Anxiety in Children and Young People: Understanding What Lies Behind It
Anxiety in children and young people takes different forms, and what makes an experience overwhelming is particular to each person. Understanding it involves exploring what is happening now alongside their history and relationships, including feelings they cannot yet recognise or put into words. Growing up continually changes our relationship to the people we depend upon and to ourselves. This article follows those changes, considering how anxiety is experienced in the body and how the search for security can become caught up in phobias or the thoughts and rituals of obsessive-compulsive disorder (OCD). Throughout, the concern is how psychoanalytic psychotherapy can help someone understand their experience and develop a different relationship to it.
Even when the focus of anxiety is clear, its force can be difficult to explain. A young person frightened of making a mistake may struggle to understand why getting something wrong feels so devastating. For one person, a mistake is a disappointment they can recover from; for another, it seems to expose something unacceptable about themselves and puts their place in a relationship at risk. The event is similar, but what it represents is different.
Such connections develop through experience without necessarily becoming conscious. Anxiety can begin to shape how someone lives, drawing them towards avoidance or repeated reassurance before they can explain what troubles them. A psychoanalytic approach gives time to these connections while taking seriously the reality of the young person’s circumstances.
When the Situation Needs to Change
If a child is being bullied at school, their anxiety about going there has an immediate context. An approach centred on managing that anxiety can leave the child carrying the burden of a situation adults need to address. Listening includes taking seriously what their distress communicates about their world, even when they cannot give a clear account of what has happened. Sometimes the first task is to change the conditions making them anxious.
The effects of an experience can also outlast the circumstances that produced it. Someone who has repeatedly been humiliated may come to expect humiliation whenever they are noticed, including in a setting where people respond differently. Being the focus of attention has become associated with exposure and danger. Helping therefore involves attention to present circumstances and to the expectations earlier experiences have left behind. External reality and personal history belong together in understanding anxiety.
Separation Anxiety: Being Apart and Becoming Independent
For a young child, being apart from a parent involves learning to feel secure without that person physically present. Starting school means entering a setting where familiar ways of finding comfort are less immediately available. Through experience, the child develops confidence that other adults can help them and that their relationship with a parent continues during the time apart. This develops at different paces, and a period of change can make separation difficult again after it had become manageable.
When separation causes persistent distress, the particular experience needs attention. A child who fears that something will happen to their parent is facing a different difficulty from one who feels unsafe in the classroom, although both become distressed at the school gate. Sometimes a desperate need to remain close is the only way the child can express something they do not yet understand. Their behaviour tells us that they are struggling, but does not by itself explain why.
As children grow, needing a parent nearby can come into conflict with wanting to do things for themselves. The presence that makes an activity possible becomes frustrating when friends seem able to manage alone. A child can want support and resent needing it, without recognising these feelings or knowing how to express them. Resentment may emerge through irritability or arguments about something apparently unrelated, leaving both child and parent bewildered when an insistence on closeness is followed by an angry attempt to push the parent away.
This ambivalence is one aspect of separation, rather than its whole explanation. Dependence brings comfort while sometimes seeming to confirm that the child cannot cope and that the world is frightening. Anger can express frustration with this position, or offer a more powerful feeling than the vulnerability of needing someone. Making room for both sides helps the relationship support greater independence without requiring the child to reject closeness or manage more than they can bear.
In adolescence, separation takes on a new significance as young people establish a life beyond the family. Leaving home can be eagerly anticipated while stirring fears about losing familiar protection. Practical readiness does not necessarily bring emotional readiness, and parents face an adjustment too as they offer care without overseeing everything their child experiences. These changes need to be understood within each family’s life, rather than measured against an expectation that independence should simply have arrived.
Separation, Bereavement and the Fear of Death
Being apart acquires another significance as children begin to understand that people can die. An ordinary departure can become frightening once a child recognises that someone they love might not always return. Repeated questions about a parent’s safety may express an effort to grasp something reassurance cannot entirely resolve: the people they depend upon are mortal.
Bereavement can make this knowledge immediate. Following the death of a grandparent, a child may begin to fear that a parent will die too. The loss has changed what they understand to be possible, and anxiety spreads beyond the person who has died. Going to school then means leaving someone they feel they must watch over, while being out of contact becomes difficult to bear. Trying to keep a loved person close can become entangled with feeling responsible for keeping them alive.
Children need truthful explanations suited to their understanding, alongside dependable care that helps them live with what they have learned. Therapy makes room for grief and the frightening questions loss has opened up, including any sense that the child must prevent another death. These concerns can return later in life when a departure brings renewed awareness that time with loved people is limited. Moving forward may then involve the emotional work of accepting a separation that nobody can make entirely safe.
Social Anxiety: Finding a Place Beyond the Family
As belonging outside the family becomes more important, other people’s responses acquire new force. Developmental research describes changes in the adolescent brain’s social systems that contribute to a heightened focus on peers. This provides a context for understanding the intensity of social experience at this age, while leaving open what acceptance or rejection means to each individual.
There can be a frightening interval between moving away from an established place within the family and finding a secure place among others. Young people become less willing to be defined through their parents while remaining uncertain about who they are among friends. A friendship difficulty can unsettle their emerging sense of where they belong, particularly when their identity has become closely connected with membership of a group.
Belonging also involves a tension between similarity and difference. A young person wants acceptance while needing room to become themselves, and may fear that the price of fitting in is concealing something important. Standing out promises recognition and risks exclusion. Earlier experiences of being criticised for being different can make this dilemma especially painful.
Social anxiety turns participation into an experience of watching oneself participate. During a conversation, the young person becomes preoccupied with how they appear; afterwards, they examine what they said as though searching for evidence of failure. Reassurance struggles to reach them because a harsh judgement is already taking place within their own experience. Understanding how this anticipated judgement has developed matters as much as knowing that they feel anxious around people.
Sexuality, Romance and Anxiety About the Body
A romantic relationship brings a particular vulnerability into this search for belonging. Wanting to matter to someone makes their response important in a new way, and signs of interest can be difficult to read. Being wanted is exciting, but closeness also means allowing another person to affect us. The uncertainty involved can feel especially exposing when a young person is still discovering their own wishes.
Developing this intimacy changes their position within existing relationships. Someone outside the family begins to occupy a more private place in their life, bringing a need for experiences their parents cannot fully share. The wish for privacy coexists with a continuing need for care, and the young person may feel uneasy about this change before being able to explain it. Becoming close to someone new can therefore bring questions of separation into the relationship itself.
The body is involved because it is both privately experienced and visible to others. As their body changes, a young person may feel unfamiliar to themselves while becoming intensely aware of how someone they are attracted to might perceive them. Anxiety about appearance can become bound up with the experience of being seen and wanted. In such circumstances, attending only to the feature they dislike may miss the wider vulnerability that has gathered around it.
Questions about sexuality and gender form part of this developing relationship to oneself and others. Sexual and gender diversity are not inherently mental health problems. What deserves attention is the individual’s experience, including the effects of prejudice and the significance these questions carry within important relationships. Therapy offers time for exploration without requiring certainty before the young person has found their own words for what they feel.
Neurodivergence and Feeling Out of Place
For a neurodivergent young person, finding a place among others can involve additional demands. An ordinary school day may require sustained effort to manage sensory experiences or interpret expectations that remain unclear. When environments repeatedly overwhelm or misunderstand them, anxiety about returning has substantial grounds in what they have lived through.
Repeated misunderstanding can also leave someone monitoring their behaviour closely, trying to anticipate rules others appear to know without explanation. Masking—the effort to conceal differences or adapt outward behaviour to fit in—can help them navigate a situation while leaving them exhausted and uncertain whether they are accepted as themselves. Social anxiety grows around the expectation of getting something wrong again.
Practical adjustments are essential when the environment is contributing to distress. Alongside these, psychotherapy can help a young person explore what their experiences have come to mean for their confidence and relationships. Neurodivergence informs the work while leaving space for a personal history that cannot be understood through a diagnosis alone.
When Anxiety Is Felt in the Body
Anxiety does not always arrive as a recognisable worry. A young person may feel an agitation that makes remaining in a room unbearable without knowing what has become so difficult about being there. The distress is experienced bodily, before any connection with thoughts or feelings becomes clear.
Some describe a mounting sense of pressure, unable to find a way for their body to settle. Even exhaustion brings little rest because they remain on alert, caught between an urgent need to do something and an inability to find anything that helps. The pressure itself becomes frightening when they cannot imagine how it will end. At these moments, being asked to explain what is wrong can add to the frustration: they may know that they are safe while remaining unable to feel safe.
An action sometimes offers relief before there is any understanding. Leaving the room reduces the pressure, or completing a familiar ritual briefly makes things feel settled. Repeated relief can make that response increasingly difficult to relinquish, even when the young person becomes frustrated by the restrictions it places on their life.
The bodily urgency deserves attention alongside what the person does to manage it. Someone might gradually notice that the pressure rises when they cannot express disagreement with an important person. If disagreeing feels dangerous to the relationship, anger itself can be difficult to recognise. What seemed an inexplicable need to escape begins to acquire a context, opening up other ways of responding. This is one possible connection, to be discovered through the person’s experience rather than assumed by the therapist.
Finding words takes time, particularly when a feeling has mainly been lived through the body or an urgent action. As the young person becomes able to express and bear it within a relationship, the need to respond in the same way can loosen. This work sits alongside appropriate medical attention to physical symptoms, which should not automatically be attributed to anxiety.
Ambivalence: When Our Wishes Pull in Different Directions
Anxiety can arise when important wishes conflict. A young person wants to be noticed, yet being noticed leaves them feeling exposed. Becoming more independent promises freedom while threatening the security of being cared for. These wishes can exist together, although the person experiencing them may feel that they ought to know which they want. Ambivalence describes this coexistence of conflicting feelings, which is part of emotional life but can become difficult to bear.
Sometimes one side of the conflict is easier to acknowledge than the other. A young person might speak readily about wanting a closer relationship while finding it harder to recognise how much closeness unsettles them. Being important to someone brings expectations, and they may also want the freedom of having less demanded of them. Anxiety can emerge around a relationship they consciously want, leaving them confused about their own response.
Aggressive feelings can make these conflicts particularly uncomfortable. A child who loves and depends upon a parent can also feel furious with them and wish to escape their demands. If that anger feels incompatible with being loving, or seems capable of damaging the relationship, acknowledging it becomes difficult. The anger does not necessarily disappear because it cannot be recognised. From a psychoanalytic perspective, anxiety can develop around feelings that the person cannot yet allow themselves to know they have.
These conflicts are often unconscious, so the young person does not experience a clear choice between two wishes. They experience distress without understanding what is at stake. Therapy offers room for feelings that have seemed impossible to hold together, allowing anger towards someone to be recognised without making it the whole truth of the relationship. As love and frustration become more possible to acknowledge together, there can be less anxiety about what an uncomfortable feeling means or what might happen if it is expressed.
Change, Uncertainty and the Search for Control
The experiences described so far involve changes that no young person can entirely direct. Growing capacities bring new expectations, so that something once done for a child becomes something they are expected to manage. Even in an outwardly settled life, growing up involves leaving behind familiar ways of feeling secure.
Some uncertainty can be addressed through preparation, but preparation cannot make every outcome predictable. A child approaching a new school still has to encounter people they do not yet know. In adolescence, changes in the body can make unpredictability feel closer still, while bereavement brings a painful encounter with the limits of anyone’s control.
A symptom can sometimes bring overwhelming uncertainty within what feels like the person’s influence. A child might feel compelled to turn a light off ten times before settling, convinced that completing the action will prevent something terrible. There is now a definite task to perform. The protection it promises comes at the cost of feeling responsible for getting the action right, and the attempt to become safe acquires demands of its own.
A phobia offers a different boundary by locating danger in something identifiable. Avoiding that object or situation brings relief, even if doing so gradually restricts life. Understanding this possible function helps explain how a symptom can be both distressing and difficult to give up. The person has found a way of managing something, although they need not know what that something is or why this particular response has become necessary.
The Unconscious: Finding Connections That Were Missing
We are affected by connections we do not consciously recognise. A present situation can carry the emotional force of earlier experiences, or bring conflicting feelings into play without our being able to identify them. Psychoanalytic work attends to this gap between what someone knows about their anxiety and what emerges as they speak.
Consider an imagined young person whose anxiety intensifies as leaving home approaches. They are enthusiastic about the opportunity and describe their family as loving and supportive. Yet conversations about home repeatedly return to a parent’s loneliness. Gradually, they notice that imagining their own enjoyment brings an uncomfortable sense of leaving that parent behind. Anxiety that seemed inexplicable begins to be understood alongside a conflict between wanting a separate life and feeling responsible for someone they love.
The parent need not have asked them to stay, and the young person has not deliberately concealed their feelings. A wish for independence can be difficult to acknowledge fully when, at another level, it feels like an injury to someone important. Love coexists with frustration and the wish to get away, but those feelings are not always easy to recognise together.
Freud used the term repression to describe a process through which troubling thoughts or wishes are kept outside conscious awareness. The feeling associated with them does not necessarily disappear. Anxiety can remain while the person has little access to what gives it force, or become attached to a concern that is easier to identify. This is a psychoanalytic way of understanding some experiences, rather than an explanation of every instance of anxiety.
Connections emerge through the person’s own associations: the thoughts and memories that come as they speak, sometimes surprising them. A phrase repeated across several conversations can reveal an expectation they have never questioned. In the imagined example, the young person might begin to recognise that “leaving” has always seemed dangerously close to “abandoning”. Being able to explore that connection makes room for a different experience of independence, although the emotional work involves more than discovering a link intellectually.
Phobias: When Anxiety Finds a Particular Focus
For someone experiencing a phobia, the feared object or situation usually feels like the whole problem. The fear is immediate and convincing, and avoidance brings relief. Introducing the possibility of connections elsewhere therefore requires care; the person needs to know that the intensity of their experience is being taken seriously.
Displacement describes how emotional significance shifts between ideas or situations, allowing anxiety to become attached to something without its wider connections being recognised. Returning to the imagined young person preparing to leave home, suppose their anxiety becomes concentrated on travelling alone. Attention is absorbed by the journey and what might go wrong, while the conflict about leaving someone behind remains outside awareness. Travel has become the focus of distress that involves more than the journey itself.
This is a possible account, not an interpretation to apply to everyone frightened of travelling. A phobia can develop following a frightening encounter with the situation itself, and its history needs to be understood individually. What matters is remaining open to how the feared situation has acquired its particular significance.
Having a definite focus can make diffuse anxiety feel more containable, but this attempted protection restricts life when avoiding danger also means avoiding wanted experiences. As the person becomes able to work with the feelings entangled in their fear, the situation can lose some of its emotional weight. Travelling may gradually become a journey again, rather than carrying the whole difficulty of separation.
OCD: When a Symptom Becomes a Way of Containing Anxiety
In obsessive-compulsive disorder, an unwanted thought can provoke doubt that feels impossible to leave unresolved. A compulsion offers something to do about it, including an action performed privately in the mind. Checking briefly restores a sense of safety before uncertainty returns, and increasing amounts of life become devoted to obtaining a certainty that never lasts.
The compulsion therefore creates suffering while also promising relief. A ritual can be exhausting while feeling indispensable, because stopping seems to expose the person to something worse. Knowing that the action does not make ordinary sense may do little to reduce its urgency.
In psychoanalytic work, I attend to the symptom while allowing the conversation to extend beyond it. The young person does not need to arrive knowing why it happens. Speaking about their wider life can reveal pressures and expectations that help us understand the place the symptom has come to occupy. We follow the connections that emerge rather than requiring everything they say to provide an explanation of the ritual.
For one person, checking becomes understandable alongside feeling responsible for a loved person’s safety; for another, the work takes a different direction. An intrusive thought should never be treated as a straightforward disclosure of a concealed wish or intention. Its disturbing content is not a confession, and attention to the unconscious must preserve this distinction.
Symptoms can change their focus, so the work remains attentive to the continuing distress as well as its outward form. That does not mean relief has to wait for a complete explanation, or that treating a symptom causes another to appear. Assessment and ongoing attention to how the young person is managing help inform the care they need.
In my clinical experience, symptoms can lose their hold as experiences that previously felt overwhelming become more possible to recognise and work through. A ritual becomes less necessary, or an obsession ceases to command the same attention. I think of this as an unhooking: something tightly bound to anxiety begins to loosen through the work. It describes a possibility within treatment, rather than a promise about every person’s outcome.
Psychotherapy for Anxiety in Children and Young People
Across these different experiences, psychotherapy aims to help someone live with greater freedom. The situation itself does not always change objectively. Leaving home still involves being apart, while a new relationship retains uncertainty about another person. What can change is the significance of the experience and the conclusions that seem to follow from it.
Someone for whom separation has felt like abandonment can begin to discover that closeness survives distance. Independence no longer has to carry the same guilt. This develops through understanding their history and through relationships in the present, including the therapeutic relationship. A young person who expects disapproval whenever they disagree may need time to express a different view to the therapist and experience the relationship accommodating it.
An explanation understood intellectually can leave an emotional conviction untouched, which is one reason the work takes time. The young person needs opportunities to return to difficult feelings and encounter them differently, within a relationship where they can be thought about. With younger children, play offers ways of expressing and exploring experiences for which words are not yet available.
Practical ways of settling anxiety can help when distress is overwhelming, but the ability to calm down is only one aspect of change. The language of resilience becomes limiting when it makes adaptation the young person’s responsibility without giving sufficient attention to what they are living through. Anxiety deserves time and respect, including attention to circumstances that need changing and to meanings that remain unconscious.
As feelings become more bearable, the need to avoid experiences or contain distress through repeated actions can diminish. Anxiety may still occur without determining so much of life. The work aims towards this more lasting freedom, alongside the relief that comes when a symptom loses its hold.
References
Freud, S. (1926). Inhibitions, Symptoms and Anxiety.
National Institute of Mental Health. The Teen Brain: 7 Things to Know.
Written by Ben French BSc, C-Psych, C-Obs, MA Psych.
Ben French is a Child and Adolescent Psychotherapist. He is registered with the British Psychoanalytic Council as a Child, Young Person and Family Psychotherapist. He has over 20 years’ experience working with children and young people, including work in NHS CAMHS and education, and works with children, teenagers and young adults aged 2–25 at Eastbourne Child Therapy.
