by Perlea, Victor ¹, Mayer, Gwendolyn ¹

• ¹ Universitätsklinikum Heidelberg

This is the extended version, for the abridged version click here

The introduction and overview can be found here

Disclaimer:We have compiled this information to the best of our knowledge based on current scientific literature (as of May 2026). However, we do not provide diagnosis or treatment recommendations. If you notice any mental health concerns in yourself or in a child or adolescent in your care, please consult a medical doctor.

Diagnostic criteria

• Excessive fear or anxiety (worry, tension) that is disproportionate to the situation, persistent over months, and difficult to control that causes significant distress or impairment in school, social, or family functioning; symptoms not better explained by substances or medical conditions (Patel et al., 2016; Ernstmayer et al., 2022).
  
• Anxiety disorders differ in the kinds of objects or situations that trigger fear, anxiety, or avoidance, as well as in their cognitive features and processes. Although comorbidity is common, different anxiety disorders can be distinguished by assessing the specific feared or avoided situations and the associated thoughts or beliefs: American Psychiatric Association (APA, 2013): https://doi.org/10.1176/appi.books.9780890425596
  
• Anxiety disorders differ from developmentally appropriate fear or anxiety in terms of being more intense or lasting longer than expected for the person’s developmental stage. They also differ from temporary, often stress-induced fear or anxiety because they are persistent—typically lasting for 6 months or more, although this criterion should be used flexibly. In children, duration may sometimes be shorter (e.g., separation anxiety disorder, selective mutism). Since individuals with anxiety disorders typically overestimate the danger in feared or avoided situations, clinicians must determine whether the fear or anxiety is excessive or disproportionate, while considering cultural context (APA, 2013).
  
• Many anxiety disorders develop in childhood and, if untreated, tend to persist. Most anxiety disorders occur more frequently in females than in males (ratio approximately 2:1). Specific anxiety disorders should only be diagnosed if symptoms are not better explained by the physiological effects of a substance or a medical condition, and if they are not better accounted for by another mental disorder (APA, 2013).

Prevention measures

• School-based programs teaching emotional literacy, problem solving, and coping skills; anti‑bullying and safe‑school policies (Patel el al., 2016).
  
• Early identification and support for anxious children (psychoeducation for families, brief CBT‑informed interventions; Patel el al., 2016).

Risk factors

• Family history of anxiety or mood disorders; temperament marked by behavioural inhibition; overprotective or critical parenting (Patel et al., 2016).
  
• Exposure to stress, bullying, trauma, chronic physical illness, and academic or social pressure (Ernstmayer et al., 2022).

Treatment approaches

• Cognitive behavioural therapy (CBT) with exposure as first‑line for most adolescent anxiety disorders: Bandelow et al., 2021: https://register.awmf.org/assets/guidelines/051-028l_S3_Behandlung-von-Angststoerungen_2021-06.pdf
  
• SSRIs for moderate–severe or treatment‑resistant cases, ideally combined with CBT; family involvement and school accommodations to reduce avoidance (Bandelow et al., 2021).

References for this article are here