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Column originally published Sep 20, 2011

Severe Anxiety Needs Counselling And Medication

Question: We are worried about our daughter. She is starting grade six. She is extremely anxious; she worries about everything. When we go out, she needs to know where we are going, and exactly what time that we will return. She worries about thunderstorm, and she keeps flipping to the weather channel even when the weather is perfectly fine outside. It will take me a whole page to list the things that she is worried about. What concerns us is that her excessive worry is going to harm her, and she will not be able to enjoy life. Most children are excited about going back to school, but she is terrified. It is not because she gets bullied there; she does well in school, and she has no trouble learning. However, every morning before school, she would get sick, sometimes to the point of vomiting. If she has a test, things will be many times worse. We couldnʼt take her to shop for school supplies. Instead, her brother and I had to do the shopping for her and hide them at home. I used to be an anxious person also, but not as severe as she. Over the years, I gradually worked through some of my anxieties. A few years ago, I developed depression, and my doctor prescribed an anti-depressant for me. Not only was my depression better, much of my anxieties are controlled as well. I understand our daughterʼs anxiety because of my own experience. I wonder whether I should take her to our doctor to check this out.


What you have described about your daughter is very severe anxiety. This is not an uncommon medical problem, even in young children. I am glad that you recognize that in yourself also. It is a genetic condition, and it has a high tendency to run in the family.

Being worried in certain situations is a very important personality trait which has allowed humans to survive. In the animal world, it is never completely safe: the larger and stronger animals prey on the smaller and weaker ones. Being cautious and careful are the most important characters that ensure survival of the individual. If there is a lion roaming around the hut, one needs to stay inside to avoid becoming the lionʼs next dinner.

Being careful and cautious is also important in our present day world. It is unsafe to cross a busy highway; we should wait for the green light to cross a busy street, and should look both ways before crossing; if the water is choppy, we donʼt go out to swim; we should buckle up when we are in the car; and we wear bike helmets when we ride our bicycles. If we have to climb up the roof to fix something, we need to make sure that the ladder is secure; if we are interested in rock climbing, we need to have all the proper gears and get proper training.

The list of things that we have to be careful about goes on and on. Every day, we do these without thinking much about it, because this is part of our nature, and part of our survival. However, sometimes when we get distracted, or when our judgement gets clouded by alcohol and drugs, and we donʼt practice precaution, disasters can strike. How many times have we heard people getting injured and killed when they drive too fast, didnʼt wear their seat belt, or under the influence of drugs and alcohol.

However, some of us are born differently, like your daughter. Instead of being careful with things that she needs to be careful about, she gets worried and frightened excessively, to the point that it affects her daily life and her education. This is not normal. If she doesnʼt get help, her anxieties can get worse over time and overwhelm her. Many people with anxiety can develop depression. Stresses like illness and deaths in family members can get many people feeling sad and down. Those with anxiety have greater difficulty coping with these stresses and can get depressed a lot easier.

Because of their anxieties, some avoid situations that may make them anxious. In the extreme cases, they isolate themselves and stay at home as much as possible, not able to pursue their interest or their career. When a child has severe anxiety, this can affect his education and his social development.

Fortunately, one doesnʼt have to suffer from anxiety, there is help out there. You have given me a very good example, you worked through some of your anxieties. However, if the anxiety is severe, extra help is needed, including counseling and medication.

Counseling can help your daughter deal with things that she worries about. It can be done individually or in groups. Medications are often needed for those with severe problems. As you have experienced, anti-depressants are very useful for both depression and anxiety, although the dose of medicine may be different for these two conditions.

As you may already know, most of the anti-depressants are not recommended for children. There is a warning that some children and teenagers can develop thoughts of hurting themselves when they take anti-depressants: this is called suicidal ideation. Fortunately, this problem is uncommon, and can happen when the medicine is started and when the dose is being increased. The most important precaution is being careful that this can happen. Parents should watch children who are given anti-depressants for the first time, and when the dose of medicine is adjusted. It should be prescribed by paediatricians and psychiatrists who are familiar with these medications.

I would suggest that you consult a paediatrician or child psychiatrist who is familiar with anxiety in young children. Her problem needs proper assessment and monitoring. Counseling with a knowledgeable psychologist or counsellor can be helpful, although she may also need medications to help her deal with her anxieties.