Anxiety is the most common mental health concern among teenagers in the United States — and it is also one of the most frequently overlooked.

That is partly because teen anxiety does not always look the way adults expect it to. It does not always look like worry. Sometimes it looks like irritability, avoidance, physical complaints, or a sudden drop in grades. Sometimes it looks like a teenager who seems fine on the surface but is quietly exhausted from holding everything together.

What teen anxiety actually looks like

Anxiety in adolescents can show up in many forms:

Avoidance. Skipping school, backing out of social plans, or refusing to try new things. Avoidance feels like relief in the short term, but it reinforces anxiety over time.

Physical symptoms. Stomachaches, headaches, and fatigue with no clear medical cause are common. The body responds to anxiety even when the mind has not fully registered it.

Perfectionism and overachievement. Some anxious teens push themselves relentlessly, driven by fear of failure or a need to feel in control. High performance can mask significant distress.

Irritability and anger. Anxiety often presents as frustration or emotional reactivity in teenagers, especially when they do not have the language to name what they are feeling.

Reassurance-seeking. Repeatedly asking parents or friends for reassurance, checking in excessively, or needing constant confirmation that things will be okay.

What drives anxiety in adolescents

Teenagers are navigating a period of significant neurological, social, and emotional change. The prefrontal cortex — the part of the brain responsible for regulating emotion and assessing risk — is still developing well into the mid-twenties.

At the same time, teens are managing academic pressure, social comparison, identity formation, and often the ambient stress of the world around them. Social media adds a layer of constant visibility and comparison that previous generations did not face.

For some teens, anxiety has a genetic component. For others, it develops in response to specific experiences — a difficult transition, a loss, a period of social difficulty, or a family stressor.

How therapy helps

Therapy for teen anxiety typically focuses on building skills rather than just talking about problems. Evidence-based approaches like Cognitive Behavioral Therapy (CBT) help teenagers:

• Identify the thoughts that fuel anxious feelings
• Recognize avoidance patterns and gradually face feared situations
• Develop coping strategies they can use in real time
• Build confidence in their ability to handle discomfort

At Sea Glass Counseling Collaborative, we work with teenagers in a way that respects their autonomy and meets them where they are. We also support parents in understanding how to respond helpfully — neither dismissing anxiety nor inadvertently reinforcing it.

When to seek support

If your teenager is avoiding things they used to enjoy, struggling to get through the school day, or showing signs of significant distress, it is worth reaching out. Early support tends to lead to better outcomes, and many teens respond well to a relatively short course of therapy.

You do not have to wait until things are severe to ask for help.

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Sea Glass Counseling Collaborative offers teen counseling in Wilmington, NC and throughout North Carolina via telehealth. Reach out to learn more about whether we might be a good fit.

Mental health crisis? If you or someone you know is in immediate distress, please call or text 988 (Suicide and Crisis Lifeline) or go to your nearest emergency room.