Generalized Anxiety Disorder: What Parents Need to Know

A teen singing.

Generalized anxiety disorder most commonly affects those between adolescence and middle age. Image via Wikipedia


Everyone worries about things, even children and teenagers.  Whether the worry is over the upcoming history test, getting a date to the prom, or making the soccer team, anxiety is a normal part of everyday life.  However, in some people, normal everyday worries can become excessive and everyday things can cause severe anxiety.  This type of anxiety is called Generalized Anxiety Disorder (GAD) and it affects about 3% of the U.S.population each year, including one in eight children.

Generalized Anxiety Disorder is characterized by exaggerated anxiety and unwarranted worry about everyday problems.  People with this disorder may obsess about the worst case scenario in every situation and are unable to stop their anxiety from spiraling out of control.  Women are two times as likely to have the disorder and it most commonly affects those between adolescence and middle age.

Teens and young adults with the disorder may not do as well in school, may be susceptible to substance abuse problems, and may struggle with social milestones if it is not treated.  However, with the right combination of treatment, support, and assistance, children with GAD can learn to manage their symptoms and successfully navigate their lives.


People with GAD experience consistent, persistent, chronic worry or anxiety about things that do not warrant this level of anxiety for more than 6 months.

One of the key differences between the anxiety everyone experiences and GAD is that everyday anxiety is temporary and GAD is not.  Adults and children with GAD can experience heightened anxiety all day, every day and it can interfere with their normal activities.  It is common for those with GAD to use avoidance as a tool for managing their anxiety.  An adolescent who is experiencing temporary anxiety will respond to comforting words, reassurances, and a list of the reasons they don’t need to be anxious.  The anxiety of a child or teen with GAD will not be soothed by these techniques.

In addition to the chronic nature of the anxious thoughts and feelings someone with GAD experiences, there are also some physical symptoms that are often present with the disorder including:

  • Unexplained fatigue and problems sleeping
  • Restlessness, edginess, and irritability
  • Gastrointestinal problems including  nausea and diarrhea
  • Difficulties concentrating and headaches


Generalized anxiety disorder has no known cause but stress, traumatic events, heredity, and biological factors may contribute to its onset.  It is relatively common and can affect people of all ages.  Although it generally develops gradually over time, many people with the disorder cannot remember a time when they did not experience some level of anxiety.


Many people with GAD respond well to cognitive behavioral therapy, medication, or a combination of both.  Therapy can be beneficial in helping a person with the disorder to identify their triggers and modify their thought patterns and behavior.  Techniques for easing anxiety and promoting relaxation can also be beneficial to those with GAD.

It is very common for people with GAD to have a co-existing disorder.  Depression, substance abuse, and other anxiety disorders are commonly seen in those with the disorder.  Getting diagnosis and treatment for any co-existing conditions is an important part of overall treatment for GAD.

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Is Obsessive Compulsive Disorder Affecting My Teenager?

Person washing his hands

Does your teen struggle with OCD?  (Photo credit: Wikipedia)

It can be difficult in this age of acronyms to know when your teenager’s behavior is appropriate for their developmental stage of life of when it’s something that a parent should be concerned about.   With anxiety disorders like Obsessive Compulsive Disorder (OCD), it is even harder to find.  The difference between the two is the impact it has on the child’s daily life.

What is Obsessive Compulsive Disorder?

Obsessive Compulsive Disorder (OCD) is an anxiety disorder that causes those who suffer from it to experience persistent anxiety, fear, or distressing thoughts and/or exhibit a ritualized behavior as a method to control their anxiety.  For example, a child might be so afraid of germs, they wash their hands every 15 minutes.  The obsessive nature of these thoughts and their compulsion to perform the ritual interfere with the teenager’s daily life.

Someone who is afraid of germs may develop a ritual that involves washing their hands a certain number of times at certain points over the course of the day.  A child who is worried about their house burning down may develop a ritual involving checking their smoke alarms and fire extinguishers to ensure they are operating.  It is important to remember that someone with Obsessive Compulsive Disorder does not believe they can control their compulsions and that these rituals offer only a temporary respite from their anxiety.

People with Obsessive Compulsive Disorder, both children and adults, may realize that their behavior is out of the ordinary but this is not always the case in children.   OCD may be accompanied by other conditions including depression and eating disorders and affects the same number of males and females.  In many cases, Obsessive Compulsive Disorder first presents during adolescence or the teen years.

What Causes Obsessive Compulsive Disorder?

Obsessive Compulsive Disorder is a brain disorder.  Research has shown that it does tend to run in families but there is no clear indication of why one person develops the condition and another doesn’t.  But the truth is clear, that OCD is no one’s fault, and especially does not occur because of something a parent did, or did not do.

What are the Symptoms of Obsessive Compulsive Disorder?

A person suffering from Obsessive Compulsive Disorder will display many of the following symptoms:

  • Repetitive thoughts that are distressing or cause anxiety about several different things.  Common obsessive topics include germs, dirt, crime, sexual acts, cleanliness, violence, or hurting others.
  • Ritual behavior patterns associated with their obsessions that they complete over and over to alleviate the anxiety.  Rituals can involve actions like repetitive hand washing, locking and unlocking doors or windows, counting, and performing things in a specific way again and again.
  • Performing rituals can be distressing and are not a source of comfort or pleasure although they do alleviate feelings of anxiety temporarily.
  • Obsessive thoughts and rituals occupy at least one hour a day and impact the person’s daily life.

Symptoms may come and go over time and it is not uncommon for people suffering from OCD to use avoidance techniques to try and keep their anxiety from being triggered.

How is Obsessive Compulsive Disorder Diagnosed?

As with many mental health conditions, start with your medical provider who can rule out any physical conditions that may be contributing or causing the symptoms.  This doctor can refer you to a mental health practitioner for diagnosis and treatment.

How is Obsessive Compulsive Disorder Treated?

Traditional treatment for Obsessive Compulsive Disorder involves both medication and exposure therapy.  This type of therapy is often combined with cognitive behavioral therapy to provide desensitization and alternative coping strategies.  Recent research supported by the National Institutes of Health’s (NIH) National Institute of Mental Health shows that children and teens respond most effectively to treatment with antidepressants in conjunction with therapy.

If you are concerned that your child or teen is experiencing obsessive thoughts and compulsive behaviors, work with a professional who can assess your child’s behavior and advise you on the appropriate course of action.

Cutting and Self Harm- What Parents Need to Know


Self-harm (Photo credit: Wikipedia)

On a good day, it can be difficult for parents to understand their teenagers.  The teen years can be a mix of intense emotions, physical changes, peer pressure, and hormonal overload that can leave teens feeling like visitors in their own bodies.  Lacking the emotional maturity and coping skills to deal with this onslaught, some teens turn to cutting and other destructive behaviors for relief.  For parents everywhere, this terrifying trend is impossible to understand.  To help, here are the basics.

What is Self Harm?

Any behavior that involves deliberately inflicting injury on your own body is considered self harm.  This includes behaviors like cutting, head banging, and burning.  Teenagers use these behaviors as coping strategies to deal with intense emotions that they don’t know how to handle.  It is important for parents to understand that self harm behaviors are not suicide attempts, although they can be a cry for help.

Common forms of self harm include severe scratching, cutting, poisoning, carving into skin, hitting, piercing the skin, biting, and burning.  It is common for people who self harm to use more than one method to cause injury.  The most common locations for self injury are those that are easily reached including legs, arms, and the front of the body.

Why Do Teens Hurt Themselves?

For some teens, self harm provides a respite of some sort.  It may be an outlet for intense emotional turmoil or it could offer a release of mounting tension.  In some teens it even brings a sense of calm and quiet.

Self harm can also be an expression of control in a world that feels completely of control or a distraction from emotional pain.  Teens may use self harm as a way to release emotions, to give their internal feelings an external representation.  In some cases, self harm is a cry for help, while in others it is simply a way to attract attention and manipulate other people.

What Causes it

There is no specific condition that causes teens to self harm.  While teens are the most prevalent sufferers, people of all ages may use self injury as a mechanism for dealing with difficult emotions. Self harm can also manifest in people who are suffering from mental illnesses like depression or eating disorders.

There are, however, some risk factors that can increase the likelihood of a teenager turning to self harm as an emotional outlet.  These factors are:

  • Age – Teenagers in the highest risk age group
  • Mental Health – People who struggle to manage negative emotions, have difficulty with impulse control, and who suffer from specific mental illnesses are more prone to self harm.
  • Life Experiences – Teens who suffered abuse, neglect, or loss during their childhood are more likely than their peers to self harm.

What to Watch For

Most teens that self harm are secretive about their struggle because they are confused and ashamed by their own behavior.  Signs to watch out for are scars, cuts, scratches, wounds, burns, and broken bones.  Teens who wear long sleeves and pants in summer or claim clumsiness as the reason for their injuries may be trying to hide their self injuries.

How to Get Help

If you have a child that is harming themself, consult your medical practitioner and request an evaluation.  These professionals can help guide you in raising the issue with your child and getting them the help they need.  Psychotherapy is the most common treatment for self harm which may include individual counseling for your teen and family group.

Helping your Teen Athlete Eat Healthy

Everyone knows that teenagers often have bigger appetites because of their rapid growth.  Teen athletes, who can burn through as many as 5,000 calories a day, need even more food than their peers.  If they don’t get enough calories it affects their energy level and can impact their athletic performance.  In some cases, insufficient calories may even cause problems with their overall growth.  But it isn’t enough for teen athletes to eat enough calories; it is also important that they are taking in the right mix of nutrients and have a relatively balanced diet.


Parents can help support the nutritional needs of their teen athletes by starting each day with a healthy breakfast.  Have carbohydrate and protein filled choices such as whole grain bagels, peanut butter, eggs, yogurt and oatmeal available for a quick and healthy breakfast at home or on the go.


Everyone needs to eat a balanced diet but for teen athletes this is even more important. Their bodies are still growing which means they need the right mix of nutrients to support that growth while also providing the building blocks to boost performance and repair minor injuries.  According to, a teen athlete’s diet should be 60-65% carbohydrates, 12-15% protein, and 20-30% healthy fats.  Each of these three is equally important to your teen athlete’s development and performance.  Carbohydrates provide the main fuel source for their body, while protein helps build muscle.  Fats like those found in avocados and fish are critical to athletic performance because they provide the fuel for sustained energy.


Teen athlete’s need to pay particular attention to their water intake and be diligent about keeping themselves hydrated.  Drinking water throughout the day as well as before, during, and after physical exertion is the best way to maintain the optimal level of hydration in the body.  When teen athletes become dehydrated, they may feel more tired, have less energy, and be less able to perform as expected on the field.


While there is no set amount of calories that all teen athletes need each day, the requirements are higher for teens that are active in sports or other physical activities.  On average, teen athletes may need 2,000 calories more per day than their less athletic friends.  The actual number is dependent on the person however and varies based on weight, sport, and age.  The best way to determine the right amount of calories for your teen athlete is to work with a registered dietitian.


One of the best ways to help teen athletes get the balanced diet and number of calories they need is to ensure they have healthy, energy boosting snacks available throughout the day.  If your teen has practice directly after school they may be hitting their worst energy slump of the day just as practice is starting.  Depending on what time lunch period is, it may have been 3 or more hours since their last meal and by the time practice is over, they may have gone for seven or more hours without anything substantial to eat.  Pack snacks in their sports bag for before and after practice to ensure they have the energy to power through.   Healthy and energy-boosting snack choices include nuts, dried fruits and fresh fruits and vegetables.

By Rachel Daberkow, MS. RD.


How Do You Know Your Teenager is on Drugs?

As a counselor who works with teens and parents, this is one of the most common questions I am asked. Parents often struggle with this issue because the natural mood swings and personality changes that are a part of the teen years can make it difficult to determine if their child is acting normal or needs help. They are also hesitant to ask difficult questions because they don’t want to damage their relationship with their teen by accusing them of taking drugs.  Maintaining a relationship built on trust can be an important part of successfully navigating the teenage years and it only takes one misstep to demolish the foundation of that trust. Parents may be hesitant to approach their teens when they are concerned because they don’t want to alienate them or push them further away.

In order to know when to be concerned, when to ask questions, and when to intervene, you need to know the facts. Here are the common signs of teenage drug use.

1. Changes in Social Circles
One sign that parents should be watching for is a significant change in their child’s friends or social circles. If your teenager has been friends with the same kids since elementary school and suddenly shifts to an entirely different set of friends, this may be cause for concern. First, look for other factors like joining a new club, or playing on a sports team that may explain an influx of new friends. Changes in social circles or standing by themselves are not always indicative of drug use, but parents should pay attention to these types of changes as they can point toward several teenage problems.

2. Changes in School Participation
Another thing to watch for is the development of a negative attitude about school in general. This includes spending less time and effort on school work and home work, skipping classes, and grades that are going down.

3. Changes in Personality
When teenagers begin using drugs, they often become more secretive and are touchier about privacy and having their own space. Signs of these behavior changes include getting angry if you are in their room, unwillingness to let you borrow their cell phone, refusing to leave their backpacks or school bags where others could access them, or offering vague answers about where they are going and who they are spending their time with.

4. Changes in Aromatic Usage
If your teen suddenly develops the need to burn incense or use room deodorizer on a regular basis, but doesn’t seem more concerned with cleaning their room, they may be trying to hide the smell of smoke or other odors. Intensified use of body spray or perfume is also a sign that something may be amiss.

5. Changes in Financial Needs
One indication that your teen may be using drugs is an increased need for money. This may be evident because of an increase in their requests to borrow money, offers to work around the house for cash, or money disappearing from purses and wallets. Teens that become suddenly invested in selling or pawning things like video games and other electronics may also have a problem that needs parental attention.

Parents and their involvement in their teenager’s lives are still the best deterrent to drug use. Providing a supportive environment with clear expectations helps set the stage for drug-free teen years. But it is equally important to know the signs that your teen is in trouble and how to help them through whatever problems they are facing.


by Jan Hamilton, MS, PMHNP-BC
Psychiatric Nurse Practitioner


Harper, Trina


Trina HarperTrina Harper, Office Manager

Trina has over 25 years’ experience in office management services. She has been involved in adolescent and women’s ministries through her church and Young Life throughout her adult life and brings a gift of compassion to her work at Doorways.


A – – Hamilton, Jan

Jan Hamilton, DoorwaysJan Hamilton, MS, PMHNP-BC

Psychiatric Nurse Practitioner

Jan Hamilton is the Founder and President of Doorways.  She is a Nationally Board Certified Psychiatric Nurse Practitioner who specializes in adolescent treatment. Her desire is to provide quality psychological and psychiatric care for adolescents and young adults in an outpatient, faith-based setting has led to the opening of Doorways in 2008. Jan is a Blue Cross Blue Shield and Aetna approved provider.

Eating Disorders Treatment, Phoenix Christian Counseling, Doorways, Arizona

How Social Media is Affecting our Teens

How Social Media is Affecting our Teens-

Since computers starting coming into the home and video games left the arcade, parents have expressed concerns about how much is too much and how these virtual interfaces will impact the lives of our children over the long term.  For years, the main concerns around overuse of electronic media have centered on physical activity levels, studying, and the effect of violent, sexist, and racist themes on young minds.   Recently I was asked my thoughts on the impact things like Facebook, Twitter, and video games are having on today’s youth.  My answers might surprise you.

One of the main problems that I see is an increase in teens and young adults with significant social anxiety problems that seem to stem from spending too much time interacting with a computer and not enough time interacting with actual people. This is especially pertinent for teens that are in the 12 to 15 year old range that are actively developing and refining the social skills that will help them throughout their lives.  The more time a child spends in isolation posting on Facebook, playing Xbox, chatting online, texting, and watching YouTube videos, the less time they spend interacting with their peers and families.  These real-world interactions are necessary for developing social skills, understanding social protocols, and building interpersonal relationships.

What Parents Should Look For

  • Parents should trust their instincts and if they are concerned there might be a problem, seek the opinion of a professional.
  • Parents also need to make the distinction between what is normal behavior and what is healthy behavior.  Your son might spend 12 hours a day playing video games which seems normal when compared to his friends, but most health professionals would agree that even if it is normal, 12 hours of video game play in a day is definitely not healthy.
  • Watch for resistance to social situations and avoidance of social interactions.  If your child is having a significant emotional response to a situation that requires social interaction, there may be a social problem that needs to be addressed.

What Parents Can Do

  • The most important step parents can take is to start young.  Set expectations and ground rules about media use early in childhood which will help your child develop good habits as they grow into teenagers.
  • Provide multiple social outlet opportunities for your children through church, community, sports, and educational activities.  But, beware of over-scheduling; children need downtime too.
  • Don’t accommodate their anxiety; it’s ok for them to be uncomfortable in social situations because they are learning how to manage those types of interactions.  Giving in and allowing them to avoid socializing only reinforces the avoidance behaviors.


“Help! I Can’t Talk to My Teenager, He Says I Don’t Understand!”

By: Jan Hamilton, MS, PMHNP-BC

Every parent who has ever had a teenager understands this feeling.  It is a topic I get asked about a lot and a frequent topic in family therapy.  As teenagers grow, one of the fundamental changes they are making is the formulation of their own identity, separate and distinct from that of their parents.  In former centuries, this change more closely coincided with actual changes in circumstances as well, like getting married, striking out on their own, or taking on more adult responsibilities.  Even so, there were probably quite a few shouting matches and just as much misunderstanding between parents and their teenagers as there is today.

Communication is the key to helping our teenagers navigate the often rocky path between childhood and adulthood.  Unfortunately, the very nature of that change creates significant challenges and barriers to communication.  In order to keep the communication channels open, parents need to take charge of keeping them clear.  Here are 6 things that will help you communicate better with your teen.

1.      Communication is more than Words

Remember that there is more to communicating than just the words that come out of your mouth.  Your teenager is attuned to the subtle and silent messages you send with your body language and the tone of your voice.  If these messages don’t match, your child will interpret what they think you really mean and respond accordingly.

2.     Watch What You Say

Most teenagers have heard what you are about to say a hundred times.  They can tell by the circumstances, your body language, and the tone of your voice what is coming and if it is old news or an unwelcome message, they may tune it out.  Pay attention to all the messages you are sending and look for ways to impart the same message without wandering into a well-known battlefield.

3.     Listen

Communication is not just about talking or educating the other person or convincing them that your point of view is right.  Communication is about a two-way exchange.  You need to learn to listen, to truly listen, to what your teen is saying before you can learn to communicate with them.  Too often, parents tune out their kids as well, only hearing the things they want to hear or using the time their child is talking to think about what they are going to say next.  Listening to your teenager is the most empowering thing you can do.

4.     Trust Your Parenting

Trust in the foundation you provided them and give them room to make choices, fail, and then learn from their mistakes.  Believe in the guidance and education you instilled in them.  Don’t lecture. Focus on listening and allow them to make decisions for themselves.  Bolster their belief in themselves by showing them you believe in their ability to make good decisions.

5.     Be a Curious Observer

One of the reasons teenagers feel so misunderstood is that their lives, bodies, hormones, and relationships are in a constant state of flux.  You can help them through these challenges by providing validation that they are OK, that they are good people, and that what they are going through is normal.  To do this, you must be curious about their lives, ask open-ended questions, and then listen to what they have to say.  But you must only be an observer; you cannot force openness and you shouldn’t use curiosity to spy or pry into their lives.

6.     Watch Out for Transference

Remember that your child is not you.   If you have issues to work through, take the initiative and work through them yourself, don’t assume your child is going down the same path you did or that they will make the same mistakes you made.  You don’t want to  limit their freedom to find their own path, make their own mistakes, and learn to live with the consequences that result because of your own fears or guilt about your past.  The healthier you are, the better you are able to let go when you need to.


About Jan Hamilton, MS, PMHNP-BC

Jan is a nationally Board Certified Psychiatric Nurse Practitioner who specializes in adolescent treatment.  She earned her Master’s of Science and Psychiatric Nurse Practitioner certification through the University of Arizona. She then worked for over eight years at Remuda Ranch providing inpatient services for adolescents and adults suffering from eating disorders. Jan has been a registered nurse for 31 years and worked in a wide variety of medical settings, including 30 years of serving young people through her work with Young Life, an interdenominational outreach program. Her desire to provide quality psychological and psychiatric care for adolescents and young adults in an outpatient, faith based setting has led to the opening of Doorways in 2008.