. 2025;118:102571. DOI: 10.1016/j.cpr.2025.102571.
https://pubmed.ncbi.nlm.nih.gov/40245462/
Iniesta-Sepúlveda M, Rodríguez-Jiménez T, Lebowitz ER, Goodman WK, Storch EA. The Relationship of Family Accommodation with Pediatric Anxiety Severity: Meta-analytic Findings and Child, Family and Methodological Moderators. Child Psychiatry & Human Development. 2021;52(1):1-14. DOI: 10.1007/s10578-020-00987-6.
https://pubmed.ncbi.nlm.nih.gov/32246361/

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Anxiety Disorders Ireland

Anxiety Disorders Ireland: Symptoms, Types, Causes, Treatment and Help for Adults, Children and Teenagers

Summary

If you or your child needs urgent help

Contents

Anxiety Disorders at a Glance

What Is Anxiety?

When Does Normal Anxiety Become a Problem?

What Does Anxiety Feel Like?

Emotional symptoms

Thinking symptoms

Behavioural symptoms

Physical symptoms

Recognised Anxiety Disorders and Other Anxiety Presentations

Recognised anxiety disorders

Common anxiety presentations that are not necessarily separate diagnoses

Related conditions where anxiety can be prominent

The Main Anxiety Disorders Explained

Generalised Anxiety Disorder

Panic Disorder

Social Anxiety Disorder

Agoraphobia

Specific Phobia

Separation Anxiety Disorder

Selective Mutism

The Complete Anxiety Map

Health and safety fears

Anxiety about bodily sensations

Social and relationship anxiety

Achievement and performance anxiety

Travel and place-related anxiety

Childhood and developmental anxiety

Change and uncertainty anxiety

What Is Your Anxiety Actually Predicting?

The Anxiety, Avoidance and Reassurance Cycle

Panic Attacks and Fear of Bodily Sensations

Health Anxiety

Specific Phobias and Powerful Fears

Anticipatory Anxiety

Anxiety in Children and Teenagers

What Anxiety Can Look Like at Different Ages

Anxiety in Younger Children

Separation fears

School-entry anxiety

Bedtime and nighttime anxiety

Toileting anxiety

Vomiting and choking fears

Medical and dental anxiety

Anxiety expressed as tantrums

Anxiety in Primary-School Children

School anxiety

Friendship anxiety

Bullying-related anxiety

Perfectionism

Performance anxiety

Sleepover anxiety

Health and death anxiety

OCD-related fears

Transition anxiety

Anxiety in Teenagers

Anxiety may look like procrastination

Anxiety may look like overachievement

Teenage social anxiety

Group-chat and social-media anxiety

Body-image anxiety

Health anxiety and panic

Driving and passenger anxiety

Future anxiety

Relationship and dating anxiety

Anxiety and substances

School Anxiety and School Refusal

Ask what “school” actually means to the child

Do not assume avoidance is the entire story

Exam Anxiety, Junior Cycle and Leaving Cert Anxiety

Social Anxiety, Friendship Anxiety and Fear of Rejection

Emetophobia, Choking Anxiety and Food-Related Fear

Emetophobia

Choking and swallowing anxiety

Food anxiety in children

Separation Anxiety