Anxiety and Physical Symptoms in Adolescents: A Guide

Q: Anxiety and Physical Symptoms in Adolescents: A Guide

Hello： <br>Q1. <br>I am currently a student in the third year of junior high school music class. <br>I have been experiencing hiccups for over a year, but after visiting a gastroenterologist, I was told that my stomach is fine. <br>The doctor prescribed medication, but it didn't

Is there any specific condition?

Hello Doctor: I have three questions I would like to ask you, as I am unsure why I am experiencing these issues.

1.
I am currently a third-year music student, and I have been experiencing hiccups for over a year.
I visited a gastroenterologist who said my stomach is fine and prescribed medication, but it has not been effective.
Sometimes I feel the urge to hiccup, and while I can control it, not being able to do so leaves me feeling uncomfortable.
I tend to hiccup excessively before my instrument classes, but it stops after the class is over.
2.
Whenever I have to go on stage or even before going on stage, I experience persistent hiccups.
In severe cases, I also have acid reflux, along with hand tremors, sweaty palms, dry heaving, and a flushed face.
Once I am on stage and see my teachers, my mind goes blank, and I am unable to perform at the level I usually practice.
After getting off stage, I often do not remember what happened while I was up there.
This issue occurs not only during performances but also when I have to present, share opinions, answer questions, introduce myself, or speak to unfamiliar people.
3.
When I first entered the second year of junior high, I did not interact much with my classmates, which led to no one wanting to group with me during activities.
At that time, there were overnight camping trips and many group activities, which made me reluctant to go to school.
I often found myself thinking thoughts like "this is so boring," "what is the meaning of my life," "why do I have to go to school," and "I wish I were dead." However, after becoming a fan of certain celebrities, these thoughts have decreased.
I am unsure if the upcoming exams are contributing to my anxiety.
I feel that I did not perform well in my practical exams due to my nervousness, and my grades have not improved.
I feel hopeless about my future and that there are no good schools for me to attend.
I am also not interested in the high school programs available, which sometimes leads me to contemplate whether I should end my life before the exams.

F, 10~19 year old female. Ask Date: 2024/04/22

Dr. Wu Menghuan reply Psychiatry

Hello:
Q1.
I am currently a student in the third year of junior high school music class.
I have been experiencing hiccups for over a year, but after visiting a gastroenterologist, I was told that my stomach is fine.
The doctor prescribed medication, but it didn't help.
Sometimes I feel the urge to hiccup, and although I can control it, it feels uncomfortable if I don't let it out.
Moreover, I tend to hiccup excessively before my instrument classes, but it stops after the class.

A1.
It is common for severe anxiety to be accompanied by physical symptoms such as sweating, trembling, palpitations, shortness of breath, and gastrointestinal symptoms.
I wonder if the situation related to "having instrument classes" causes you stress and possibly triggers anxiety.
Q2.
I always start hiccupping before going on stage, and during severe episodes, I even experience acid reflux, along with trembling hands, sweaty palms, dry heaving, and a flushed face.
When I go on stage and see the teachers, my mind goes blank, and I cannot perform at the level I usually practice.
After getting off stage, I often forget what happened up there.
This happens not only during performances but also when I have to report, express opinions, answer questions, introduce myself, face a crowd, or talk to unfamiliar people.

A2.
It sounds very likely that situations such as "performing on stage, facing an audience, and talking to unfamiliar people" trigger severe anxiety.
Symptoms like trembling hands, sweaty palms, dry heaving, flushed face, and a blank mind are likely manifestations of severe anxiety and autonomic nervous system dysregulation.
It may also be worth considering whether you have social anxiety disorder.
I recommend visiting a child and adolescent psychiatry clinic for evaluation and appropriate treatment.
Q3.
When I first started the second year of junior high, I didn't interact much with my classmates, which led to no one wanting to group with me during activities.
At that time, I didn't want to go to school because there were many group activities, including an overnight camping trip.
I often had thoughts like "this is so boring," "what is the meaning of my life," "why do I have to go to school," and "I want to die." However, after getting into fandom, these thoughts have decreased.
I am not sure if it is due to the upcoming exams, but I feel that I didn't perform well in my practical exams because I was too nervous, and my grades haven't improved.
I feel hopeless about my future and that there are no good schools for me to attend.
I am also not interested in the high school programs, so recently I have sometimes thought about whether I should commit suicide before the exams.
A3.
You mentioned experiencing low mood, negative thoughts, and feelings of meaninglessness since the second year of junior high.
Recently, with the pressure of exams, these symptoms have worsened, and you have developed thoughts of hopelessness and suicide.
This is very likely a manifestation of depression.
I recommend that you seek immediate evaluation and treatment at a child and adolescent psychiatry clinic with the support of your family.
Thank you for your message.
Wishing you peace and well-being.

Reply Date: 2024/04/22

More Info

It sounds like you're experiencing a significant amount of anxiety and distress related to your academic and social situations, which is not uncommon among adolescents, especially those in high-pressure environments like music programs. Let's break down your concerns and explore them further.

1. Persistent Hiccups and Anxiety: You mentioned that your hiccups have persisted for over a year, particularly worsening before music classes or performances. This could be a psychosomatic response, where your body reacts physically to stress or anxiety. When faced with performance situations, your body may trigger a fight-or-flight response, leading to symptoms like hiccups, sweating, and shaking. It's essential to recognize that while hiccups can have physical causes, in your case, they may be exacerbated by anxiety. Techniques such as deep breathing, mindfulness, or even cognitive behavioral strategies could help manage your anxiety before performances.

2. Performance Anxiety: The symptoms you experience before and during performances—such as shaking, sweating, and feeling mentally blank—are classic signs of performance anxiety, also known as stage fright. This condition is prevalent among musicians and can significantly impact your ability to perform. It may help to practice relaxation techniques before going on stage, such as visualization, where you imagine a successful performance, or grounding exercises that help you stay present. Additionally, rehearsing in front of small, supportive groups can gradually desensitize you to the anxiety of performing in front of larger audiences.

3. Negative Thoughts and Feelings of Hopelessness: The thoughts you described during your second year of middle school, such as questioning your existence and feeling hopeless, are concerning. It's crucial to take these feelings seriously. Adolescents often experience fluctuations in mood and self-worth, particularly during stressful periods like exams. However, if these thoughts persist or intensify, it is essential to seek help. Talking to a trusted adult, such as a parent, teacher, or school counselor, can provide support. They can help you access mental health resources, such as therapy, which can be incredibly beneficial in addressing feelings of hopelessness and anxiety.

Given your experiences, I strongly encourage you to reach out for professional help. A mental health professional can provide a safe space to explore your feelings and develop coping strategies tailored to your needs. They can also help you understand the connection between your physical symptoms and anxiety, providing you with tools to manage both.

In summary, your experiences of anxiety manifesting as physical symptoms, particularly in performance situations, are valid and warrant attention. You are not alone in feeling this way, and there are effective strategies and support systems available to help you navigate these challenges. Remember, seeking help is a sign of strength, and taking that step can lead to significant improvements in your overall well-being.

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