Dear Dr. Karyn,
I'm really concerned for my 17 year old daughter, Megan. She gets enormous anxiety and now it's affecting her sleep, concentration at school and physical health - she's biting her nails and even her skin. She is really hard on herself and nothing seems to be good enough for her. I think she really lacks self-esteem. My husband and I don't put any pressure on her. I'm really concerned for her overall happiness. We have taken her to see our doctor and he's recommended counseling. Do you deal with these kinds of issues at your practice?

Answer:
The quick answer is yes, I have coached hundreds of teens who struggle with anxiety and panic attacks. I'm glad to hear that you've already seen your family physician because that would have been my first recommendation. You brought up some key themes: anxiety, perfection and self-esteem. Unfortunately, these are all highly connected. There is a high correlation between a perfectionist and those who struggle with anxiety. Teens I've coached who are anxious are often perfectionists - striving for perfection in all or parts of their life (i.e. school, sports, body, friendships). Since perfection is an impossible goal, they feel anxious because they know they will never achieve their goal. Here are a couple quick tips to help your daughter through this. First, model ‘striving for excellence’ not ‘striving for perfection’. If teens see their parents as perfectionists, they’ll likely believe perfectionism is expected of them. Second, manage your own emotions in a healthy manner. Learn to talk out your feelings (i.e. "I feel hurt, frustrated, and anxious.”) instead of acting them out. Once again, you need to show your daughter how to do this through example, not lecture. Third, when your daughter talks to you about her goals, challenge her by saying, "Is that goal realistic?” or “Did you try your best?". Praise her, not for the end result ("Megan, I'm so proud that you got an A on that test"), but for her effort ("Megan, I'm so proud of how hard and diligent you worked on that test"). By affirming her character and not her behaviour, you are modeling how you'd like her to treat herself. Finally, I'm glad to hear you will be taking her to counseling. A professional counselor will work more closely with your daughter to help her develop these important life skills.