ANXIETY IN TEEN GIRLS AND WOMEN
By Alexis Anderson, DO Psychiatrist for Teen Girls and Women | Bozeman and Telehealth Throughout Montana
Anxiety is one of the most common reasons girls and women seek psychiatric care, and it is among the most treatable. Girls are diagnosed with anxiety disorders more often than boys, and women are diagnosed about twice as often as men. Anxiety rarely has a single cause. Temperament, hormones, sleep, stress, and life experience all play a part, which is why good treatment starts with understanding the whole person.
Anxiety is also easy to miss in the girls and women who appear to be coping. A teenager who earns top grades, keeps her friends, and is “no trouble at all” may be anxious every day. A woman who runs her household and her job may feel a constant hum of dread that no one around her can see. The earlier anxiety is recognized, the easier it is to treat.
What does anxiety look like in teen girls and women?
In teen girls
Anxiety in teenagers often looks like something other than fear. Parents commonly notice:
Constant worry about grades, friendships, or the future
Perfectionism, procrastination, or spending hours on work that is already done
Stomachaches, headaches, or nausea with no clear medical cause
Trouble falling asleep, or lying awake replaying the day
Needing frequent reassurance
Avoiding school, social events, or situations that feel risky
Irritability, tearfulness, or outbursts at home after holding it together all day
Panic attacks, with a racing heart, shortness of breath, dizziness, or a sense of dread that comes on suddenly
A teenager who falls apart at home after a “perfect” day at school is often showing anxiety, not defiance.
In women
Women often describe:
A racing mind, especially at night
Constant worry that is hard to switch off, even when things are going well
Muscle tension, restlessness, or feeling keyed up
A pounding heart, tightness in the chest, or shortness of breath
Trouble concentrating or a mind that goes blank
Fatigue from being on alert all day
Overfunctioning, people-pleasing, or an inability to relax or delegate
Avoiding situations that trigger worry
Panic that seems to arrive from nowhere
Anxiety that is new, or that has changed in character, is worth taking seriously at any age.
Why are girls and women more vulnerable to anxiety?
No single cause explains it. Several factors tend to work together.
Temperament and learned patterns. Some children are born more sensitive to uncertainty and threat. Perfectionism, a strong sense of responsibility, and a habit of expecting the worst make anxiety more likely and harder to let go of.
Biology. Estrogen and progesterone act on brain systems that regulate mood, fear, and calm, including the serotonin and GABA systems. Some girls and women appear to be more sensitive to hormonal change than others.
Stress and circumstances. School and social pressure, family conflict, trauma, loss, caregiving, demanding work, and limited support all raise the baseline level of worry.
Sleep and physical health. Poor sleep makes anxiety worse, and anxiety makes sleep worse. Thyroid problems, anemia, and some medications can add to the picture.
These factors feed one another. A sensitive nervous system, a poor night’s sleep, and a stressful week can together produce more anxiety than any one of them would alone.
Hormones across a woman’s life
The teen years. Anxiety often begins or increases around puberty. Hormonal change is part of the explanation, but so are rapid brain development, growing academic and social pressure, and a stronger awareness of how others see her. If anxiety clusters around the same days each cycle, that pattern is worth tracking together.
Premenstrual days. Many girls and women notice more anxiety, tension, or irritability in the days before a period. When symptoms are severe and disrupt daily life, the cause may be premenstrual dysphoric disorder (PMDD).
Perimenopause. During the menopausal transition, estrogen levels fluctuate unpredictably, and sleep is often disrupted by night sweats. Research from the Study of Women’s Health Across the Nation (SWAN) found that women were more likely to report high levels of anxiety symptoms during the transition than before it [1]. The risk is not universal. It is higher for women with a history of anxiety or depression, significant hot flashes, poor sleep, or major life stress.
Is it anxiety, or something else?
Anxiety can be hard to separate from other conditions, and it often occurs alongside them.
Depression. Anxiety and depression frequently appear together, and each can make the other worse.
ADHD. Restlessness, trouble concentrating, and a mind that will not settle can come from ADHD, from anxiety, or from both.
OCD and trauma-related conditions. Intrusive thoughts, rituals, and constant vigilance can look like worry.
Panic disorder. Sudden surges of fear with physical symptoms may be panic attacks rather than a medical emergency, although new chest pain or fainting should be checked.
Medical causes. Thyroid disease, anemia, heart rhythm problems, asthma medications, stimulants, caffeine, energy drinks, alcohol, and cannabis can all cause or worsen anxiety.
Perimenopause. Hot flashes, night sweats, and a pounding heart can mimic panic, and poor sleep can amplify every symptom.
Anxiety is missed in two opposite ways. Sometimes it is dismissed as “just stress,” “just a phase,” or “just hormones,” and a treatable anxiety disorder goes unrecognized. Other times everything is attributed to anxiety, and a medical or psychiatric condition goes unexamined. A careful evaluation keeps both possibilities open.
How anxiety is evaluated
In my practice, evaluation is unhurried and starts with listening.
For teen girls, the first session is with your daughter. The second is with you, her parents. In the third, we typically meet as a family, and I share my impressions and treatment recommendations.
For women, the first visit is a long conversation about your symptoms, history, sleep, medical conditions, medications, stress, and goals. When it is relevant, I also ask about premenstrual and menopausal history.
I look at when the anxiety began, what triggers it, what you avoid, how it affects sleep and daily life, and what has helped before. I also ask about caffeine, alcohol, and other substances, and about safety. If a medical cause is possible, I coordinate with your pediatrician or primary care clinician. Screening questionnaires can be useful, but they do not replace a clinical evaluation.
How anxiety is treated
Treatment is individualized to the diagnosis, severity, medical history, and your preferences. In my practice, every appointment includes psychotherapy, and medication is offered when it is helpful, never on its own.
Psychotherapy
Cognitive behavioral therapy (CBT) is the best-studied psychotherapy for anxiety. It teaches how anxious thoughts work and builds the skill of gradually facing feared situations instead of avoiding them, because avoidance keeps anxiety going. Psychodynamic psychotherapy explores where perfectionism, self-criticism, and fear come from, and how they shape relationships and self-worth. For teens, family therapy helps parents and daughters understand the anxiety together and change the patterns at home that unintentionally keep it going.
Medication
SSRIs and SNRIs are first-line medications for anxiety disorders when symptoms are moderate to severe or do not improve with therapy alone. In children and teens with anxiety, a large multicenter trial found that combining CBT with the SSRI sertraline worked better than either treatment alone [2]. Antidepressants carry an FDA boxed warning about increased suicidal thoughts in people under 25, so teens are monitored closely, especially in the first weeks. Benzodiazepines are generally not used as an ongoing treatment because of tolerance and dependence.
For women, medication is chosen after considering symptoms, previous response, side effects, sleep, medical history, and other medications. Some options can also ease hot flashes.
Hormonal care for women
Menopause hormone therapy is not approved to treat anxiety, and evidence that it helps anxiety is limited and mixed. Research during the menopausal transition has focused mainly on depressive symptoms [3]. Decisions about hormone therapy belong with your OB/GYN or menopause specialist. I do not prescribe it, and I coordinate with your clinician so that psychiatric and hormonal care are not considered in isolation.
Sleep and daily life
Regular sleep, daily movement, time outdoors, and less caffeine help. Energy drinks and large amounts of coffee can worsen both anxiety and sleep. These habits support treatment, but they are rarely enough on their own when anxiety is significant.
How parents can help
If you are worried about your daughter:
Name it without alarm. For example: “A lot of people feel this way, and it is very treatable.”
Validate her feelings, then keep reassurance short. Long, repeated reassurance can feed the worry.
Be careful about helping her avoid everything that feels hard. Skipping school or rescuing her from every uncomfortable moment brings relief now and strengthens anxiety later. A clinician can help you plan gradual steps.
Keep routines steady for sleep, meals, and movement, and limit caffeine and energy drinks.
Take physical complaints seriously. Mention them to her pediatrician, and also consider anxiety.
If she also seems down or hopeless, ask directly about thoughts of hurting herself. Asking does not put the idea in her head.
When to seek psychiatric care
Consider an evaluation when anxiety:
Lasts for weeks rather than passing
Interferes with school, work, relationships, or sleep
Leads to avoiding school, activities, or social situations
Includes panic attacks
Comes with physical symptoms that have no clear medical cause
Is being managed with alcohol, cannabis, or other substances
Keeps getting worse despite support and self-care
You do not need to decide whether it is “bad enough.” That is what an evaluation is for.
When to seek urgent help
Panic can feel like a medical emergency. If you have chest pain, fainting, or trouble breathing and are not sure of the cause, seek emergency care. Thoughts of suicide, self-harm, or feeling unable to stay safe need immediate attention. Call or text 988 to reach the 988 Suicide & Crisis Lifeline at any time. If you or someone else is in immediate danger, call 911 or go to the nearest emergency department.
Frequently asked questions
Is it normal for a teenager to feel anxious a lot? Everyone feels anxious sometimes, and teenagers face real pressures. Anxiety becomes a concern when it is frequent, hard to control, and gets in the way of school, friendships, sleep, or family life. If you are unsure, an evaluation can help sort it out.
Can hormones cause anxiety? Hormonal changes can contribute, especially around puberty, the premenstrual days, and perimenopause. They are rarely the only cause, and anxiety deserves treatment whatever its source.
How do I know if my anxiety is hormonal? There is no single test. Clues include anxiety that began or sharply worsened during a hormonal transition, symptoms that shift with your cycle, and accompanying hot flashes or night sweats. A full psychiatric, medical, and hormonal history is the best way to sort out the contributors.
Do I have to take medication for anxiety? No. Many people improve with psychotherapy alone. Medication is one option, discussed openly along with its benefits, risks, and alternatives. In my practice it is never offered without psychotherapy.
Do you provide care across Montana? Yes. I practice from Bozeman and see teen girls and women by secure video throughout Montana. Patients must be physically located in Montana at the time of each appointment.
The most important takeaway
Anxiety in girls and women is common, real, and treatable. It is not a character flaw, and it is not just stress or just hormones. Good care takes it seriously, looks at the whole person, and starts early. Reaching out sooner usually makes recovery easier.
About the author
Alexis Anderson, DO, is a Yale- and UCSF-trained psychiatrist who practices in Bozeman, Montana, providing psychotherapy and psychiatry for teen girls and women by telehealth throughout Montana. She completed adult psychiatry residency at Yale University and child and adolescent psychiatry fellowship at the University of California, San Francisco, and has been in private practice since 2008. Every appointment includes psychotherapy, with medication when it’s helpful.
Learn more about Dr. Alexis Anderson.
Looking for psychiatric care for your teenage daughter or for yourself? Dr. Anderson meets weekly with each teen girl, meets regularly with parents, and offers family therapy when it helps. She also works with women experiencing anxiety, depression, insomnia, and the mood changes of hormonal transitions.
Explore psychiatric care throughout Montana.
Explore psychiatric care for teen girls and women in Bozeman.
References
Bromberger JT, Kravitz HM, Chang Y, Randolph JF Jr, Avis NE, Gold EB, Matthews KA. Does risk for anxiety increase during the menopausal transition? Study of Women’s Health Across the Nation. Menopause. 2013;20(5):488–495.
Walkup JT, Albano AM, Piacentini J, et al. Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. New England Journal of Medicine. 2008;359(26):2753–2766.
Gordon JL, Rubinow DR, Eisenlohr-Moul TA, Xia K, Schmidt PJ, Girdler SS. Efficacy of transdermal estradiol and micronized progesterone in the prevention of depressive symptoms in the menopause transition: a randomized clinical trial. JAMA Psychiatry. 2018;75(2):149–157.
This article is for educational purposes and does not provide individual medical advice or establish a physician-patient relationship. Treatment decisions should be made with a qualified healthcare professional who can evaluate your individual circumstances.